The following table presents the Company’s updated outlook for fiscal year 2015 (all amounts are approximate): (1)
| Premium Revenue | $13.5 billion | ||
| Health Insurer Fee Revenue (2) | $260 million | ||
| Premium Tax Revenue | $400 million | ||
| Service Revenue | $180 million | ||
| Investment Income and Other Revenue | $17 million | ||
| Total Revenue | $14.3 billion | ||
| Total Medical Care Costs | $12.1 billion | ||
| Medical Care Ratio (3) | 89.5% | ||
| Total Cost of Service Revenue | $145 million | ||
| General and Administrative Expenses | $1.1 billion | ||
| G&A Ratio (4) | 7.6% | ||
| Premium Tax Expenses | $400 million | ||
| Health Insurer Fee Expenses | $165 million | ||
| Depreciation and Amortization | $105 million | ||
| Interest and Other Expenses | $60 million | ||
| Income Before Income Tax Expense | $300 million | ||
| Net Income | $132 million | ||
| EBITDA(5) | $485 million | ||
| Effective Tax Rate | 56% | ||
| Diluted Weighted Average Shares Outstanding(6) | 56 million | ||
| Diluted net income per share | $2.35 | ||
| Adjusted net income per share(5) | $2.90 |
| _____________________ | |
| (1) | All amounts are estimates; actual results may differ materially. See our risk factors as discussed in our Form 10-K and other filings as well as the cautionary statements below. 2015 outlook assumes the closing by September 2015 of our recently announced expansion in Michigan. |
| (2) | 2015 outlook assumes full reimbursement of the Health Insurer Fee and related tax effects for 2015, and includes the recognition of $18 million in revenue relating to the 2014 HIF. |
| (3) | Medical care ratio represents medical care costs as a percentage of premium revenue. |
| (4) | G&A Ratio represents general and administrative expenses as a percentage of total revenue. |
| (5) | See reconciliation of non-GAAP financial measures. |
| (6) | Estimate of weighted average shares outstanding for full year 2015 includes impact of existing convertible notes and the assumed issuance of 5.75 million shares in June 2015. Estimate assumes an average daily weighted average share price of $70 for the period June 1, 2015 through December 31, 2015. |
Non-GAAP Financial Measures
EBITDA and adjusted net income per diluted share are non-GAAP financial
measures used by management as supplemental metrics in evaluating
financial performance, financing and business decisions, and in
forecasting and planning for future periods. These measures are not
determined in accordance with accounting principles generally accepted
in
The following table reconciles net income, which the Company believes to be the most comparable GAAP measure, to EBITDA:
|
2015 |
|||
| Net income | $ 132 million | ||
| Adjustments: | |||
|
Depreciation, and amortization of intangible assets and capitalized software |
125 million | ||
| Interest expense | 60 million | ||
| Income tax expense | 168 million | ||
| EBITDA | $ 485 million | ||
The following table reconciles net income per diluted share, which the Company believes to be the most comparable GAAP measure, to adjusted net income per diluted share:
|
2015 |
|||
| Net income per diluted share | $ 2.35 | ||
| Adjustments, net of tax: | |||
|
Amortization of convertible senior notes and lease financing obligations |
0.35 | ||
| Amortization of intangible assets | 0.20 | ||
| Adjusted net income per diluted share | $ 2.90 | ||
| ______________________ | |
| (1) | All amounts are estimates and subject to change. Computation assumes 56 million diluted weighted average shares outstanding. |
About
Cautionary Statement under the Private Securities Litigation Reform Act of 1995: This earnings release contains “forward-looking statements” regarding the Company’s plans, expectations, and anticipated future events. Actual results could differ materially due to numerous known and unknown risks and uncertainties, including, without limitation, risk factors related to the following:
-
continuing uncertainties associated with the implementation of the
Affordable Care Act, including the full grossed up reimbursement by
states of the non-deductible ACA health insurer fee, the
