Delaware
|
|
1-31719
|
|
13-4204626
|
(State
of incorporation)
|
|
(Commission
File Number)
|
|
(I.R.S.
Employer Identification
Number)
|
o
|
Written
communications pursuant to Rule 425 under the Securities Act (17
CFR
230.425)
|
o
|
Soliciting
material pursuant to Rule 14a-12 under the Exchange Act (17 CFR
240.14a-12)
|
o
|
Pre-commencement
communications pursuant to Rule 14d-2(b) under the Exchange Act
(17 CFR
240.14d-2(b))
|
o
|
Pre-commencement
communications pursuant to Rule 13e-4(c) under the Exchange Act
(17 CFR
240.13e-4(c))
|
Exhibit
No.
|
Description |
99.1
|
Press
release of Molina Healthcare, Inc. issued November 1, 2007, as to
financial results for the third quarter and nine months ended September
30, 2007.
|
|
|
|
|
MOLINA
HEALTHCARE, INC.
|
Date:
November 1, 2007
|
|
By: /s/
Mark L. Andrews
|
||
|
|
Mark
L. Andrews
Chief
Legal Officer, General Counsel,
and
Corporate Secretary
|
Exhibit
No.
|
Description |
99.1
|
Press
release of Molina Healthcare, Inc. issued November 1, 2007, as to
financial results for the third quarter and nine months ended September
30, 2007.
|
·
|
The
increased revenue resulting from rate increases for San Bernardino
and
Riverside counties effective October 1,
2007;
|
·
|
Better-than-anticipated
medical cost performance in Washington, New Mexico, and
Texas;
|
·
|
The
November 1st
closing of
the Company’s acquisition of Mercy CarePlus in Missouri. Previously issued
guidance did not include any benefit from the acquisition of Mercy
CarePlus;
|
·
|
The
impact on investment income and interest expense of the Company’s recent
issuance of $200 million in convertible senior notes, as well as
the
impact on investment income of declining interest rates;
and
|
·
|
Uncertainty
surrounding any rate increase in Michigan as a result of state budget
issues.
|
·
|
Increased
enrollment at the Ohio and Texas health plans. The Ohio health
plan contributed $125.5 million in premium revenue in the third quarter
of
2007, an increase of $104.5 million from a year ago. The Texas
health plan, which commenced operations in September 2006, contributed
$25.0 million in premium revenue in the third quarter of 2007 and
less
than $0.3 million in September
2006.
|
·
|
Increased
revenue of approximately $14.0 million at the New Mexico health plan
due
to:
|
§
|
A
rate increase of approximately 5% effective July 1,
2007;
|
§
|
Increased
enrollment; and
|
§
|
A
one time out-of-period increase to revenue of approximately $2.2
million. This adjustment was made to reduce the amount the
Company estimated was owed back to the state for the two-year period
ending June 30, 2007, based upon direct medical costs incurred during
that
period.
|
·
|
Termination
of operations at the Company’s Indiana health plan effective January 1,
2007. The Indiana health plan contributed no premium revenue in
the third quarter of 2007 compared with $24.6 million in premium
revenue
in the third quarter of 2006.
|
·
|
Reduced
revenue of approximately $11.8 million at the Utah health plan due
to:
|
§
|
Lower
enrollment;
|
§
|
Lower
medical costs, which reduced revenue under the Utah health plan’s
cost-plus reimbursement contract;
and
|
§
|
An
out-of-period reduction of approximately $1.7 million to the amount
receivable under a savings sharing agreement with the
state. The amount of the receivable for this item has been
reduced from approximately $4.7 million at June 30, 2007, to $3.0
million
at September 30, 2007. The Utah health plan continues to work
with the state in an effort to assure an appropriate determination
of
amounts due under the savings sharing
agreement.
|
·
|
An
improvement in the medical care ratios of the Ohio and Texas health
plans. The medical care ratio of the Ohio health plan declined
to 88.8% in the third quarter of 2007 from 97.6% in the third quarter
of
2006 and 91.1% in the second quarter of 2007. The medical care
ratio of the Texas health plan declined to 76.2% in the third quarter
of
2007 from 91.3% in the second quarter of 2007. The Texas health
plan did not have significant premium revenue or medical expense
in the
third quarter of 2006. The Company believes that the medical
care costs of its Ohio and Texas health plans are developing as
anticipated, although the medical care costs of its Texas plan have
been
somewhat better than anticipated. Nevertheless, the limited
claims payment experience for the many members who have been added
during
2007 adds a degree of uncertainty to the medical care cost estimates
in
both Ohio and Texas that is not found with the Company’s more mature
health plans.
