Document


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 27, 2016
______________
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 27, 2016, Molina Healthcare, Inc. issued a press release announcing its financial results for the third quarter and the nine months ended September 30, 2016. 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 27, 2016, as to financial results for the third quarter and the nine months ended September 30, 2016.





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.
 
 
 
Date:
October 27, 2016
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 October 27, 2016, as to financial results for the third quarter and nine months ended September 30, 2016.



Exhibit

MOH Reports Third Quarter 2016 Results
Page 1
October 27, 2016

https://cdn.kscope.io/c916fa4600cef1020e98d264a92dcb2d-molinaa03a01a01a09.jpg


News Release

Contact:
Juan José Orellana
Investor Relations
562-435-3666, ext. 111143


MOLINA HEALTHCARE REPORTS
THIRD QUARTER 2016 RESULTS

Net income per diluted share for the quarter of $0.76.
Adjusted net income per diluted share for the quarter of $0.85.
Net income per diluted share for the quarter up 31% over second quarter 2016.
Adjusted net income per diluted share for the quarter up 27% over second quarter 2016.
Total revenue for the quarter of $4.5 billion, up 26% over third quarter 2015.
Aggregate membership up 22% over third quarter 2015.

Long Beach, California (October 27, 2016) – Molina Healthcare, Inc. (NYSE: MOH) today reported its financial results for the third quarter of 2016.
“Our third quarter results demonstrate continuing improvement in our overall business,” said J. Mario Molina, M.D., chief executive officer of Molina Healthcare, Inc. “Although these results highlight the need for programmatic adjustments to the Affordable Care Act’s health insurance Marketplaces, Molina Healthcare’s combination of product and geographic diversification, quality focused medical care, and efficient operations continues to deliver value to our members, our government partners, and our investors.”
Update on Financial Performance
Third Quarter 2016 Compared With Second Quarter 2016
Third quarter 2016 financial performance improved significantly when compared with the second quarter of 2016. Earnings per diluted share increased to $0.76 in the third quarter of 2016 from $0.58 in the second quarter. Adjusted earnings per diluted share increased to $0.85 in the third quarter of 2016 from $0.67 in the second quarter.
Higher profitability in the third quarter of 2016, when compared with the second quarter of 2016, was primarily the result of:
Improved profitability among products other than the Marketplace, partially offset by lower profitability for the Marketplace product. Excluding adjustments related to 2015 dates of service, the medical care ratio for all products combined (excluding Marketplace) declined to 89.6% in the third quarter from 90.3% in the second quarter. The medical care ratio for the Marketplace program (also excluding adjustments related to 2015 dates of service) increased to 89.0% in the third quarter from 79.7% in the second quarter. Although third quarter results for the Marketplace business were lower than anticipated, we believe that Marketplace performance for full year 2016 dates of service

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MOH Reports Third Quarter 2016 Results
Page 2
October 27, 2016

