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) |
MOLINA HEALTHCARE, INC. | |||
Date: | February 8, 2016 | By: | /s/ Jeff D. Barlow |
Jeff D. Barlow | |||
Chief Legal Officer and Secretary |
Exhibit | |
No. | Description |
99.1 | Press release of Molina Healthcare, Inc. issued February 8, 2016, as to financial results for the fourth quarter and year ended December 31, 2015. |
• | Full year 2015 net income per diluted share of $2.57, up nearly 100% over 2014. |
• | Full year 2015 total revenue of $14.1 billion, up 46% over 2014. |
• | Aggregate membership up 35% over 2014. |
• | Excluding a contract settlement charge of $0.16 per diluted share, diluted net income per share for the fourth quarter of 2015 would have been $0.67 compared with $0.69 for the fourth quarter of 2014. |
• | During the quarter, the Company recorded a contract settlement charge of approximately $15 million ($0.16 per diluted share) as a result of its termination of a hospital management agreement. |
• | During the fourth quarter of 2015, the Company recognized approximately $6 million ($0.07 per diluted share) of interest expense related to $700 million of senior notes due 2022 issued in November. |
• | General and administrative expense for the fourth quarter 2015 includes approximately $3 million ($0.03 per diluted share) in transaction costs for business acquisitions. |
• | uncertainties and evolving market and provider economics associated with the implementation of the Affordable Care Act, the Medicaid expansion, the insurance marketplaces, the effect of various implementing regulations, and uncertainties regarding the Medicare-Medicaid dual eligible demonstration programs in California, Illinois, Michigan, Ohio, South Carolina, and Texas; |
• | management of our medical costs, including seasonal flu patterns and rates of utilization that are consistent with our expectations, and our ability to reduce over time the high medical costs commonly associated with new patient populations; |
• | federal or state medical cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit sharing arrangements, and conflicting interpretations thereof; |
• | the interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures; |
• | cyber-attacks or other privacy or data security incidents resulting in an inadvertent unauthorized disclosure of protected health information; |
• | the success of our new health plan in Puerto Rico, including the successful resolution of the Puerto Rico debt crisis and the payment of all amounts due under our Medicaid contract; |
• | specialty drugs or generic drugs that are exorbitantly priced but not factored into the calculation of our capitated rates; |
• | significant budget pressures on state governments and their potential inability to maintain current rates, to implement expected rate increases, or to maintain existing benefit packages or membership eligibility thresholds or criteria, including the resolution of the Illinois budget impasse and continued payment of our Illinois health plan; |
• | the accurate estimation of incurred but not reported or paid medical costs across our health plans; |
• | retroactive adjustments to premium revenue or accounting estimates which require adjustment based upon subsequent developments; |
• | efforts by states to recoup previously paid amounts; |
• | the success of our efforts to retain existing government contracts and to obtain new government contracts in connection with state requests for proposals (RFPs) in both existing and new states; |