|
·
|
An
improvement in the medical care ratio of the New Mexico health plan
as a
result of a 1.5% increase to per member per month medical care costs
compared with the third quarter of 2006 and the increases to premium
revenue discussed above.
|
·
|
An
improvement in the medical care ratio of the California health plan
as a
result of a 5% decrease to per member per month medical care costs
compared with the third quarter of 2006, and increases to premium
revenue
that took effect during the first half of 2007, particularly in San
Diego
County.
|
·
|
Increases
in the medical care ratios of the Washington and Michigan health
plans
when compared with the third quarter of 2006. The Company
believes that the medical care ratios experienced by the Washington
and
Michigan health plans in the third quarter of 2006 were not reasonably
sustainable on a long-term basis.
|
·
|
The
termination of operations in Indiana. The Indiana health plan
had a medical care ratio of 103.1% in the third quarter of
2006.
|
Three
Months Ended
|
Nine
Months Ended
|
||||||||||||||||
September
30,
|
September
30,
|
||||||||||||||||
2007
|
2006
|
2007
|
2006
|
||||||||||||||
Revenue:
|
|||||||||||||||||
Premium
revenue
|
$ |
628,402
|
$ |
512,080
|
$ |
1,791,764
|
$ |
1,441,197
|
|||||||||
Investment
income
|
7,632
|
5,385
|
21,061
|
14,278
|
|||||||||||||
Total
revenue
|
636,034
|
517,465
|
1,812,825
|
1,455,475
|
|||||||||||||
Expenses:
|
|||||||||||||||||
Medical
care costs
|
525,902
|
430,870
|
1,519,244
|
1,215,832
|
|||||||||||||
General
and administrative expenses
|
74,235
|
60,504
|
204,831
|
168,025
|
|||||||||||||
Depreciation
and amortization
|
7,082
|
5,633
|
20,274
|
15,265
|
|||||||||||||
Impairment
charge on purchased software (1)
|
–
|
–
|
782
|
–
|
|||||||||||||
Total
expenses
|
607,219
|
497,007
|
1,745,131
|
1,399,122
|
|||||||||||||
Operating
income
|
28,815
|
20,458
|
67,694
|
56,353
|
|||||||||||||
Other
expense:
|
|||||||||||||||||
Interest
expense
|
(530 | ) | (645 | ) | (2,380 | ) | (1,636 | ) | |||||||||
Total
other expense
|
(530 | ) | (645 | ) | (2,380 | ) | (1,636 | ) | |||||||||
Income
before income taxes
|
28,285
|
19,813
|
65,314
|
54,717
|
|||||||||||||
Income
tax expense
|
10,772
|
7,472
|
24,895
|
20,634
|
|||||||||||||
Net
income
|
$ |
17,513
|
$ |
12,341
|
$ |
40,419
|
$ |
34,083
|
|||||||||
Net
income per share:
|
|||||||||||||||||
Basic
|
$ |
0.62
|
$ |
0.44
|
$ |
1.43
|
$ |
1.22
|
|||||||||
Diluted
|
$ |
0.62
|
$ |
0.44
|
$ |
1.43
|
$ |
1.21
|
|||||||||
Weighted
average number of common shares and
|
|||||||||||||||||
potential
dilutive common shares outstanding
|
28,441,000
|
28,346,000
|
28,356,000
|
28,253,000
|
|||||||||||||
Operating
Statistics:
|
|||||||||||||||||
Medical
care ratio (2)
|
83.7% | 84.1% | 84.8% | 84.4% | |||||||||||||
General
and administrative expense ratio (3),
|
|||||||||||||||||
excluding
premium taxes
|
8.4% | 8.6% | 8.0% | 8.5% | |||||||||||||
Premium
taxes included in general and
|
|||||||||||||||||
administrative
expenses
|
3.3% | 3.1% | 3.3% | 3.0% | |||||||||||||
Total
general and administrative expense ratio
|
11.7% | 11.7% | 11.3% | 11.5% | |||||||||||||
Depreciation
and amortization expense ratio (4)
|
1.1% | 1.1% | 1.1% | 1.0% | |||||||||||||
Effective
tax rate
|
38.1% | 37.7% | 38.1% | 37.7% |
(1)
|
Amounts
represent an impairment charge related to commercial software no
longer
used for operations.
