Well being Care Sharing Ministry Information Level to Issues for Customers, Regulators

By Nadia Stovicek and JoAnn Volk

A latest examine from the Authorities Accountability Workplace (GAO) sheds new mild on well being care sharing ministries (HCSMs). The GAO interviewed officers from 5 HCSMs on plan options, enrollment, and advertising and marketing. The report contains, for instance, details about HCSM use of paid gross sales representatives, administrative prices (one HCSM directs as much as 40 p.c of members’ contributions to administrative prices) and membership (one HCSM mentioned a survey of their members discovered 42 p.c had revenue underneath 200 p.c of the poverty stage, which might make them eligible for substantial subsidies for a Market plan). However the report affords solely a snapshot of a handful of HCSMs.

Regardless of a historical past of fraud and unpaid payments, HCSMs are largely a black field for insurance coverage regulators and most of the people. Trinity, an HCSM administered by the corporate Aliera, lately went bankrupt; not less than 14 states have taken motion to close down Aliera due to their malfeasance. Members suing Aliera are solely anticipated to recoup one to 5 p.c of the cash they’re owed, which may quantity to a whole bunch of hundreds of {dollars}. Extra lately, the North Dakota Legal professional Common settled a lawsuit with HCSM Jericho Share for creating “a misunderstanding that its merchandise are medical insurance” and utilizing that misunderstanding to promote memberships. Past the info within the GAO report, little is understood in regards to the operations or funds of HCSMs. A shopper contemplating changing into a member of a well being care sharing ministry—with an expectation that their well being care payments might be paid—might need to know, for instance, if the HCSM has a historical past of secure income or retains in reserve sufficient funds to cowl members’ well being care payments. To raised perceive what info is accessible, we reviewed publicly obtainable audits and income experiences to the IRS to see what info an bold shopper might receive about an HCSM earlier than enrolling.

What are HCSMs?

HCSMs’ members comply with comply with a standard set of spiritual or moral beliefs and contribute common funds to assist pay the qualifying medical bills of different members. HCSMs have many options which are much like these of insurance coverage. For instance, members’ funds are usually required on a month-to-month foundation and will differ relying on age and stage of protection, very similar to a premium. Members should pay some prices out-of-pocket earlier than they’ll submit payments to the HCSM for cost, akin to a deductible; member pointers for protection usually require members to pay co-insurance and use a community supplier when getting care. Even the advertising and marketing depends closely on the similarity to insurance coverage, which may mislead shoppers into pondering they’re getting extra from a membership than an HCSM gives.

Regardless of these similarities, most states don’t think about HCSMs to be medical insurance issuers, and don’t topic them to the requirements that insurance coverage firms should meet. This may go away members financially susceptible. HCSMs make no assure that they may cowl any well being care declare, even people who meet pointers for sharing, and so they don’t have to fulfill monetary requirements to make sure they’ve sufficient funds to pay claims. Additionally they don’t have to adjust to the buyer protections of the Reasonably priced Care Act (ACA). For instance, HCSMs don’t have to cowl important well being advantages, which embrace hospitalization, maternity care, psychological well being and substance use dysfunction providers, pharmaceuticals, and preventative providers. Actually, HCSMs usually exclude protection for preexisting situations, behavioral well being, and maternity care besides in restricted circumstances, and restrict protection for pharmaceuticals.

What information is publicly obtainable?

State regulators want information to know how HCSMs function and market memberships to shoppers, however most states don’t accumulate such info. Solely Colorado requires information from all HCSMs promoting memberships in-state; Massachusetts collects information from these HCSMs whose members can declare credit score for protection underneath the state’s particular person protection requirement. The federal authorities doesn’t accumulate or present to the general public actionable information about HCSMs both.

Nevertheless, some states require HCSMs that search an exemption from state insurance coverage necessities to make obtainable an annual audit upon request. The ACA definition of HCSMs whose members are exempt from the person mandate additionally contains that requirement. Primarily based on these annual audit reporting necessities, we contacted seven HCSMs, representing the most important HCSMs working throughout states to request a duplicate of their annual audit: Altrua, Christian Healthcare Ministries (CHM), Medi-share, Samaritan, Sedera Well being, Solidarity, and Liberty HealthShare.

These audits are usually carried out by an accounting agency and supply an summary of the monetary solvency of a company, together with statements of economic positions, actions, purposeful bills, and money flows. Of the 7 HCSMs we contacted, solely 3 offered us with an audit when requested. (See Desk 1.) One HCSM, Medi-Share, solely offered a temporary doc with extra restricted information than could be required in an official audit.