• | the continuation and renewal of the government contracts of both our health plans and Molina Medicaid Solutions and the terms under which such contracts are renewed; |
• | complications, member confusion, or enrollment backlogs related to the annual renewal of Medicaid coverage; |
• | government audits and reviews, and any fine, enrollment freeze, or monitoring program that may result therefrom; |
• | changes with respect to our provider contracts and the loss of providers; |
• | approval by state regulators of dividends and distributions by our health plan subsidiaries; |
• | changes in funding under our contracts as a result of regulatory changes, programmatic adjustments, or other reforms; |
• | high dollar claims related to catastrophic illness; |
• | the favorable resolution of litigation, arbitration, or administrative proceedings; |
• | the relatively small number of states in which we operate health plans; |
• | the effect on our Los Angeles County subcontract of Centene’s acquisition of Health Net; |
• | the availability of adequate financing on acceptable terms to fund and capitalize our expansion and growth, repay our outstanding indebtedness at maturity and meet our liquidity needs, including the interest expense and other costs associated with such financing; |
• | the failure of a state in which we operate to renew its federal Medicaid waiver; |
• | changes generally affecting the managed care or Medicaid management information systems industries; |
• | increases in government surcharges, taxes, and assessments; |
• | newly emergent viruses or widespread epidemics, including the Zika virus, and associated public alarm; |
• | changes in general economic conditions, including unemployment rates; |
• | the sufficiency of our funds, on hand to pay the amounts due upon conversion of our outstanding notes; |
• | increasing competition and consolidation in the Medicaid industry; |
Three Months Ended | Year Ended | ||||||||||||||
December 31, | December 31, | ||||||||||||||
2015 | 2014 | 2015 | 2014 | ||||||||||||
(Dollar amounts in millions, except net income per share) | |||||||||||||||
Revenue: | |||||||||||||||
Premium revenue | $ | 3,488 | $ | 2,599 | $ | 13,140 | $ | 9,023 | |||||||
Service revenue | 106 | 54 | 252 | 210 | |||||||||||
Premium tax revenue | 104 | 91 | 393 | 294 | |||||||||||
Health insurer fee revenue | 61 | 52 | 264 | 120 | |||||||||||
Investment income | 6 | 2 | 18 | 8 | |||||||||||
Other revenue | — | 4 | 5 | 12 | |||||||||||
Total revenue | 3,765 | 2,802 | 14,072 | 9,667 | |||||||||||
Operating expenses: | |||||||||||||||
Medical care costs | 3,110 | 2,322 | 11,691 | 8,076 | |||||||||||
Cost of service revenue | 90 | 39 | 193 | 157 | |||||||||||
General and administrative expenses | 317 | 205 | 1,147 | 765 | |||||||||||
Premium tax expenses | 104 | 91 | 393 | 294 | |||||||||||
Health insurer fee expenses | 40 | 23 | 157 | 89 | |||||||||||
Depreciation and amortization | 28 | 25 | 104 | 93 | |||||||||||
Total operating expenses | 3,689 | 2,705 | 13,685 | 9,474 | |||||||||||
Operating income | 76 | 97 | 387 | 193 | |||||||||||
Other expenses, net: | |||||||||||||||
Interest expense | 22 | 15 | 67 | 57 | |||||||||||
Other (income) expense, net | (2 | ) | — | (2 | ) | 1 | |||||||||
Total other expenses, net | 20 | 15 | 65 | 58 | |||||||||||
Income from continuing operations before income tax expense | 56 | 82 | 322 | 135 | |||||||||||
