UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
______________
FORM 8-K
______________
Current
Report
Pursuant
to Section 13 or 15(d) of the Securities Exchange Act of 1934
Date of
Report (Date of earliest event reported): October 30, 2014
______________
MOLINA
HEALTHCARE, INC.
(Exact
name of registrant as specified in its charter)
Delaware |
1-31719 |
13-4204626 |
(State of incorporation) |
(Commission File Number) |
(I.R.S. Employer Identification Number) |
______________
200 Oceangate, Suite 100, Long Beach, California 90802 |
(Address of principal executive offices) |
Registrant’s telephone number, including area code: (562) 435-3666
Check the
appropriate box below if the Form 8-K filing is intended to
simultaneously satisfy the filing obligation of the registrant under any
of the following provisions:
⃞ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)
⃞ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)
⃞ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))
⃞ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))
Item 2.02. |
Results of Operations and Financial Condition. |
On October 30, 2014, Molina Healthcare, Inc. issued a press release announcing its financial results for the third quarter and nine months ended September 30, 2014. The full text of the press release is included as Exhibit 99.1 to this report. The information contained in the websites cited in the press release is not part of this report
The information in this Form 8-K and the exhibit attached hereto shall not be deemed to be “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, or otherwise subject to the liabilities of that section, nor shall it be deemed incorporated by reference in any filing under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended, except as expressly set forth by specific reference in such a filing.
Item 9.01. |
Financial Statements and Exhibits. |
(d) |
Exhibits: |
Exhibit |
|
No. |
Description |
99.1 |
Press release of Molina Healthcare, Inc. issued October 30, 2014, as to financial results for the third quarter and nine months ended September 30, 2014. |
SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
MOLINA HEALTHCARE, INC. |
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Date: | October 30, 2014 | By: |
/s/ Jeff D. Barlow |
Jeff D. Barlow |
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Chief Legal Officer and Secretary |
EXHIBIT INDEX
Exhibit |
|
No. | Description |
99.1 |
Press release of Molina Healthcare, Inc. issued October 30, 2014, as to financial results for the third quarter and nine months ended September 30, 2014. |
Exhibit 99.1
Molina Healthcare Reports Third Quarter 2014 Results
LONG BEACH, Calif.--(BUSINESS WIRE)--October 30, 2014--Molina Healthcare, Inc. (NYSE: MOH):
Molina Healthcare, Inc. (NYSE: MOH) today reported its financial results for the third quarter of 2014.
“Molina Healthcare continues to grow and diversify,” said J. Mario Molina, M.D., chief executive officer of Molina Healthcare, Inc. “Premium revenue grew $150 million, or almost 7%, in this quarter alone. We continued to expand the operations of our Medicare Medicaid dual eligible plans in California, Illinois and Ohio, and our general and administrative expense ratio was the lowest it has been in over five years.”
Overview of Financial Results, Continuing Operations
Increased premium revenue and a lower general and administrative expense ratio in the third quarter of 2014 offset an increase in the medical care ratio, allowing net income per diluted share, continuing operations, to double in the third quarter of 2014 when compared to the third quarter of 2013.
Strong enrollment growth across all of the Company’s products (Medicaid, Medicare special needs plans and dual eligible Medicare-Medicaid Plans) generated almost $2 billion, or 40%, more premium revenue for the nine months ended September 30, 2014, when compared with the same period in 2013.
Despite an increase in medical care costs as a percentage of premium revenue (the medical care ratio), higher per-member per-month (PMPM) premiums produced an increase of 8.5%, or $52.5 million, in medical margin for the nine months ended September 30, 2014, when compared with the same period in 2013.
The medical care ratio increased substantially in 2014 as a result of three developments:
For example, at the Washington health plan, a minimum medical loss ratio requirement for the Medicaid expansion program reduced income before taxes by approximately $17 million for the third quarter of 2014, and $23 million for the nine months ended September 30, 2014. Simultaneously, the Washington health plan incurred a medical care ratio in excess of 100% for its aged, blind or disabled members. However, the Company is unable to offset profits from its Medicaid expansion contract against its other contracts. The Washington health plan is therefore left in a position where it must return profits under its Medicaid expansion contract to the state; while it receives no relief from losses incurred under another contract.
In a similar manner, at the New Mexico health plan, a contract provision limiting profits on retroactively added members reduced income before taxes by approximately $6 million for the nine months ended September 30, 2014. At the same time, the New Mexico health plan’s LTSS program operated at a medical care ratio in excess of 100%.
The Company reported substantial improvements in administrative cost efficiency in 2014. General and administrative expenses as a percentage of revenue declined to 7.2% for the third quarter of 2014, from 10.4% for the same period in 2013, and was 8.2% for the year-to-date period ended September 30, 2014, versus 9.8% in the same period of 2013. The Company’s quarterly general and administrative expense ratio has not been below 7.2% since the second quarter of 2009.
Affordable Care Act Health Insurer Fee Update
The Company previously reported that its results have been adversely affected by delays in reimbursement (including reimbursement for tax effects) of the Affordable Care Act’s Health Insurer Fee (ACA HIF) from California, Michigan, New Mexico, Texas and Utah.
During the third quarter, Michigan and Utah committed to reimbursement of the ACA HIF, but not to the reimbursement of the related tax effects. However, both states have informally indicated that it is their desire to reimburse the Company for those tax effects. As a result of these developments, the Company was able to recognize an additional $11 million in ACA HIF revenue (but not amounts related to tax effects) from Michigan and Utah during the third quarter of 2014.
Nevertheless, ACA HIF not reimbursed by California, New Mexico and Texas, as well as tax effects not yet reimbursed by Michigan and Utah, reduced income before taxes by approximately $6 million, or $0.07 per diluted share, for the third quarter of 2014, and $37 million, or $0.49 per diluted share, for the nine months ended September 30, 2014 (per-share amounts for both periods are on a GAAP and adjusted basis). While the Company remains guardedly optimistic that it will eventually secure reimbursement from all of its state partners, it no longer expects that all reimbursement will be secured prior to the close of 2014. Accordingly, the Company does not expect to recognize the full amount of revenue associated with reimbursement of its ACA HIF payment during 2014.