will be approximately breakeven. We continue to record substantial liabilities for Marketplace risk transfer payments. We estimate that such payments reduced our Marketplace premium revenue by approximately 25% for the nine months ended September 30, 2016. We have recommended that the risk transfer formula be modified so that payments between health plans are allocated based solely upon medical costs, rather than upon premiums. Such a change would have lowered the percentage of premium revenue returned as a result of risk transfer from 25% to 20% for the nine months ended September 30, 2016. We believe that the methodology used to calculate Marketplace risk transfer payments penalizes comparatively efficient and affordable health plans and, as a result, those purchasing affordable Marketplace policies ultimately pay higher premiums.
Improved administrative efficiency. Our general and administrative expense ratio fell to 7.6% in the third quarter of 2016 from 8.1% in the second quarter.
Lower effective tax rate. The benefit of approximately $5 million in discrete items reduced our effective tax rate to 54.0% in the third quarter of 2016, from 59.8% in the second quarter.
Net Income per Share Guidance
Our net income per share guidance for fiscal year 2016 remains unchanged. As previously disclosed, we expect the following factors, among others, to affect our financial performance in the rest of 2016:
The ultimate savings to be realized from various cost savings initiatives and the speed at which such savings will be realized.
Medicaid rate increases (excluding Medicaid Expansion) of approximately 3.0% in California (effective July 1, 2016); approximately 2.5% in Puerto Rico (effective July 1, 2016); approximately 3.0% in Texas (effective September 1, 2016); and approximately 4.0% in Florida (effective September 1, 2016). All rate changes are consistent with our previous expectations.
Medicaid Expansion rate decreases of approximately 11.0% in California (effective July 1, 2016) and approximately 2.0% in Ohio (effective July 1, 2016). All rate changes are consistent with our previous expectations.
The implementation of a medical care ratio floor of 86.0% for the South Carolina Medicaid program effective July 1, 2016.
Declining margins for our Marketplace business during the second half of 2016 due to normal membership attrition; the addition of higher cost members through the special enrollment process; higher costs as members reach the limits of the cost-sharing provisions of their insurance coverage; and increasing utilization as members become more engaged with our care networks.
Conference Call
Management will host a conference call and webcast to discuss Molina Healthcare's third quarter results at 5:00 p.m. Eastern time on Thursday, October 27, 2016. The number to call for the interactive teleconference is (212) 231-2903. A telephonic replay of the conference call will be available from 7:00 p.m. Eastern time on Thursday, October 27, 2016, through 6:00 p.m. Eastern Time on Friday, October 28, 2016, by dialing (800) 633-8284 and entering confirmation number 21818529. A live audio broadcast of Molina Healthcare’s conference call will be available on our 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 12 states across the nation and in the Commonwealth of Puerto Rico, Molina currently serves approximately 4.2 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.

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MOH Reports Third Quarter 2016 Results
Page 3
October 27, 2016

Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995: This earnings release contains “forward-looking statements” regarding our 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:
the success of our profit improvement and cost-cutting initiatives;
uncertainties and evolving market and provider economics associated with the implementation of the Affordable Care Act (the “ACA”), 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 our ability to reduce over time the high medical costs commonly associated with new patient populations;
our ability to predict with a reasonable degree of accuracy utilization rates, including utilization rates in new plans, geographies, and programs where we have less experience with patient and provider populations, and also including utilization rates associated with seasonal flu patterns or other newly emergent diseases;
our ability to manage growth, including maintaining and creating adequate internal systems and controls relating to authorizations, approvals, provider payments, and the overall success of our care management initiatives;
our ability to consummate and realize benefits from proposed acquisitions, including the pending Aetna-Humana Medicare Advantage divestiture transaction;
our receipt of adequate premium rates to support increasing pharmacy costs, including costs associated with specialty drugs and costs resulting from formulary changes that allow the option of higher-priced non-generic drugs;
our ability to operate profitably in an environment where the trend in premium rate increases lags behind the trend in increasing medical costs;
the interpretation and implementation of federal or state medical cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit sharing arrangements, and risk adjustment provisions;
our estimates of amounts owed for such cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit-sharing arrangements, and risk adjustment provisions, including but not limited to cost-plus reimbursement for retroactively eligible members in New Mexico, the Medicaid expansion cost corridors in New Mexico and Washington, and any other retroactive adjustment to revenue where methodologies and procedures are subject to interpretation, or are at least partially dependent upon information about the health status of state or federal program participants who are not Molina members;
the interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures, and our ability to recognize revenue amounts associated therewith;
the interpretation and implementation of state contract performance requirements regarding the achievement of certain quality measures, and our ability to avoid liquidated damages associated therewith;
cyber-attacks or other privacy or data security incidents resulting in an inadvertent unauthorized disclosure of protected health information;
the success of our health plan in Puerto Rico, including the resolution of the Puerto Rico debt crisis, payment of all amounts due under our Medicaid contract, the effect of the newly enacted PROMESA law, and our efforts to better manage the health care costs of our Puerto Rico health plan;
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 all amounts due to our Illinois health plan;
the accurate estimation of incurred but not reported or paid medical costs across our health plans;
subsequent adjustments to reported premium revenue based upon subsequent developments or new information, including changes to estimated amounts payable or receivable related to Marketplace risk adjustment/risk transfer, risk corridors, and reinsurance;
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 our health plans, Molina Medicaid Solutions, and Pathways, 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 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;

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MOH Reports Third Quarter 2016 Results
Page 4
October 27, 2016

changes generally affecting the managed care or Medicaid management information systems industries;
increases in government surcharges, taxes, and assessments, including but not limited to the deductibility of certain compensation costs;
newly emergent viruses or widespread epidemics, including the Zika virus, public catastrophes or terrorist attacks, 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;
and numerous other risk factors, including those discussed in our periodic reports and filings with the Securities and Exchange Commission. These reports can be accessed under the investor relations tab of our website or on the SEC’s website at sec.gov. Given these risks and uncertainties, we can give no assurances that our forward-looking statements will prove to be accurate, or that any other results or events projected or contemplated by our 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 our judgment as of October 27, 2016, and we disclaim any obligation to update any forward-looking statements to conform the statement to actual results or changes in our expectations.



