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): July 30, 2015
______________
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 July 30, 2015, Molina Healthcare, Inc. issued a press release announcing its financial results for the second quarter and six months ended June 30, 2015. 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 July 30, 2015, as to financial results for the second quarter and six months ended June 30, 2015. |
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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|
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Date: | July 30, 2015 | By: |
/s/ Jeff D. Barlow |
Jeff D. Barlow |
|||
Chief Legal Officer and Secretary |
EXHIBIT INDEX
Exhibit |
|
No. | Description |
99.1 |
Press release of Molina Healthcare, Inc. issued July 30, 2015, as to financial results for the second quarter and six months ended June 30, 2015. |
Exhibit 99.1
Molina Healthcare Reports Second Quarter 2015 Results
LONG BEACH, Calif.--(BUSINESS WIRE)--July 30, 2015--Molina Healthcare, Inc. (NYSE: MOH):
Molina Healthcare, Inc. (NYSE: MOH) today reported its financial results for the second quarter of 2015.
“Our second quarter results mark continued progress and momentum in our business. We were able to improve our profit margins while simultaneously growing our top-line revenue and enrollment,” said J. Mario Molina M.D., chief executive officer of Molina Healthcare, Inc. “We remain confident that we have the right plans in place for the rest of 2015 and look forward to closing our recently announced Medicaid acquisitions in Florida, Illinois, and Michigan later this year.”
Overview of Financial Results, Continuing Operations
Financial results for the second quarter of 2015 improved significantly over the same quarter of 2014 due to higher revenue, greater medical and administrative cost efficiency, and more complete state reimbursement of the Affordable Care Act Health Insurer Fee (HIF).
Income from continuing operations, before tax expense, increased to $101 million in the second quarter of 2015, from $18 million in the second quarter of 2014, and $67 million in the first quarter of this year.
Premium revenue increased approximately 52% in the second quarter of 2015 compared with the second quarter of 2014 due to increased Medicaid expansion and Marketplace enrollment, growth in the Company’s Illinois health plan, and the recent start-up of the Company’s Puerto Rico health plan.
Medical care costs as a percent of premium revenue (the “medical care ratio”) decreased to 88.7% in the second quarter of 2015, from 89.3% in the second quarter of 2014, and were unchanged from the first quarter of this year.
General and administrative expenses as a percentage of total revenue (the “general and administrative expense ratio”) decreased to 8.1% in the second quarter of 2015, from 8.4% in the second quarter of 2014, and were unchanged from the first quarter of this year.
Financing Activities
In June 2015, the Company issued 5.75 million shares of common stock, raising $373 million after offering costs. Additionally in June 2015, the Company entered into a $250 million revolving credit facility. Both of these actions will finance working capital needs, acquisitions, capital expenditures, and other general corporate activities.
Health Insurer Fee Update
The Company continues to make progress in securing full reimbursement for the Medicaid portion of its expense under the Affordable Care Act Health Insurer Fee (HIF).
During the second quarter of 2015, the Company recognized as revenue the entire HIF reimbursement due from California for the period January 1, 2014 through June 30, 2015. The Company recognized approximately $12 million ($0.14 per diluted share) related to 2014; and approximately $17 million ($0.20 per diluted share) related to the first half of 2015. After allowing for HIF revenue not recognized for Michigan and Utah (approximately $8 million, or $0.10 per diluted share, for each of the first and second quarters), the net impact of HIF reimbursement was $12 million ($0.14 per diluted share) favorable for the second quarter and $5 million ($0.06 per diluted share) unfavorable for the six months ended June 30.
The comparable amount of HIF reimbursement not recognized in 2014 was approximately $15 million ($0.20 per diluted share) for the second quarter and approximately $32 million ($0.42 per diluted share) for the six months ended June 30.
Texas Health Plan Quality Revenue Update
As previously disclosed, the Company has deferred recognition of that portion of its quality related revenue in Texas that is based upon measures for which the Company does not have historical information, clear definitions, and clarity around minimum standards. Such revenue is estimated to be approximately $20 million for all of 2014 and $12 million for the first half of 2015. The Company has not recognized any of this revenue through June 30, 2015.
Conference Call
The Company’s management will host a conference call and webcast to discuss its second quarter results at 5:00 p.m. Eastern time on Thursday, July 30, 2015. The number to call for the interactive teleconference is (212) 231-2937. A telephonic replay of the conference call will be available from 7:00 p.m. Eastern time on Thursday, July 30, 2015, through 6:00 p.m. on Friday, July 31, 2015, by dialing (800) 633-8284 and entering confirmation number 21770257. A live audio broadcast of Molina Healthcare’s conference call will be available on the Company’s website, 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 and in the Commonwealth of Puerto Rico, Molina currently serves over 3 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 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 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 July 30, 2015, 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.