The following table summarizes the status of ACA HIF Medicaid revenue recognition for the nine months ended September 30, 2014:
ACA HIF Medicaid Revenue | ||||||||||||
Recognized |
Required Reimbursement through Sept. 30, 2014 |
Not
Recognized |
||||||||||
(In millions) | ||||||||||||
Quarter 1 | $ | 16.6 | $ | 32.7 | $ | 16.1 | ||||||
Quarter 2 | 17.2 | 32.7 | 15.5 | |||||||||
Quarter 3 | 27.0 | 32.7 | 5.7 | |||||||||
Nine months ended September 30, 2014 | $ | 60.8 | $ | 98.1 | $ | 37.3 |
The Company has secured agreements allowing the recognition of approximately $20 million of ACA HIF revenue in the fourth quarter of 2014. The Company has not yet secured agreements from the states of California, New Mexico, Texas, Michigan (tax effect not secured), and Utah (tax effect not secured). The total amount of ACA HIF revenue for which agreements have not been secured is approximately $50 million for the full year of 2014.
Texas Health Plan Quality Revenue Update
The Company’s non-recognition of a portion of the Texas health plan’s quality revenue reduced income before taxes by approximately $4 million, or $0.05 per diluted share, for the third quarter of 2014, and $18 million, or $0.23 per diluted share, for the nine months ended September 30, 2014 (per-share amounts for both periods are on a GAAP and adjusted basis). Unless it receives clarification of the standards and full transparency on the calculations by which quality revenue is to be assessed by the state, the Company is unable to independently assess its performance against those standards. As such, the Company is doubtful that it will be able to recognize the full amount of its Texas quality revenue in 2014.
The following table summarizes the status of Texas quality revenue recognition for the nine months ended September 30, 2014:
Texas Quality Revenue | ||||||||||
Recognized | Available | Not Recognized | ||||||||
(In millions) | ||||||||||
Quarter 1 | $ | 2.6 | $ | 8.6 | $ | 6.0 | ||||
Quarter 2 | 1.1 | 8.6 | 7.5 | |||||||
Quarter 3 | 4.6 | 8.8 | 4.2 | |||||||
Nine months ended September 30, 2014 | $ | 8.3 | $ | 26.0 | $ | 17.7 |
Washington Health Plan Settlement Update
As previously disclosed, the Company recorded a net decrease to premium revenue and income before taxes of approximately $11 million, or $0.14 per diluted share, in the third quarter of 2014 as a result of the settlements of three unrelated issues with the Washington Health Care Authority that related to periods prior to 2014.
Income Tax Update
During the third quarter of 2014, the Internal Revenue Service (IRS) issued final regulations related to compensation deduction limitations applicable to certain health insurance issuers. Pursuant to these final regulations the Company recognized a tax benefit during the third quarter of 2014 of approximately $7 million, or $0.15 per diluted share, for periods prior to the third quarter of 2014.
Full Year 2014 Update
The Company has previously disclosed issues relating to its inability to fully recognize ACA HIF revenue and Texas quality revenue in 2014. These issues, along with medical care costs that are trending higher than the Company anticipated compared with its full year estimate, and the impact of certain contractual provisions that limit the Company’s ability to retain profits, will adversely impact 2014 earnings. Accordingly, the Company now expects that its net income per diluted share, continuing operations, and adjusted net income per diluted share, continuing operations, may fall short of the low end of the ranges for those respective metrics as included in the Company’s previously issued 2014 guidance.
Conference Call
The Company’s management will host a conference call and webcast to discuss its third quarter results at 5:00 p.m. Eastern time on Thursday, October 30, 2014. The number to call for the interactive teleconference is (212) 271-4651. A telephonic replay of the conference call will be available from 7:00 p.m. Eastern time on Thursday, October 30, 2014, through 6:00 p.m. on Friday, October 31, 2014, by dialing (800) 633-8284 and entering confirmation number 21733502. A live broadcast of Molina Healthcare’s conference call will be available on the Company’s website, www.molinahealthcare.com. A 30-day online replay will be available approximately an hour following the conclusion of the live broadcast.
About Molina Healthcare
Molina Healthcare, Inc., a FORTUNE 500 company, provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through our locally operated health plans in 11 states across the nation, Molina currently serves approximately 2.4 million members. Dr. C. David Molina founded our company in 1980 as a provider organization serving low-income families in Southern California. Today, we continue his mission of providing high quality and cost-effective health care to those who need it most. For more information about Molina Healthcare, please visit our website at www.molinahealthcare.com.
Notes:
1. Adjusted net income per diluted share, continuing operations, is a non-GAAP financial measure used by management as a supplemental metric in evaluating its financial performance, its financing and business decisions, and in forecasting and planning for future periods. This measure is not determined in accordance with accounting principles generally accepted in the United States of America (GAAP) and should not be viewed as a substitute for the most directly comparable GAAP measure, which is diluted net income per share, continuing operations. See below for reconciliations of the Company’s non-GAAP measures to the most directly comparable GAAP measures.
Safe Harbor 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. Those known risks and uncertainties include, but are not limited to, the following:
and numerous other risk factors, including those discussed in the Company’s periodic reports and filings with the Securities and Exchange Commission. These reports can be accessed under the investor relations tab of the Company’s website or on the SEC’s website at www.sec.gov. Given these risks and uncertainties, we can give no assurances that the Company’s forward-looking statements will prove to be accurate, or that any other results or events projected or contemplated by the Company’s forward-looking statements will in fact occur, and we caution investors not to place undue reliance on these statements. All forward-looking statements in this release represent the Company’s judgment as of October 30, 2014, and we disclaim any obligation to update any forward-looking statements to conform the statement to actual results or changes in the Company’s expectations.
