Hacia Salud Health Insurance CO-OP is applying for startup and solvency loans totaling $95.7 million to operate in 15 Central California counties. It aims to serve the health care needs of hourly wage and Latino workers through affordable plans using a network of community clinics and hospitals. The CO-OP expects enrollment to grow from 94,000 in 2015 to nearly 167,000 by 2026, offering essential benefits at lower costs. It will implement initiatives like mobile clinics, health educators, and local governance to improve access and care quality for its target population. An experienced management team will oversee Hacia Salud's operations.

1. Hacia Salud Insurance CO-OP
Application Abstact Page 1
Loan Funding Opportunity Number: OO-COO-11-001
Applicant Entity Legal Name: Hacia Salud Health Insurance CO-OP
Applicant Phone Number: (949) 232-9178 Website Address: www.haciasalud.org
Applicant Business Address: 721 South A Street, Oxnard CA 93030-7971
Project Officer Legal Name: James Edward McClements, Jr.
Project Officer Phone Number: (949) 232-9178 Project Officer Email: emcclements@haciasalud.org
Project Officer Business Address: 721 South A Street, Oxnard CA 93030-7971
Projected Date for Accepting Applications: 10/1/2014 for 1/1/2015 eff. date
Projected Exchange Go-Live Date: 1/1/2015
Congressional Districts Served:
4th Tom McClintock 17th Sam Farr 21st Devin Nunes 24th Elton Gallegly
10th John Garamendi 18th Dennis Cardoza 22nd Kevin McCarthy 25th Howard McKeon
16th Zoe Lofgren 20th Jim Costa 23rd Lois Capps 26th David Dreier
California Legislative Update:
• Specify that a licensed CO-OP is subject to all other provisions of CA health insurance law.
• Authorizes the Ins. Commissioner to revoke a CO-OP's certificate of authority for violating those standards.
• Permits Federal Solvency Loans to be treated as Surplus for purposes of formation and capitalization.
• Prohibits CO-OP conversion or selling a for-profit or non-consumer-operated entity after receiving a solvency loan.
History of Applicant Entity:
Population Served:
Target Market:
Projected Annual Enrollment During the Life of the Solvency Loan (source: Milliman):
2015
2016
2017
2018
On September 30, 2012, Governor Jerry Brown signed into law California's CO-OP enabling legislation. Known as
AB1846, this law conforms California's Insurance Code and Health and Safety Code to authorize and regulate health
CO-OPs. AB1846 accomplishes the following:
2023
2024
2025
2026147,7832022134,623
2033
2034
2021123,914 146,320
153,784
2029
2030
Hacia Salud Health Insurance CO-OP - Application Abstract
Applying for both Start-up and Solvency Loans: $11,652,148 for Start-Up and $84,046,759 for Solvency purposes
CDFA # 93.545
2019
2020 2032
161,628
2028
Hacia Salud will initially operate in the 15 Central California Counties that constitute California's agricultural
heartland: Fresno, Kern, Kings, Madera, Mariposa, Merced, Monterey, San Benito, San Joaquin, San Luis Obispo, Santa
Barbara, Santa Cruz, Stanislaus, Tulare, and Ventura. It will deliver to the marketplace cost-effective plans that meet
(or exceed) Essential Benefit Levels for all Californians residing or working inside of these counties. Hacia Salud is
tailored to meet the health care needs and income limitations of California's hourly wage workers, a disproportionate
number of whom are Latino. Hacia Salud will provide quality care to California’s medically underserved workers at an
affordable price using a geographically dispersed network of top performing traditional safety net providers -- FQHCs,
community clinics, as well as ancillary and hospital providers. Simultaneously it will greatly expand preventive care
utilization by incorporating emerging low cost/high value delivery modalities uniquely suited to serving a working
California's agricultural and other low wage hourly workers are poorly served by California’s health care insurers,
especially in rural areas. Hacia Salud will build a high quality provider network that gives members a "medical home"
and serves as the platform for extensive preventive outreach and educational activities to address unmet health care
needs as well as a full continuum of ancillary and specialty care. This CO-OP funding opportunity is a chance to bring
long overdue technology, delivery and access innovation to California’s insurance marketplace at an affordable price
and bring into coverage a number of Californians who will (despite the enactment of the ACA) otherwise stay
uninsured. Our eventual goal is to serve all of California, from the Mexican border to the AZ, NV and OR state lines.
