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Colorado CO-OP Becomes 17th Funded by CMS to Support New Health Law

In 2014 they will offer health plans through Affordable Insurance Exchanges

July 30, 2012 - The Colorado Health Insurance Cooperative, Inc. (CHI) became the 17th Consumer Operated and Oriented Plan (CO-OP) to be provided a start-up loan by the Centers for Medicare & Medicaid Services to launch a new private non-profit, consumer-governed health insurance company to serve Colorado.

Created by the Affordable Care Act, CO-OPs encourage eligible groups to create new, innovative and consumer–responsive health insurance companies to increase competition in the individual and small business markets. Beginning in 2014, CO-OPs will offer plans through the Affordable Insurance Exchanges.

This CO-OP to serve Colorado was awarded a loan of $69,396,000, according the announcement on July 27. CMS says the CO-OPS are “private, nonprofit entities that demonstrate a high probability of financial viability.”

 

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All CO-OPs receiving loans were selected by CMS on a competitive basis based on external independent review by a multi-disciplinary team. Only when CO-OPs meet or exceed developmental milestones are funds allowed to be incrementally drawn down.

 “CO-OPs will promote competition and give consumers more health insurance choices,” said Marilyn Tavenner, CMS Acting Administrator.

“These new private nonprofit insurers will be run by consumers and are designed to offer individuals and small businesses more affordable, consumer-friendly and high-quality health insurance options.”

In addition to giving consumers more choices and improving competition in their States, as consumer-run insurers, CO-OPs will operate differently from traditional insurance companies. More than half of the Board of Directors must be the customers or members of the CO-OP, and all directors must be elected by a majority vote of the members, improving accountability and transparency.

Under the Affordable Care Act, profits gained by a CO-OP must go directly back to their enrollees, to be used to lower premiums, expand benefits, or improve quality.

To ensure CO-OPs are truly new entities, the health care reform law prohibits any State-licensed health insurance company that existed on July 16, 2009 from qualifying for the CO-OP program.

CMS states on its website that it will closely monitor CO-OPs to ensure they are meeting program goals. 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. The CO-OPs are required to meet State and federal standards for qualified health plans to sell coverage through the Exchanges and the State’s Small Business Health Option Programs (SHOP Exchanges).

Following is an explanation of this program appearing on the HealthCare.gov website:

New Loan Program Helps Create Customer-Driven Non-Profit Health Insurers

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 18 non-profits offering coverage in 18 states have been awarded $1,399,051,940.

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, and the third round of applications was due on April 2, 2012. There will be subsequent quarterly application deadlines through 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 says it 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, click here.

Detailed below is information about the 17 awardees to date:

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.

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.

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.

Midwest Members Health
Service Area: Iowa and Nebraska
Award Amount: $112,612,100
Award Date: February 21, 2012

Midwest Members 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.

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.

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.

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.

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.

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.

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.

 

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