Policy Initiatives:

Medicaid and Health Safety Net Reform

The Mission

To transform Medicaid and the safety net to improve the well-being of the recipients and ensure that it is accountable to the taxpayers.


Gary D. Alexander

Gary D. Alexander is head of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute. Over the past 20 years, he served as Secretary of Health and Human Services for both Pennsylvania and Rhode Island, and Rhode Island’s Medicaid Director.

Guiding Principles
  • The purpose of a health care safety net is articulated in Medicaid’s statutory charge: “Furnish rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care.”
  • Medicaid delivers poor results, failing both those who rely on the program and taxpayers.
  • Personal empowerment is essential to achieving fulfillment and prosperity as well as the best program outcomes.
  • Overall well-being encompasses much more than medical care and is, in large part, a function of family, friends, community, work, and faith or sense of purpose.
  • Medicaid’s current financial structure, with an open-ended federal reimbursement of state expenditures, leads to significant improper and inappropriate spending in the program that disproportionately benefits special interests rather than the intended recipients.

Bringing it to life.

Goal 1.

Accountable and Efficient Program.
Ensure that eligible recipients receive the most efficient services in the right setting and at the right time.

Use proper incentives to maximize actual value for patients from public spending.

Develop appropriate standards to assess the program’s outcomes.

Realign incentives and reform financing so both the federal government and states are accountable for results and concerned about the value of the programs.

Goal 2.

Improved Health and Well-being of Patients.
Give patients opportunities to choose holistic, individualized health care options.

Empower recipients to improve health outcomes through proactive, healthy behavior, social and community engagement, and smart interactions with the health care system.

Consider the overall impact of the variety of social welfare programs on recipients and their incentives to lead the most productive and meaningful lives.
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Paragon Health Institute (PHI) is a non-partisan, not-for-profit policy research institute. Any views, beliefs, or opinions expressed by PHI’s Public Advisors are those of its Advisors and do not necessarily reflect the official policies or positions of PHI or its employees. Any views, beliefs, or opinions expressed by PHI or its employees belong solely to PHI and do not necessarily reflect those of PHI’s Public Advisors.