The Affordable Care Act creates a new type of private nonprofit health insurer, called a Consumer Operated and Oriented Plan, or “CO-OP.” CO-OPs are directed by their customers and designed to offer individuals and small businesses more affordable, consumer-friendly and high quality health insurance options.
The CO-OP program offers low-interest loans to eligible nonprofit groups to help set up and maintain these issuers. To date, a total of 24 non-profits offering coverage in 24 states have been awarded $1,980,728,696.
Starting January 1, 2014, CO-OPs, will be able to offer health plans through the new, competitive health care marketplaces in their state, called the Affordable Insurance Exchanges. In addition to offering health plans through an Exchange, CO-OPs may also offer health plans outside of an Exchange.
The first round of applications was due on October 17, 2011, the second round of applications was due on January 3, 2012, the third round of applications was due on April 2, 2012, the fourth round of applications was due on July 2, 2012, and the fifth round of applications was due on October 1, 2012. The next quarterly application deadline is December 31, 2012. Awards will be announced on a rolling basis.
CO-OP loans are only made to private, nonprofit entities that demonstrate a high probability of financial viability. All CO-OPs receiving loans were selected by CMS on a competitive basis based on external independent review by a multi-disciplinary team. As CO-OPs meet or exceed developmental milestones, funds are allowed to be incrementally drawn down.
CMS will closely monitor CO-OPs to ensure they are meeting program goals and will be able to repay loans. To ensure strong financial management, CO-OPs are required to submit quarterly financial statements, including cash flow and enrollment data, receive site visits, and undergo annual external audits. This monitoring is concurrent with the financial and operational oversight by state insurance regulators.
For more information on CO-OPs, including what federal loans are available, who can apply and licensing requirements, please visit: http://cciio.cms.gov/resources/factsheets/coop_final_rule.html
Detailed below is some additional information about the new awardee:
Land of Lincoln Health (incorporated as Metropolitan Chicago Healthcare Council CO-OP)
Service Area: Illinois
Award Amount: $160,154,812
Award Date: December 21, 2012
Land of Lincoln Health (incorporated as Metropolitan Chicago Healthcare Council CO-OP) intends to offer health plans throughout the State of Illinois that facilitate the delivery of efficient, evidence-based medical care through a consumer-focused and innovative health care delivery model. The CO-OP is sponsored by The Metropolitan Chicago Healthcare Council (MCHC). MCHC is a membership and service association comprising more than 150 hospitals and health care organizations working together, since 1935, to improve the delivery of health care services.
In addition to this new award, the following applicants were awarded CO-OP loans in previous rounds:
Compass Cooperative Health Network
Service Area: Arizona
Award Amount: $93,313,233
Award Date: June 8, 2012
Compass Cooperative Health Network (CCHN) is sponsored by prominent local experts in insurance, chronic disease coordination, use of health information technology to better coordinate care, and business startup. Compass Cooperative Health Network (CCHN) plans to offer health insurance coverage statewide over time in Arizona.
Colorado Health Insurance Cooperative, Inc. (CHI)
Service Area: Colorado
Award Amount: $69,396,000
Award Date: July 27, 2012
The Colorado Health Insurance Cooperative, Inc. (CHI) is sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation, Inc. (RMFU Foundation), which houses educational and outreach programs, and a regional cooperative development center. A significant component of CHI’s plan is to create chapters in communities throughout the state in an effort to fully engage members in the business of the CO-OP. CHI intends to offer benefit plans designed for individuals and employers inside and outside the Colorado Health Benefit Exchange. The CO-OP is committed to offering a qualified health plan at the Silver and Gold benefit levels in both the individual and Small Business Health Options Program (SHOP) Exchange markets. CHI also plans to offer at least one Value Based Plan (VBP) in the small group market. CHI is planning on marketing its insurance programs on a state-wide basis.
HealthyCT
Service Area: Connecticut
Award Amount: $75,801,000
Award Date: June 8, 2012
HealthyCT is sponsored by the Connecticut State Medical Society (CSMS) and the CSMS-IPA (a statewide Independent Practice Association), and plans to offer high-quality, coordinated medical care with strong physician-patient relationships at its foundation. HealthyCT will encourage the use of patient-centered medical homes in providing health insurance coverage statewide.
