CareSource West Virginia Co

What it reported doing in 2024

CareSource West Virginia Co. ("CSWV") is a nonprofit organization established under the state law of West Virginia. On August 30, 2017, CSWV received a determination letter from the Internal Revenue Service, recognizing CSWV as an organization exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code, effective as of the date of CSWV's formation. CSWV 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, CSWV 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. CSWV is accredited for its Qualified Health Plan ("QHP") through the National Committee for Quality Assurance ("NCQA"). Accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance and consumer experience. The CSWV Marketplace-qualified dental, vision and fitness plans cover more than the essential health benefits. They offer adult dental through DentaQuest, adult vision through EyeMed, and the Active&Fit program. There are no lifetime maximums for most benefits, no medical review for enrollment, and CSWV covers an extensive list of prescription drugs. Members enrolled in our CSWV 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) Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy),(8) Prescription drugs, (9) Rehabilitative and habilitative services and devices, (10) Laboratory services, (11) Preventive and wellness services and chronic disease management,(12) Pediatric services, including dental and vision care, and (13) Birth control coverage. CSWV focuses on prevention with a goal of improving Member health, the quality of health care services received, and accessibility of health care services for its Members. This is done through an innovative health and wellness methodology. CSWV has built a high-performing provider network to operate as a Health Maintenance Organization ("HMO"). This provider network relies heavily upon Federally Qualified Health Centers ("FQHCs"). FQHCs are generally health care providers that have been recognized by the federal government as providing care to populations that have limited access to medical treatment due to conditions such as poverty and geographic location. CSWV's QHP on the Health Insurance Marketplace primarily serves low-income individuals and was designed for those low-income adults who are recently uninsured or have never been insured. The plan is affordable, with a majority of Members qualifying for subsidies to lower their monthly premiums or out-of-pocket costs. Members have the choice of buying plans with only the essential health benefits, or ones that also include adult dental, vision, and fitness supplemental benefits. Members can also receive assistance through CSWV's many programs designed to remove barriers to health and well-being. CSWV can, therefore, further its mission as a means of improving the health and well-being of West Virginia's low-income populations.

Financial Efficiency

• Mission deployment rate: 81%; rating input score 81
• Program expense ratio: 85.1%; rating input score 85
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 100%; rating input score 100; 68th 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: 2.4%; rating input score 45; 45th percentile among comparable filings
• Total-asset coverage ratio: 0.67; rating input score 26; 26th percentile among comparable filings
• Liabilities to assets ratio: 0.88; rating input score 14; 14th percentile among comparable filings
• Officer compensation ratio: 5.4%; rating input score 14; 14th percentile among comparable filings

Growth

• Program expense growth: 24.8% per year; rating input score 100; 95th percentile among comparable filings
• Revenue growth: 26% per year; rating input score 100; 96th percentile among comparable filings
• Asset growth: 26.8% per year; rating input score 100; 97th percentile among comparable filings