POLL QUESTION

Maine hires conservative firm to study Medicaid expansion, bolster welfare efficiency

Posted Nov. 19, 2013, at 2:17 p.m.
Last modified Nov. 19, 2013, at 5:23 p.m.

Poll Question

AUGUSTA, Maine — The state has contracted a conservative former welfare administrator with a history of slashing benefits to review Maine’s Medicaid system and other welfare programs.

The Alexander Group, based in Rhode Island and spearheaded by former Pennsylvania and Rhode Island welfare chief Gary Alexander, will be paid nearly $1 million over eight months for its services, which will include a report on potential costs of expanding Medicaid under terms of the Affordable Care Act.

Democrats twice advanced legislation earlier this year to have Maine take part in the eligibility expansion, but Republican Gov. Paul LePage vetoed both efforts. Democrats plan to introduce a similar proposal in the legislative session that begins in January.

In addition to studying the long- and short-term costs of Medicaid expansion, the Alexander Group also will work with the Department of Health and Human Services to assess every state welfare program, with an eye toward adding flexibility and efficiency and integrating disparate programs that often benefit the same people.

The contract with Alexander has been in effect for two months, though the LePage administration did not make the deal public until Tuesday. The group will be paid with a combination of state and federal dollars, including about $450,000 from the state’s general fund.

Sam Adolphsen, a former staffer at the Maine Heritage Policy Center who now works in the governor’s administration, will be one of the state’s designees to work with the Alexander Group. Adolphsen’s background is in business administration, not social services or health care, a fact that Democrats were quick to point out.

The consulting firm recently completed a similar four-month study in Arkansas, where it recommended across-the-board reductions in spending on welfare and a plan to push state-sponsored health insurance recipients into the private marketplace.

Arkansas paid $220,000 for the Alexander Group’s services. When asked why Maine was paying so much more, Health and Human Services Commissioner Mary Mayhew said she couldn’t comment on another state’s dealings but stressed that the work to be undertaken is substantial.

Although the group is looking into Medicaid expansion, that doesn’t mean LePage is any warmer to accepting Democrats’ plan to accept additional federal dollars for the program.

“[The governor’s] position has not changed,” said LePage press secretary Adrienne Bennett. “We have said we are seeking more flexibility from the federal government, but we haven’t gotten that flexibility.”

Mayhew praised the group in a news release announcing the contract.

“We are excited about the opportunity to work with such a knowledgeable group of experts,” she said. “In the constantly shifting landscape of the Affordable Care Act and ever-changing rules from Washington, it will be extremely helpful to have someone with significant Medicaid experience lending a hand to our program reform efforts.”

Meanwhile, Democrats are criticizing Alexander for his controversial record in Rhode Island and Pennsylvania, where he most recently served as that state’s welfare chief. There, he hit the same rhetorical notes often struck by LePage and House Republicans, focusing his attention on trimming the welfare rolls and fighting fraud and abuse.

They are also lambasting LePage for contracting the company without a public process. Mayhew said in an interview that there was no request for proposals, and that DHHS had gone directly to the Alexander Group to seek out what she said was its unique expertise.

Lawmakers said Tuesday was the first they learned that DHHS has hired the group. Rep. Jeff McCabe, D-Skowhegan, said the state was wasting its money on Alexander, who he said would give proposals based on ideology, not a detached analysis.

“Are we really trying to dive into this issue of welfare reform, or have we just hired someone who will find things that coincide with the governor’s political message?” he said.

In Rhode Island, Alexander successfully fought for a global Medicaid waiver, which gave the state total flexibility in administering its Medicaid program by effectively turning federal funding into a block grant. LePage would be keen to obtain the same waiver in Maine.

In Pennsylvania, Alexander’s regime was marked by efforts to find savings to stem ballooning welfare costs. He instituted several reform efforts, including tighter restrictions of food stamp applicants and cash benefits, according to local news reports.

In January 2012, the Philadelphia Inquirer reported that about 88,000 children were cut from Medicaid in the last five months of 2011, which some advocates for the poor claimed should never have happened.

Alexander himself was also fodder for the state’s political reporters. He faced criticism for a strict dress code that seemingly mandated women wear skirts or dresses, spending $20,000 for a flagpole while the department cut spending on services, and for taking on a second job while he ran Pennsylvania’s largest department.

Mayhew waved off the concerns from Alexander’s critics.

“I don’t know how anyone could look at this group and think that [cuts to benefits] is all they do,” she said.

She said the governor had made clear since he took office that DHHS must effectively meet the needs of the state’s most vulnerable, while helping them become self-sufficient. Those are the goals that will be used in evaluating Alexander’s proposals, she said.

“It is incumbent upon this administration that we evaluate comprehensively the management of our programs, that we are good stewards of taxpayer resources and that we utilize national expertise to identify best practices and reforms that have produced quality outcomes for social service agencies in the best interest of serving those who best depend on our agency,” she said.

Follow Mario Moretto on Twitter at @riocarmine.

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