Income tax expense | 26 | 48 | 179 | 73 | |||||||||||
Income from continuing operations | 30 | 34 | 143 | 62 | |||||||||||
Net income | $ | 30 | $ | 34 | $ | 143 | $ | 62 | |||||||
Diluted net income per share: (1) | |||||||||||||||
Income from continuing operations | $ | 0.51 | $ | 0.69 | $ | 2.57 | $ | 1.30 | |||||||
Loss from discontinued operations | — | — | — | (0.01 | ) | ||||||||||
Diluted net income per share | $ | 0.51 | $ | 0.69 | $ | 2.57 | $ | 1.29 | |||||||
Diluted weighted average shares outstanding | 57.7 | 48.9 | 55.6 | 48.3 | |||||||||||
Operating Statistics, Continuing Operations: (1) | |||||||||||||||
Medical care ratio (2) | 89.2 | % | 89.4 | % | 89.0 | % | 89.5 | % | |||||||
Service revenue ratio (3) | 84.7 | % | 72.6 | % | 76.4 | % | 74.6 | % | |||||||
General and administrative expense ratio (4) | 8.4 | % | 7.3 | % | 8.2 | % | 7.9 | % | |||||||
Premium tax ratio (2) | 2.9 | % | 3.4 | % | 2.9 | % | 3.2 | % | |||||||
Effective tax rate | 47.0 | % | 58.6 | % | 55.5 | % | 53.8 | % | |||||||
Net profit margin, continuing operations (4) | 0.8 | % | 1.2 | % | 1.0 | % | 0.6 | % |
(1) | Source data for calculations in thousands. |
(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). |
(4) | Computed as a percentage of total revenue. |
December 31, | |||||||
2015 | 2014 | ||||||
(Amounts in millions, except per-share data) | |||||||
ASSETS | |||||||
Current assets: | |||||||
Cash and cash equivalents | $ | 2,329 | $ | 1,539 | |||
Investments | 1,801 | 1,019 | |||||
Receivables | 597 | 596 | |||||
Income taxes refundable | 13 | — | |||||
Prepaid expenses and other current assets | 192 | 49 | |||||
Derivative asset | 374 | — | |||||
Total current assets | 5,306 | 3,203 | |||||
Property, equipment, and capitalized software, net | 393 | 341 | |||||
Deferred contract costs | 81 | 54 | |||||
Intangible assets, net | 122 | 89 | |||||
Goodwill | 519 | 272 | |||||
Restricted investments | 109 | 102 | |||||
Derivative asset | — | 329 | |||||
Deferred income taxes | 18 | 15 | |||||
Other assets | 28 | 30 | |||||
$ | 6,576 | $ | 4,435 | ||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | |||||||
Current liabilities: | |||||||
Medical claims and benefits payable | $ | 1,582 | $ | 1,201 | |||
Amounts due government agencies | 834 | 527 | |||||
Accounts payable and accrued liabilities | 360 | 242 | |||||
Deferred revenue | 223 | 196 | |||||
Income taxes payable | — | 9 | |||||
Current portion of long-term debt | 449 | — | |||||
Derivative liability | 374 | — | |||||
Total current liabilities | 3,822 | 2,175 | |||||
Senior notes | 962 | 690 | |||||
Lease financing obligations | 198 | 157 | |||||
Lease financing obligations - related party | — | 40 | |||||
Derivative liability | — | 329 | |||||
Other long-term liabilities | 37 | 34 | |||||
Total liabilities | 5,019 | 3,425 | |||||
Stockholders’ equity: | |||||||
Common stock, $0.001 par value; 150 shares authorized; outstanding: 56 shares at December 31, 2015 and 50 shares at December 31, 2014 | — | — | |||||
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding | — | — | |||||
Additional paid-in capital | 803 | 396 | |||||
Accumulated other comprehensive loss | (4 | ) | (1 | ) | |||
Retained earnings | 758 | 615 | |||||
Total stockholders’ equity | 1,557 | 1,010 | |||||
$ | 6,576 | $ | 4,435 |
Three Months Ended | Year Ended | ||||||||||||||
December 31, | December 31, | ||||||||||||||
2015 | 2014 | 2015 | 2014 | ||||||||||||
(Amounts in millions) | |||||||||||||||
Operating activities: | |||||||||||||||