Desk 1.

HSCMAudit offered?
Christian Healthcare MinistriesSure
Medi-Share Christian Care MinistryNo
Samaritan MinistriesSure
Sedera Well beingNo
Solidarity HealthShareNo
Liberty HealthShareSure

Supply: Authors’ communication with the listed ministries

As a result of we had been unable to acquire an annual audit from all seven HCSMs, we additionally reviewed their publicly obtainable 990 varieties to investigate monetary information. Non-profit organizations should yearly file a Kind 990 with the Inner Income Service (IRS). With this manner, non-profits report required information on the group’s actions, funds, governance, and compensation paid to sure workers and people in management positions. We obtained a number of years of 990 varieties via ProPublica, a information web site, and the IRS web site for the entire HCSMs we reviewed besides Sedera. It’s unclear why Sedera, which claims to be a non-profit on its web site, wouldn’t have submitted a 990. As a result of the IRS has not but printed 2021-2022 990s, we couldn’t assessment the latest information.

What the Information Reveal

Audits, the place obtainable, present larger element than a 990. For instance, audits present info on “purposeful bills,” which embrace spending on public relations, worker advantages and taxes, amongst different bills. Two audits additionally reported loans acquired underneath the Paycheck Safety Program: $3 million to Liberty HealthShare and $2.5 million to Christian Healthcare Ministries, each of which had been forgiven.

However audit information aren’t reported in a constant method. For instance, Samaritan Ministries and Christian Healthcare Ministries record members’ presents and dues as income; Liberty HealthShare doesn’t rely member contributions as income as a result of they’re held in members’ sharing accounts, which aren’t mirrored within the audit. In one other instance, Samaritan Ministries experiences spending on promoting, Christian Healthcare Ministries experiences spending on “member growth charges,” which is claimed to mirror spending on promoting, and Liberty HealthShare experiences “member growth charges” and “promoting” prices individually, which suggests member growth charges might embrace commissions to brokers. HCSMs that pay dealer commissions usually pay considerably increased commissions than these paid to brokers who enroll individuals in ACA protection, which may drive larger enrollment.

As a result of we had been in a position to receive a number of years of 990s, we had been in a position to evaluate income adjustments over time. HCSMs report whole income on 990s based mostly on contributions, program providers, or each. The 990s lack element however it’s seemingly the income not less than roughly displays rising membership. Most HCSMs’ 990s that we reviewed noticed enormous income progress between the years we might assessment. (See Graph 1). For instance, Solidarity HealthShare’s reported income grew a whopping 62,143% in 4 years, and Altrua grew about 4,010% in 5 years. Medi-Share was a notable exception to this development; it reported little or no income and progress between 2011 and 2020. It’s not clear why, as Medi-Share is likely one of the oldest and largest HCSMs within the nation.

Graph 1.

Supply: authors’ evaluation of 990 filings

A majority of the HCSM 990 varieties we reviewed (Solidarity, Samaritan, Christian Healthcare Ministries, Medi-share, and Altrua) indicated spending in extra of revenues in some years and substantial income fluctuations year-to-year. This raises questions in regards to the adequacy and stability of funding obtainable to cowl members’ well being care prices. One HCSM, Liberty HealthShare, has come underneath latest scrutiny for his or her historical past of not paying their members’ claims.

One problem with the info obtainable on the 990s is that every HCSM experiences its information otherwise, making it troublesome to make comparisons between them. In distinction, well being insurers should use a standardized template to report monetary information to state regulators, making it doable to know and evaluate insurers based mostly on premium income, obtainable reserves, and bills paid for administrative prices and members’ well being care claims.


The dramatic progress in income for almost all of HCSMs we checked out suggests substantial progress in enrollment. Nevertheless, the numerous income fluctuations from year-to-year, coupled with some HCSMs displaying bills that exceed revenues, increase questions on whether or not shoppers who select an HCSM as an alternative choice to complete protection can rely on their well being care payments getting paid. Regulators searching for to know the rising function of HCSMs of their markets—and the dangers to shoppers who’re persuaded, usually by deceptive advertising and marketing, to purchase memberships—want extra full information reported regularly. Guaranteeing HCSMs adjust to the requirement to make obtainable an annual audit is a spot to start out in states the place that applies, however even that information is restricted and all states ought to have an curiosity in acquiring extra full information to higher perceive this rising phase of protection.

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