Alexander

The Carcieri administration has quietly shuffled the ranks of top administrators in the state’s Department of Human Services to put someone new in charge of pushing for federal approval of a first-of-its kind Medicaid “waiver” aimed at saving $67 million this year by giving the state more flexibility in how it spends the money.

Gary Alexander, director of the state’s Department of Human Services, is no longer is charge of the day-to-day operations of the agency, according to a memo obtained by The Providence Journal that says he has been reassigned so that he can “focus all of his efforts” on “reforming the Medicaid Program and achieving Medicaid budget savings.”

While Alexander will be allowed to keep his title — and his $121,353-a-year cabinet-level salary — William Camara, the former administrator of the Rhode Island Veterans Home in Bristol, has been temporarily named “acting deputy director” of the mammoth DHS and asked “to take on the leadership and day to day operations of all other Department of Human Services divisions and programs.”

“Bill will report directly to me so that Gary can dedicate all of his attention to Medicaid,” wrote Adelita Orefice, the deputy secretary in charge of the state’s Office of Health & Human Services, in the e-mail that went out last week.

Driving the move is the state’s slow-moving effort to win a “global” Medicaid waiver that would, in essence, end the notion that Medicaid is an entitlement and give the Carcieri administration more discretion than the state has now to decide how the dollars are spent, in exchange for agreeing to cap all Medicaid spending over the next five years. Interest groups and key lawmakers from here to Washington fear the administration could create a “catastrophe” for 186,000 Rhode Islanders –– nearly 18 percent of the state’s population –– who depend on Medicaid funding for medical treatment.

The request has now been submitted to the federal government. But as the Fitch Rating Service noted earlier this week when it downgraded the credit rating on $1 billion in Rhode Island debt: “The estimated $67 million in Medicaid savings is based on reform contingent upon a federal waiver that does not appear to be forthcoming in the near term, making it difficult for the state to achieve the same amount of savings through alternate measures.”

In her e-mail, Orefice wrote: “We face many challenges in state government. As the economy continues to worsen, state revenues will be impacted negatively adding even more stress to the budget. Medicaid reform and approval of the Global Waiver are critical components of the state budget. Given this, the Governor has decided to realign leadership resources within the Department of Human Services.

“The Governor has asked Gary Alexander, Director of the Department of Human Services, to focus all of his efforts on negotiating and implementing the Global Waiver, reforming the Medicaid Program, and achieving Medicaid budget savings. Given the criticality of this work, Gary will report directly to the Governor and work collaboratively with the health and human services agencies. At the same time, I have asked Bill Camara, Acting Deputy Director of the Department of Human Services, to take on the leadership and day to day operations of all other Department of Human Services divisions and programs.”

Coincidentally, Camara was part of a leadership team that was criticized in a report on past operations at the Rhode Island Veterans Home in Bristol that was aired at a State House hearing last night. Just before the hearing got under way, H. Reed Cosper, the state’s mental-health advocate who heads the commission that studied the Veterans Home, expressed unease about Camara’s move.

“I know Bill [Camara] and like him. I think he’s intelligent and I think he might be a good leader, but given the fact that he was immersed in the leadership problems, it’s kind of interesting that he has moved so high in the state bureaucracy. … If you believe in accountability, you have to wonder why he’s moved so far, so fast,” Cosper said.

Orefice yesterday defended Camara whom, she said, was not in charge during the period under review. But Sen. Rhoda Perry, the Providence Democrat who chairs the Senate Committee on Health & Human Services, questioned Camara’s qualifications to take over day-to-day operations of the $1.8-billion state agency with more than 994 authorized employees that oversees subsidized child care, welfare, Food Stamps, rehabilitative services and an array of community programs.

“I am concerned,” said Perry. “I don’t know what the qualifications are of this Mr. Bill Camara … I am concerned about his knowledge, his understanding of the day-to-day necessities of the operations of the department. … I don’t know what his understanding is of the budgetary situation.” (The governor’s office was unable to provide a résumé for Camara, who described himself in a brief interview as a 13-year employee of the Veterans Home, who spent less than a year as its administrator before his move to DHS.)

Perry raised the possibility that the musical chairs began with a need to move Orefice aside as the lead negotiator on the state’s Medicaid waiver request because she may not have the authority — as a deputy in an agency without a Senate-confirmed chief at the top — to negotiate such a far-reaching agreement. Perry said it has been her “understanding” that federal regulations require states to have a “clear line of authority.”

But with respect to the veterans home, House Veterans Affairs Committee chairman Kenneth Carter issued a statement yesterday in which he said “hope has grown for significant improvements at the home with the hiring of a new administrator — Rick Baccus, who headed the U.S. detention camp at Guantanamo Bay, Cuba.”

“We believe this hiring will eliminate many of the problems that seemed to exist under previous management, policies and procedures that were detrimental to residents’ care and treatment,”Carter said.

The shakeup gave Camara a new title and a raise from $83,157 to $107,114 a year. Baccus was also elevated, from a $76,639 administrator within MHRH, to the $84,937 job as acting administrator of the Veterans Home.

The Carcieri administration never announced Alexander’s reassignment — or any of the other attendant moves. Carcieri spokeswoman Amy Kempe said that’s because it was viewed as an informal shuffling of responsibilities. “There has not been a change in leadership,” she said. “What this simply does is allow Gary [Alexander] and a core team of individuals to concentrate on the global waiver and getting those negotiations completed.”

She would not elaborate on the exact status of those negotiations, but denied the reassignments resulted from federal officials asking to negotiate with someone of enough stature to make major statewide decisions. “That is a completely unfounded rumor,” Kempe said. “It was just so we could have a core team of DHS people, lead by Gary [Alexander], concentrating on the waiver.”

The move makes Alexander the third cabinet-level director in the Carcieri administration to get a new role, at the same salary, while others were put in charge of their agencies. Carcieri removed MHRH director Ellen R. Nelson and appointed her as his special adviser on hospital acquisitions and mergers. Former Department of Administration Director Beverly Najarian became the governor’s deputy chief of staff.

CORRECTION: An earlier headline on this story incorrectly indicated that Gary Alexander was no longer the head of the Department of Human Services. He remains the director of the agency.

cneedham@projo.com