|
(2)
|
Medical
care ratio represents medical care costs as a percentage of premium
revenue.
|
(3)
|
General
and administrative expense ratio represents such expenses as a percentage
of total revenue.
|
(4)
|
Depreciation
and amortization expense ratio represents such expenses as a percentage
of
total revenue.
|
MOLINA
HEALTHCARE, INC.
|
|||||||||
CONDENSED
CONSOLIDATED BALANCE SHEETS
|
|||||||||
(Dollars
in thousands, except per share data)
|
|||||||||
|
Sept.
30,
|
Dec.
31,
|
|||||||
2007
|
2006
|
||||||||
|
(Unaudited)
|
||||||||
ASSETS
|
|||||||||
Current
assets:
|
|||||||||
Cash
and cash equivalents
|
$ |
447,594
|
$ |
403,650
|
|||||
Investments
|
108,161
|
81,481
|
|||||||
Receivables
|
124,145
|
110,835
|
|||||||
Income
tax receivable
|
–
|
7,960
|
|||||||
Deferred
income taxes
|
577
|
313
|
|||||||
Prepaid
expenses and other current assets
|
11,424
|
9,263
|
|||||||
Total
current assets
|
691,901
|
613,502
|
|||||||
Property
and equipment, net
|
47,431
|
41,903
|
|||||||
Goodwill
and intangible assets, net
|
133,502
|
143,139
|
|||||||
Restricted
investments
|
27,762
|
20,154
|
|||||||
Receivable
for ceded life and annuity contracts
|
30,929
|
32,923
|
|||||||
Other
assets
|
14,492
|
12,854
|
|||||||
Total
assets
|
|
$ |
946,017
|
$ |
864,475
|
||||
LIABILITIES
AND STOCKHOLDERS’ EQUITY
|
|||||||||
Current
liabilities:
|
|||||||||
Medical
claims and benefits payable
|
$ |
308,722
|
$ |
290,048
|
|||||
Deferred
revenue
|
42,043
|
18,120
|
|||||||
Income
tax payable
|
1,242
|
–
|
|||||||
Accounts
payable and accrued liabilities
|
61,778
|
46,725
|
|||||||
Total
current liabilities
|
413,785
|
354,893
|
|||||||
Long-term
debt
|
20,000
|
45,000
|
|||||||
Deferred
income taxes
|
1,056
|
6,700
|
|||||||
Liability
for ceded life and annuity contracts
|
30,929
|
32,923
|
|||||||
Other
long-term liabilities
|
11,808
|
4,793
|
|||||||
Total
liabilities
|
477,578
|
444,309
|
|||||||
Stockholders’
equity:
|
|||||||||
Common
stock, $0.001 par value; 80,000,000 shares authorized;
issued
and outstanding: 28,346,685 shares at September 30, 2007,
and
28,119,026 shares at December 31, 2006
|
28 | 28 | |||||||
Preferred
stock, $0.001 par value; 20,000,000 shares authorized,
no
shares issued and outstanding
|
- | - | |||||||
Additional
paid-in capital
|
181,841
|
173,990
|
|||||||
Accumulated
other comprehensive gain (loss)
|
111
|
(337
|
) | ||||||
Retained
earnings
|
306,849
|
266,875
|
|||||||
Treasury
stock (1,201,174 shares, at cost)
|
(20,390
|
) |
(20,390
|
) | |||||
Total
stockholders’ equity
|
468,439
|
420,166
|
|||||||
Total
liabilities and stockholders’ equity
|
$ |
946,017
|
$ |
864,475
|
MOLINA
HEALTHCARE, INC.