Net income | $ | 30 | $ | 34 | $ | 143 | $ | 62 | |||||||
Adjustments to reconcile net income to net cash provided by operating activities: | |||||||||||||||
Depreciation and amortization | 33 | 35 | 126 | 134 | |||||||||||
Deferred income taxes | 5 | 9 | (7 | ) | (2 | ) | |||||||||
Share-based compensation | 7 | 6 | 23 | 22 | |||||||||||
Amortization of convertible senior notes and lease financing obligations | 8 | 7 | 30 | 27 | |||||||||||
Other, net | 6 | 3 | 19 | 7 | |||||||||||
Changes in operating assets and liabilities: | |||||||||||||||
Receivables | 79 | (171 | ) | 56 | (298 | ) | |||||||||
Prepaid expenses and other current assets | 28 | 32 | (35 | ) | (20 | ) | |||||||||
Medical claims and benefits payable | 20 | 77 | 379 | 531 | |||||||||||
Amounts due government agencies | (146 | ) | 129 | 307 | 470 | ||||||||||
Accounts payable and accrued liabilities | 48 | 37 | 82 | 11 | |||||||||||
Deferred revenue | 153 | 5 | 24 | 74 | |||||||||||
Income taxes | (52 | ) | 17 | (22 | ) | 42 | |||||||||
Net cash provided by operating activities | 219 | 220 | 1,125 | 1,060 | |||||||||||
Investing activities: | |||||||||||||||
Purchases of investments | (612 | ) | (337 | ) | (1,923 | ) | (953 | ) | |||||||
Proceeds from sales and maturities of investments | 263 | 159 | 1,126 | 633 | |||||||||||
Purchases of property, equipment, and capitalized software | (31 | ) | (43 | ) | (132 | ) | (115 | ) | |||||||
Increase in restricted investments | (1 | ) | (10 | ) | (6 | ) | (34 | ) | |||||||
Net cash paid in business combinations | (373 | ) | (36 | ) | (450 | ) | (44 | ) | |||||||
Other, net | (1 | ) | (8 | ) | (35 | ) | (23 | ) | |||||||
Net cash used in investing activities | (755 | ) | (275 | ) | (1,420 | ) | (536 | ) | |||||||
Financing activities: | |||||||||||||||
Proceeds from senior notes offerings, net of issuance costs | 689 | — | 689 | 123 | |||||||||||
Proceeds from common stock offering, net of issuance costs | — | — | 373 | — | |||||||||||
Contingent consideration liabilities settled | — | — | — | (50 | ) | ||||||||||
Proceeds from employee stock plans | 10 | 6 | 18 | 14 | |||||||||||
Principal payments on convertible senior notes | — | (10 | ) | — | (10 | ) | |||||||||
Other, net | 2 | — | 5 | 2 | |||||||||||
Net cash provided by (used in) financing activities | 701 | (4 | ) | 1,085 | 79 | ||||||||||
Net increase (decrease) in cash and cash equivalents | 165 | (59 | ) | 790 | 603 | ||||||||||
Cash and cash equivalents at beginning of period | 2,164 | 1,598 | 1,539 | 936 | |||||||||||
Cash and cash equivalents at end of period | $ | 2,329 | $ | 1,539 | $ | 2,329 | $ | 1,539 |
Three Months Ended | Year Ended | ||||||||||||||
December 31, | December 31, | ||||||||||||||
2015 | 2014 | 2015 | 2014 | ||||||||||||
(Amounts in millions) | |||||||||||||||
Net income | $ | 30 | $ | 34 | $ | 143 | $ | 62 | |||||||
Adjustments: | |||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 33 | 30 | 120 | 114 | |||||||||||
Interest expense | 22 | 15 | 67 | 57 | |||||||||||
Income tax expense | 26 | 48 | 179 | 72 | |||||||||||
EBITDA | $ | 111 | $ | 127 | $ | 509 | $ | 305 |
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||||||||||||||||||
2015 | 2014 | 2015 | 2014 | ||||||||||||||||||||||||||||
(In millions, except per diluted share amounts) | |||||||||||||||||||||||||||||||
Amount | Per share | Amount | Per share | Amount | Per share | Amount | Per share | ||||||||||||||||||||||||