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MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED STATEMENTS OF INCOME |
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Three Months Ended September 30, |
Nine Months Ended September 30, |
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2014 | 2013 | 2014 | 2013 | |||||||||||||
(Amounts in thousands, except net income per share) | ||||||||||||||||
Revenue: | ||||||||||||||||
Premium revenue | $ | 2,316,759 | $ | 1,584,656 | $ | 6,424,238 | $ | 4,583,818 | ||||||||
Service revenue | 52,557 | 51,100 | 156,419 | 150,528 | ||||||||||||
Premium tax revenue | 81,240 | 43,723 | 203,053 | 127,606 | ||||||||||||
Health insurer fee revenue (1) | 29,427 | — | 67,785 | — | ||||||||||||
Investment income | 2,041 | 1,740 | 5,615 | 4,884 | ||||||||||||
Other revenue | 2,327 | 5,860 | 8,523 | 16,476 | ||||||||||||
Total revenue | 2,484,351 | 1,687,079 | 6,865,633 | 4,883,312 | ||||||||||||
Operating expenses: | ||||||||||||||||
Medical care costs | 2,097,836 | 1,383,213 | 5,753,793 | 3,965,834 | ||||||||||||
Cost of service revenue | 40,067 | 40,113 | 117,831 | 119,188 | ||||||||||||
General and administrative expenses | 178,879 | 176,233 | 560,205 | 478,990 | ||||||||||||
Premium tax expenses | 81,240 | 43,723 | 203,053 | 127,606 | ||||||||||||
Health insurer fee expenses (1) | 22,308 | — | 66,443 | — | ||||||||||||
Depreciation and amortization | 24,242 | 18,871 | 67,835 | 52,449 | ||||||||||||
Total operating expenses | 2,444,572 | 1,662,153 | 6,769,160 | 4,744,067 | ||||||||||||
Operating income | 39,779 | 24,926 | 96,473 | 139,245 | ||||||||||||
Other expenses, net: | ||||||||||||||||
Interest expense | 14,419 | 13,532 | 42,234 | 38,236 | ||||||||||||
Other expense (income), net | 863 | (24 | ) | 810 | 3,347 | |||||||||||
Total other expenses, net | 15,282 | 13,508 | 43,044 | 41,583 | ||||||||||||
Income from continuing operations before income tax expense | 24,497 | 11,418 | 53,429 | 97,662 | ||||||||||||
Income tax expense | 8,427 | 3,865 | 24,784 | 43,791 | ||||||||||||
Income from continuing operations | 16,070 | 7,553 | 28,645 | 53,871 | ||||||||||||
Income (loss) from discontinued operations,
net of tax |
52 | 16 | (214 | ) | 8,184 | |||||||||||
Net income | $ | 16,122 | $ | 7,569 | $ | 28,431 | $ | 62,055 | ||||||||
Diluted net income (loss) per share: | ||||||||||||||||
Continuing operations | $ | 0.33 | $ | 0.16 | $ | 0.60 | $ | 1.15 | ||||||||
Discontinued operations | — | — | (0.01 | ) | 0.18 | |||||||||||
Diluted net income per share | $ | 0.33 | $ | 0.16 | $ | 0.59 | $ | 1.33 | ||||||||
Diluted weighted average shares outstanding | 48,644 | 47,062 | 48,088 | 46,767 | ||||||||||||
Operating Statistics, Continuing Operations: | ||||||||||||||||
Medical care ratio (2) | 90.6 | % | 87.3 | % | 89.6 | % | 86.5 | % | ||||||||
Service revenue ratio (3) | 76.2 | % | 78.5 | % | 75.3 | % | 79.2 | % | ||||||||
General and administrative expense ratio (4) | 7.2 | % | 10.4 | % | 8.2 | % | 9.8 | % | ||||||||
Premium tax ratio (2) | 3.4 | % | 2.7 | % | 3.1 | % | 2.7 | % | ||||||||
Effective tax rate | 34.4 | % | 33.9 | % | 46.4 | % | 44.8 | % | ||||||||
(1) Health insurer fee expenses represent insurer fees levied by the federal government under the Affordable Care Act, which are not tax deductible. Associated revenues represent state and federal reimbursement of such fees (including the related income tax effect) for Medicaid and Medicare insurers. |
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(2) Medical care ratio represents medical care costs as a percentage of premium revenue; premium tax ratio represents premium tax expenses as a percentage of premium revenue plus premium tax revenue. Medical care costs include costs incurred for providing long term services and supports (LTSS). |
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(3) Service revenue ratio represents cost of service revenue as a percentage of service revenue. |
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(4) Computed as a percentage of total revenue. |
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MOLINA HEALTHCARE, INC. CONSOLIDATED BALANCE SHEETS |
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(Unaudited) | ||||||||
September 30, 2014 |
December 31, 2013 |
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(Amounts in thousands,
except per-share data) |
||||||||
ASSETS | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | $ | 1,598,596 | $ | 935,895 | ||||
Investments | 842,683 | 703,052 | ||||||
Receivables | 425,683 | 298,935 | ||||||
Income taxes refundable | 7,679 | 32,742 | ||||||
Deferred income taxes | 30,817 | 26,556 | ||||||
Prepaid expenses and other current assets | 82,062 | 42,484 | ||||||
Total current assets | 2,987,520 | 2,039,664 | ||||||
Property, equipment, and capitalized software, net | 328,547 | 292,083 | ||||||
Deferred contract costs | 51,179 | 45,675 | ||||||
Intangible assets, net | 85,035 | 98,871 | ||||||
Goodwill | 236,635 | 230,738 | ||||||
Restricted investments | 93,119 | 63,093 | ||||||
Derivative asset | 222,997 | 186,351 | ||||||