|
||||||||
CONDENSED
CONSOLIDATED STATEMENTS OF CASH FLOWS
|
||||||||
(Dollars
in thousands)
|
||||||||
(Unaudited)
|
||||||||
Nine
Months Ended
|
||||||||
September
30,
|
||||||||
2007
|
2006
|
|||||||
Operating
activities:
|
||||||||
Net
income
|
$ |
40,419
|
$ |
34,083
|
||||
Adjustments
to reconcile net income to net cash provided by operating
activities:
|
||||||||
Depreciation
and amortization
|
20,274
|
15,265
|
||||||
Amortization
of capitalized credit facility fees
|
646
|
646
|
||||||
Deferred
income taxes
|
(4,139 | ) | (2,510 | ) | ||||
Stock-based
compensation
|
5,238
|
4,331
|
||||||
Changes
in operating assets and liabilities:
|
||||||||
Receivables
|
(13,310 | ) | (13,099 | ) | ||||
Prepaid
expenses and other current assets
|
(2,161 | ) |
2,068
|
|||||
Medical
claims and benefits payable
|
18,674
|
17,036
|
||||||
Deferred
revenue
|
23,923
|
–
|
||||||
Accounts
payable and accrued liabilities
|
14,763
|
7,411
|
||||||
Income
taxes
|
8,989
|
1,955
|
||||||
Net
cash provided by operating activities
|
113,316
|
67,186
|
||||||
Investing
activities:
|
||||||||
Purchases
of property and equipment
|
(16,5140 | ) | (13,285 | ) | ||||
Purchases
of investments
|
(85,252 | ) | (103,702 | ) | ||||
Sales
and maturities of investments
|
59,292
|
115,866
|
||||||
Net
cash acquired in purchase transactions
|
–
|
5,820
|
||||||
Increase
in restricted cash
|
(7,608 | ) | (738 | ) | ||||
Increase
in other long-term liabilities
|
6,569
|
42
|
||||||
Increase
in other assets
|
(2,921 | ) | (1,218 | ) | ||||
Net
cash (used in) provided by investing activities
|
(46,434 | ) |
2,785
|
|||||
Financing
activities:
|
||||||||
Borrowings
under credit facility
|
–
|
20,000
|
||||||
Repayment
of amounts borrowed under credit facility
|
(25,000 | ) | (5,000 | ) | ||||
Repayment
of credit facility fees
|
(551 | ) |
–
|
|||||
Repurchase
and retirement of common stock
|
(480 | ) |
–
|
|||||
Tax
benefit from exercise of employee stock options
|
||||||||
recorded
as additional paid-in capital
|
554
|
1,094
|
||||||
Proceeds
from exercise of stock options and employee stock
purchases
|
2,539
|
1,816
|
||||||
Net
cash (used in) provided by financing activities
|
(22,938 | ) |
17,910
|
|||||
Net
increase in cash and cash equivalents
|
43,944
|
87,881
|
||||||
Cash
and cash equivalents at beginning of period
|
403,650
|
249,203
|
||||||
Cash
and cash equivalents at end of period
|
$ |
447,594
|
$ |
337,084
|
MOLINA
HEALTHCARE, INC.
|
|||||||||||||
MEMBERSHIP
DATA
|
|||||||||||||
(Unaudited)
|
|||||||||||||
Sept.
30,
|
June
30,
|
Sept.
30,
|
|||||||||||
Total
Ending Membership by Health Plan:
|
2007
|
2007
|
2006
|
||||||||||
California
|
288,000
|
291,000
|
302,000
|
||||||||||
Michigan
|
211,000
|
217,000
|
227,000
|
||||||||||
New
Mexico
|
69,000
|
66,000
|
62,000
|
||||||||||
Ohio
|
138,000
|
138,000
|
33,000
|
||||||||||
Texas
|
30,000
|
30,000
|
3,000
|
(2)
|
|||||||||
Utah
|
50,000
|
47,000
|
54,000
|
||||||||||
Washington
|
284,000
|
287,000
|
280,000
|
||||||||||
Subtotal
|
1,070,000
|
1,076,000
|
961,000
|
||||||||||
Indiana
|
N/A
|
(1) |
N/A
|
(1) |
54,000
|
||||||||
Total
|
1,070,000
|
1,076,000
|
1,015,000
|
||||||||||
(1) The
Company’s Indiana health plan ceased serving members effective January
1,
2007.
|
|||||||||||||
(2) The
Company’s Texas health plan commenced operations in September
2006.
|
|||||||||||||
Total
Ending Membership by State for the Company’s
|
Sept.
30,
|
June
30,
|
|
Sept.
30,
|
|||||||||
Medicare
Advantage Special Needs Plans:
|
2007
|
2007
|
|
2006
|
|||||||||
California
|
875
|
724
|
455
|
||||||||||
Michigan
|
814
|
|
459
|
138
|
|||||||||
Nevada
|
178
|
9
|
–
|
||||||||||
Utah
|
1,802
|
1,646
|
1,426
|
||||||||||
Washington
|
446
|
413
|
153
|
||||||||||
Total
|
4,115
|
3,251
|
2,172
|
||||||||||
Total
Ending Membership by State for the Company’s
|
Sept.