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MOH Reports Third Quarter 2016 Results
Page 5
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED CONSOLIDATED STATEMENTS OF INCOME
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
2016
 
2015
 
2016
 
2015
 
(Dollar amounts in millions, except net income per share)
Revenue:
 
 
 
 
 
 
 
Premium revenue
$
4,191

 
$
3,377

 
$
12,215

 
$
9,652

Service revenue
133

 
47

 
408

 
146

Premium tax revenue
127

 
99

 
345

 
289

Health insurer fee revenue
85

 
81

 
251

 
203

Investment income
9

 
5

 
25

 
12

Other revenue
1

 
2

 
4

 
5

Total revenue
4,546

 
3,611

 
13,248

 
10,307

Operating expenses:
 
 
 
 
 
 
 
Medical care costs
3,748

 
3,016

 
10,930

 
8,581

Cost of service revenue
119

 
34

 
362

 
103

General and administrative expenses
343

 
287

 
1,034

 
830

Premium tax expenses
127

 
99

 
345

 
289

Health insurer fee expenses
55

 
36

 
163

 
117

Depreciation and amortization
36

 
26

 
102

 
76

Total operating expenses
4,428

 
3,498

 
12,936

 
9,996

Operating income
118

 
113

 
312

 
311

Interest expense
26

 
15

 
76

 
45

Income before income tax expense
92

 
98

 
236

 
266

Income tax expense
50

 
52

 
137

 
153

Net income
$
42

 
$
46

 
$
99

 
$
113

 
 
 
 
 
 
 
 
Diluted net income per share
$
0.76

 
$
0.77

 
$
1.77

 
$
2.07

 
 
 
 
 
 
 
 
Diluted weighted average shares outstanding
56.1

 
60.0

 
56.2

 
54.7

 
 
 
 
 
 
 
 
Operating Statistics:
 
 
 
 
 
 
 
Medical care ratio (1)
89.4
%
 
89.3
%
 
89.5
%
 
88.9
%
General and administrative expense ratio (2)
7.6
%
 
8.0
%
 
7.8
%
 
8.1
%
Premium tax ratio (1)
2.9
%
 
2.8
%
 
2.7
%
 
2.9
%
Effective tax rate
54.0
%
 
52.6
%
 
58.0
%
 
57.3
%
Net profit margin (2)
0.9
%
 
1.3
%
 
0.7
%
 
1.1
%
____________
(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.
(2)
Computed as a percentage of total revenue.

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MOH Reports Third Quarter 2016 Results
Page 6
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED CONSOLIDATED BALANCE SHEETS
 
September 30,
 
December 31,
 
2016
 
2015
 
(Unaudited)
 
 
 
(Amounts in millions,
except per-share data)
ASSETS
Current assets:
 
 
 
Cash and cash equivalents
$
2,842

 
$
2,329

Investments
1,735

 
1,801

Receivables
1,053

 
597

Income taxes refundable

 
13

Prepaid expenses and other current assets
169

 
192

Derivative asset
314

 
374

Total current assets
6,113

 
5,306

Property, equipment, and capitalized software, net
450

 
393

Deferred contract costs
83

 
81

Intangible assets, net
149

 
122

Goodwill
619

 
519

Restricted investments
116

 
109

Deferred income taxes

 
18

Other assets
40

 
28

 
$
7,570

 
$
6,576

 
 
 
 
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
 
 
 
Medical claims and benefits payable
$
1,871

 
$
1,685

Amounts due government agencies
1,232

 
729

Accounts payable and accrued liabilities
383

 
362

Deferred revenue
380

 
223

Income taxes payable
19

 

