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Illinois Medicaid contractor failed to deliver basic medical services to foster children

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Illinois

* From the BGA’s new Illinois Answers Project…

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.

* To get Centene’s basic performance records, the Better Government Association filed a lawsuit in 2021 after being defined records…

The contract has rolled out in phases as some foster parents complained they could not fill prescriptions or even schedule regular check-ups for children with serious medical conditions.

Last year, Meridian began producing for state officials quarterly slideshows with basic data about its performance in delivering care. The slides are meant to outline whether Meridian is meeting timeliness and quality standards, and what it’s doing to overcome problems.

But when the BGA asked last month to see those slideshows, state officials turned them over almost completely redacted — with entire slides blacked out.

The contractor’s performance data constituted “trade secrets,” HFS explained in its denial letter to the BGA.

* Across the country, Centene has showered politicians with contributions while settling over-billing allegations. Missouri Independent…

Since 2015, the Clayton-based insurance behemoth, its subsidiaries, its top executives, and their spouses have given more than $26.9 million to state politicians in 33 states, to their political parties, and to nonprofit fundraising groups, according to a KHN analysis of IRS tax filings and data from the nonpartisan, nonprofit group OpenSecrets. That total doesn’t include the millions of dollars Centene and its subsidiaries have given to state politicians’ political action committees because OpenSecrets doesn’t track those donations. The KHN analysis also does not include giving to congressional and presidential candidates.

It’s a purposeful political investment: Centene earns billions of dollars from governments and then uses its profits to back the campaigns of the officials who oversee those government contracts. The company has developed this sophisticated, multipronged strategy as it pursues even more state government-funded contracts and defends against sweeping accusations that it overbilled many of those very governments.

Centene declined to make a representative available for an interview and didn’t respond to specific questions about its political giving. But company spokesperson Suzy DePrizio said in a statement that the company follows all local, state, and federal laws and records all contributions from its political action committee. She said Centene’s contributions “are intended to serve as support to those who advocate for sound public policy healthcare decisions, which is evident by our nearly equal support of candidates from both parties.”

This year, according to IRS filings that go through Sept. 30, Centene has given $2.2 million, combined, to the Republican and Democratic governors’ associations, which help elect candidates from their respective parties. And Centene gave $250,000, combined, to the Republican Attorneys General Association and its Democratic counterpart.

posted by Isabel Miller
Monday, Nov 14, 22 @ 12:06 pm

Comments

How many ways can DCFS fail kids?

Comment by Demoralized Monday, Nov 14, 22 @ 12:08 pm
No surprise the State has failed yet again, while HFS tries to hide behind FOIA exemptions.

Comment by thisjustinagain Monday, Nov 14, 22 @ 12:13 pm
Sorry. HFS. Not DCFS.

Comment by Demoralized Monday, Nov 14, 22 @ 12:19 pm
Great work by the BGA. The writers sure did hang in after the Team Pritzker fought FOIA requests for a year or more and Centene refused to answer their questions.
Really shameful how these poor people and their children are treated.
While the failure to respond to legitimate questions by an established and highly regarded organization like the BGA is no surprise, these are children in need and the BGA highlighting this conduct by the Pritzker Administration and Centene should be a wake up call for all of us that this conduct should not be tolerated.
Where is the General Assembly in investigating this mess?

Comment by Back to the Future Monday, Nov 14, 22 @ 12:23 pm
The general rule still applies: The government contracting out work to private entities to run entire programs is almost always bad.

Comment by Homebody Monday, Nov 14, 22 @ 12:27 pm
Agree with Homebody.

Comment by Back to the Future Monday, Nov 14, 22 @ 12:46 pm
The purpose of managed care organizations is to delay and deny care for patients as well as delay and deny payment to providers. So Centene is just living up to the job description.

The FOIA issue is troubling, though. The state needs to be transparent about its contracts.

Comment by Friendly Bob Adams Monday, Nov 14, 22 @ 1:30 pm
Shareholders in Centene could step up and vote no on these corporate directors.
I wonder how Governor Pritzker’s shares were voted in terms of supporting the type of conduct the BGA highlighted in it’s research.

