Founded in Dayton, Ohio, in 1989, CareSource is a not-for-profit health insurer that serves Medicare, Medicaid and Affordable Care Act exchange members in five states, though Ohio remains its largest market. Following its founding mission of expanding health care access to needy populations, in 2015 the insurer branched out to seniors, launching its first Medicare Advantage (MA) plans in Ohio. CareSource also serves Ohio’s Medicare-Medicaid dual eligible population through the state’s CMS-backed duals demonstration program.
After a much-publicized dispute between the Ohio Department of Medicaid, its contracted managed care orgs and their pharmacy benefit managers, CareSource in 2020 partnered with Cigna Corp.’s Express Scripts to launch CareSource RxInnovations, its current PBM. Ohio is transitioning to a single Medicaid PBM, Gainwell Technologies, as part of its 2022 managed care transformation.
While CareSource has seen significant enrollment gains as a result of the COVID-19 pandemic, the insurer is also looking to expand its Medicaid presence to new states. In September 2021, CareSource announced it would bid to serve Iowa’s managed care program, Iowa Health Link. “Our industry-leading social programs, complex care capabilities and core operations will result in improved quality and health outcomes for Iowa’s Medicaid population, while also providing a better experience for both members and the providers who care for them,” Erhardt Preitauer, CareSource president and CEO, said in a statement. Awards are expected this fall.
Then in December 2021, CareSource unveiled a partnership with TrueCare, a large provider-sponsored health organization in Mississippi, to serve Medicaid members in the state. Mississippi began its procurement process in January. And while CareSource failed to win a bid for Oklahoma’s Medicaid managed care transformation, the program was ultimately blocked by a federal judge.
In addition to its market expansion plans, CareSource in December 2021 acquired the Philadelphia-based Columbus Organization, which provides health care services to more than 100,000 individuals with intellectual and developmental disabilities in 13 states. Financial terms of the deal were not disclosed.
SOURCE: AIS’s Directory of Health Plans as of January 2022; MMIT Analytics as of 1Q 2022.