CareSource

What it reported doing in 2024

CareSource Ohio, Inc. ("CSOH"), is a nonprofit organization established under the state law of Ohio. CSOH is a member of the CareSource group of nonprofit tax-exempt organizations (the "CareSource Public Charities"). (Continued on Schedule O)The sole member of the CareSource Public Charities is CareSource, an Ohio nonprofit corporation that is tax-exempt under section 501(c)(3) of the Internal Revenue Code of 1986 (the "Code"). The CareSource Public Charities' primary activity for the last three decades has been to provide nonprofit Medicaid, Medicare, and Marketplace health maintenance organization ("HMO") services. As a mission-driven organization, CSOH follows the guidance of the CareSource Public Charities and is focused on transforming health care with innovative programs that address the social determinants of health, health equity, prevention and access to care. CSOH serves nearly 1.2 million Members in Ohio. CSOH'S membership includes: (1) Medicaid consumers, including families with low income, children, pregnant women, adoption and children in foster care, those who are aged, blind or disabled, (2) Medicaid consumers who are eligible for Home and Community Based services through execution of an annual Provider Agreement with the Ohio Department of Medicaid ("ODM"), (3) Dually eligible consumers for Medicare and Medicaid through Ohio's Dual Demonstration program, MyCare, (4) Medicare Advantage consumers, and (5) a Qualified Health Plan offered through the Federal Health Insurance Marketplace, providing low-cost comprehensive coverage for individuals and families. Medicaid: Our Members get all medically-necessary, Medicaid-covered services at no cost. Examples include preventive check-ups, inpatient and outpatient hospital services, and dental care. Members enrolled in our Ohio Medicaid plans have access to the following services: (1) Rewards programs, (2) One-on-one coaching for up to 24 months with a certified Life Coach, (3) Telehealth to talk to a doctor 24/7/365 using a smartphone or computer,(4) Large provider network for easy access to care,(5) Transportation to and from appointments, food pantries, pharmacies, WIC offices and County Department of Job and Family Services (CDJFS) appointments, (6) Vision and dental care, including checkups and teeth cleanings. Members can also get an allowance for a large selection of eyeglasses and an allowance for contact lenses and fitting, (7) Behavioral health resources that support the health of mind, body and spirit,(8) A team of nurses who can answer health questions 24/7/365, (9) Disease management programs, (10) Local care managers to coordinate health care needs and help connect members to community resources such as utility assistance, housing and food banks, and(11) CareSource mobile app for access to member ID card, "how-to" videos and a quick search for doctors. MyCare Ohio: Plans contract with both Medicare and Ohio Medicaid to provide benefits of both programs to its Members in 12 Ohio counties. To improve the way Medicare and Ohio Medicaid benefits work together, Members must enroll in a MyCare Ohio plan. The plan is for people with disabilities, older adults and individuals who need behavioral health services. CareSource Marketplace: Marketplace plans are available in 86 counties in Ohio. CSOH's Marketplace-qualified Vision and Fitness plans cover more than the essential health benefits. They offer adult vision through EyeMed, and a fitness program. There are no lifetime maximums for most benefits, no medical review for enrollment, and we cover an extensive list of prescription drugs. Members enrolled in our Ohio Marketplace plans have access to the following services: (1) $0 copay telehealth office visits via Teladoc with 24/7 access to U.S.-licensed physicians, (2) Ambulatory patient services (outpatient care), (3) Emergency services,(4) Hospitalization, (5) Pregnancy, maternity and newborn care (both before and after birth), (6) Breastfeeding coverage,(7) Men

Financial Efficiency

• Mission deployment rate: 84.7%; rating input score 85
• Program expense ratio: 86.3%; rating input score 86
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 92.9%; rating input score 93; 17th percentile among comparable filings
• Pay-setting controls: 0 of 6 controls in place; rating input score 0
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Missing
  • Board or committee approval: Missing
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Limited
• Related-party transparency: Limited

Accountability

• Independent voting board: 0%; rating input score 0; 4th percentile among comparable filings
• Governance controls: 7 of 9 controls in place; rating input score 78
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Fail
  • Other executive compensation review process: Fail
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 1.1%; rating input score 38; 38th percentile among comparable filings
• Total-asset coverage ratio: 0.27; rating input score 8; 8th percentile among comparable filings
• Liabilities to assets ratio: 0.62; rating input score 27; 27th percentile among comparable filings
• Officer compensation ratio: 0.1%; rating input score 92; 92nd percentile among comparable filings

Growth

• Program expense growth: 4.9% per year; rating input score 100; 39th percentile among comparable filings
• Revenue growth: 8.4% per year; rating input score 100; 69th percentile among comparable filings
• Asset growth: 6.8% per year; rating input score 100; 50th percentile among comparable filings