Comment by Back to the Future Monday, Nov 14, 22 @ 1:32 pm
the GA should do significant MCO reform this session. Pritzker and his admin have avoided taking Medicaid challenges seriously and they hide behind managed care, but we all know that the MCOs put profits before people. the part of this story that made me truly sad was when the woman said that the state’s failures reinforce their belief that they are undeserving of love. that is devastating to me, and, if any person in this administration cares about human beings, they should call these MCOs to testify to the failures. its terrible.

Comment by former cubs fan Monday, Nov 14, 22 @ 1:32 pm
==an established and highly regarded organization like the BGA==

A good rule of thumb is that any point you’re trying to make, regardless of merit, loses its oomph when you say something this silly in the same breath.

Generally, I also agree with Homebody and I’d add that the failure of state government to succeed in areas like this is largely a failure to fund personnel and innovation. You can’t fund health care for children with good intentions, so you farm it out to the lowest bidder. It’s a set up.

Comment by Who Else Monday, Nov 14, 22 @ 1:36 pm
Appreciate the concerns expressed about the BGA, but thinking they are doing a great job on this Centene issue.
From the first article by this award winning writer and his DePaul Interns to this latest story by the same writer and Rachael Hinton, a well respected reporter, the BGA is doing what no other group is doing on this story.
These reporters have been working on this story for at well over a year and deserve a big “Thank You” for standing up for these children.

Comment by Back to the Future Monday, Nov 14, 22 @ 1:47 pm
Where is the ILGA? Cashing their Centene campaign contributions, Im sure.

Comment by Dupage mom Monday, Nov 14, 22 @ 1:49 pm
>Across the country, Centene has showered politicians with contributions while settling over-billing allegations

It’s a profitable business model and good for politicians who need campaign contributions. Costs efffective and good for people it is not. That’s a lot of cost-efficient tier 2 state jobs communities would have instead of managed care and no profits heading out of state out of the funds to provide healthcare.

Comment by Earnest. Monday, Nov 14, 22 @ 2:42 pm
“an established and highly regarded organization like the BGA”

BGA has engaged in far too much partisan hackery of late to earn that moniker. And yea, even “respected and award-winning” reporters can come to a story with tremendous baggage and a closed mind. A lot of their previous recent stories fit in this category. In this case, if you know the BGA and you know some of the advocates identified in this story, you knew where this was going before you had to read a word.

So here’s my question. How is this program doing compared to the old fee for service model? How does the network compare? Has care coordination improved? Is Smith right when he said, “feedback his agency has gotten has been overwhelmingly “positive about our engagement with YouthCare?” Or is the program worse than before? And has it improved since the corrective action was taken? I read this story twice and have no clue nor do I know whether they tried to find out.

In my experience working with the HFS team, they’re incredibly diligent and focused on big, broad improvements in care and they’ve launched numerous big-time efforts to do just that. Eagleson in particular had been exceptionally capable for someone managing such an incredibly difficult and complex agency. Are there continuing problems in the implementation of this program? Of course there are. But the question is the trajectory and I have zero clue about that from this hatchet-job.

Comment by Yea, but.... Monday, Nov 14, 22 @ 2:56 pm
Why the lack of transparency by the Pritzker group, Centene and this agency?
Why take over a year to produce an answer to the FOIA request?
Looking at the redactions in the response goes a long way to highlighting the arrogance and shenanigans surrounding Centene and Team Pritzker.
These are children in need. It’s time to put their needs before Centene’s profits regardless of who in state government owns shares in the company or what any Governor Staff person’s relationship with a lobbyist is.
A simple check on Google shows this company has had trouble in other states and has been subjected to monetary penalties for their behavior.
I do appreciate the comments on the BGA, but clearly this behavior regarding Centene would not be available to the public if not for the reporting done by BGA.
We have some really good journalists in Illinois. We should celebrate them and the work they do.

Comment by Back to the Future Monday, Nov 14, 22 @ 3:43 pm
The fee for service program or pccm served this population significantly better. There were no blocks to getting immunisations or doctors visits as you could go to any enrolled medicaid provider which would include all the Fuchs and their look alike. To be fair to HFS, the staff there never advocated for the use of MCOs as they knew it would likely disimprove care. It was the general assembly that forced this at the bidding and excessive lobbying by MCOs. On the other hand, HFS under Eagleson’s leadership has been slow to implement many pieces of legislation designed to improve Medicaid and have been underwhelming in their oversight of the MCOs.

Comment by WestChicago Monday, Nov 14, 22 @ 4:09 pm