Other assets | 51,108 | 46,462 | ||||||
$ | 4,056,140 | $ | 3,002,937 | |||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||
Current liabilities: | ||||||||
Medical claims and benefits payable | $ | 1,123,846 | $ | 669,787 | ||||
Accounts payable and accrued liabilities | 609,444 | 319,965 | ||||||
Deferred revenue | 190,856 | 122,216 | ||||||
Current maturities of long-term debt | 11,927 | 182,008 | ||||||
Total current liabilities | 1,936,073 | 1,293,976 | ||||||
Convertible senior notes | 697,210 | 416,368 | ||||||
Lease financing obligations | 160,412 | 159,394 | ||||||
Lease financing obligations – related party | 39,258 | 27,092 | ||||||
Deferred income taxes | 7,719 | 580 | ||||||
Derivative liability | 222,877 | 186,239 | ||||||
Other long-term liabilities | 28,300 | 26,351 | ||||||
Total liabilities | 3,091,849 | 2,110,000 | ||||||
Stockholders’ equity: | ||||||||
Common stock, $0.001 par value; 150,000 shares authorized; outstanding: 48,279 shares at September 30, 2014 and 45,871 shares at December 31, 2013 | 48 | 46 | ||||||
Preferred stock, $0.001 par value; 20,000 shares authorized, no shares issued and outstanding | — | — | ||||||
Additional paid-in capital | 383,300 | 340,848 | ||||||
Accumulated other comprehensive loss | (617 | ) | (1,086 | ) | ||||
Retained earnings | 581,560 | 553,129 | ||||||
Total stockholders’ equity | 964,291 | 892,937 | ||||||
$ | 4,056,140 | $ | 3,002,937 | |||||
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MOLINA HEALTHCARE, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS, CONTINUING AND DISCONTINUED OPERATIONS |
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Three Months Ended |
Nine Months Ended |
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2014 | 2013 | 2014 | 2013 | |||||||||||||
(Amounts in thousands) | ||||||||||||||||
Operating activities: | ||||||||||||||||
Net income | $ | 16,122 | $ | 7,569 | $ | 28,431 | $ | 62,055 | ||||||||
Adjustments to reconcile net income to net cash
provided by operating activities: |
||||||||||||||||
Depreciation and amortization | 33,810 | 24,128 | 99,464 | 68,035 | ||||||||||||
Deferred income taxes | (12,397 | ) | (16,287 | ) | (10,705 | ) | (38,442 | ) | ||||||||
Stock-based compensation | 5,659 | 8,504 | 16,115 | 20,654 | ||||||||||||
Amortization of convertible senior notes and lease financing obligations | 6,740 | 6,440 | 20,195 | 16,128 | ||||||||||||
Other, net | 2,152 | 4,396 | 3,875 | 14,406 | ||||||||||||
Changes in operating assets and liabilities: | ||||||||||||||||
Receivables | 47,831 | (80,191 | ) | (126,748 | ) | (144,285 | ) | |||||||||
Prepaid expenses and other assets | 15,305 | (4,696 | ) | (51,582 | ) | (27,552 | ) | |||||||||
Medical claims and benefits payable | 199,664 | 167,219 | 454,059 | 138,176 | ||||||||||||
Accounts payable and accrued liabilities | 136,894 | 37,959 | 314,391 | 20,991 | ||||||||||||
Deferred revenue | 144,911 | 78,439 | 68,640 | (17,410 | ) | |||||||||||
Income taxes | 9,047 | (9,988 | ) | 25,063 | (1,012 | ) | ||||||||||
Net cash provided by operating activities | 605,738 | 223,492 | 841,198 | 111,744 | ||||||||||||
Investing activities: | ||||||||||||||||
Purchases of investments | (248,020 | ) | (95,802 | ) | (616,324 | ) | (627,953 | ) | ||||||||
Sales and maturities of investments | 147,188 | 78,380 | 473,836 | 227,800 | ||||||||||||
Purchases of equipment | (34,101 | ) | (29,197 | ) | (71,771 | ) | (64,426 | ) | ||||||||
Increase in restricted investments | (8,679 | ) | (8,290 | ) | (24,301 | ) | (21,124 | ) | ||||||||
Net cash paid in business combinations | (7,500 | ) | (57,684 | ) | (7,500 | ) | (57,684 | ) | ||||||||
Other, net | (7,832 | ) | 2,989 | (15,220 | ) | 1,971 | ||||||||||
Net cash used in investing activities | (158,944 | ) | (109,604 | ) | (261,280 | ) | (541,416 | ) | ||||||||
Financing activities: | ||||||||||||||||
Proceeds from issuance of convertible senior notes, net of deferred financing costs | 123,387 | — | 123,387 | 537,973 | ||||||||||||
Proceeds from sale-leaseback transactions | — | — | — | 158,694 | ||||||||||||
Purchase of call option | — | — | — | (149,331 | ) | |||||||||||
Proceeds from issuance of warrants | — | — | — | 75,074 | ||||||||||||
Treasury stock purchases | — | — | — | (50,000 | ) | |||||||||||
Principal payments on term loan | — | — | — | (47,471 | ) | |||||||||||
Repayment of amounts borrowed under credit facility | — | — | — | (40,000 | ) | |||||||||||
Contingent consideration liabilities settled | — | — | (50,349 | ) | — | |||||||||||
Proceeds from employee stock plans | 11 | 304 | 7,628 | 5,156 | ||||||||||||
Other, net | 1,053 | (306 | ) | 2,117 | 363 | |||||||||||
Net cash provided by (used in) financing activities | 124,451 | (2 | ) | 82,783 | 490,458 | |||||||||||
Net increase in cash and cash equivalents | 571,245 | 113,886 | 662,701 | 60,786 | ||||||||||||
Cash and cash equivalents at beginning of period | 1,027,351 | 742,670 | 935,895 | 795,770 | ||||||||||||
Cash and cash equivalents at end of period | $ | 1,598,596 | $ | 856,556 | $ | 1,598,596 | $ | 856,556 |
MOLINA HEALTHCARE, INC.
