This story was co-published with The Dallas Morning News.
The ranking member of the Senate health committee has complained for months about the Trump administrationâ€™s failure to look into Medicaid contractors that have reaped big profits while sometimes failing to provide crucial patient services.
So last week, Sen. Bob Casey, D-Pa., called in the top boss of Centene, the nationâ€™s largest Medicaid managed care company. He wanted to question the company about reports that its Texas subsidiary denied life-sustaining care to sick and disabled children â€” in one case, leaving a baby in foster care to suffer a catastrophic brain injury.
The meeting with longtime Centene CEO Michael Neidorff did not go well, according to Casey.
â€œI thought they would try to persuade me that they were going to do better, but they didnâ€™t seem interested in that at all,â€ Casey told ProPublica and The Dallas Morning News in an interview. â€œI just couldnâ€™t believe it.â€
Casey said the Centene official denied providing inadequate care and cast blame for failures on foster parents and nurses.
Centene declined to make Neidorff available for an interview and emailed a brief statement in response to questions about the meeting with Casey.
â€œCentene and its subsidiaries care deeply about each and every member we serve,â€ the email read. â€œWe work tirelessly to ensure we provide the appropriate level of care for our members.â€
Under Neidorff, Centene has grown from a tiny health network in the Midwest into a $60-billion-a-year health care empire, backed almost entirely with taxpayer money. The company cares for more than 8.5 million Medicaid patients.
The company came under criticism last year after an eight-part investigation published in the Morning News examined whether Centene and other Medicaid managed care companies were skimping on care to bolster profits. The series raised questions about Centeneâ€™s Texas subsidiary, Superior HealthPlan, and its handling of the case of Dâ€™ashon Morris, a Texas toddler who was born with severe defects and was living in a foster home.
The series, titled â€œPain & Profit,â€ reported that Dâ€™ashon was denied 24/7 nursing care and suffered brain damage after a medical incident that occurred while he did not have his nurse around. (Read the full story here.)
The Morning News reported that state health officials had found the Centene subsidiary in violation of state and federal Medicaid rules and recommended the company face steep fines for what happened to the child. But top Texas health officials never assessed those fines, the Morning News reported.
Dâ€™ashonâ€™s adoptive mother sued the Centene subsidiary in Texas state court. That case is tied up in the Texas appeals court, where the Centene subsidiary has argued that the lawsuit should be dismissed because Dâ€™ashon and his mother are stifling the companyâ€™s right to free speech.
During hearings in the state Capitol, Superior representatives denied that the companyâ€™s refusal to provide 24/7 nursing was improper.
After his meeting with the Centene official, Casey sent a strongly worded letter to Seema Verma, a former health consultant appointed by President Donald Trump to run the Centers for Medicare and Medicaid Services.
In the letter, Casey called Centeneâ€™s response to questions about Dâ€™ashonâ€™s case â€œcallous.â€
He also asked Medicaid officials to dig further into Centeneâ€™s business practices and to provide documentation on any response to the Morning News investigation.
â€œItâ€™s another indication that the regulatory approach here by the administration is, at best, suspect,â€ Casey said.
A CMS spokesman said that Texas officials have shared with the agency an â€œaction plan they intended to take to address the concerns raised,â€ adding that CMS is in regular communication to ensure the state improves.
â€œCMS has received Sen. Caseyâ€™s letter and will respond to his office directly,â€ spokesman Brian Leshak said in an email.
Caseyâ€™s position as the top Democrat on two Senate panels overseeing federal health programs gives him the standing to raise questions about the Medicaid managed care system.
Itâ€™s not unusual for company officials facing a federal audit or investigation to meet with members of Congress to address concerns, but it is unusual for such meetings to spill into public view.
Casey said he sent the letter to CMS because of what he called Centeneâ€™s â€œcold and clinicalâ€ defense of what happened in Dâ€™ashonâ€™s case. He said it gave him concern about how the company cares for other patients â€” and what, if anything, regulators are doing when things go wrong.
Last month, more than a year after the Morning News story was published, Centene officials provided Caseyâ€™s office with a one-page rebuttal titled: â€œThe Dallas Morning News got it wrong.â€
The companyâ€™s explanations include that Dâ€™ashonâ€™s foster mother was a trained nurse. But, as the Morning News reported, she was on an approved vacation at the time of Dâ€™ashonâ€™s injury, and he had been placed in a different foster home.
The company also said Dâ€™ashonâ€™s foster mother should have restrained the baby, but the Morning News previously reported that Texas foster care officials confirmed restraints would have required a doctorâ€™s order, which she did not have.
â€œIt was all blame shifting and pointing to other factors,â€ Casey said of Centeneâ€™s letter.
Casey said the meeting left him wondering why federal regulators werenâ€™t doing more.
â€œIt might even be worse than asleep at the wheel,â€ he said of CMS under Vermaâ€™s watch.
â€œThey may be awake at the wheel but choosing consciously to say, â€˜Weâ€™re going the other direction.â€™â€
Without commenting on specific cases, the CMS spokesman said the agency routinely monitors states and intervenes when necessary.
Problems with this privatized Medicaid model have grabbed headlines in other states, too. And advocates in those states said they havenâ€™t heard much from CMS, which they say is a shift from the Obama administration.
In Iowa, for instance, The Des Moines Register reported failures to provide care and chronicled patients who had been caught in that stateâ€™s broken medical appeals system.
Rob Sand, Iowaâ€™s state auditor, wrote to state officials in June that two large managed care companies had â€œsignificantly harmedâ€ two paraplegic patients by refusing to provide services they needed.
Mary Nelle Trefz, of Iowaâ€™s Child and Family Policy Center, said sheâ€™s been shocked to hear nothing about that from CMS.
â€œI donâ€™t feel, or canâ€™t observe, or point to anything, where CMS has stepped in to provide that oversight and accountability,â€ she said.
In March, Californiaâ€™s state auditor found that millions of children in that stateâ€™s privatized Medicaid system werenâ€™t being provided services that taxpayers had paid for. Auditor Elaine Howle blamed California health officialsâ€™ â€œdeficient oversight of the managed care plans.â€
Andy Schneider, a researcher at Georgetownâ€™s Center for Children and Families, and a former top adviser to CMS under the Obama administration, said these episodes come at an inconvenient time for the Trump administration, which is focused on reducing regulation and creating additional eligibility hurdles like work requirements.
CMS has taken a hands-off approach compared with the previous administration, he said.
â€œThese are reports coming from reputable media sources,â€ he said. â€œTheyâ€™re very concerning, they have to do with the operation of the program, they suggest that something is wrong.â€