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED STATEMENTS OF INCOME |
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Three Months Ended
June 30, |
Six Months Ended
June 30, |
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2015 | 2014 | 2015 | 2014 | ||||||||||||||
(Amounts in thousands, except net income per share) | |||||||||||||||||
Revenue: | |||||||||||||||||
Premium revenue | $ | 3,304,372 | $ | 2,167,142 | $ | 6,275,024 | $ | 4,107,479 | |||||||||
Service revenue | 47,243 | 50,232 | 99,101 | 103,862 | |||||||||||||
Premium tax revenue | 94,609 | 70,120 | 189,956 | 121,813 | |||||||||||||
Health insurer fee revenue | 73,890 | 19,662 | 121,838 | 38,358 | |||||||||||||
Investment income | 3,828 | 1,945 | 6,843 | 3,574 | |||||||||||||
Other revenue | 948 | 2,938 | 3,251 | 6,196 | |||||||||||||
Total revenue | 3,524,890 | 2,312,039 | 6,696,013 | 4,381,282 | |||||||||||||
Operating expenses: | |||||||||||||||||
Medical care costs | 2,929,534 | 1,934,299 | 5,565,318 | 3,655,957 | |||||||||||||
Cost of service revenue | 32,819 | 37,107 | 68,721 | 77,764 | |||||||||||||
General and administrative expenses | 286,496 | 193,239 | 542,586 | 381,326 | |||||||||||||
Premium tax expenses | 94,609 | 70,120 | 189,956 | 121,813 | |||||||||||||
Health insurer fee expenses | 40,652 | 21,945 | 81,430 | 44,135 | |||||||||||||
Depreciation and amortization | 25,152 | 22,902 | 50,144 | 43,593 | |||||||||||||
Total operating expenses | 3,409,262 | 2,279,612 | 6,498,155 | 4,324,588 | |||||||||||||
Operating income | 115,628 | 32,427 | 197,858 | 56,694 | |||||||||||||
Other expenses, net: | |||||||||||||||||
Interest expense | 14,946 | 13,993 | 29,822 | 27,815 | |||||||||||||
Other income, net | (32 | ) | (9 | ) | (42 | ) | (53 | ) | |||||||||
Total other expenses, net | 14,914 | 13,984 | 29,780 | 27,762 | |||||||||||||
Income from continuing operations before income tax expense |
100,714 | 18,443 | 168,078 | 28,932 | |||||||||||||
Income tax expense | 61,783 | 10,702 | 101,006 | 16,357 | |||||||||||||
Income from continuing operations | 38,931 | 7,741 | 67,072 | 12,575 | |||||||||||||
Income (loss) from discontinued operations, net of tax |
12 | 70 | 24 | (266 | ) | ||||||||||||
Net income | $ | 38,943 | $ | 7,811 | $ | 67,096 | $ | 12,309 | |||||||||
Diluted net income per share: | |||||||||||||||||
Income from continuing operations | $ | 0.72 | $ | 0.16 | $ | 1.29 | $ | 0.26 | |||||||||
Diluted net income per share | $ | 0.72 | $ | 0.16 | $ | 1.29 | $ | 0.26 | |||||||||
Diluted weighted average shares outstanding | 53,871 | 48,003 | 52,008 | 47,824 | |||||||||||||
Operating Statistics, Continuing Operations: | |||||||||||||||||
Medical care ratio (1) | 88.7 | % | 89.3 | % | 88.7 |
% |
89.0 | % | |||||||||
Service revenue ratio (2) | 69.5 | % | 73.9 | % | 69.3 | % | 74.9 | % | |||||||||
General and administrative expense ratio (3) | 8.1 | % | 8.4 | % | 8.1 | % | 8.7 | % | |||||||||
Premium tax ratio (1) | 2.8 | % | 3.1 | % | 2.9 | % | 2.9 | % | |||||||||
Effective tax rate | 61.3 | % | 58.0 | % | 60.1 | % | 56.5 | % | |||||||||
Net profit margin, continuing operations (3) | 1.1 | % | 0.3 | % | 1.0 | % | 0.3 | % | |||||||||
(1) 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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(2) Service revenue ratio represents cost of service revenue as a percentage of service revenue. |
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(3) Computed as a percentage of total revenue. |
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MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED BALANCE SHEETS |
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June 30, 2015 |
December 31, 2014 |
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(Unaudited) | |||||||||
(Amounts in thousands, except per-share data) |
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ASSETS | |||||||||
Current assets: | |||||||||
Cash and cash equivalents | $ | 2,013,882 | $ | 1,539,063 | |||||
Investments | 1,466,622 | 1,019,462 | |||||||
Receivables | 631,124 | 596,456 | |||||||
Deferred income taxes | 37,480 | 39,532 | |||||||
Prepaid expenses and other current assets | 148,615 | 50,884 | |||||||
Derivative asset | 508,504 | — | |||||||
Total current assets | 4,806,227 | 3,245,397 | |||||||
Property, equipment, and capitalized software, net | 363,244 | 340,778 | |||||||
Deferred contract costs | 65,410 | 53,675 | |||||||
Intangible assets, net | 80,462 | 89,273 | |||||||
Goodwill | 272,046 | 271,964 | |||||||
Restricted investments | 110,956 | 102,479 | |||||||
Derivative asset | — | 329,323 | |||||||
Other assets | 37,814 | 44,326 | |||||||
$ | 5,736,159 | $ | 4,477,215 | ||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | |||||||||
Current liabilities: | |||||||||
Medical claims and benefits payable | $ | 1,492,252 | $ | 1,200,522 | |||||
Amounts due government agencies | 824,934 | 527,193 | |||||||
Accounts payable and accrued liabilities | 399,186 | 241,654 | |||||||
Deferred revenue | 57,723 | 196,076 | |||||||
Income taxes payable | 10,396 | 8,987 | |||||||
Current portion of long-term debt | 445,668 | 341 | |||||||
Derivative liability | 508,355 | — | |||||||
Total current liabilities | 3,738,514 | 2,174,773 | |||||||