UNAUDITED NON-GAAP FINANCIAL
MEASURES
The Company uses two non-GAAP financial measures as supplemental metrics in evaluating its financial performance, making financing and business decisions, and forecasting and planning for future periods. For these reasons, management believes such measures are useful supplemental measures to investors in comparing the Company’s performance to the performance of other public companies in the health care industry. These non-GAAP financial measures should be considered as supplements to, and not as substitutes for or superior to, GAAP measures. The first of these non-GAAP measures is earnings before interest, taxes, depreciation and amortization (EBITDA). The following table reconciles net income, which the Company believes to be the most comparable GAAP measure, to EBITDA.
Three Months Ended |
Nine Months Ended |
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2014 | 2013 | 2014 | 2013 | ||||||||||||
(Amounts in thousands) | |||||||||||||||
Net income | $ | 16,122 | $ | 7,569 | $ | 28,431 | $ | 62,055 | |||||||
Adjustments: | |||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 29,307 | 24,128 | 83,513 | 68,035 | |||||||||||
Interest expense | 14,419 | 13,532 | 42,234 | 38,236 | |||||||||||
Income tax expense | 8,439 | 3,962 | 24,436 | 33,745 | |||||||||||
EBITDA | $ | 68,287 | $ | 49,191 | $ | 178,614 | $ | 202,071 | |||||||
The second of these non-GAAP measures is adjusted net income, continuing operations (including adjusted net income per diluted share). The following tables reconcile net income from continuing operations (and net income per diluted share), which the Company believes to be the most comparable GAAP measure, to adjusted net income, continuing operations (and adjusted net income per diluted share).
Three Months Ended September 30, | |||||||||||||||
2014 | 2013 | ||||||||||||||
(In thousands, except per diluted share amounts) | |||||||||||||||
Net income, continuing operations | $ | 16,070 | $ | 0.33 | $ | 7,553 | $ | 0.16 | |||||||
Adjustments, net of tax: | |||||||||||||||
Depreciation, and amortization of capitalized software | 15,275 | 0.31 | 11,821 | 0.25 | |||||||||||
Amortization of convertible senior notes and lease financing obligations | 4,246 | 0.09 | 4,058 | 0.08 | |||||||||||
Stock-based compensation | 1,739 | 0.04 | 7,010 | 0.15 | |||||||||||
Amortization of intangible assets | 3,189 | 0.06 | 3,378 | 0.07 | |||||||||||
Change in fair value of derivatives, net | 1 | — | (1 | ) | — | ||||||||||
Adjusted net income, continuing operations | $ | 40,520 | $ | 0.83 | $ | 33,819 | $ | 0.71 | |||||||
Nine Months Ended September 30, | |||||||||||||||
2014 | 2013 | ||||||||||||||
(In thousands, except per diluted share amounts) | |||||||||||||||
Net income, continuing operations | $ | 28,645 | $ | 0.60 | $ | 53,871 | $ | 1.15 | |||||||
Adjustments, net of tax: | |||||||||||||||
Depreciation, and amortization of capitalized software | 42,887 | 0.89 | 33,375 | 0.71 | |||||||||||
Amortization of convertible senior notes and lease financing obligations | 12,723 | 0.26 | 10,161 | 0.21 | |||||||||||
Stock-based compensation | 10,960 | 0.23 | 17,026 | 0.36 | |||||||||||
Amortization of intangible assets | 9,727 | 0.20 | 9,485 | 0.20 | |||||||||||
Change in fair value of derivatives, net | (5 | ) | — | 3,582 | 0.08 | ||||||||||
Adjusted net income, continuing operations | $ | 104,937 | $ | 2.18 | $ | 127,500 | $ | 2.71 | |||||||
MOLINA HEALTHCARE, INC. UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP DATA, CONTINUING OPERATIONS |
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Sept. 30, |
June 30, |
Dec. 31, |
Sept. 30, |
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Ending Membership by Health Plan: | |||||||||||
California | 496,000 | 455,000 | 368,000 | 363,000 | |||||||
Florida (1) | 98,000 | 58,000 | 89,000 | 84,000 | |||||||
Illinois | 21,000 | 6,000 | 4,000 | — | |||||||
Michigan | 238,000 | 244,000 | 213,000 | 213,000 | |||||||
New Mexico | 207,000 | 195,000 | 168,000 | 172,000 | |||||||
Ohio | 337,000 | 302,000 | 255,000 | 261,000 | |||||||
South Carolina (2) | 118,000 | 119,000 | — | — | |||||||
Texas | 249,000 | 247,000 | 252,000 | 258,000 | |||||||
Utah | 83,000 | 83,000 | 86,000 | 87,000 | |||||||
Washington | 473,000 | 461,000 | 403,000 | 409,000 | |||||||
Wisconsin | 84,000 | 85,000 | 93,000 | 95,000 | |||||||
2,404,000 | 2,255,000 | 1,931,000 | 1,942,000 | ||||||||
Ending Membership by Program: | |||||||||||
Temporary Assistance for Needy Families (TANF) | 1,608,900 | 1,564,500 | 1,503,800 | 1,519,200 | |||||||
Medicaid Expansion (3) | 314,500 | 232,300 | — | — | |||||||
Aged, Blind or Disabled (ABD) | 314,400 | 305,300 | 288,600 | 283,200 | |||||||
Children’s Health Insurance Program (CHIP) | 69,000 | 77,000 | 99,200 | 101,500 | |||||||
Medicare Special Needs Plans | 46,400 | 44,000 | 39,400 | 38,100 | |||||||
Medicare-Medicaid Plan (MMP) - Medicaid Only (4)(5) | 20,500 | 8,400 | — | — | |||||||
MMP - Integrated (4)(6) | 14,400 | 5,200 | — | — | |||||||
Health Insurance Marketplaces (3) | 15,900 | 18,300 | — | — | |||||||
2,404,000 | 2,255,000 | 1,931,000 | 1,942,000 | ||||||||
