Illinois’ top Medicaid contractor has repeatedly failed to deliver basic medical services to thousands of foster children, from dental visits to immunizations to well-being checks, leaving foster parents to scramble to find health care, wait months for appointments and pay medical expenses out of their own pockets for the abused and neglected children they take into their homes, an Illinois Answers Project investigation has found.
Since 2020, the state of Illinois has paid nearly $370 million to the for-profit insurance powerhouse Centene Corp. to manage health care for 36,700 current and former foster children as part of the state’s YouthCare program.
These payments were made even as Centene repeatedly failed to meet common benchmarks, government records show.
The failures have forced foster parents — people who take in abused or neglected children frequently in need of urgent medical care — to grapple with a health care program that’s often underperforming and in disarray. That’s according to state data obtained through a lawsuit and interviews with foster parents, medical providers and state officials.
During the first quarter of this year, Centene produced what’s called an individualized plan of care for fewer than 2% of the Illinois foster children who had the greatest need, records show. The state said Centene later corrected the number — to 8%.
According to Centene’s data, 62% of foster children had an annual dental visit in 2021, 55% got standard immunizations and about 67% of adolescent foster kids had the “well-care visit” required under the company’s state contract.
The state Department of Healthcare and Family Services says it expects at least 70% of new Medicaid enrollees to have a health screening within 60 days of joining enrollment. Yet, in the fourth quarter of last year, while enrolling 571 foster children, YouthCare screened only 22% within 60 days.
Only once during the previous 12 months did YouthCare’s percentage exceed 50%, according to state records.
The state officials who oversee the YouthCare program — Theresa Eagleson, director of HFS, and Marc Smith, director of the Illinois Department of Children and Family Services — defended it and their oversight.
Eagleson said she’s not happy with the 22% figure but that foster parents who don’t take responsibility for getting children screened also are to blame.
“I’m not saying that 22% is ideal, and I’d much rather see it between 50 and 70%, but I also know that sometimes it’s hard to get a hold of families, for all kinds of reasons,” Eagleson said. “They’re at their jobs. They’re not at home when somebody might try to catch them at home. They decide not to return the phone call to do the health risk screening. People have choices, right? … Again, not OK with 22%, but it’s better than where we were. And we’re working on improving it.”
According to her agency, as of June, YouthCare was in “nearly complete or complete compliance.”
Problems emerge, state cites Centene
To get Centene’s basic performance records, the Better Government Association, the publisher of the Illinois Answers Project, waged a year-long Freedom of Information Act lawsuit in Sangamon County circuit court that ultimately forced HFS to release records initially withheld after Centene argued its performance metrics should be considered “trade secrets.
Eventually, the state released heavily redacted documents.
“The performance of YouthCare during this period of time was unacceptable,” a spokeswoman for HFS said in a written statement.
Separately, a Centene spokesman wrote, in part: “We have progressively improved our metrics. … We are committed to increasing access to care for our members.”
It was only after reporters began asking questions that HFS acknowledged for the first time that it took enforcement action earlier this year, halting automatic enrollments of new Medicaid patients to the Centene subsidiary that runs YouthCare — Meridian Health Plan of Illinois. HFS barred automatic enrollments of new Illinois Medicaid patients of all ages and types, not just foster youth, Eagleson said.
“We did not want to let it fester,” she said.
In addition to the 36,700 current and former foster children in YouthCare, Meridian oversees medical care for 876,000 other Illinois Medicaid patients under a separate state contract.
HFS’s disciplinary action wasn’t posted on the agency’s website, as the agency normally does with sanctions and fines. The details were obtained through a public records request to California’s Medicaid agency. Centene had to disclose information on disciplinary actions in all states as part of an unsuccessful bid for a Medicaid contract in California this year.
In the California filing, Centene said it was subject to an HFS “corrective action plan.”