Convertible senior notes | 272,930 | 704,097 | |||||||
Lease financing obligations | 161,323 | 160,710 | |||||||
Lease financing obligations - related party | 40,016 | 40,241 | |||||||
Deferred income taxes | 29,174 | 24,271 | |||||||
Derivative liability | — | 329,194 | |||||||
Other long-term liabilities | 31,095 | 33,487 | |||||||
Total liabilities | 4,273,052 | 3,466,773 | |||||||
Stockholders’ equity: | |||||||||
Common stock, $0.001 par value; 150,000 shares authorized; outstanding: 56,050 shares at June 30, 2015 and 49,727 shares at December 31, 2014 | 56 | 50 | |||||||
Preferred stock, $0.001 par value; 20,000 shares authorized, no shares issued and outstanding | — | — | |||||||
Additional paid-in capital | 782,433 | 396,059 | |||||||
Accumulated other comprehensive loss | (1,830 | ) | (1,019 | ) | |||||
Retained earnings | 682,448 | 615,352 | |||||||
Total stockholders’ equity | 1,463,107 | 1,010,442 | |||||||
$ | 5,736,159 | $ | 4,477,215 |
MOLINA HEALTHCARE, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS, CONTINUING AND DISCONTINUED OPERATIONS |
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Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||||
2015 | 2014 | 2015 | 2014 | |||||||||||||||
(Amounts in thousands) | ||||||||||||||||||
Operating activities: | ||||||||||||||||||
Net income | $ | 38,943 | $ | 7,811 | $ | 67,096 | $ | 12,309 | ||||||||||
Adjustments to reconcile net income to net cash provided by operating activities: |
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Depreciation and amortization | 29,502 | 32,660 | 62,076 | 65,654 | ||||||||||||||
Deferred income taxes | 6,308 | 2,362 | 7,405 | 1,692 | ||||||||||||||
Share-based compensation | 3,566 | 4,860 | 9,241 | 10,456 | ||||||||||||||
Amortization of convertible senior notes and lease financing obligations | 7,395 | 6,781 | 14,685 | 13,455 | ||||||||||||||
Other, net | 5,077 | 3,271 | 8,641 | 1,723 | ||||||||||||||
Changes in operating assets and liabilities: | ||||||||||||||||||
Receivables | (139,694 | ) | (135,282 | ) | (34,668 | ) | (174,579 | ) | ||||||||||
Prepaid expenses and other current assets | 40,251 | 11,136 | (97,027 | ) | (66,887 | ) | ||||||||||||
Medical claims and benefits payable | 44,120 | 104,641 | 291,730 | 254,395 | ||||||||||||||
Amounts due government agencies | 202,776 | 76,607 | 297,741 | 119,872 | ||||||||||||||
Accounts payable and accrued liabilities | (31,639 | ) | (1,327 | ) | 157,734 | 57,625 | ||||||||||||
Deferred revenue | (112,088 | ) | (100,331 | ) | (138,353 | ) | (76,271 | ) | ||||||||||
Income taxes | (440 | ) | 11,374 | 1,409 | 16,016 | |||||||||||||
Net cash provided by operating activities | 94,077 | 24,563 | 647,710 | 235,460 | ||||||||||||||
Investing activities: | ||||||||||||||||||
Purchases of investments | (554,387 | ) | (226,159 | ) | (992,978 | ) | (368,304 | ) | ||||||||||
Proceeds from sales and maturities of investments | 285,441 | 179,278 | 541,050 | 326,648 | ||||||||||||||
Purchases of property, equipment, and capitalized software |
(40,886 | ) | (19,882 | ) | (65,860 | ) | (37,670 | ) | ||||||||||
Increase in restricted investments | (9,590 | ) | (1,241 | ) | (14,202 | ) | (15,622 | ) | ||||||||||
Net cash paid in business combinations | — | — | (8,006 | ) | — | |||||||||||||
Other, net | (9,637 | ) | (6,841 | ) | (16,853 | ) | (7,388 | ) | ||||||||||
Net cash used in investing activities | (329,059 | ) | (74,845 | ) | (556,849 | ) | (102,336 | ) | ||||||||||
Financing activities: | ||||||||||||||||||
Proceeds from common stock offering, net of issuance costs | 373,151 | — | 373,151 | — | ||||||||||||||
Contingent consideration liabilities settled | — | (12,230 | ) | — | (50,349 | ) | ||||||||||||
Proceeds from employee stock plans | 7,298 | 6,287 | 8,387 | 7,617 | ||||||||||||||
Other, net | (1,609 | ) | 207 | 2,420 | 1,064 | |||||||||||||
Net cash provided by (used in) financing activities | 378,840 | (5,736 | ) | 383,958 | (41,668 | ) | ||||||||||||
Net increase (decrease) in cash and cash equivalents | 143,858 | (56,018 | ) | 474,819 | 91,456 | |||||||||||||
Cash and cash equivalents at beginning of period | 1,870,024 | 1,083,369 | 1,539,063 | 935,895 | ||||||||||||||
Cash and cash equivalents at end of period | $ | 2,013,882 | $ | 1,027,351 | $ | 2,013,882 | $ | 1,027,351 |
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 | Six Months Ended | ||||||||||||||||
June 30, | June 30, | ||||||||||||||||
2015 | 2014 | 2015 | 2014 | ||||||||||||||
(Amounts in thousands) | |||||||||||||||||
Net income | $ | 38,943 | $ | 7,811 | $ | 67,096 | $ | 12,309 | |||||||||
Adjustments: | |||||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 28,688 | 28,292 | 57,798 | 54,206 | |||||||||||||
Interest expense | 14,946 | 13,993 | 29,822 | 27,815 | |||||||||||||
Income tax expense | 61,799 | 10,760 | 101,039 | 15,997 | |||||||||||||
EBITDA | $ | 144,376 | $ | 60,856 | $ | 255,755 | $ | 110,327 | |||||||||
The second of these non-GAAP measures is adjusted net income, continuing operations (including adjusted net income per diluted share). The following table reconciles net income from continuing operations, which the Company believes to be the most comparable GAAP measure, to adjusted net income, continuing operations.
