There’s cause for concern in several aspects of a recent announcement that Maine’s health and human services department is paying an outside firm $925,000 to undertake a comprehensive review of the state’s Medicaid and public welfare programs.
Democratic skeptics have focused on the conservative credentials of the firm’s head and said the final product will simply back up Gov. Paul LePage’s past, critical rhetoric on Medicaid and welfare. Gary Alexander led Rhode Island’s Executive Office of Health and Human Services under Republican former Gov. Donald Carcieri before serving as secretary of Pennsylvania’s Department of Public Welfare in Republican Gov. Tom Corbett’s administration.
We don’t approve of the LePage administration awarding the contract to the Alexander Group without first publishing a request for proposals and then selecting the most competitive bid. And the cost of the study has rightly raised eyebrows.
But Democrats should also agree with Republicans and the LePage administration that Maine’s $2.5 billion Medicaid program is in need of reform and could benefit from an outside review. And with the contract already signed, lawmakers should focus on making sure Maine gets its money’s worth from Alexander.
The LePage administration considers Alexander to have unique expertise to help it plan and carry out an overhaul of the Department of Health and Human Services and the programs it administers. In Rhode Island, Alexander successfully obtained a “global waiver” from the federal government that allowed the state additional flexibility in designing its Medicaid program. Maine Health and Human Services Commissioner Mary Mayhew and LePage have often spoken about a need for additional flexibility and a “global waiver” from the federal government to administer Medicaid largely as they see fit.
While Alexander’s qualifications would seem to fit the bill, it’s worth noting that he has generated his share of controversy.
After he left his Rhode Island post, he published a report with a conservative think tank claiming the measures implemented as a result of the state’s Medicaid waiver generated $100 million in savings in the first 18 months. Rhode Island’s Medicaid chief said very little in the report was accurate. Instead, an independent analysis found the state saved nearly $23 million as a result of waiver-related measures in the program’s first three years; other Medicaid changes that didn’t require the waiver authority generated $32.3 million in additional savings during that period.
In Pennsylvania, Alexander drew criticism for driving his taxpayer-funded car to visit his family in Rhode Island and for founding a real estate company while still serving in Pennsylvania’s executive branch. While he left his Keystone State post in February, a Democratic lawmaker in that state is asking the attorney general to investigate Alexander to determine whether he oversaw an improperly carried-out process that led to a Boston company taking over payroll management for home health caregivers.
With all that in mind, Alexander’s work in Maine is underway. By Sunday, according to the contract, his firm is expected to deliver its first requested analysis — a feasibility study on expanding Medicaid under the federal Affordable Care Act. The contract orders four other deliverables, with the last one due in May 2014.
On Medicaid, the Department of Health and Human Services is asking Alexander to chart a reform course for a program that now accounts for about a quarter of Maine’s state budget and whose inflation-adjusted costs have increased more than 50 percent since 2000.
There’s plenty about Maine’s Medicaid program that needs fixing, from excessive emergency room use among recipients to a fee-for-service system that encourages more medical procedures rather than better health to ballooning long-term care costs for elderly and disabled residents.
Rhode Island’s Medicaid waiver program addressed many of those issues. And the state, now under a Democratic governor, is working with the federal government to renew the waiver.
Maine Democrats shouldn’t immediately dismiss Alexander’s recommendations because of the more controversial aspects of his record. Instead, they should consider them for their potential to improve care, keep Medicaid recipients healthy and control costs.
And if LePage attempts to make some of Alexander’s recommendations law, lawmakers should remember that they and the federal government would have wide latitude to reject major Medicaid changes they don’t support, especially while Democrats enjoy majorities in both chambers of the Maine Legislature.