CoOportunity Health (formerly Midwest Members Health)
Service Area: Iowa and Nebraska
Award Amount: $112,612,100
Award Date: February 21, 2012
CoOportunity Health is sponsored by the Iowa Institute, a community organization. They plan to provide health insurance coverage throughout Iowa and Nebraska.
Kentucky Health Care Cooperative
Service Area: Kentucky
Award Amount: $58,831,500
Award Date: June 22, 2012
Kentucky Health Care Cooperative is sponsored by a coalition of business leaders, providers and community organizations who plan to improve health outcomes throughout the Commonwealth of Kentucky by providing better access to high quality care at an affordable cost. The Cooperative will participate in Kentucky’s Health Insurance Exchange, as well as in the individual and small group marketplace.
Louisiana Health Cooperative, Inc.
Service Area: Lousiana
Award Amount: $65,040,660
Award Date: September 28, 2012
Louisiana Health Cooperative, Inc. (LAHC) is sponsored by a coalition of providers and business leaders, including Ochsner Health System, who plan to improve health outcomes by providing better access to high quality care at an affordable cost. LAHC plans to provide statewide coverage in Louisiana with the mission of serving their members by promoting and supporting the delivery of integrated healthcare in each of their products and services. LAHC will participate in the individual and small group Health Insurance Exchanges operating in Louisiana, as well as in the health insurance marketplace.
Maine Community Health Options (MCHO)
Service Area: Maine
Award Amount: $62,100,000
Award Date: March 23, 2012
Maine Community Health Options is sponsored by Maine Primary Care Association, which is a membership organization comprised of Maine’s community, tribal, migrant, and homeless health centers.
Evergreen Health Cooperative Inc.
Service Area: Maryland
Award Amount: $65,450,900
Award Date: September 28, 2012
Evergreen Health Cooperative, Inc. (Evergreen) plans to provide high quality, affordable care to Maryland residents while pioneering innovative forms of healthcare delivery. Evergreen intends to provide health insurance coverage statewide and in the Maryland Health Benefit Exchange
Minutemen Health, Inc.
Service Area: Massachusetts
Award Amount: $88,498,080
Award Date: August 31, 2012
Minuteman Health, Inc. (MHI) is sponsored by Tufts Medical Center and Vanguard Health Systems, two hospital systems that intend to participate in the MHI network. MHI’s mission is to deliver efficient, quality healthcare financing to their future membership. They propose to initially provide regional coverage in eastern and central Massachusetts and expand to offer statewide coverage by July 2014.
Michigan Consumer’s Healthcare CO-OP
Service Area: Michigan
Award Amount: $71,534,300
Award Date: May 18, 2012
Michigan Consumer’s Healthcare CO-OP is sponsored by a coalition of 15 county health plans, which are private, non-profit corporations that provide a limited health coverage benefit to low-income individuals in Michigan. Michigan Consumer’s Healthcare CO-OP plans to provide health insurance coverage statewide.
Montana Health Cooperative
Service Area: Montana
Award Amount: $58,138,300
Award Date: February 21, 2012
Montana Health Cooperative is sponsored by a coalition of small businesses and community leaders and plans to add a strong primary care capacity to Montana’s rural and medically underserved communities. Montana Health Cooperative will provide health insurance coverage statewide.
Hospitality Health CO-OP
Service Area: Nevada
Award Amount: $65,925,396
Award Date: May 18, 2012
Hospitality Health CO-OP is sponsored by the Culinary Health Fund, its national parent Unite HERE Health, and the Health Services Coalition. Hospitality Health CO-OP will operate for everyone in the Exchanges and the individual and small group markets. Hospitality Health CO-OP plans to provide health insurance coverage statewide.
Freelancers CO-OP of New Jersey
Service Area: New Jersey
Award Amount: $107,213,300
Award Date: February 21, 2012
Freelancers CO-OP of New Jersey is sponsored by Freelancers Union, an association of independent workers that is partnering with providers with an innovative and effective Patient-Centered Medical Home model. Freelancers CO-OP of New Jersey will provide health insurance coverage statewide.
New Mexico Health Connections
Service Area: New Mexico
Award Amount: $70,364,500
Award Date: February 21, 2012
New Mexico Health Connections is sponsored by a coalition of community groups, business leaders, and providers that plan to work with their provider community to improve health outcomes in 11 counties and expand statewide within two years.