Three Months Ended June 30, | Six Months Ended June 30, | ||||||||||||||||||||||||||||||||
2015 | 2014 | 2015 | 2014 | ||||||||||||||||||||||||||||||
(In thousands, except per diluted share amounts) | |||||||||||||||||||||||||||||||||
Net income, continuing operations | $ | 38,931 | $ | 0.72 | $ | 7,741 | $ | 0.16 | $ | 67,072 | $ | 1.29 | $ | 12,575 | $ | 0.26 | |||||||||||||||||
Adjustments, net of tax: | |||||||||||||||||||||||||||||||||
Amortization of convertible senior notes and lease financing obligations | 4,659 | 0.09 | 4,272 | 0.09 | 9,252 | 0.18 | 8,477 | 0.18 | |||||||||||||||||||||||||
Amortization of intangible assets | 2,671 | 0.05 | 3,209 | 0.07 | 5,548 | 0.10 | 6,538 | 0.14 | |||||||||||||||||||||||||
Adjusted net income, continuing operations (1) | $ | 46,261 | $ | 0.86 | $ | 15,222 | $ | 0.32 | $ | 81,872 | $ | 1.57 | $ | 27,590 | $ | 0.58 | |||||||||||||||||
(1) Beginning in the first quarter of 2015, the Company revised its calculation of adjusted net income, continuing operations. The Company no longer subtracts “depreciation, and amortization of capitalized software” and “share-based compensation” from net income, continuing operations to arrive at adjusted net income, continuing operations. The Company has made this change to better reflect the way in which it evaluates its financial performance, makes financing and business decisions, and forecasts and plans for future periods. All periods presented conform to this presentation.
MOLINA HEALTHCARE, INC. UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP, CONTINUING OPERATIONS |
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June 30, 2015 |
March 31, 2015 |
December 31, 2014 |
June 30, 2014 |
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Ending Membership by Health Plan: | ||||||||||||
California | 593,000 | 574,000 | 531,000 | 455,000 | ||||||||
Florida | 348,000 | 352,000 | 164,000 | 58,000 | ||||||||
Illinois | 101,000 | 102,000 | 100,000 | 6,000 | ||||||||
Michigan | 260,000 | 256,000 | 242,000 | 244,000 | ||||||||
New Mexico | 225,000 | 222,000 | 212,000 | 195,000 | ||||||||
Ohio | 332,000 | 350,000 | 347,000 | 302,000 | ||||||||
Puerto Rico (1) |
361,000 | — | — | — | ||||||||
South Carolina | 114,000 | 111,000 | 118,000 | 119,000 | ||||||||
Texas | 266,000 | 268,000 | 245,000 | 247,000 | ||||||||
Utah | 92,000 | 90,000 | 83,000 | 83,000 | ||||||||
Washington | 553,000 | 533,000 | 497,000 | 461,000 | ||||||||
Wisconsin | 107,000 | 107,000 | 84,000 | 85,000 | ||||||||
3,352,000 | 2,965,000 | 2,623,000 | 2,255,000 | |||||||||
Ending Membership by Program: | ||||||||||||
Temporary Assistance for Needy Families (TANF), CHIP (2) | 2,180,000 | 1,825,000 | 1,809,000 | 1,642,000 | ||||||||
Medicaid Expansion (3) | 475,000 | 437,000 | 385,000 | 232,000 | ||||||||
Aged, Blind or Disabled (ABD) | 353,000 | 358,000 | 347,000 | 314,000 | ||||||||
Marketplace (3) | 261,000 | 266,000 | 15,000 | 18,000 | ||||||||
Medicare Special Needs Plans | 44,000 | 45,000 | 49,000 | 44,000 | ||||||||
Medicare-Medicaid Plan (MMP) – Integrated (4) | 39,000 | 34,000 | 18,000 | 5,000 | ||||||||
3,352,000 | 2,965,000 | 2,623,000 | 2,255,000 | |||||||||
(1) The Puerto Rico health plan began serving members effective April 1, 2015. |
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(2) CHIP stands for Children’s Health Insurance Program. |
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(3) Medicaid Expansion membership phased in, and Marketplace became available for consumers to access coverage, beginning January 1, 2014. |
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(4) MMP members who receive both Medicaid and Medicare coverage from the Company. The Company began serving members under this program in the second quarter of 2014.
