Oregon’s much-criticized system for delivering health care to the poor received a big vote of confidence from the private sector this week when 24 organizations notified the state, that they hope to get into the coordinated care organization business.

Coordinated care organizations, or CCOs, oversee, coordinate and in many cases provide health care for nearly 900,000 Oregonians on the Oregon Health Plan, the state’s version of Medicaid.

The new bidders for that role include subsidiaries of health care giants Kaiser and Providence. The Kaiser Foundation Health Plan of the Northwest hopes to serve the tri-county metro area. Providence wants to operate in the metro area as well as Hood River, Clatsop and Jackson counties, according to state filings.

‚Providence and Kaiser already are partners in Health Share, a Portland-based CCO. Officials with both companies say they want to continue that relationship. They filed their own letters of intent with the state primarily to keep their options open in case Health Share doesn’t get renewed by the state.

Health insurer Moda also hopes to significantly expand its presence in the CCO niche. Now running a single coordinating organization in eastern Oregon, Moda filed letters of intent to run three others in the Portland metro area, in Clatsop, Tillamook and Columbia counties, and in Lane County.

The new contracts with CCOs represent the largest procurement in state history, totaling more than $5 billion for the 2020 contract year.

The state gives CCOs money on a per-patient basis and charges them with finding a cost-effective, medically effective way of keeping those patients healthy. CCOs are rewarded for achieving specific health outcomes and quality measures.

Some people had questioned the viability of the system after Portland-based FamilyCare folded. Pat Allen, director of the Oregon Health Authority, on Monday said the bidders’ strong interest is a vindication of the CCO system.

FamilyCare got into an acrimonious legal battle with the state that is still being waged in state court.

FamilyCare insists that it didn’t get fair treatment or adequate compensation from the health authority. The beef fueled talk that the coordinated care model was not performing as promised.

It raised questions about whether the whole system was in trouble. “I think this much interest in serving Oregon’s Medicaid customers answers that question definitely,” Allen said.

Medicaid is largely paid for by the federal government. But the state’s share is increasing, which has led to an enormous $800 million budget gap. Gov. Kate Brown has proposed new or larger taxes on hospitals, health insurers and smokers to fill that gap.

Lane County may become one of the most hotly contested territories. Three major players, Moda, the Umpqua Health Alliance in Roseburg and PacificSource Community Services, all have given notice they want to serve the county. They’ll have to compete with the incumbent CCO, Trillium Community Health Plans.

Trillium made headlines in 2015 when the original owners sold the organization. Centene Corp., a national insurance company, paid $109 million. The purchase led to questions about whether windfall profits for shareholders are appropriate for an organization using largely taxpayer money to serve the poor.

The deadline to submit letters of intent was Monday Complete applications will be due to the state by April 22. Only organizations that submitted letters of intent may submit applications at that point. Organizations that submitted a letter of intent are not obliged to follow through with a complete application.

Awards for the CCO contracts are expected to be announced in July.

Oregon first established the coordinated care organization in 2012. They were an integral part of Gov. John Kitzhaber’s bold plan to transform health care delivery in the state.