Net income, continuing operations | $ | 30 | $ | 0.51 | $ | 34 | $ | 0.69 | $ | 143 | $ | 2.57 | $ | 62 | $ | 1.30 | |||||||||||||||
Adjustments, net of tax: | |||||||||||||||||||||||||||||||
Amortization of convertible senior notes and lease financing obligations | 5 | 0.08 | 4 | 0.09 | 19 | 0.34 | 17 | 0.36 | |||||||||||||||||||||||
Amortization of intangible assets | 3 | 0.06 | 3 | 0.06 | 11 | 0.20 | 13 | 0.27 | |||||||||||||||||||||||
Adjusted net income, continuing operations (1) | $ | 38 | $ | 0.65 | $ | 41 | $ | 0.84 | $ | 173 | $ | 3.11 | $ | 92 | $ | 1.93 |
(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 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. |
As of December 31, | ||||||||
2015 | 2014 | 2013 | ||||||
Ending Membership by Health Plan: | ||||||||
California | 620,000 | 531,000 | 368,000 | |||||
Florida | 440,000 | 164,000 | 89,000 | |||||
Illinois | 98,000 | 100,000 | 4,000 | |||||
Michigan | 328,000 | 242,000 | 213,000 | |||||
New Mexico | 231,000 | 212,000 | 168,000 | |||||
Ohio | 327,000 | 347,000 | 255,000 | |||||
Puerto Rico (1) | 348,000 | — | — | |||||
South Carolina | 99,000 | 118,000 | — | |||||
Texas | 260,000 | 245,000 | 252,000 | |||||
Utah | 102,000 | 83,000 | 86,000 | |||||
Washington | 582,000 | 497,000 | 403,000 | |||||
Wisconsin | 98,000 | 84,000 | 93,000 | |||||
3,533,000 | 2,623,000 | 1,931,000 | ||||||
Ending Membership by Program: | ||||||||
Temporary Assistance for Needy Families (TANF), CHIP(2) | 2,312,000 | 1,809,000 | 1,603,000 | |||||
Medicaid Expansion(3) | 557,000 | 385,000 | — | |||||
Aged, Blind or Disabled (ABD) | 366,000 | 347,000 | 289,000 | |||||
Marketplace(3) | 205,000 | 15,000 | — | |||||
Medicare-Medicaid Plan (MMP) - Integrated(4) | 51,000 | 18,000 | — | |||||
Medicare Special Needs Plans | 42,000 | 49,000 | 39,000 | |||||
3,533,000 | 2,623,000 | 1,931,000 |
(1) | The Puerto Rico health plan began serving members effective April 1, 2015. |
(2) | CHIP stands for Children’s Health Insurance Program. |
(3) | Medicaid Expansion membership phased in, and Marketplace became available for consumers to access coverage, beginning January 1, 2014. |
(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. |
Three Months Ended December 31, 2015 | |||||||||||||||||||||||||
Member Months(1) | Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.8 | $ | 563 | $ | 309.31 | $ | 474 | $ | 260.44 | 84.2 | % | $ | 89 | ||||||||||||
Florida | 1.2 | 329 | 277.71 | 318 | 268.98 | 96.9 | 11 | ||||||||||||||||||
Illinois | 0.3 | 85 | 287.88 | 79 | 266.91 | 92.7 | 6 | ||||||||||||||||||
Michigan | 1.0 | 329 | 334.44 | 282 | 287.00 | 85.8 | 47 | ||||||||||||||||||
New Mexico | 0.7 | 304 | 438.82 | 263 | 379.10 | 86.4 | 41 | ||||||||||||||||||
Ohio | 1.0 | 500 | 501.11 | 437 | 436.77 | 87.2 | 63 | ||||||||||||||||||
Puerto Rico | 1.1 | 192 | 184.79 | 159 | 153.04 | 82.8 | 33 | ||||||||||||||||||
South Carolina | 0.3 | 78 | 261.07 | 69 | 229.48 | 87.9 | 9 | ||||||||||||||||||
Texas | 0.7 | 543 | 693.06 | 496 | 633.77 | 91.4 | 47 | ||||||||||||||||||
Utah | 0.4 | 89 | 290.05 | 77 | 251.55 | 86.7 | 12 | ||||||||||||||||||
Washington | 1.7 | 416 | 241.28 | 376 | 217.77 | 90.3 | 40 | ||||||||||||||||||
Wisconsin | 0.3 | 55 | 186.57 | 53 | 182.41 | 97.8 | 2 | ||||||||||||||||||
Other(3) | — | 5 | — | 27 | — | — | (22 | ) | |||||||||||||||||
10.5 | $ | 3,488 | $ | 334.62 | $ | 3,110 | $ | 298.43 | 89.2 | % | $ | 378 | |||||||||||||
Three Months Ended December 31, 2014 | |||||||||||||||||||||||||