30,
|
June
30,
|
|
Sept.
30,
|
|||||||||
Aged,
Blind and Disabled (“ABD”) Population:
|
2007
|
2007
|
|
2006
|
|
||||||||
California
|
|
10,912
|
10,728
|
10,368
|
|||||||||
Michigan
|
31,488
|
31,940
|
22,553
|
||||||||||
New
Mexico
|
6,844
|
6,822
|
6,674
|
||||||||||
Ohio
|
14,965
|
15,117
|
–
|
||||||||||
Texas
|
16,515
|
16,603
|
–
|
||||||||||
Utah
|
7,056
|
6,876
|
6,763
|
||||||||||
Washington
|
2,715
|
2,693
|
2,727
|
||||||||||
Total
|
90,495
|
90,779
|
49,085
|
Quarter
Ended
|
Nine
Months Ended
|
||||||||||||
Total
Member Months (1)
|
Sept.
30,
|
June
30,
|
|
Sept.
30,
|
Sept.
30,
|
Sept.
30,
|
|
||||||
by
Health Plan:
|
2007
|
2007
|
|
2006
|
2007
|
2006
|
|
||||||
California
|
859,000
|
874,000
|
911,000
|
2,619,000
|
2,785,000
|
||||||||
Michigan
|
640,000
|
|
658,000
|
681,000
|
1,967,000
|
1,677,000
|
|||||||
New
Mexico
|
200,000
|
197,000
|
181,000
|
589,000
|
535,000
|
||||||||
Ohio
|
416,000
|
399,000
|
95,000
|
1,155,000
|
229,000
|
||||||||
Texas
|
90,000
|
91,000
|
3,000
|
(3)
|
247,000
|
|
3,000
|
(3) | |||||
Utah
|
142,000
|
145,000
|
167,000
|
438,000
|
527,000
|
||||||||
Washington
|
854,000
|
860,000
|
846,000
|
2,570,000
|
2,572,000
|
||||||||
Subtotal
|
3,201,000
|
3,224,000
|
2,884,000
|
9,585,000
|
8,328,000
|
||||||||
Indiana
|
N/A
|
(2)
|
N/A
|
(2)
|
150,000
|
N/A
|
(2)
|
328,000
|
|
||||
Total
|
3,201,000
|
3,224,000
|
3,034,000
|
9,585,000
|
8,656,000
|
||||||||
(1) Total
member months is defined as the aggregate of each month’s ending
membership for the period.
|
|||||||||||||
(2) The
Company’s Indiana health plan ceased serving members effective January
1,
2007.
|
|||||||||||||
(3) The
Company’s Texas health plan commenced operations in September
2006.
|
|
Three
Months Ended September 30, 2007
|
||||||||||||||||||||||||
Premium
Revenue
|
Medical
Care Costs
|
Medical
|
Premium
Tax
|
||||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
Care
Ratio
|
Expense
|
||||||||||||||||||||
California
|
$ |
93,154
|
$ |
108.39
|
$ |
76,443
|
$ |
88.95
|
82.1% | $ |
2,382
|
||||||||||||||
Michigan
|
119,752
|
187.19
|
100,378
|
156.90
|
83.8% |
7,069
|
|||||||||||||||||||
New
Mexico
|
72,543
|
361.23
|
56,984
|
283.76
|
78.6% |
2,828
|
|||||||||||||||||||
Ohio
|
125,452
|
302.02
|
111,387
|
268.16
|
88.8% |
5,645
|
|||||||||||||||||||
Texas
|
24,997
|
279.39
|
19,041
|
212.82
|
76.2% |
450
|
|||||||||||||||||||
Utah
|
27,513
|
193.52
|
26,534
|
186.63
|
96.4% |
–
|
|||||||||||||||||||
Washington
|
164,367
|
192.43
|
130,216
|
152.45
|
79.2% |
2,748
|
|||||||||||||||||||
Other
|
624
|
–
|
4,919
|
–
|
–
|
7
|
|||||||||||||||||||
Consolidated
|
$ |
628,402
|
$ |
196.29
|
$ |
525,902
|
$ |
164.27
|
83.7% | $ |
21,129
|
Three
Months Ended September 30, 2006
|
||||||||||||||||||||||||
Premium
Revenue
|
Medical
Care Costs
|
Medical
|
Premium
Tax
|
|||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
Care
Ratio
|
Expense
|
|||||||||||||||||||