"Hacia Salud" means "towards health" in Spanish. Hacia Salud is a grassroots organization formally certified as a
California Non-Profit Mutual Benefit Corporation on 12/23/2011. Hacia Salud was formed as a legal entity solely for
the purpose of providing interested employers, insurance consultants and farm worker advocates the opportunity to
join together and create a Consumer Operated and Oriented Plan (as described in the Affordable Care Act).
94,278
107,836
141,102
144,515
2027 2031149,261
150,753
152,261
166,525
155,321
156,875
158,443
160,028
163,244
164,877

2. Hacia Salud Insurance CO-OP
Application Abstact Page 2
Access Problems of Target Population
• Language/cultural barriers are likely to stop about 100,000 Californians from enrolling through the CA HB Exchange.
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Essential Benefits Offered At Lower Cost
• Tailored Primary Care network consisting of the State’s highest quality community based clinic providers.
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Description of Proposed Network
• Primary care network is a select group of 18 independent safety net providers, operating at 257 clinic locations.
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• Reliance on safety-net providers reduces disruption potential due to MediCal "churn."
• Hacia Salud will facilitate local, regional, state and federal IT infrastructure goals.
• Our 2-tier hospital network approach provides access to (24) local hospitals + regional Centers of Excellence.
• Up-front funding aids participating clinics struggling with increased patient loads.
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Consumer Focused Care Innovations
• Literacy-related access problems solved through use of video (English/Spanish/other lang.) for plan communications.
• Local "Care Committees" provide a strong local voice (inclusive of providers and members) in plan spending.
• Funding established for peer-to-peer health layperson "promotores" programs.
• Expansion of Mobile Medical Clinics - Harvard research reveals $36 to $1 ROI to lower health system costs.
• Targeting a minimum 80% of members to receive preventive care in first 12 months.
• Financial assistance available for members with medical debt due to deductibles and out-of-pocket costs.
Governance
• 9 Operational BOD members - 5 from membership / 4 subject matter experts - all voted in by membership.
• Central California subdivided into 4 "Care Areas" for improved member involvement and local governance.
• Regional Care Committees (members, staffers, and medical providers) created and focused on local care issues.
• Real-time (English/Spanish) translation and child care reimbursement provided at Care Committee meetings.
• "Town-Hall" forums at each Care Committee meeting to encourage members to share ideas and concerns.
• Board members will take an "Oath of Service" prior to installation on Board of Directors.
Seasoned Management
• CEO - Ed McClements - Past Exec. VP of non-profit health plan with 35 yrs. of employee benefit ins. experience.
• CFO - Fred Ryder - Past Senior VP for PacifiCare (CA) and Blue Cross/Blue Shield (FL), with 25 years of experience.
• General Counsel - Joel Diringer, JD, MPH - Bilingual farmworker health policy consultant with 30 yrs. of experience.
• Public Policy - Hilary Frazer-Abeger, MPH – 18 years of experience focused on vulnerable underserved populations.
• Claims - (name withheld) - Current Sr. VP of health plan, with more than 25 yrs. of claims management experience.
• Board Mbr. - Glen Michael - Third Party Administrator with more than 36 yrs. experience.
• Board Mbr. - Allen Miller - Pres. of COPE Health Solutions - health systems strategy analyst with 18 yrs. of experience
• Board Mbr. - Al Barkley – 38 yrs. experience. Past Pres. of Ins. Co. / Current Board member of major financial CO-OP.
Actuarial firm Milliman confirms our projections for a product with estimated lower than avg. premiums due to a
plan design tailored to meet the needs of the target population. Described as a “new paradigm plan” by well-
known health policy researchers, our high value-to-cost method includes:
Only 16% of California's harvest workers have employer based health insurance.
Connecting our members with a target set of high quality clinics ensures members have a Medical Home and these
providers have stable patient encounter levels.
Providers enjoy “hassle free” 100% claim reimbursement (collections of deductibles and coinsurance handled by
Hacia Salud, not clinic billing departments).
Re-investment of 10% of premiums at the community level into preventive care efforts that benefit members
(allocations made pursuant to local member and provider recommendations).
Fleet of state-of-the-art Mobile Medical Clinics brings outreach and primary care preventive services directly to
members’ homes, workplaces and communities.
Connect all new members with a "medical home" to encourage integrated care delivery and reduce episodic
care patterns and inappropriate ED use and to encourage regular preventive care.
Many families unable to pay for mainstream insurance to be offered through the Exchange (at modest income
levels estimated to cost up to 9.5% of income).
Geography and usual provider hours of operation limit access to affordable primary care for many hourly wage
workers, including farmworkers.