Freelancers Health Service Corporation
Service Area: New York
Award Amount: $174,445,000
Award Date: February 21, 2012
Freelancers Health Service Corporation is sponsored by Freelancers Union, an association of independent workers whose model is driven by a focus on providing high quality, consumer oriented coverage and financial sustainability that emphasizes the use of patient-centered medical homes. Freelancers Health Service Corporation will provide health insurance coverage throughout New York State.
Coordinated Health Plans of Ohio, Inc.
Service Area: Ohio
Award Amount: $129,225,604
Award Date: October 12, 2012
Coordinated Health Plans of Ohio, Inc. (CHP-OH) is sponsored by Community Health Solutions of America LLC, an organization that develops healthcare delivery networks and systems to improve primary care. CHP-OH plans to provide statewide coverage in Ohio with the mission of offering health insurance that delivers high quality health care to citizens throughout the state.
Freelancers CO-OP of Oregon
Service Area: Oregon
Award Amount: $59,487,500
Award Date: February 21, 2012
Freelancers CO-OP of Oregon, sponsored by Freelancers Union, is partnering with providers that have an extensive integrated primary care model that will be a strong asset to this CO-OP. Freelancers CO-OP of Oregon will provide health insurance coverage statewide
Oregon’s Health CO-OP (Incorporated as Community Care of Oregon)
Service Area: Oregon
Award Amount: $56,656,900
Award Date: March 23, 2012
Oregon’s Health CO-OP (Incorporated as Community Care of Oregon) is sponsored by CareOregon, a non-profit Medicaid Managed Care Organization. Oregon’s Health CO-OP will apply its CO-OP loans to participate in the state’s new Health Insurance Exchange marketplace. They plan to provide coverage statewide.
Consumers’ Choice Health Insurance Company (CCHIC)
Service Area: South Carolina
Award Amount: $87,578,208
Award Date: March 27, 2012
Consumers’ Choice Health Insurance Company is sponsored by a dedicated team of volunteers from not-for-profit organizations, member-driven employer groups and business advocates with expertise in the South Carolina health care and insurance markets.
Community Health Alliance Mutual Insurance Company
Service Area: Tennessee
Award Amount: $73,306,700
Award Date: August 31, 2012
Community Health Alliance Mutual Insurance Company (CHA) is sponsored by Healthcare 21 Business Coalition (HC21), a member of the National Business Coalition on Health, and LBMC Employment Partners (LBMS), a professional services organization providing financial, accounting services, and Professional Employer Organization (PEO) services to small employers in Tennessee. CHA’s mission is to create new health insurance options expected to meet the medical, wellness, and financial needs of insurance consumers in Tennessee. CHA is planning on offering its insurance plans state-wide.
Aarches Community Health Care (AHC or Aarches)
Service Area: Utah
Award Amount: $85,400,303
Award Date: July 13, 2012
Aarches Community Health Care (AHC or Aarches) is supported by the Association of Utah Community Health, the Salt Lake City Chamber, and the Utah Health Policy Project. This CO-OP will participate in the individual and small group market Exchanges with the mission of transforming the nature of insurance payments and benefits to promote high-quality, patient-centered, integrated, and value-based care in Utah.
The Vermont Health CO-OP (Incorporated as the Consumer Health Coalition of Vermont)
Service Area: Vermont
Award Amount: $33,837,800
Award Date: June 22, 2012
The Vermont Health CO-OP (incorporated as the Consumer Health Coalition of Vermont) was founded by Vermonters with extensive experience in health insurance and regulation, State health reform efforts, health care delivery, and successful corporate start-ups, with the support of providers, employers, and consumers. The CO-OP will work with Vermont Managed Care, the network affiliated with Vermont’s academic medical center, to coordinate the delivery of health services statewide through its growing network of hospitals, physicians, primary care medical homes and other health care providers.
Common Ground Healthcare Cooperative
Service Area: Wisconsin
Award Amount: $56,416,600
Award Date: February 21, 2012
Common Ground Healthcare Cooperative is sponsored by Common Ground, a community organization in Wisconsin that represents almost 100 small businesses, churches, unions, colleges, and community groups. Beginning its operations in southeastern Wisconsin, Common Ground Healthcare Cooperative will provide health insurance coverage throughout Wisconsin within five years.
Posted on: February 21, 2012