California
|
$ |
93,590
|
$ |
102.71
|
$ |
85,283
|
$ |
93.59
|
91.1% | $ |
2,934
|
|||||||||||||
Indiana
|
24,626
|
164.15
|
25,384
|
169.20
|
103.1% |
–
|
||||||||||||||||||
Michigan
|
122,209
|
179.25
|
95,049
|
139.42
|
77.8% |
7,505
|
||||||||||||||||||
New
Mexico
|
58,648
|
324.51
|
50,533
|
279.61
|
86.2% |
2,164
|
||||||||||||||||||
Ohio
|
20,977
|
219.76
|
20,466
|
214.41
|
97.6% |
968
|
||||||||||||||||||
Texas
|
280
|
108.86
|
361
|
140.69
|
129.2% |
24
|
||||||||||||||||||
Utah
|
39,268
|
234.81
|
35,961
|
215.03
|
91.6% |
–
|
||||||||||||||||||
Washington
|
152,481
|
180.40
|
112,372
|
132.95
|
73.7% |
2,587
|
||||||||||||||||||
Other
|
1
|
–
|
5,461
|
–
|
–
|
2
|
||||||||||||||||||
Consolidated
|
$ |
512,080
|
$ |
168.77
|
$ |
430,870
|
$ |
142.00
|
84.1% | $ |
16,184
|
Nine
Months Ended September 30, 2007
|
||||||||||||||||||||||||
Premium
Revenue
|
Medical
Care Costs
|
Medical
|
Premium
Tax
|
|||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
Care
Ratio
|
Expense
|
|||||||||||||||||||
California
|
$ |
280,796
|
$ |
107.22
|
$ |
228,952
|
$ |
87.42
|
81.5% | $ |
8,614
|
|||||||||||||
Michigan
|
364,945
|
185.54
|
306,163
|
155.66
|
83.9% |
21,942
|
||||||||||||||||||
New
Mexico
|
191,073
|
324.23
|
159,152
|
270.07
|
83.3% |
6,438
|
||||||||||||||||||
Ohio
|
311,853
|
270.08
|
282,164
|
244.37
|
90.5% |
14,033
|
||||||||||||||||||
Texas
|
64,406
|
260.88
|
55,163
|
223.44
|
85.6% |
1,140
|
||||||||||||||||||
Utah
|
88,473
|
201.87
|
81,535
|
186.04
|
92.2% |
–
|
||||||||||||||||||
Washington
|
489,254
|
190.36
|
392,201
|
152.60
|
80.2% |
8,117
|
||||||||||||||||||
Other
|
964
|
–
|
13,914
|
–
|
–
|
21
|
||||||||||||||||||
Consolidated
|
$ |
1,791,764
|
$ |
186.93
|
$ |
1,519,244
|
$ |
158.50
|
84.8% | $ |
60,305
|
Nine
Months Ended September 30, 2006
|
||||||||||||||||||||||||
Premium
Revenue
|
Medical
Care Costs
|
Medical
|
Premium
Tax
|
|||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
Care
Ratio
|
Expense
|
|||||||||||||||||||
California
|
$ |
279,161
|
$ |
100.23
|
$ |
245,599
|
$ |
88.18
|
88.0% | $ |
8,918
|
|||||||||||||
Indiana
|
54,873
|
167.16
|
52,980
|
161.40
|
96.6% |
–
|
||||||||||||||||||
Michigan
|
301,739
|
179.88
|
234,950
|
140.06
|
77.9% |
18,259
|
||||||||||||||||||
New
Mexico
|
168,088
|
314.30
|
141,657
|
264.88
|
84.3% |
6,039
|
||||||||||||||||||
Ohio
|
49,555
|
216.18
|
46,199
|
201.54
|
93.2% |
2,237
|
||||||||||||||||||
Texas
|
280
|
108.86
|
381
|
148.47
|
136.4% |
24
|
||||||||||||||||||
Utah
|
126,741
|
240.30
|
115,828
|
219.61
|
91.4% |
–
|
||||||||||||||||||
Washington
|
460,733
|
179.17
|
362,800
|
141.08
|
78.7% |
7,937
|
||||||||||||||||||
Other
|
27
|
–
|
15,438
|
–
|
–
|
2
|
||||||||||||||||||
Consolidated
|
$ |
1,441,197
|
$ |
166.49
|
$ |
1,215,832
|
$ |
140.45
|
84.4% | $ |
43,416
|
Three
Months Ended
|
Three
Months Ended
|
||||||||||||||||||||||||
September
30, 2007
|
September