(1) Enrollment at the Florida health plan declined between the first and second quarters of 2014 due to a reassignment of membership as part of the implementation of Florida’s Managed Medical Assistance program. In the third quarter of 2014, such enrollment increased by approximately 40,000 members due primarily to the addition of certain service areas effective August 1, 2014. |
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(2) The South Carolina health plan began serving members under the state of South Carolina’s new full-risk Medicaid managed care program effective January 1, 2014. |
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(3) Medicaid Expansion membership phased in, and Health Insurance Marketplaces became available for consumers to access coverage, beginning January 1, 2014. |
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(4) Medicare-Medicaid Plans serve members who are dually eligible for Medicare and Medicaid. The Company’s MMP implementations in California and Illinois offered coverage beginning in April 2014 and Ohio beginning in June 2014. |
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(5) MMP members who receive Medicaid coverage only from the Company. |
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(6) MMP members who receive both Medicaid and Medicare coverage from the Company. |
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MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA, CONTINUING OPERATIONS (In thousands, except percentages and per-member-per-month amounts) |
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Three Months Ended September 30, 2014 | ||||||||||||||||||||||||||
Member
Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | ||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||
California | 1,451 | $ | 384,147 | $ | 264.79 | $ | 327,389 | $ | 225.66 | 85.2 | % | $ | 56,758 | |||||||||||||
Florida | 243 | 106,275 | 437.47 | 103,898 | 427.69 | 97.8 | 2,377 | |||||||||||||||||||
Illinois (3) | 38 | 34,514 | 906.78 | 28,333 | 744.41 | 82.1 | 6,181 | |||||||||||||||||||
Michigan | 727 | 208,873 | 287.15 | 177,680 | 244.27 | 85.1 | 31,193 | |||||||||||||||||||
New Mexico | 652 | 284,058 | 435.67 | 265,697 | 407.51 | 93.5 | 18,361 | |||||||||||||||||||
Ohio | 994 | 454,410 | 457.17 | 395,098 | 397.49 | 86.9 | 59,312 | |||||||||||||||||||
South Carolina | 355 | 95,455 | 268.97 | 74,489 | 209.89 | 78.0 | 20,966 | |||||||||||||||||||
Texas | 748 | 337,430 | 451.24 | 306,577 | 409.98 | 90.9 | 30,853 | |||||||||||||||||||
Utah | 250 | 78,703 | 315.04 | 75,270 | 301.30 | 95.6 | 3,433 | |||||||||||||||||||
Washington | 1,410 | 280,883 | 199.18 | 274,213 | 194.45 | 97.6 | 6,670 | |||||||||||||||||||
Wisconsin | 252 | 42,933 | 170.40 | 38,107 | 151.25 | 88.8 | 4,826 | |||||||||||||||||||
Other (4) | — | 9,078 | — | 31,085 | — | — | (22,007 | ) | ||||||||||||||||||
7,120 | $ | 2,316,759 | $ | 325.40 | $ | 2,097,836 | $ | 294.65 | 90.6 | % | $ | 218,923 | ||||||||||||||
Three Months Ended September 30, 2013 | ||||||||||||||||||||||||||
Member
Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | ||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||
California | 1,076 | $ | 184,235 | $ | 171.16 | $ | 166,774 | $ | 154.93 | 90.5 | % | $ | 17,461 | |||||||||||||
Florida | 251 | 67,688 | 269.58 | 60,127 | 239.46 | 88.8 | 7,561 | |||||||||||||||||||
Illinois | — | — | — | — | — | — | — | |||||||||||||||||||
Michigan | 641 | 174,706 | 272.65 | 143,498 | 223.95 | 82.1 | 31,208 | |||||||||||||||||||
New Mexico | 435 | 130,318 | 299.19 | 111,599 | 256.21 | 85.6 | 18,719 | |||||||||||||||||||
Ohio | 786 | 280,964 | 357.66 | 245,148 | 312.07 | 87.3 | 35,816 | |||||||||||||||||||
South Carolina | — | — | — | — | — | — | — | |||||||||||||||||||
Texas | 780 | 320,657 | 411.17 | 287,446 | 368.59 | 89.6 | 33,211 | |||||||||||||||||||
Utah | 261 | 84,525 | 323.83 | 66,555 | 254.98 | 78.7 | 17,970 | |||||||||||||||||||
Washington | 1,234 | 294,808 | 238.96 | 254,430 | 206.23 | 86.3 | 40,378 | |||||||||||||||||||
Wisconsin | 287 | 39,676 | 138.36 | 27,694 | 96.58 | 69.8 | 11,982 | |||||||||||||||||||
Other (3)(4) | — | 7,079 | — | 19,942 | — | — | (12,863 | ) | ||||||||||||||||||
5,751 | $ | 1,584,656 | $ | 275.55 | $ | 1,383,213 | $ | 240.52 | 87.3 | % | $ | 201,443 |
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | The Illinois health plan’s results prior to October 1, 2013, were insignificant and reported in “Other.” | |
(4) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA, CONTINUING OPERATIONS (In thousands, except percentages and per-member-per-month amounts) |
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Nine Months Ended September 30, 2014 | ||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
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Total | PMPM | Total | PMPM | |||||||||||||||||||||||
California | 4,040 | $ | 1,059,860 | $ | 262.34 | $ | 889,656 | $ | 220.21 | 83.9 | % | $ | 170,204 | |||||||||||||
Florida | 742 | 312,864 | 421.80 | 290,224 | 391.28 | 92.8 | 22,640 | |||||||||||||||||||
Illinois (3) | 69 | 68,948 | 998.03 | 63,299 | 916.26 | 91.8 | 5,649 | |||||||||||||||||||