Member Months(1) | Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.6 | $ | 463 | $ | 291.27 | $ | 379 | $ | 238.49 | 81.9 | % | $ | 84 | ||||||||||||
Florida | 0.4 | 126 | 348.60 | 129 | 356.76 | 102.3 | (3 | ) | |||||||||||||||||
Illinois | 0.2 | 84 | 353.71 | 78 | 323.76 | 91.5 | 6 | ||||||||||||||||||
Michigan | 0.7 | 213 | 294.14 | 185 | 254.41 | 86.5 | 28 | ||||||||||||||||||
New Mexico | 0.7 | 299 | 456.40 | 294 | 448.99 | 98.4 | 5 | ||||||||||||||||||
Ohio | 1.1 | 492 | 475.15 | 426 | 412.02 | 86.7 | 66 | ||||||||||||||||||
Puerto Rico | — | — | — | — | — | — | — | ||||||||||||||||||
South Carolina | 0.4 | 93 | 263.97 | 73 | 208.10 | 78.8 | 20 | ||||||||||||||||||
Texas | 0.8 | 339 | 458.42 | 299 | 404.88 | 88.3 | 40 | ||||||||||||||||||
Utah | 0.2 | 76 | 300.28 | 69 | 277.44 | 92.4 | 7 | ||||||||||||||||||
Washington | 1.4 | 364 | 246.91 | 342 | 232.08 | 94.0 | 22 | ||||||||||||||||||
Wisconsin | 0.2 | 38 | 148.99 | 36 | 139.75 | 93.8 | 2 | ||||||||||||||||||
Other(3) | — | 12 | — | 12 | — | — | — | ||||||||||||||||||
7.7 | $ | 2,599 | $ | 338.52 | $ | 2,322 | $ | 302.60 | 89.4 | % | $ | 277 |
(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. Source data in thousands. |
(3) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. |
Year Ended December 31, 2015 | |||||||||||||||||||||||||
Member Months(1) | Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 7.1 | $ | 2,101 | $ | 296.93 | $ | 1,823 | $ | 257.67 | 86.8 | % | $ | 278 | ||||||||||||
Florida | 4.1 | 1,197 | 289.38 | 1,081 | 261.49 | 90.4 | 116 | ||||||||||||||||||
Illinois | 1.2 | 397 | 328.93 | 367 | 303.72 | 92.3 | 30 | ||||||||||||||||||
Michigan | 3.4 | 1,067 | 317.15 | 903 | 268.27 | 84.6 | 164 | ||||||||||||||||||
New Mexico | 2.8 | 1,237 | 446.27 | 1,106 | 398.98 | 89.4 | 131 | ||||||||||||||||||
Ohio | 4.1 | 2,034 | 499.34 | 1,718 | 421.61 | 84.4 | 316 | ||||||||||||||||||
Puerto Rico | 3.2 | 567 | 178.31 | 505 | 158.80 | 89.1 | 62 | ||||||||||||||||||
South Carolina | 1.3 | 348 | 267.25 | 278 | 213.30 | 79.8 | 70 | ||||||||||||||||||
Texas | 3.1 | 1,961 | 621.25 | 1,809 | 573.32 | 92.3 | 152 | ||||||||||||||||||
Utah | 1.2 | 331 | 286.22 | 300 | 259.32 | 90.6 | 31 | ||||||||||||||||||
Washington | 6.6 | 1,602 | 242.36 | 1,470 | 222.36 | 91.7 | 132 | ||||||||||||||||||
Wisconsin | 1.2 | 261 | 213.48 | 215 | 176.01 | 82.4 | 46 | ||||||||||||||||||
Other(3) | — | 37 | — | 116 | — | — | (79 | ) | |||||||||||||||||
39.3 | $ | 13,140 | $ | 334.71 | $ | 11,691 | $ | 297.81 | 89.0 | % | $ | 1,449 | |||||||||||||
Year Ended December 31, 2014 | |||||||||||||||||||||||||
Member Months(1) | Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 5.6 | $ | 1,523 | $ | 270.51 | $ | 1,269 | $ | 225.37 | 83.3 | % | $ | 254 | ||||||||||||
Florida | 1.1 | 439 | 397.79 | 419 | 379.95 | 95.5 | 20 | ||||||||||||||||||
Illinois | 0.3 | 153 | 498.48 | 141 | 456.88 | 91.7 | 12 | ||||||||||||||||||
Michigan | 2.8 | 781 | 278.68 | 661 | 235.81 | 84.6 | 120 | ||||||||||||||||||
New Mexico | 2.5 | 1,076 | 435.17 | 996 | 402.92 | 92.6 | 80 | ||||||||||||||||||
Ohio | 3.7 | 1,553 | 425.47 | 1,335 | 365.87 | 86.0 | 218 | ||||||||||||||||||
Puerto Rico | — | — | — | — | — | — | — | ||||||||||||||||||
South Carolina | 1.5 | 381 | 260.72 | 323 | 220.89 | 84.7 | 58 | ||||||||||||||||||
Texas | 3.0 | 1,318 | 442.32 | 1,197 | 401.81 | 90.8 | 121 | ||||||||||||||||||
Utah | 1.0 | 310 | 310.64 | 285 | 286.43 | 92.2 | 25 | ||||||||||||||||||
Washington | 5.5 | 1,305 | 236.27 | 1,219 | 220.75 | 93.4 | 86 | ||||||||||||||||||