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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 June 30, 2015 | |||||||||||||||||||||||||||
Member
Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical Margin |
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Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
California | 1,767 | $ | 503,739 | $ | 285.14 | $ | 459,045 | $ | 259.85 | 91.1 | % | $ | 44,694 | ||||||||||||||
Florida | 1,053 | 257,317 | 244.35 | 216,906 | 205.97 | 84.3 | 40,411 | ||||||||||||||||||||
Illinois | 301 | 101,769 | 337.55 | 98,260 | 325.91 | 96.6 | 3,509 | ||||||||||||||||||||
Michigan | 773 | 237,506 | 307.27 | 199,940 | 258.67 | 84.2 | 37,566 | ||||||||||||||||||||
New Mexico | 690 | 321,808 | 466.46 | 276,144 | 400.27 | 85.8 | 45,664 | ||||||||||||||||||||
Ohio | 996 | 508,468 | 510.30 | 432,186 | 433.75 | 85.0 | 76,282 | ||||||||||||||||||||
Puerto Rico | 1,082 | 193,984 | 179.33 | 184,240 | 170.32 | 95.0 | 9,744 | ||||||||||||||||||||
South Carolina | 337 | 93,089 | 276.36 | 66,332 | 196.92 | 71.3 | 26,757 | ||||||||||||||||||||
Texas | 806 | 512,408 | 635.74 | 468,629 | 581.42 | 91.5 | 43,779 | ||||||||||||||||||||
Utah | 277 | 79,964 | 288.60 | 71,727 | 258.88 | 89.7 | 8,237 | ||||||||||||||||||||
Washington | 1,643 | 409,758 | 249.39 | 370,437 | 225.46 | 90.4 | 39,321 | ||||||||||||||||||||
Wisconsin | 320 | 74,532 | 233.15 | 56,140 | 175.62 | 75.3 | 18,392 | ||||||||||||||||||||
Other (3) | — | 10,030 | — | 29,548 | — | — | (19,518 | ) | |||||||||||||||||||
10,045 | $ | 3,304,372 | $ | 328.96 | $ | 2,929,534 | $ | 291.65 | 88.7 | % | $ | 374,838 | |||||||||||||||
Three Months Ended June 30, 2014 | |||||||||||||||||||||||||||
Member
Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical Margin |
|||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
California | 1,335 | $ | 398,071 | $ | 298.11 | $ | 324,923 | $ | 243.33 | 81.6 | % | $ | 73,148 | ||||||||||||||
Florida | 229 | 101,423 | 443.05 | 92,865 | 405.67 | 91.6 | 8,558 | ||||||||||||||||||||
Illinois | 17 | 19,263 | 1,136.20 | 20,472 | 1,207.48 | 106.3 | (1,209 | ) | |||||||||||||||||||
Michigan | 702 | 185,337 | 264.18 | 163,392 | 232.89 | 88.2 | 21,945 | ||||||||||||||||||||
New Mexico | 617 | 267,994 | 434.57 | 240,151 | 389.42 | 89.6 | 27,843 | ||||||||||||||||||||
Ohio | 849 | 328,630 | 386.79 | 276,716 | 325.69 | 84.2 | 51,914 | ||||||||||||||||||||
Puerto Rico | — | — | — | — | — | — | — | ||||||||||||||||||||
South Carolina | 360 | 96,453 | 268.38 | 84,686 | 235.64 | 87.8 | 11,767 | ||||||||||||||||||||
Texas | 742 | 320,966 | 432.46 | 297,899 | 401.38 | 92.8 | 23,067 | ||||||||||||||||||||
Utah | 249 | 76,574 | 307.47 | 73,094 | 293.49 | 95.5 | 3,480 | ||||||||||||||||||||
Washington | 1,364 | 336,959 | 247.03 | 305,098 | 223.67 | 90.5 | 31,861 | ||||||||||||||||||||
Wisconsin | 256 | 36,925 | 144.42 | 33,143 | 129.63 | 89.8 | 3,782 | ||||||||||||||||||||
Other (3) | — | (1,453 | ) | — | 21,860 | — | — | (23,313 | ) | ||||||||||||||||||
6,720 | $ | 2,167,142 | $ | 322.52 | $ | 1,934,299 | $ | 287.87 | 89.3 | % | $ | 232,843 | |||||||||||||||
(1) A member month is defined as the aggregate of each month’s ending membership for the period presented. |
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(2) The MCR represents medical costs as a percentage of premium revenue. |
|||||||||||||||||||||||||||
(3) “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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Six Months Ended June 30, 2015 | |||||||||||||||||||||||||||
Member
Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical Margin |
|||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
California | 3,440 | $ | 1,014,283 | $ | 294.85 | $ | 911,480 | $ | 264.97 | 89.9 | % | $ | 102,803 | ||||||||||||||
