YouthCare of Centene Corp., Illinois Medicaid’s main contractor, failed to place children in foster care, with ‘unacceptable’ medical care

Illinois’ main Medicaid contractor has repeatedly failed to provide basic medical services to thousands of adoptive children, from dental visits to vaccinations to wellness checks, leaving adoptive parents scramble to find healthcare, wait months for appointments and pay medical bills out of their own pockets for the abused and neglected children they take home, an Illinois Answers Project survey has found .

Since 2020, the state of Illinois has paid nearly $370 million to for-profit insurance powerhouse Centene Corp. to manage the health care of 36,700 current and former foster children through the state’s YouthCare program.

These payments were made even as Centene repeatedly failed to meet common benchmarks, according to government records.

The failures have forced adoptive parents — people who foster abused or neglected children often in need of urgent medical attention — to grapple with an often underperforming and disarrayed health care program. That’s according to state data obtained through a trial and interviews with adoptive parents, medical providers and state officials.

During the first quarter of this year, Centene produced what is called an individualized care plan for less than 2% of Illinois adoptive children who needed it most, according to records. The state said Centene later corrected the number – to 8%.

According to data from Centene, 62% of foster children had an annual dental check-up in 2021, 55% received standard vaccinations and around 67% of foster teens had the “care visit” required under the company’s state contract.

The state Department of Health and Family Services says it expects at least 70% of new Medicaid enrollees to undergo a medical exam within 60 days of enrollment. Yet in the fourth quarter of last year, while enrolling 571 children in foster care, YouthCare screened just 22% in 60 days.

Only once in the previous 12 months has the YouthCare percentage exceeded 50%, according to state records.

State officials who oversee the YouthCare program — Theresa Eagleson, director of HFS, and Marc Smith, director of the Illinois Department of Child and Family Services — have defended it and their oversight.

Eagleson said she was unhappy with the 22% figure, but that adoptive parents who do not take responsibility for getting children tested are also to blame.

“I’m not saying 22% is ideal, and I’d much rather see it between 50 and 70%, but I also know it’s hard to reach families sometimes, for all sorts of reasons,” Eagleson said. . “They are at their post. They are not at home when someone might try to catch them at home. They decide not to return the phone call to do the health risk screening. People have a choice, right? … Again, not OK with 22%, but it’s better than where we were. And we are working to improve it.

Theresa Eagleson, director of the Illinois Department of Health and Family Services.

Provided

Marc Smith, director of the Illinois Department of Child and Family Services.

Marc Smith, director of the Illinois Department of Child and Family Services.

Ashlee Rezin/Sun-Times

According to his agency, as of June, YouthCare was “in near or full compliance.”

Problems arise, state cites Centene

To obtain Centene’s baseline performance records, the Better Government Association, publisher of the Illinois Answers Project, filed a year-long Freedom of Information Act lawsuit in the county circuit court. of Sangamon, which ultimately forced HFS to release originally withheld recordings after Centene argued its performance metrics. should be considered “trade secrets”.

Eventually, the state released heavily redacted documents.

“YouthCare’s performance during this time was unacceptable,” an HFS spokeswoman said in a written statement.

Separately, a Centene spokesperson wrote, “We have gradually improved our measurements. … We are committed to increasing access to care for our members.

It was only after reporters began asking questions that HFS first admitted to taking enforcement action earlier this year, halting automatic enrollments of new Medicaid patients at the Centene subsidiary that runs YouthCare – Meridian Health Plan of Illinois. HFS banned automatic enrollments of new Illinois Medicaid patients of all ages and types, not just young adoptees, Eagleson said.

“We didn’t want it to escalate,” she said.

In addition to the 36,700 current and former foster children of YouthCare, Meridian oversees the medical care of another 876,000 Illinois Medicaid patients under a separate state contract.

HFS’s disciplinary action was not posted on the agency’s website, as the agency normally does with penalties and fines. The details were obtained through a public records request with the California Medicaid agency. Centene had to release information about disciplinary action in all states in an unsuccessful bid for a Medicaid contract in California this year.