Eagleson said her agency never publicly disclosed the enrollment freeze because it wasn’t part of a formal corrective action plan. According to HFS, that was imposed by its contracted auditor, not by the department.
Centene got paid as foster parents scrambled
In interviews, parents spoke of struggling to get basic health services for their foster children.
“YouthCare is the lowest level quality of Medicaid possible,” said Alicia Wehby, a foster parent for 15 years who helps run a Northern Illinois nonprofit that provides foster families with cribs, clothes and advice. “You need a psych evaluation for a child in your care because you’re trying to figure out the root cause so you can help them. You have to basically jump through hoops to prove they may need additional help because YouthCare is so bad. You are on a minimum one-year wait just to get the evaluation done.”
Wehby said she worries about other parents entering foster parenthood without support or knowledge of their foster children’s needs.
“These kids are being dropped off in people’s houses without their full story, and then families don’t know how to respond because they don’t know why their child is acting the way that they’re acting,” Wehby said. “Ad we’re just further traumatizing the children because we are not prepared as foster parents to have any idea how to deal with them. Because we’re not told their story.
“Now, the [child is] moved again, just reiterating the lesson that, ‘we’re not good enough, we’re not lovable.’ ”
Melissa Thomforde of Crystal Lake, who has been a foster parent for 11 years, said she understands why her foster children might emulate the violence they’ve experienced or witnessed. She recounted desperately seeking help for an 11-year-old foster child who attacked a sibling.
“We have all of our foster children on our own private insurance to get them the services that they need,” Thomforde said. “If you rely on [YouthCare], you either get subpar providers, or the wait list is so long it’s just ridiculous.”
Even as Centene was being paid more than $5.2 billion over the past year to provide care for its Illinois Medicaid and Medicare patients, foster parents said they have needed to pay out of their pockets for expensive medical services that YouthCare was paid to provide.
Eva Green said she navigated urgent-care clinics, often paying out of pocket for her new foster son’s medications without the benefit of a comprehensive assessment of his health needs and history.
“They didn’t even give him a physical assessment,” Green said. “It’s like the system is causing further trauma to these kids by not having foster parents who are equipped to take care of them...”
Wehby said wait lists for a psychiatric assessment or treatment can be as long as a year on YouthCare, but, on her private insurance, “I could get my kids in within a couple of months.”
Smith, the DCFS director, said foster parents can seek reimbursement for those private medical expenses and that feedback his agency has gotten has been overwhelmingly “positive about our engagement with YouthCare.
Doctors paid little or late
Illinois medical providers also have faced problems with YouthCare, saying they’re paid little, late or not at all.
Stephanie Barisch, director of therapeutic services for The Center for Youth and Family Solutions in Bloomington, said her agency had $70,000 in unpaid YouthCare claims last year for services to foster children.
HFS extended the YouthCare contract for three years, agreeing to pay it an additional $1 billion.
But, in the two years since the launch of YouthCare, Centene and HFS haven’t established benchmarks on the rates of care HFS expects for services ranging from frequency of doctor visits to psychological assessments. HFS said it expects those benchmarks to be in place by the end of this year.
“The expectation is that, at a minimum ,YouthCare must meet or exceed the HealthChoice Illinois thresholds,” an HFS spokeswoman said.
Cook County Public Guardian Charles Golbert, who reviewed HFS’s data submissions at the request of Illinois Answers, said he was struck by the amount of data withheld at Centene’s request because the company argued its performance metrics constituted trade secrets.
“Every word of YouthCare’s initiatives: redacted,” Golbert said. “All progress toward annual goals: redacted. Every single word about disparities and opportunities for action: redacted. You would think that that’s something taxpayers should be entitled to know about.”
Eagleson said her agency and Centene aren’t withholding information from the public.
“We try in this administration to be very transparent, right, about what we’re working on and what we’re trying to improve,” she said. “We’re trying to figure out every day how we can do a better job for the people that we serve.”
Manny Ramos reports for the Illinois Answers Project.