Florida | 1,950 | 568,288 | 291.33 | 498,295 | 255.45 | 87.7 | 69,993 | ||||||||||||||||||||
Illinois | 606 | 205,914 | 339.72 | 187,697 | 309.66 | 91.2 | 18,217 | ||||||||||||||||||||
Michigan | 1,529 | 457,031 | 298.87 | 384,703 | 251.57 | 84.2 | 72,328 | ||||||||||||||||||||
New Mexico | 1,374 | 635,464 | 462.62 | 567,970 | 413.48 | 89.4 | 67,494 | ||||||||||||||||||||
Ohio | 2,051 | 1,023,555 | 498.96 | 845,260 | 412.05 | 82.6 | 178,295 | ||||||||||||||||||||
Puerto Rico | 1,082 | 193,984 | 179.33 | 184,240 | 170.32 | 95.0 | 9,744 | ||||||||||||||||||||
South Carolina | 680 | 184,415 | 271.35 | 140,601 | 206.88 | 76.2 | 43,814 | ||||||||||||||||||||
Texas | 1,581 | 894,193 | 565.45 | 820,107 | 518.60 | 91.7 | 74,086 | ||||||||||||||||||||
Utah | 543 | 157,106 | 289.42 | 145,871 | 268.72 | 92.8 | 11,235 | ||||||||||||||||||||
Washington | 3,206 | 786,108 | 245.22 | 722,811 | 225.47 | 91.9 | 63,297 | ||||||||||||||||||||
Wisconsin | 622 | 134,874 | 216.85 | 104,849 | 168.58 | 77.7 | 30,025 | ||||||||||||||||||||
Other (3) | — | 19,809 | — | 51,434 | — | — | (31,625 | ) | |||||||||||||||||||
18,664 | $ | 6,275,024 | $ | 336.21 | $ | 5,565,318 | $ | 298.18 | 88.7 | % | $ | 709,706 | |||||||||||||||
Six Months Ended June 30, 2014 | |||||||||||||||||||||||||||
Member
Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical Margin |
|||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
California | 2,589 | $ | 675,713 | $ | 260.97 | $ | 562,267 | $ | 217.16 | 83.2 | % | $ | 113,446 | ||||||||||||||
Florida | 499 | 206,589 | 414.17 | 186,326 | 373.55 | 90.2 | 20,263 | ||||||||||||||||||||
Illinois | 31 | 34,434 | 1,109.99 | 34,966 | 1,127.12 | 101.5 | (532 | ) | |||||||||||||||||||
Michigan | 1,350 | 358,833 | 265.81 | 298,712 | 221.27 | 83.2 | 60,121 | ||||||||||||||||||||
New Mexico | 1,166 | 493,062 | 423.00 | 436,560 | 374.53 | 88.5 | 56,502 | ||||||||||||||||||||
Ohio | 1,621 | 606,925 | 374.33 | 514,044 | 317.04 | 84.7 | 92,881 | ||||||||||||||||||||
Puerto Rico | — | — | — | — | — | — | — | ||||||||||||||||||||
South Carolina | 754 | 192,473 | 255.31 | 174,948 | 232.07 | 90.9 | 17,525 | ||||||||||||||||||||
Texas | 1,491 | 641,062 | 429.85 | 590,857 | 396.19 | 92.2 | 50,205 | ||||||||||||||||||||
Utah | 495 | 155,228 | 313.67 | 140,294 | 283.49 | 90.4 | 14,934 | ||||||||||||||||||||
Washington | 2,640 | 660,420 | 250.15 | 603,205 | 228.48 | 91.3 | 57,215 | ||||||||||||||||||||
Wisconsin | 530 | 75,453 | 142.48 | 61,952 | 116.99 | 82.1 | 13,501 | ||||||||||||||||||||
Other (3) | — | 7,287 | — | 51,826 | — | — | (44,539 | ) | |||||||||||||||||||
13,166 | $ | 4,107,479 | $ | 311.98 | $ | 3,655,957 | $ | 277.69 | 89.0 | % | $ | 451,522 | |||||||||||||||
(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) “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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Three Months Ended June 30, 2015 (1) | |||||||||||||||||||||||||||
Member
Months (2) |
Premium Revenue | Medical Care Costs | MCR (3) |
Medical Margin |
|||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
TANF and CHIP | 6,556 | $ | 1,169,277 | $ | 178.38 | $ | 1,063,489 | $ | 162.24 | 91.0 | % | $ | 105,788 | ||||||||||||||
Medicaid Expansion | 1,387 | 582,443 | 419.67 | 474,198 | 341.67 | 81.4 | 108,245 | ||||||||||||||||||||
ABD | 1,069 | 1,053,098 | 984.99 | 947,093 | 885.84 | 89.9 | 106,005 | ||||||||||||||||||||
Marketplace | 789 | 161,214 | 204.22 | 89,368 | 113.21 | 55.4 | 71,846 | ||||||||||||||||||||
Medicare | 133 | 140,137 | 1,059.90 | 140,508 | 1,062.71 | 100.3 | (371 | ) | |||||||||||||||||||
MMP | 111 | 198,203 | 1,784.30 | 214,878 | 1,934.40 | 108.4 | (16,675 | ) | |||||||||||||||||||
10,045 | $ | 3,304,372 | $ | 328.96 | $ | 2,929,534 | $ | 291.65 | 88.7 | % | $ | 374,838 | |||||||||||||||
Six Months Ended June 30, 2015 (1) | |||||||||||||||||||||||||||