Michigan | 2,077 | 567,706 | 273.28 | 476,392 | 229.33 | 83.9 | 91,314 | |||||||||||||||||||
New Mexico | 1,818 | 777,120 | 427.55 | 702,257 | 386.36 | 90.4 | 74,863 | |||||||||||||||||||
Ohio | 2,615 | 1,061,335 | 405.81 | 909,142 | 347.62 | 85.7 | 152,193 | |||||||||||||||||||
South Carolina | 1,109 | 287,928 | 259.69 | 249,437 | 224.97 | 86.6 | 38,491 | |||||||||||||||||||
Texas | 2,239 | 978,492 | 437.00 | 897,434 | 400.80 | 91.7 | 81,058 | |||||||||||||||||||
Utah | 745 | 233,931 | 314.13 | 215,564 | 289.47 | 92.1 | 18,367 | |||||||||||||||||||
Washington | 4,050 | 941,303 | 232.40 | 877,418 | 216.63 | 93.2 | 63,885 | |||||||||||||||||||
Wisconsin | 782 | 118,386 | 151.48 | 100,059 | 128.03 | 84.5 | 18,327 | |||||||||||||||||||
Other (4) | — | 16,365 | — | 82,911 | — | — | (66,546 | ) | ||||||||||||||||||
20,286 | $ | 6,424,238 | $ | 316.69 | $ | 5,753,793 | $ | 283.64 | 89.6 | % | $ | 670,445 |
Nine Months Ended September 30, 2013 | ||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
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Total | PMPM | Total | PMPM | |||||||||||||||||||||||
California | 3,132 | $ | 552,950 | $ | 176.54 | $ | 497,314 | $ | 158.78 | 89.9 | % | $ | 55,636 | |||||||||||||
Florida | 712 | 187,689 | 263.62 | 161,446 | 226.76 | 86.0 | 26,243 | |||||||||||||||||||
Illinois | — | — | — | — | — | — | — | |||||||||||||||||||
Michigan | 1,941 | 508,748 | 262.14 | 432,105 | 222.65 | 84.9 | 76,643 | |||||||||||||||||||
New Mexico | 984 | 298,767 | 303.59 | 252,001 | 256.07 | 84.3 | 46,766 | |||||||||||||||||||
Ohio | 2,234 | 819,879 | 367.03 | 688,266 | 308.11 | 83.9 | 131,613 | |||||||||||||||||||
South Carolina | — | — | — | — | — | — | — | |||||||||||||||||||
Texas | 2,417 | 969,063 | 400.90 | 829,854 | 343.31 | 85.6 | 139,209 | |||||||||||||||||||
Utah | 781 | 236,992 | 303.41 | 193,261 | 247.42 | 81.5 | 43,731 | |||||||||||||||||||
Washington | 3,722 | 892,627 | 239.85 | 779,339 | 209.41 | 87.3 | 113,288 | |||||||||||||||||||
Wisconsin | 780 | 104,540 | 134.04 | 82,543 | 105.84 | 79.0 | 21,997 | |||||||||||||||||||
Other (3)(4) | — | 12,563 | — | 49,705 | — | — | (37,142 | ) | ||||||||||||||||||
16,703 | $ | 4,583,818 | $ | 274.43 | $ | 3,965,834 | $ | 237.43 | 86.5 | % | $ | 617,984 |
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | The Illinois health plan’s results prior to October 1, 2013, were insignificant and reported in “Other.” | |
(4) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED FINANCIAL DATA (Dollars in thousands, except per-member-per-month amounts)
|
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The following tables provide the details of the Company’s medical care costs from continuing operations for the periods indicated: |
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Three Months Ended September 30, | |||||||||||||||||||||
2014 | 2013 | ||||||||||||||||||||
Amount | PMPM |
% of
Total |
Amount | PMPM |
% of
Total |
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Fee for service | $ | 1,469,765 | $ | 206.43 | 70.1 | % | $ | 928,165 | $ | 161.39 | 67.1 | % | |||||||||
Pharmacy | 337,150 | 47.35 | 16.1 | 237,073 | 41.22 | 17.1 | |||||||||||||||
Capitation | 190,277 | 26.73 | 9.1 | 162,554 | 28.27 | 11.8 | |||||||||||||||
Direct delivery | 24,863 | 3.49 | 1.1 | 9,612 | 1.67 | 0.7 | |||||||||||||||
Other | 75,781 | 10.65 | 3.6 | 45,809 | 7.97 | 3.3 | |||||||||||||||
$ | 2,097,836 | $ | 294.65 | 100.0 | % | $ | 1,383,213 | $ | 240.52 | 100.0 | % | ||||||||||
Nine Months Ended September 30, | |||||||||||||||||||||
2014 | 2013 | ||||||||||||||||||||
Amount | PMPM |
% of
Total |
Amount | PMPM |
% of
Total |
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Fee for service | $ | 4,028,863 | $ | 198.61 | 70.0 | % | $ | 2,674,785 | $ | 160.14 | 67.5 | % | |||||||||
Pharmacy | 919,374 | 45.32 | 16.0 | 691,903 | 41.42 | 17.4 | |||||||||||||||
Capitation | 536,533 | 26.45 | 9.3 | 441,287 | 26.42 | 11.1 | |||||||||||||||
Direct delivery | 69,947 | 3.45 | 1.2 | 27,739 | 1.66 | 0.7 | |||||||||||||||
Other | 199,076 | 9.81 | 3.5 | 130,120 | 7.79 | 3.3 | |||||||||||||||
$ | 5,753,793 | $ | 283.64 | 100.0 | % | $ | 3,965,834 | $ | 237.43 | 100.0 | % | ||||||||||
The following table provides the details of the Company’s medical claims and benefits payable as of the dates indicated: |
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Sept. 30,
2014 |
Dec. 31,
2013 |
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Fee-for-service claims incurred but not paid (IBNP) | $ | 796,433 | $ | 424,173 | |||
Pharmacy payable | 62,322 | 45,037 | |||||
Capitation payable | 31,535 | 20,267 | |||||
Other (1) | 233,556 | 180,310 | |||||
$ | 1,123,846 | $ | 669,787 | ||||
(1) “Other” medical claims and benefits payable include amounts payable to certain providers for which the Company acts as an intermediary on behalf of various state agencies without assuming financial risk. Such receipts and payments do not impact our consolidated statements of income. Such non-risk provider payables amounted to $136.0 million and $151.3 million as of September 30, 2014 and December 31, 2013, respectively. |
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MOLINA HEALTHCARE, INC.
