[7][8] In February 2012 the Montana group became one of the first CO-OPs to receive a federal loan of $58 million to begin operations as a nonprofit, member-controlled insurer.

Previous marketing director Karen Early said, “[Montana Health] became operational in Idaho because there was a need for greater competition in the state of Idaho.”[12] This venture was aided by a $25 million federal loan for expansion efforts.

On December 10, 2015, DistilInfo reported that then CEO Jerry Dworak and board member John Morrison said that despite these losses they believed “that co-ops have introduced more competition into the marketplace and ultimately saved consumers money.”[14] Starting in December 2016, Mountain Health voluntarily paused enrollment for new members in the Montana market for 9 months to boost financial reserves and avoid facing closure like many of the other CO-OPs were seeing at the time.

What helped them through this period was an $8 million surplus note given by St. Luke's Health System in Boise that was paid back in full.

[25] In January 2023 they started their first initiative, Little Peeps, which is a program that offers free vision screenings, eye exams, and glasses to children.

[25][26] The Daily Inter Lake reports that their $750,000 in funding will help to provide more than 3,000 vision exams and 800 pairs of glasses annually over the first seven years of their operation.

[27] On January 30, 2018, Mountain Health CO-OP filed a claim against the United States government over unpaid cost-sharing reduction (CSR) payments from 2017.

[29] In 2017, President Donald Trump cancelled these CSR payments on the grounds that the Obama administration had overstepped its executive authority by requiring Congress to appropriate the funds.

[29] In defense, the U.S. Department of Health and Human Services argued, "The Obama administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.

"[30] The court ruled in favor of Mountain Health, finding that the government had a statutory obligation to make these payments and that it was irrelevant if congress had not appropriated the funds or not.