Member
Months (2) |
Premium Revenue | Medical Care Costs | MCR (3) |
Medical Margin |
|||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
TANF and CHIP | 12,035 | $ | 2,141,316 | $ | 177.93 | $ | 1,960,315 | $ | 162.89 | 91.5 | % | $ | 181,001 | ||||||||||||||
Medicaid Expansion | 2,661 | 1,089,339 | 409.29 | 867,229 | 325.84 | 79.6 | 222,110 | ||||||||||||||||||||
ABD | 2,120 | 1,993,366 | 940.23 | 1,809,613 | 853.56 | 90.8 | 183,753 | ||||||||||||||||||||
Marketplace | 1,371 | 354,725 | 258.66 | 245,682 | 179.15 | 69.3 | 109,043 | ||||||||||||||||||||
Medicare | 264 | 273,472 | 1,036.95 | 269,005 | 1,020.01 | 98.4 | 4,467 | ||||||||||||||||||||
MMP | 213 | 422,806 | 1,986.04 | 413,474 | 1,942.20 | 97.8 | 9,332 | ||||||||||||||||||||
18,664 | $ | 6,275,024 | $ | 336.21 | $ | 5,565,318 | $ | 298.18 | 88.7 | % | $ | 709,706 | |||||||||||||||
(1) Three and six months ended June 30, 2014 data not presented due to lack of comparability. |
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(2) A member month is defined as the aggregate of each month’s ending membership for the period presented. |
|||||||||||||||||||||||||||
(3) The MCR represents medical costs as a percentage of premium revenue. |
MOLINA HEALTHCARE, INC. | ||||||||||||||||||||||||||
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA, | ||||||||||||||||||||||||||
CONTINUING OPERATIONS | ||||||||||||||||||||||||||
(In thousands, except percentages and per-member per-month amounts) | ||||||||||||||||||||||||||
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 June 30, | ||||||||||||||||||||||||||
2015 | 2014 | |||||||||||||||||||||||||
Amount | PMPM |
% of
Total |
Amount | PMPM |
% of
Total |
|||||||||||||||||||||
Fee for service | $ | 2,102,776 | $ | 209.34 | 71.8 | % | $ | 1,378,037 | $ | 205.08 | 71.2 | % | ||||||||||||||
Pharmacy | 391,899 | 39.01 | 13.3 | 295,596 | 43.99 | 15.3 | ||||||||||||||||||||
Capitation | 248,357 | 24.72 | 8.5 | 176,817 | 26.31 | 9.1 | ||||||||||||||||||||
Direct delivery | 27,885 | 2.78 | 1.0 | 23,063 | 3.43 | 1.2 | ||||||||||||||||||||
Other | 158,617 | 15.80 | 5.4 | 60,786 | 9.06 | 3.2 | ||||||||||||||||||||
$ | 2,929,534 | $ | 291.65 | 100.0 | % | $ | 1,934,299 | $ | 287.87 | 100.0 | % | |||||||||||||||
Six Months Ended June 30, | ||||||||||||||||||||||||||
2015 | 2014 | |||||||||||||||||||||||||
Amount | PMPM |
% of
Total |
Amount | PMPM |
% of
Total |
|||||||||||||||||||||
Fee for service | $ | 4,051,081 | $ | 217.05 | 72.8 | % | $ | 2,559,098 | $ | 194.38 | 70.0 | % | ||||||||||||||
Pharmacy | 743,097 | 39.81 | 13.4 | 582,224 | 44.22 | 15.9 | ||||||||||||||||||||
Capitation | 464,682 | 24.90 | 8.3 | 346,256 | 26.30 | 9.5 | ||||||||||||||||||||
Direct delivery | 54,656 | 2.93 | 1.0 | 45,084 | 3.42 | 1.2 | ||||||||||||||||||||
Other | 251,802 | 13.49 | 4.5 | 123,295 | 9.37 | 3.4 | ||||||||||||||||||||
$ | 5,565,318 | $ | 298.18 | 100.0 | % | $ | 3,655,957 | $ | 277.69 | 100.0 | % | |||||||||||||||
The following table provides the details of the Company’s medical claims and benefits payable as of the dates indicated: |
||||||||||||||||||||||||||
June 30, 2015 |
December 31, 2014 |
|||||||||||||||||||||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,138,794 | $ | 870,429 | ||||||||||||||||||||||
Pharmacy payable | 80,902 | 71,412 | ||||||||||||||||||||||||
Capitation payable | 30,673 | 28,150 | ||||||||||||||||||||||||
Other (1) | 241,883 | 230,531 | ||||||||||||||||||||||||
$ | 1,492,252 | $ | 1,200,522 | |||||||||||||||||||||||
(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 the Company’s unaudited consolidated statements of income. As of June 30, 2015 and December 31, 2014, the Company had recorded non-risk provider payables of approximately $134.2 million and $119.3 million, respectively. |
MOLINA HEALTHCARE, INC.