In the California filing, Centene said he was on an HFS “corrective action plan.”

Eagleson said his agency never publicly disclosed the enrollment freeze because it was not part of a formal corrective action plan. According to HFS, this was imposed by its contract auditor, not the department.

Centene got paid as adoptive parents scrambled

In interviews, parents said they struggled to get basic health services for their adoptive children.

“YouthCare is the lowest possible standard of Medicaid,” said Alicia Wehby, a foster carer of 15 years who helps run a northern Illinois nonprofit that provides families with reception of cradles, clothes and advice. “You need a psychological assessment for a child in your care because you are trying to determine the root cause so you can help them. You basically have to jump through hoops to prove that they may need some extra help because YouthCare is so bad. You wait at least a year just for the assessment to be done.

Wehby said she is concerned about other parents entering foster care without support or knowledge of their foster children’s needs.

“These children are dropped into people’s homes without their full history, and then the families don’t know how to react because they don’t know why their child is acting the way they are acting,” Wehby said. “And we only traumatize the children more because we are not prepared, as foster parents, to know how to take care of them. Because we are not told their story.

“Now the [child is] moved again, simply reiterating the lesson that “we’re not good enough, we’re not lovable.” ”

Melissa Thomforde., a foster family from Crystal Lake.

Crystal Lake adoptive mother Melissa Thomforde says she can’t rely on YouthCare for her adoptive children because “either you get substandard providers or the waiting list is so long, that’s all. just ridiculous”.

Victor Hilitski/Illinois Responses Project

Melissa Thomforde of Crystal Lake, who has been a foster mother for 11 years, said she understands why her adopted children might mimic the abuse they have experienced or witnessed. She said she was desperate for help for an 11-year-old foster child who had attacked a sibling.

“We have all of our adoptive children on our own private insurance to provide them with the services they need,” Thomforde said. “If you rely on [YouthCare]either you get below average vendors or the waiting list is so long it’s just ridiculous.

Even as Centene received more than $5.2 billion over the past year to provide care for its Illinois Medicaid and Medicare patients, adoptive parents said they had to pay out of pocket. expensive medical services for which YouthCare was paid.

Eva Green said she navigated urgent care clinics, often paying out of pocket for her new adopted son’s medication without receiving a full assessment of his health needs and background.

“They didn’t even give him a physical evaluation,” Green said. “It’s as if the system is causing further trauma to these children by not having foster parents equipped to care for them…”

Wehby said waiting lists for psychiatric assessment or treatment can last up to a year on YouthCare, but, on his private insurance, “I could have my kids here in a few months.”

Smith, the director of DCFS, said foster parents can seek reimbursement for these private medical expenses and the feedback his agency has received has been overwhelmingly “positive about our engagement with YouthCare.

Doctors paid little or late

Illinois medical providers have also had issues with YouthCare, saying they are paid little, late, or not paid at all.

Stephanie Barisch, director of therapeutic services at the Center for Youth and Family Solutions in Bloomington, said her agency had $70,000 in unpaid YouthCare claims last year for childcare services.

HFS extended the YouthCare contract for three years, agreeing to pay him an additional $1 billion.

But, in the two years since the launch of YouthCare, Centene and HFS have not established benchmarks on the rates of care expected by HFS 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.

“YouthCare, at a minimum, is expected to meet or exceed HealthChoice Illinois thresholds,” an HFS spokeswoman said.

Charles Golbert, Cook County Public Guardian.

Charles Golbert, Cook County Public Guardian.

Ashlee Rezin / Sun-Times,

Cook County Public Guardian Charles Golbert, who reviewed HFS 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 that its performance metrics were trade secrets.

“Every word of YouthCare initiatives: redacted,” Golbert said. “All progress toward annual goals: redacted. Every word on disparities and opportunities for action: redacted. You would think this is something taxpayers should be entitled to know.

Eagleson said his agency and Centene are not withholding information from the public.

“We’re trying in this administration to be very transparent, okay, about what we’re working on and what we’re trying to improve,” she said. “We try to figure out every day how we can do a better job for the people we serve.”

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