Still out of Compliance, Saint Francis Ministries Holds Restricted Child Placing License

By Emily Chen-Newton

LAst Updated on September 30th, 2021

SEPTEMBER 30th UPDATE: Saint Francis Ministries will now operate with a restrictive probationary child placing license after an inspection by the Nebraska Department of Health and Human Services Licensure Unit found persisting deficiencies within the organization. Effective October 1, 2021 Saint Francis Ministries (SFM) is restricted from taking on new children for the next 60 days.

According to the press release from DHHS, "To ensure that the children and families of Nebraska receive the needed supports, the Division of Children and Families (CFS) will assume any new referrals in the ESA.” The Eastern Service Area, encompasses Douglas and Sarpy counties where about 45% of Nebraska’s system involved youth live and where SFM manages the cases of roughly 1,930 children. Saint Francis Ministries has 16 months left of its current contract with the state. The contract ends one month after Governor Ricketts leaves office.

AUGUST 6th UPDATE:

As of early June, Saint Francis Ministries, the agency managing child welfare for the Omaha area has been operating with their child-placing license on probation. Saint Francis was given a deadline of August 1st to amend 20 corrective action items to maintain their license. Saint Francis Ministries told NOISE on August 4th, 2021), that they have yet to reach compliance on all 20 action items, and yet their child placing license has not been revoked, nor have any fines been imposed by Nebraska’s Department of Health and Human Services.

Saint Francis Ministries’s Exec. Director of Marketing & Communications Morgan Rothenberger told NOISE via email that SFM has “made excellent progress in addressing the licensing requirements”. Both Rothenberger and Garret Swanson, spokesperson for Nebraska’s DHHS confirmed that Saint Francis’ probationary period has been extended until September 30, 2021, and their license has not been revoked. In fact, none of the disciplinary options outlined in revised Nebraska Statute 71-1941 have been imposed on Saint Francis except the nonpunitive label of “probation”. According to this statute, “the department may impose any one or a combination of” disciplinary actions against a child placing agency found out of compliance.

NOISE asked spokesperson Swanson why DHHS did not take disciplinary action in response to SFM's noncompliance.

Swanson replied,“ The recent extension of probation is part of the disciplinary action that DHHS has imposed per the state statute. We are unable to speak to any other specifics”. 

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“May” seems to be the key word for Nebraska’s DHHS, as spokesperson Swanson told NOISE the department did conduct a review of SFM in light of their August 1st deadline - and still they decided to hold off on any punitive actions regardless of their noncompliance.

According to testimony given early this July in front of the special legislative committee investigating SFM, by Inspector General of Child Welfare Jennifer Carter, the licensing trouble began over eight months ago. Last December the Division of Public Health (DPH) found multiple violations while conducting a compliance check and originally handed down 25 corrective action items. SFM’s license was officially put on probation in June of this year, as 20 of the 25 items had not been corrected. 

This is not the first time departments under the Ricketts’ Administration have hung their actions on the word “may.” In the opening statement for LB61, Senator Kolterman spoke about one of the original missed opportunities for intervention when the department declined to review the legitimacy of Saint Francis’ cost proposal in 2019. According to the state’s own Request for Proposal, “The State reserves the right to review all aspects of cost for reasonableness and to request clarification of any proposal where the cost component shows significant and unsupported deviation from industry standards.” Sen. Kolterman noted in his opening statement that “While they reserved the right, it is abundantly clear the State never exercised this right.” 

That missed opportunity was in 2019, and now again in 2021 the Department of Health and Human Services under the Ricketts Administration was faced with the right to intervene on behalf of Nebraskan children, but not an obligation to exercise that right. Kolterman’s LB61 seeks to establish defined protocols for protest when contracts over 10 million dollars are awarded and mismanagement is suspected. Sen. Kolterman wrote, “Sure, it may slow down the procurement process, but we are talking about contracts that cost our taxpayers tens of millions of dollars” and in the case of Saint Francis Ministries, we are talking about millions of dollars and the lives of thousands of children. 

For full details, read the article as it was originally published on July 26, 2021, below:

In July of 2019, a contract between Saint Francis Ministries (SFM) and the state of Nebraska was finalized tasking Saint Francis with managing the care of roughly 2,000 (at that time) abused and neglected children in and around Omaha. Since then, Saint Francis, which originally claimed they could do the job for roughly 40% less than their competitor, has repeatedly fallen short of compliance with various child welfare regulations, and recently their “Child Placing Agency License” has been put on probation. This probation is far from the first red flag for SFM, but never before has their ability to care for children across the whole state hung in the balance as it does now.

Saint Francis is currently contracted to manage child welfare cases in and around Omaha, however, they also operate in a more narrow role as a child placing agency in western and central parts of the state. So, their Child Placing Agency License is essential for getting children out of unsafe situations and into foster and adoptive homes across the entire state. 

DHHS’s Division of Public Health clearly states on their website, “anyone who provides foster care or adoption services to children and youth must be licensed.”

Image credit: Josiah Hazel

According to testimony given on July 9th, 2021 by Inspector General of Child Welfare Jennifer Carter, the licensing trouble began late last year when the Division of Public Health (DPH) found multiple violations while conducting a compliance check. DPH handed down 25 corrective action items in December of 2020. In Carter’s July 9th testimony given in front of the special legislative committee investigating SFM, she explained that as of early this June SFM’s Nebraska license to place children in foster and adoptive homes was put on probation because 20 of the 25 items were still insufficient. SFM has until August 1st to achieve compliance on all items. 