Medicaid expansion, the insurance marketplaces, the effect of various implementing regulations, the King v. Burwell case now pending before theSupreme Court , and uncertainties regarding the Medicare-Medicaid dual eligible demonstration programs inCalifornia ,Illinois ,Michigan ,Ohio , andSouth Carolina ; - management of our medical costs, including seasonal flu patterns and rates of utilization that are consistent with our expectations, and our ability to reduce over time the high medical costs commonly associated with new patient populations;
- federal or state medical cost expenditure floors, administrative cost and profit ceilings, and profit sharing arrangements;
- the interpretation and implementation of at-risk premium revenue recognition rules regarding the achievement of certain quality measures;
- cyber-attacks or other privacy or data security incidents resulting in an inadvertent unauthorized disclosure of protected health information;
-
the timely closing and successful integration of our recently
announced expansion in
Michigan ; -
the success of our new health plan in
Puerto Rico , and the ability of ASES, the Puerto Rico Medicaid agency, to pay ourPuerto Rico health plan throughout 2015 under the terms of itsMedicaid contract; -
newly
FDA -approved specialty drugs such as Sovaldi, Olysio, Harvoni, and other specialty drugs or generic drugs that are exorbitantly priced but not factored into the calculation of our capitated rates; - significant budget pressures on state governments and their potential inability to maintain current rates, to implement expected rate increases, or to maintain existing benefit packages or membership eligibility thresholds or criteria;
- the accurate estimation of incurred but not paid medical costs across our health plans;
-
retroactive adjustments to premium revenue or accounting estimates
which require adjustment based upon subsequent developments, including
Medicaid pharmaceutical rebates or retroactive premium rate increases; - efforts by states to recoup previously paid amounts;
-
the success of our efforts to retain existing government contracts
and to obtain new government contracts in connection with state
requests for proposals (RFPs) in both existing and new states,
including the success of the proposal of Molina Medicaid Solutions in
New Jersey ; - the continuation and renewal of the government contracts of both our health plans and Molina Medicaid Solutions and the terms under which such contracts are renewed;
-
complications, member confusion, or enrollment backlogs related to
the annual renewal of
Medicaid coverage; - government audits and reviews, and any fine, enrollment freeze, or monitoring program that may result therefrom;
- changes with respect to our provider contracts and the loss of providers;
- approval by state regulators of dividends and distributions by our health plan subsidiaries;
- changes in funding under our contracts as a result of regulatory changes, programmatic adjustments, or other reforms;
- high dollar claims related to catastrophic illness;
-
the favorable or unfavorable resolution of litigation, arbitration,
or administrative proceedings, including pending qui tam actions in
Florida andCalifornia , and the litigation commenced against us by the state ofLouisiana alleging that Molina Medicaid Solutions and its predecessors used an incorrect reimbursement formula for the payment of pharmaceutical claims; - the relatively small number of states in which we operate health plans;
-
our management of a portion of College Health Enterprises’ hospital
in
Long Beach, California ; - the availability of adequate financing on acceptable terms to fund and capitalize our expansion and growth, repay our outstanding indebtedness in accordance with its terms and meet our liquidity needs, including the interest expense and other costs associated with such financing;
-
the failure of a state in which we operate to renew its federal
Medicaid waiver; -
changes generally affecting the managed care or
Medicaid management information systems industries; - increases in government surcharges, taxes, and assessments;
- public alarm associated with the Ebola virus, measles, or any actual widespread epidemic;
- changes in general economic conditions, including unemployment rates;
-
increasing competition and consolidation in the
Medicaid industry;
and numerous other risk factors, including those discussed in the
Company’s periodic reports and filings with the
View source version on businesswire.com: http://www.businesswire.com/news/home/20150601005767/en/
Source:
Molina Healthcare, Inc.
Juan José Orellana, 562-435-3666, ext.
111143
Investor Relations