UNAUDITED CHANGE IN MEDICAL CLAIMS
AND BENEFITS PAYABLE
(Dollars in thousands, except
per-member amounts)
The Company’s claims liability includes an allowance for adverse claims deviation 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 presents the components of the change in medical claims and benefits payable from continuing and discontinued operations combined for the periods indicated:
Six Months Ended |
Year Ended December 31, 2014 |
||||||||||||
June 30, | |||||||||||||
2015 | 2014 | ||||||||||||
Medical claims and benefits payable, beginning balance | $ | 1,200,522 | $ | 669,787 | $ | 669,787 | |||||||
Components of medical care costs related to: | |||||||||||||
Current period | 5,703,391 | 3,693,730 | 8,122,885 | ||||||||||
Prior period (1) | (138,131 | ) | (37,131 | ) | (45,979 | ) | |||||||
Total medical care costs | 5,565,260 | 3,656,599 | 8,076,906 | ||||||||||
Change in non-risk provider payables | 14,826 | (83,044 | ) | (31,973 | ) | ||||||||
Payments for medical care costs related to: | |||||||||||||
Current period | 4,448,820 | 2,891,174 | 7,064,427 | ||||||||||
Prior period | 839,536 | 427,986 | 449,771 | ||||||||||
Total paid | 5,288,356 | 3,319,160 | 7,514,198 | ||||||||||
Medical claims and benefits payable, ending balance | $ | 1,492,252 | $ | 924,182 | $ | 1,200,522 | |||||||
Benefit from prior period as a percentage of: | |||||||||||||
Balance at beginning of period | 11.5 | % | 5.5 | % | 6.9 | % | |||||||
Premium revenue, trailing twelve months | 1.2 | % | 0.5 | % | 0.5 | % | |||||||
Medical care costs, trailing twelve months | 1.4 | % | 0.6 | % | 0.6 | % | |||||||
Fee-For-Service Claims Data: | |||||||||||||
Days in claims payable, fee for service | 49 | 46 | 49 | ||||||||||
Number of members at end of year | 3,352,000 | 2,255,000 | 2,623,000 | ||||||||||
Number of claims in inventory at end of year | 463,200 | 180,600 | 307,700 | ||||||||||
Billed charges of claims in inventory at end of year | $ | 904,800 | $ | 400,000 | $ | 718,500 | |||||||
Claims in inventory per member at end of year | 0.14 | 0.08 | 0.12 | ||||||||||
Billed charges of claims in inventory per member at end of year | $ | 269.93 | $ | 177.38 | $ | 273.92 | |||||||
Number of claims received during the year | 18,679,000 | 12,641,300 | 27,597,000 | ||||||||||
Billed charges of claims received during the year | $ | 21,505,000 | $ | 13,609,000 | $ | 30,315,600 | |||||||
(1) The benefit from prior period development of medical claims and benefits payable for the six months ended June 30, 2015, included approximately $22 million relating to programs that contain medical cost floor or corridor provisions. Accordingly, premium revenue for the six months ended June 30, 2015, was reduced by the same amount. |
|||||||||||||
MOLINA HEALTHCARE, INC. HEALTH INSURER FEE DETAILS BY HEALTH PLAN (In thousands) |
||||||||||||||||||||
HIF Reimbursement Revenue, Gross (1) | ||||||||||||||||||||
Six Months Ended June 30, 2015 |
Year Ending Dec. 31, 2015 |
|||||||||||||||||||
Recognized |
Necessary for Full Reimbursement |
Necessary for Full Reimbursement |
||||||||||||||||||
Q1 2015 | Q2 2015 | Total | ||||||||||||||||||
2015 HIF: | ||||||||||||||||||||
California | $ | — | $ | 17,258 | $ | 17,258 | $ | 17,258 | $ | 34,517 | ||||||||||
Florida | 2,027 | 2,042 | 4,069 | 4,069 | 8,139 | |||||||||||||||
Illinois | 965 | 973 | 1,938 | 1,938 | 3,875 | |||||||||||||||
Michigan | — | — | — | 13,776 | 27,551 | |||||||||||||||
New Mexico | 7,539 | 7,597 | 15,136 | 15,136 | 30,273 | |||||||||||||||
Ohio | 11,936 | 12,027 | 23,963 | 23,963 | 47,925 | |||||||||||||||
South Carolina | 3,053 | 3,077 | 6,130 | 6,130 | 12,261 | |||||||||||||||
Texas | 5,839 | 5,884 | 11,723 | 11,723 | 23,446 | |||||||||||||||
Utah | — | — | — | 2,968 | 5,936 | |||||||||||||||
Washington | 10,951 | 10,963 | 21,914 | 21,914 | 43,828 | |||||||||||||||
Wisconsin | 1,126 | 1,135 | 2,261 | 2,261 | 4,522 | |||||||||||||||
Subtotal, Medicaid | 43,436 | 60,956 | 104,392 | 121,136 | 242,273 | |||||||||||||||
Marketplace | 398 | 400 | 798 | 798 | 1,595 | |||||||||||||||
Medicare | 5,702 | 3,652 | 9,354 | 9,354 | 18,702 | |||||||||||||||
49,536 | 65,008 | 114,544 | $ | 131,288 | $ | 262,570 | ||||||||||||||
2014 HIF: | ||||||||||||||||||||
California | — | 11,616 | 11,616 | |||||||||||||||||
$ | 49,536 | $ | 76,624 | $ | 126,160 | |||||||||||||||
Recognized in: | ||||||||||||||||||||
Health insurer fee revenue | $ | 47,948 | $ | 73,890 | $ | 121,838 | ||||||||||||||
Premium tax revenue | 1,588 | 2,734 | 4,322 | |||||||||||||||||
$ | 49,536 | $ | 76,624 | $ | 126,160 | |||||||||||||||
(1) Amounts in the table include the Company’s estimate of the full economic impact of the excise tax including premium tax and the income tax effect. |
CONTACT:
Molina Healthcare, Inc.
Investor Relations:
Juan José
Orellana, 562-435-3666, ext. 111143