UNAUDITED CHANGE IN MEDICAL CLAIMS
AND BENEFITS PAYABLE
The Company’s claims liability includes an allowance for adverse claims development based on historical experience and other factors including, but not limited to, variations in claims payment patterns, changes in utilization and cost trends, known outbreaks of disease, and large claims. The Company’s reserving methodology is consistently applied across all periods presented. The amounts displayed for “Components of medical care costs related to: Prior period” represent the amount by which the Company’s original estimate of claims and benefits payable at the beginning of the period were more than the actual amount of the liability based on information (principally the payment of claims) developed since that liability was first reported. The following table shows the components of the change in medical claims and benefits payable from continuing and discontinued operations as of the periods indicated:
Nine Months Ended |
Year Ended |
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2014 | 2013 | |||||||||||
(Dollars in thousands, except per-member amounts) | ||||||||||||
Balances at beginning of period | $ | 669,787 | $ | 494,530 | $ | 494,530 | ||||||
Components of medical care costs related to: | ||||||||||||
Current period | 5,795,404 | 4,021,461 | 5,434,443 | |||||||||
Prior period | (41,033 | ) | (54,040 | ) | (52,779 | ) | ||||||
Total medical care costs | 5,754,371 | 3,967,421 | 5,381,664 | |||||||||
Change in non-risk provider payables | (15,344 | ) | 83,671 | 111,267 | ||||||||
Payments for medical care costs related to: | ||||||||||||
Current period | 4,841,429 | 3,534,392 | 4,932,195 | |||||||||
Prior period | 443,539 | 378,524 | 385,479 | |||||||||
Total paid | 5,284,968 | 3,912,916 | 5,317,674 | |||||||||
Balances at end of period | $ | 1,123,846 | $ | 632,706 | $ | 669,787 | ||||||
Benefit from prior period as a percentage of: | ||||||||||||
Balance at beginning of period | 6.1 | % | 10.9 | % | 10.7 | % | ||||||
Premium revenue, trailing twelve months | 0.5 | % | 0.9 | % | 0.9 | % | ||||||
Medical care costs, trailing twelve months | 0.6 | % | 1.0 | % | 1.0 | % | ||||||
Claims Data: | ||||||||||||
Days in claims payable, fee for service | 50 | 41 | 43 | |||||||||
Number of members at end of period | 2,404,000 | 1,942,000 | 1,931,000 | |||||||||
Number of claims in inventory at end of period | 315,900 | 137,100 | 145,800 | |||||||||
Billed charges of claims in inventory at end of period | $ | 749,300 | $ | 257,600 | $ | 276,500 | ||||||
Claims in inventory per member at end of period | 0.13 | 0.07 | 0.08 | |||||||||
Billed charges of claims in inventory per member
at end of period |
$ | 311.69 | $ | 132.65 | $ | 143.19 | ||||||
Number of claims received during the period | 19,703,300 | 15,751,500 | 21,317,500 | |||||||||
Billed charges of claims received during the period | $ | 21,506,500 | $ | 15,848,900 | $ | 21,414,600 | ||||||
MOLINA HEALTHCARE, INC. ACA HIF MEDICAID REVENUE DETAILS BY HEALTH PLAN (In thousands) |
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Three Months Ended |
Nine Months |
Required |
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March 31, |
June 30, |
Sept. 30, |
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Gross (1) | |||||||||||||||||||
California | $ | — | $ | — | $ | — | $ | — | $ | 11,616 | |||||||||
Florida | 1,416 | 1,473 | 1,487 | 4,376 | 5,835 | ||||||||||||||
Illinois | 40 | 42 | 40 | 122 | 162 | ||||||||||||||
Michigan | — | — | 8,011 | 8,011 | 17,471 | ||||||||||||||
New Mexico | — | — | — | — | 11,322 | ||||||||||||||
Ohio | 7,791 | 8,117 | 6,912 | 22,820 | 30,426 | ||||||||||||||
Texas | — | — | — | — | 18,518 | ||||||||||||||
Utah | — | — | 3,000 | 3,000 | 5,332 | ||||||||||||||
Washington | 6,229 | 6,489 | 6,217 | 18,935 | 25,246 | ||||||||||||||
Wisconsin | 1,080 | 1,126 | 1,372 | 3,578 | 4,771 | ||||||||||||||
Medicaid | 16,556 | 17,247 | 27,039 | 60,842 | 130,699 | ||||||||||||||
Medicare | 2,892 | 3,199 | 3,068 | 9,159 | 12,212 | ||||||||||||||
$ | 19,448 | $ | 20,446 | $ | 30,107 | $ | 70,001 | $ | 142,911 | ||||||||||
(1) Amounts in the table include the full economic impact of the excise tax including premium tax and the income tax effect. |
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CONTACT:
Molina Healthcare, Inc.
Juan José Orellana, 562-435-3666,
ext. 111143
Investor Relations