Wisconsin | 1.0 | 156 | 150.87 | 136 | 130.91 | 86.8 | 20 | ||||||||||||||||||
Other(3) | — | 28 | — | 95 | — | — | (67 | ) | |||||||||||||||||
28.0 | $ | 9,023 | $ | 322.68 | $ | 8,076 | $ | 288.84 | 89.5 | % | $ | 947 |
(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. Source data in thousands. |
(3) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. |
Three Months Ended December 31, 2015 (1) | |||||||||||||||||||||||||
Member Months(2) | Premium Revenue | Medical Care Costs | MCR(3) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
TANF and CHIP | 6.9 | $ | 1,203 | $ | 175.96 | $ | 1,092 | $ | 159.83 | 90.8 | % | $ | 111 | ||||||||||||
Medicaid Expansion | 1.7 | 637 | 386.27 | 503 | 305.28 | 79.0 | 134 | ||||||||||||||||||
ABD | 1.1 | 1,059 | 967.72 | 995 | 910.11 | 94.0 | 64 | ||||||||||||||||||
Marketplace | 0.6 | 126 | 223.57 | 111 | 194.80 | 87.1 | 15 | ||||||||||||||||||
MMP | 0.1 | 330 | 2,160.91 | 290 | 1,905.00 | 88.2 | 40 | ||||||||||||||||||
Medicare | 0.1 | 133 | 1,076.00 | 119 | 954.40 | 88.7 | 14 | ||||||||||||||||||
10.5 | $ | 3,488 | $ | 334.62 | $ | 3,110 | $ | 298.43 | 89.2 | % | $ | 378 |
Year Ended December 31, 2015 (1) | |||||||||||||||||||||||||
Member Months(2) | Premium Revenue | Medical Care Costs | MCR(3) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
TANF and CHIP | 25.5 | $ | 4,483 | $ | 175.64 | $ | 4,122 | $ | 161.50 | 92.0 | % | $ | 361 | ||||||||||||
Medicaid Expansion | 5.9 | 2,291 | 391.62 | 1,828 | 312.58 | 79.8 | 463 | ||||||||||||||||||
ABD | 4.3 | 4,122 | 966.37 | 3,784 | 887.27 | 91.8 | 338 | ||||||||||||||||||
Marketplace | 2.6 | 651 | 251.96 | 481 | 185.85 | 73.8 | 170 | ||||||||||||||||||
MMP | 0.5 | 1,063 | 2,033.76 | 974 | 1,863.93 | 91.6 | 89 | ||||||||||||||||||
Medicare | 0.5 | 530 | 1,038.15 | 502 | 982.50 | 94.6 | 28 | ||||||||||||||||||
39.3 | $ | 13,140 | $ | 334.71 | $ | 11,691 | $ | 297.81 | 89.0 | % | $ | 1,449 |
(1) | Three and twelve months ended December 31, 2014 data not presented due to lack of comparability. |
(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. Source data in thousands. |
Three Months Ended December 31, | |||||||||||||||||||||
2015 | 2014 | ||||||||||||||||||||
Amount | PMPM | % of Total | Amount | PMPM | % of Total | ||||||||||||||||
Fee for service | $ | 2,297 | $ | 220.34 | 73.9 | % | $ | 1,644 | $ | 214.14 | 70.8 | % | |||||||||
Pharmacy | 449 | 43.08 | 14.4 | 354 | 46.12 | 15.3 | |||||||||||||||
Capitation | 257 | 24.69 | 8.3 | 211 | 27.60 | 9.1 | |||||||||||||||
Direct delivery | 43 | 4.14 | 1.4 | 26 | 3.42 | 1.1 | |||||||||||||||
Other | 64 | 6.18 | 2.0 | 87 | 11.32 | 3.7 | |||||||||||||||
$ | 3,110 | $ | 298.43 | 100.0 | % | $ | 2,322 | $ | 302.60 | 100.0 | % |
Year Ended December 31, | |||||||||||||||||||||
2015 | 2014 | ||||||||||||||||||||
Amount | PMPM | % of Total | Amount | PMPM | % of Total | ||||||||||||||||
Fee for service | $ | 8,572 | $ | 218.35 | 73.3 | % | $ | 5,673 | $ | 202.87 | 70.2 | % | |||||||||
Pharmacy | 1,610 | 41.01 | 13.8 | 1,273 | 45.54 | 15.8 | |||||||||||||||
Capitation | 982 | 25.02 | 8.4 | 748 | 26.77 | 9.3 | |||||||||||||||
Direct delivery | 128 | 3.26 | 1.1 | 96 | 3.44 | 1.2 | |||||||||||||||
Other | 399 | 10.17 | 3.4 | 286 | 10.22 | 3.5 | |||||||||||||||
$ | 11,691 | $ | 297.81 | 100.0 | % | $ | 8,076 | $ | 288.84 | 100.0 | % |
December 31, | |||||||
2015 | 2014 | ||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,191 | $ | 871 | |||
Pharmacy payable | 88 | 71 | |||||
Capitation payable | 37 | 28 | |||||