30, 2006
|
||||||||||||||||||||||||
%
of Total
|
%
of Total
|
||||||||||||||||||||||||
Medical
|
Medical
|
||||||||||||||||||||||||
Amount
|
PMPM
|
Care
Costs
|
Amount
|
PMPM
|
Care
Costs
|
||||||||||||||||||||
Medical
care costs:
|
|||||||||||||||||||||||||
Fee
for service costs
|
$ |
339,841
|
$ |
106.15
|
64.6% | $ |
284,648
|
$ |
93.81
|
66.1% | |||||||||||||||
Capitation
|
95,879
|
29.95
|
18.2% |
68,144
|
22.46
|
15.8% | |||||||||||||||||||
Pharmacy
|
67,844
|
21.19
|
12.9% |
51,697
|
17.04
|
12.0% | |||||||||||||||||||
Other
|
22,338
|
6.98
|
4.3% |
26,381
|
8.69
|
6.1% | |||||||||||||||||||
Total
medical
|
|||||||||||||||||||||||||
care
costs
|
$ |
525,902
|
$ |
164.27
|
100.0% | $ |
430,870
|
$ |
142.00
|
100.0% |
Nine
Months Ended
|
Nine
Months Ended
|
||||||||||||||||||||||||
September
30, 2007
|
September
30, 2006
|
||||||||||||||||||||||||
%
of Total
|
%
of Total
|
||||||||||||||||||||||||
Medical
|
Medical
|
||||||||||||||||||||||||
Amount
|
PMPM
|
Care
Costs
|
Amount
|
PMPM
|
Care
Costs
|
||||||||||||||||||||
Medical
care costs:
|
|||||||||||||||||||||||||
Fee
for service costs
|
$ |
984,375
|
$ |
102.70
|
64.8% | $ |
814,928
|
$ |
94.14
|
67.0% | |||||||||||||||
Capitation
|
276,742
|
28.87
|
18.2% |
187,997
|
21.72
|
15.5% | |||||||||||||||||||
Pharmacy
|
194,354
|
20.28
|
12.8% |
148,858
|
17.19
|
12.2% | |||||||||||||||||||
Other
|
63,773
|
6.65
|
4.2% |
64,049
|
7.40
|
5.3% | |||||||||||||||||||
Total
medical
|
|||||||||||||||||||||||||
care
costs
|
$ |
1,519,244
|
$ |
158.50
|
100.0% | $ |
1,215,832
|
$ |
140.45
|
100.0% |
Nine
Months Ended
|
||||||||
September
30,
|
||||||||
2007
|
2006
|
|||||||
Balances
at beginning of period
|
$ |
290,048
|
$ |
217,354
|
||||
Medical
claims and benefits payable from business acquired during the
period
|
–
|
22,536
|
||||||
Components
of medical care costs related to:
|
||||||||
Current
year
|
1,568,949
|
1,254,174
|
||||||
Prior
years
|
(49,705 | ) | (38,342 | ) | ||||
Total
medical care costs
|
1,519,244
|
1,215,832
|
||||||
Payments
for medical care costs related to:
|
||||||||
Current
year
|
1,278,321
|
1,017,923
|
||||||
Prior
years
|
222,249
|
180,872
|
||||||
Total
paid
|
1,500,570
|
1,198,795
|
||||||
Balances
at end of period
|
$ |
308,722
|
$ |
256,927
|
Nine
Months Ended
|
||||||||
September
30,
|
||||||||
2007
|
2006
|
|||||||
Days
in claims payable
|
54
|
54
|
||||||
Number
of members at end of period
|
1,070,000
|
1,015,000
|
||||||
Number
of claims in inventory at end of period (1)
|
179,186
|
246,435
|
||||||
Billed
charges of claims in inventory at end of period (in thousands)
(1)
|
$ |
231,753
|
$ |
234,494
|
||||
Claims
in inventory per member at end of period (1)
|
0.17
|
0.26
|
||||||
(1) 2006
claims data excludes information for Cape Health Plan membership
of
approximately 85,000 members. Cape membership was processed on
a separate claims platform through December 31, 2006.
|