NOISE reached out to both DHHS and SFM repeatedly about these 20 remaining corrective action items. Olga Dack, DHHS’s deputy director of communications, would not discuss the 20 action items or whether SFM’s contract with the state would be in jeopardy if they lose their child placing license. Instead, Dack provided the following response. “DHHS is working daily to ensure that St. Francis Ministries prioritizes the quality of services, continuity of care, and well-being and safety of children in its decision-making.” 

Governor Ricketts appoints many of the leadership positions within the state’s DHHS and the Department of Administrative Services (DAS), responsible for SFM’s contract. NOISE asked the governor if he finds it concerning that DHHS will not discuss even in vague terms these “corrective action items” and is not forthcoming with information affecting the lives of thousands of vulnerable children in Nebraska? Taylor Gage, the governor’s director of strategic communications responded via email, “Please refer to the statement provided to you by DHHS,” which does not address the aforementioned question.

According to reporting from the Omaha World Herald about the July 9th briefing, despite the damning testimonies given that day about SFM’s performance and financial management, “it remains unknown if St. Francis will be forced to correct its failures.” Indeed, when NOISE spoke to Inspector General Jennifer Carter, she clarified that while it remains a possibility, there is no guarantee the DPH will strip Saint Francis of their license if they fail to comply on all 20 action items by August 1st.  On behalf of DHHS, Dack explained the possible disciplinary actions for SFM’s non-compliance are outlined in Nebraska Revised Statute 71-1941. The consequences range from fines (no more than $1,000 per violation) to revocation of the license. In accordance with the statute, a licensee who loses their license “shall not apply for a license for a minimum of two years after the date of revocation.”

SFM’s Executive Director of Marketing and Communications Morgan Rothenberger told NOISE via email that Saint Francis does not expect to lose their license. Also unwilling to discuss the 20 action items she explained, “Going deeply into the 20 items would be delving into the complexities of child welfare. To summarize, the challenges revolved around how we had been maintaining files. We have retrained staff and worked with everyone to make sure that we are meeting DHHS expectations and also following best practices that will serve our children and families well.”

The Inspector General’s testimony outlined SFM’s shortcomings of care highlighting that this recent red flag of license probation is not simply a matter of bureaucratic red tape; there are daily failures that persist within SFM’s care for Nebraska children. For example, roughly 16% of cases (one case can involve multiple children) do not currently have monthly face-to-face contact with someone from SFM. Additionally, SFM has struggled from the very beginning to comply with a Nebraska State Statute to assign no more than 17 cases per caseworker. Their most current scorecard shows only 38% of their caseworkers comply with this statute. 

Saint Francis’ recent scorecard from DHHS from June 28th, 2021

Despite these failures, and a child placing licence on shaky ground since last December when the 25 corrective action items were first identified, the state signed an emergency contract increasing SFM’s budget by $82.9 million this past January. The emergency contract was signed eight days after the SFM’s interim CEO testified that at their current spending rate, SFM would run out of money within weeks. This and other details surrounding SFM’s financial relationship with the state were brought to the attention of the investigative committee by an analyst in the Legislative Fiscal Office, Liz Hruska, as she testified on July 9th along with the inspector general. Hruska testified that Saint Francis’ contract now exceeds the bid from their only other competitor for the contract (PromiseShip) by “$3.7 million when converted to the same 38-month time period,” pertinent information as it’s now been revealed that  “Cost Proposal” was the only category where SFM scored higher than the competitor during the original bidding process. Representatives from SFM have claimed their financial woes are due in part to being unaware of the specific Nebraska statute limiting their caseloads, and in fact, they did request an additional $15 million before their original contract was signed in 2019 in order to comply with the statute. This request was denied by the Nebraska Department of Administrative Services. Hruska noted though, even if the additional $15 million had been awarded, SFM’s bid would still have been only 69% of their competitors (and far below the costs they have now accrued in the state). SFM’s competitor, PromiseShip, outscored SFM in all other written categories including “Technical Approach'', “Corporate Overview” and even “Financial Requirements.” 

As the scoring gaps have manifested over the past year and a half into operational issues, several state senators have raised questions about the contract acquisition process and the privatization of child welfare. Senators Machaela Cavanaugh and Mark Kolterman have both introduced bills in response to the mishandeling of this contract. Kolterman spearheaded a bill creating a defined protest process for contracts awarded by the state “in excess of ten million dollars.” And Cavanaugh introduced LB491 to end privatization of child welfare in the Omaha area. These bills won’t be up for a vote until next year’s legislative session. In the meantime, the investigative committee for Saint Francis Ministries will hold a hearing open to the public and livestreamed on October 8th, 2021. The hearing will include individuals from the Department of Administrative Services, DHHS and SFM according to Committee Chairman Sen. John Arch.

The committees involved in the SFM investigation and their respective members are listed below:

Health and Human Services Committee: Sen. John Arch - chair, Sen. Matt Williams - vice chair, Sen. Michaela Cavanaugh, Sen. Jen Day, Sen. Ben Hansen, Sen. Dave Murman, and Sen. Lynn Walz

LR 29 Investigative Committee: Sen. John Arch - chair, Sen. Justin Wayne - vice chair, Sen. Robert Clements, Sen. Suzanne Geist, Sen. Matt Hansen, Sen. Mark Kolterman, Sen. Terrell McKinney, Sen. Dave Murman, and Sen. Rita Sanders.