Other (1) | 266 | 231 | |||||
$ | 1,582 | $ | 1,201 |
(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 consolidated statements of income. As of December 31, 2015 and 2014, the Company had recorded non-risk provider payables of approximately $167 million and $119 million, respectively. |
Year Ended | |||||||
December 31, | |||||||
2015 | 2014 | ||||||
Medical claims and benefits payable, beginning balance | $ | 1,201 | $ | 670 | |||
Components of medical care costs related to: | |||||||
Current period | 11,832 | 8,123 | |||||
Prior period | (141 | ) | (46 | ) | |||
Total medical care costs | 11,691 | 8,077 | |||||
Change in non-risk provider payables | 48 | (32 | ) | ||||
Payments for medical care costs related to: | |||||||
Current period | 10,448 | 7,064 | |||||
Prior period | 910 | 450 | |||||
Total paid | 11,358 | 7,514 | |||||
Medical claims and benefits payable, ending balance | $ | 1,582 | $ | 1,201 | |||
Benefit from prior period as a percentage of: | |||||||
Balance at beginning of period | 11.8 | % | 6.9 | % | |||
Premium revenue, trailing twelve months | 1.1 | % | 0.5 | % | |||
Medical care costs, trailing twelve months | 1.2 | % | 0.6 | % | |||
Fee-For-Service Claims Data: | |||||||
Days in claims payable, fee for service | 48 | 49 | |||||
Number of members at end of year | 3,533,000 | 2,623,000 | |||||
Number of claims in inventory at end of year | 380,800 | 307,700 | |||||
Billed charges of claims in inventory at end of year | $ | 816 | $ | 719 | |||
Claims in inventory per member at end of year | 0.11 | 0.12 | |||||
Billed charges of claims in inventory per member at end of year | $ | 230.91 | $ | 273.92 | |||
Number of claims received during the year | 40,173,300 | 27,597,000 | |||||
Billed charges of claims received during the year | $ | 46,211 | $ | 30,316 |
HIF Reimbursement Revenue, Gross(1) | |||||||||||||||||||||||
Year Ended December 31, 2015 | |||||||||||||||||||||||
Recognized | Necessary for Full Reimbursement | ||||||||||||||||||||||
Q1 2015 | Q2 2015 | Q3 2015 | Q4 2015 | Total | |||||||||||||||||||
2015 HIF: | |||||||||||||||||||||||
California | $ | — | $ | 17 | $ | 6 | $ | 8 | $ | 31 | $ | 31 | |||||||||||
Florida | 2 | 2 | 2 | 2 | 8 | 8 | |||||||||||||||||
Illinois | 1 | 1 | 1 | 1 | 4 | 4 | |||||||||||||||||
Michigan | — | — | 21 | 7 | 28 | 28 | |||||||||||||||||
New Mexico | 7 | 8 | 8 | 7 | 30 | 30 | |||||||||||||||||
Ohio | 12 | 12 | 12 | 12 | 48 | 48 | |||||||||||||||||
South Carolina | 3 | 3 | 3 | 3 | 12 | 12 | |||||||||||||||||
Texas | 6 | 6 | 6 | 5 | 23 | 23 | |||||||||||||||||
Utah | — | — | 4 | 2 | 6 | 6 | |||||||||||||||||
Washington | 11 | 11 | 6 | 9 | 37 | 37 | |||||||||||||||||
Wisconsin | 1 | 1 | 1 | 2 | 5 | 5 | |||||||||||||||||
Subtotal, Medicaid | 43 | 61 | 70 | 58 | 232 | 232 | |||||||||||||||||
Marketplace | — | — | 1 | 1 | 2 | 2 | |||||||||||||||||
Medicare | 6 | 4 | 4 | 5 | 19 | 19 | |||||||||||||||||
49 | 65 | 75 | 64 | 253 | $ | 253 | |||||||||||||||||
2014 HIF: | |||||||||||||||||||||||
California | — | 12 | — | — | 12 | ||||||||||||||||||
Michigan | — | — | 7 | — | 7 | ||||||||||||||||||
Utah | — | — | 1 | — | 1 | ||||||||||||||||||
$ | 49 | $ | 77 | $ | 83 | $ | 64 | $ | 273 | ||||||||||||||
Recognized in: | |||||||||||||||||||||||
Health insurer fee revenue | $ | 48 | $ | 74 | $ | 81 | $ | 61 | $ | 264 | |||||||||||||
Premium tax revenue | 1 | 3 | 2 | 3 | 9 | ||||||||||||||||||
$ | 49 | $ | 77 | $ | 83 | $ | 64 | $ | 273 |
(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. |