PROVIDENCE — Amid unanswered questions about how much he relied on the Medicaid reform proposals of a failed GOP congressional candidate in New Hampshire for whom he campaigned and raised money, the state’s acting chief of health and human services, Gary Alexander, won Senate confirmation to the $135,661-a-year job on Tuesday.

The vote was 33-to-0.

Alexander, interim chief of the Executive Office of Health and Human Services since February, oversees both the Department of Health and the network of sister state agencies that provide cash assistance — and other kinds of services — to more than 300,000 Rhode Islanders, including the departments of Health; Human Services; Mental Health, Retardation and Hospitals; Elderly Affairs, and Children, Youth and Families.

An ordained deacon in the Sts. Sahag and Mesrob Armenian Apostolic Church, in Providence, Alexander, 40, was awarded a law degree in 2002 by Suffolk University. He will continue in his dual role as DHS director, in what a spokeswoman for Governor Carcieri described as a cost-saving measure.

In leaving Alexander in charge of the day-to-day operations of the $1.8-billion-a-year DHS, spokeswoman Amy Kempe said the governor also hopes to “streamline operations across agencies.” Alexander began his state government career in 1997 as a $39,240-a-year project manager in the office of Republican Lt. Gov. Bernard Jackvony. A year later, he began his rise through the ranks of the Department of Human Services.

When Republican Carcieri nominated Alexander in February to succeed Adelita Orefice as health and human services secretary, he cited his role in helping Rhode Island win a global Medicaid waiver that capped spending on the government-financed health insurance program for the elderly, the poor and the disabled, while giving Rhode Island unprecedented freedom in how it spends those state and federal Medicaid dollars.

The waiver was initially aimed at saving the state $67 million this year by steering the elderly away from nursing homes to “community-based” settings, redefining who is sick enough for certain services and creating “selected” treatment networks. As a result of delays in implementation, the savings expectation has dropped to $7 million.

Carcieri has nonetheless hailed the waiver, granted during the final days of the Bush administration, as a major win for Rhode Island and declared that “Gary Alexander has distinguished himself as both an architect of and proponent for lasting reforms that make government more responsive, accountable and cost-effective.”

But Alexander’s nomination was put on hold by the Democrat-controlled Senate in late May as new details came to light about the state’s reliance on one and then another company affiliated with John Stephen, a former health and human services commissioner in New Hampshire who mounted an unsuccessful GOP congressional campaign there in 2008, with Alexander campaigning with him at one point, and hosting a fundraiser for him at his home.

When Stephen’s name first surfaced, along with that of The Lucas Group, a Boston-based consulting company, Kempe said the company was working on the state’s global Medicaid waiver negotiations with federal officials on a “voluntary basis. ... We are not engaged with Lucas ... It’s strictly voluntarily offering advice and guidance.” Stephen is a partner in the company.

On its own Web site, however, The Lucas Group takes credit for having “originated” and “constructed” and then “led” the negotiations with federal officials that resulted in Rhode Island’s winning the Medicaid waiver.

Alexander did not respond to queries about the company’s description of its role. The company has not been paid, and both Alexander and the governor’s office have repeatedly refused to say whether it has requested payment.

Alexander’s predecessors at the Executive Office of Health and Human Services — Orefice and Jane Hayward — have both denied any role in enlisting the help of Stephen or The Lucas Group.

“I am less troubled by a consulting firm trying to sell its wares than I am ... an administration not being forthcoming ... about how much work was outsourced,” said one senator, Joshua Miller, D-Cranston, after The Providence Journal reported the company’s claims on Monday.

Sen. Rhoda Perry, the chairwoman of the Senate committee that recommended Alexander’s confirmation, said she also had concerns, but did not press Alexander with further questions before Tuesday’s vote because she believed “he had an appropriate resumé. He had a lot of experience in the different departments within the secretariat; that he was respected and held in high regard at least by the colleagues that I spoke with … and we have done advice and consent on many people in this building and none of them are without …” Her voice dropped off.

kgregg@projo.com