Feds probe huge Centene contract that failed Illinois foster kids with inadequate healthcare
In response to an Illinois Answers Project investigation, federal authorities are probing the massive Illinois contract that provides health care to 36,700 foster children.
Insurance powerhouse Centene Corp. often failed to deliver basic medical care from dental visits to immunizations, the nonprofit newsroom reported in November. Some foster parents waited months for critical medical appointments for the abused and neglected youth in their care.
The scope of the federal inquiry is not clear, but it was confirmed by state officials and a spokesperson for the Centers for Medicare & Medicaid Services, also known as CMS, a federal agency within the United States Department of Health and Human Services that administers the Medicaid program.
“CMS has engaged with the state to discuss the serious issues raised in the November report,” a spokesperson for that agency told Illinois Answers. “As a matter of policy, CMS does not comment on active discussions with states,” the spokesperson added.
Officials from 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 — confirmed they were questioned by authorities from HHS but provided few details and sought to minimize the inquiries.
CMS recently requested information from the Illinois Department of Healthcare and Family Services, HFS spokeswoman Jamie Munks told Illinois Answers in an email.
“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,” Munks wrote.
Separately, HHS Associate Commissioner Aysha Schomburg met for an hour on Monday with DCFS Director Marc Smith to discuss YouthCare, DCFS Director of Communications Bill McCaffrey confirmed to the BGA in an emailed statement.
Schomburg heads a sister agency within HHS, the U.S. Children’s Bureau, which funds state programs, monitors performance and imposes improvement plans.
“The discussion was centered on YouthCare, as you know,” McCaffrey wrote. “DCFS regularly meets with officials from the Children’s Bureau, including more than 25 times in 2022, on a number of issues.”
A spokesperson for the U.S. Children’s Bureau told Illinois Answers that DCFS officials were “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 lawsuit in Sangamon County circuit court that ultimately forced HFS to release records initially withheld because Centene argued 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 the number to 8%.
The failures 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 was often underperforming and in disarray.
Munks said in email on January 6 that her agency was already taking steps to address contract shortfalls prior to the Illinois Answers article.
“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 wrote in the email.
Munks added that those and other measures were proceeding “long before” reporters from Illinois Answers contacted HFS with questions before publishing 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 wrote.
A Centene spokesman previously told the Illinois Answers Project the multinational insurance giant is improving its performance metrics. Centene has been paid $370 million under Illinois’ YouthCare contract since 2020, government records show.