Illinois Medicaid contractor Centene Corp. under federal scrutiny over foster kids’ medical care

Federal authorities are probing a massive Illinois contract that provides health care to 36,700 foster children in response to an investigation by the Illinois Answers Project published by the Chicago Sun-Times in November.

Insurance powerhouse Centene Corp. often failed to deliver basic medical care from dental visits to immunizations, the investigation found, with some foster parents having to wait months for critical medical appointments for the abused and neglected children in their care.

The scope of the federal inquiry is not clear, but it was confirmed by state officials and a spokesperson for the federal Centers for Medicare & Medicaid Services, the U.S. Department of Health and Human Services agency that administers the Medicaid program.

“CMS has engaged with the state to discuss the serious issues raised in the November report,” the spokesperson said.

Officials with the two Illinois state agencies that oversee Centene’s YouthCare contract — the Department of Healthcare and Family Services and the Department of Children and Family Services — said they were questioned by authorities with HHS but provided few details and sought to minimize the inquiries.

CMS recently requested information from HFS, according to spokeswoman Jamie Munks: “The department did receive an inquiry from CMS after the article was published. HFS asked to have a meeting to discuss and . . . [we have] not heard back.”

On Monday, HHS officials met for an hour with Marc Smith, director of DCFS, to discuss YouthCare, DCFS spokesman Bill McCaffrey said. Those officials were from a sister agency within HHS, the U.S. Children’s Bureau, that funds state programs, monitors performance and imposes improvement plans.

“The discussion was centered on YouthCare,” McCaffrey said. “DCFS regularly meets with officials from the Children’s Bureau, including more than 25 times in 2022, on a number of issues.”

A Children’s Bureau spokesperson said DCFS officials are “aware of the issue but … still in the process of investigating and developing a response.”

To obtain Centene’s basic performance records, the Better Government Association — which publishes the Illinois Answers Project — waged a year-long Freedom of Information Act court fight in downstate Sangamon County that forced HFS to release records that had been withheld because Centene said its performance metrics should be considered “trade secrets.”

The state eventually provided heavily redacted documents that showed Centene produced an individualized plan of care for fewer than 2% of the Illinois foster children who had the greatest need during the first quarter of last year. The state said Centene later corrected that figure to 8%.

The failures forced foster parents — who take in abused or neglected children frequently in need of urgent medical care — to grapple with a health care program that often was underperforming and in disarray.

Victor Hilitski / Illinois Answers Project

Munks said her agency already was taking steps to address contract shortfalls prior to the November story.

“The department had already identified issues with YouthCare’s performance and swiftly took steps to impel the plan to make improvements, including but not limited to ongoing meetings to discuss the concerns with YouthCare’s leadership at the time, and initiating an audit performed by HFS’ external quality review organization to assess YouthCare’s compliance with the contract requirements,” Munks said.

Munks said those and other measures were proceeding “long before” reporters contacted HFS with questions for the November story.

“The department’s top priority has always been to ensure that the youth enrolled in YouthCare have access to the highest-quality care possible, and HFS will continue to hold YouthCare and all of the [managed care organizations] accountable for meeting the requirements in their contracts,” Munks said.

A Centene spokesman previously has said the multinational insurance giant is improving its performance metrics.

Centene has been paid $370 million under Illinois’ YouthCare contract since 2020, government records show.

Editor’s note: This story has been amended to remove erroneous information provided by a spokesman for the state Department of Children and Family Services regarding who attended a Jan. 9 meeting between DCFS and the U.S. Department of Health and Human Services.

Illinois Answers Project

Manny Ramos reports for the Illinois Answers Project.