Current portion of long-term debt
466

 
449

Derivative liability
314

 
374

Total current liabilities
4,665

 
3,822

Senior notes
971

 
962

Lease financing obligations
198

 
198

Deferred income taxes
6

 

Other long-term liabilities
39

 
37

Total liabilities
5,879

 
5,019

Stockholders’ equity:
 
 
 
Common stock, $0.001 par value; 150 shares authorized; outstanding: 57 shares at September 30, 2016 and 56 shares at December 31, 2015

 

Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding

 

Additional paid-in capital
831

 
803

Accumulated other comprehensive gain (loss)
3

 
(4
)
Retained earnings
857

 
758

Total stockholders’ equity
1,691

 
1,557

 
$
7,570

 
$
6,576



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MOH Reports Third Quarter 2016 Results
Page 7
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
2016
 
2015
 
2016
 
2015
 
(Amounts in millions)
Operating activities:
 
 
 
 
 
 
 
Net income
$
42

 
$
46

 
$
99

 
$
113

Adjustments to reconcile net income to net cash provided by operating activities:
 
 
 
 
 
 
 
Depreciation and amortization
46

 
31

 
135

 
93

Deferred income taxes
(19
)
 
(19
)
 
20

 
(12
)
Share-based compensation
8

 
7

 
24

 
16

Amortization of convertible senior notes and lease financing obligations
8

 
7

 
23

 
22

Other, net
3

 
4

 
14

 
13

Changes in operating assets and liabilities:
 
 
 
 
 
 
 
Receivables
(12
)
 
12

 
(427
)
 
(23
)
Prepaid expenses and other assets
27

 
34

 
(116
)
 
(63
)
Medical claims and benefits payable
86

 
67

 
168

 
359

Amounts due government agencies
(6
)
 
155

 
503

 
453

Accounts payable and accrued liabilities
(146
)
 
(124
)
 
1

 
34

Deferred revenue
276

 
9

 
157

 
(129
)
Income taxes
42

 
29

 
32

 
30

Net cash provided by operating activities
355

 
258

 
633

 
906

Investing activities:
 
 
 
 
 
 
 
Purchases of investments
(470
)
 
(318
)
 
(1,444
)
 
(1,311
)
Proceeds from sales and maturities of investments
700

 
322

 
1,512

 
863

Purchases of property, equipment, and capitalized software
(41
)
 
(35
)
 
(143
)
 
(101
)
Change in restricted investments
(1
)
 
9

 
4

 
(5
)
Net cash paid in business combinations
(40
)
 
(69
)
 
(48
)
 
(77
)
Other, net
(6
)
 
(17
)
 
(12
)
 
(34
)
Net cash provided by (used in) investing activities
142

 
(108
)
 
(131
)
 
(665
)
Financing activities:
 
 
 
 
 
 
 
Proceeds from common stock offering, net of issuance costs

 

 

 
373

Proceeds from employee stock plans

 

 
10

 
8

Other, net

 

 
1

 
3

Net cash provided by financing activities

 

 
11

 
384

Net increase in cash and cash equivalents
497

 
150

 
513

 
625

Cash and cash equivalents at beginning of period
2,345

 
2,014

 
2,329

 
1,539

Cash and cash equivalents at end of period
$
2,842

 
$
2,164

 
$
2,842

 
$
2,164


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MOH Reports Third Quarter 2016 Results
Page 8
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED NON-GAAP FINANCIAL MEASURES
We use two non-GAAP financial measures as supplemental metrics in evaluating our 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 our 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). We believe that EBITDA is particularly helpful in assessing our ability to meet the cash demands of our operating units. The following table reconciles net income, which we believe to be the most comparable GAAP measure, to EBITDA.
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
2016
 
2015
 
2016
 
2015
 
(Amounts in millions)
Net income
$
42

 
$
46

 
$
99

 
$
113

Adjustments:
 
 
 
 
 
 
 
Depreciation, and amortization of intangible assets and capitalized software
42

 
29

 
118

 
87

Interest expense
26

 
15

 
76

 
45

Income tax expense
50

 
52

 
137

 
153

EBITDA
$
160

 
$
142

 
$
430

 
$
398

The second of these non-GAAP measures is adjusted net income (including adjusted net income per diluted share). We believe that adjusted net income per diluted share is very helpful in assessing our financial performance exclusive of the non-cash impact of the amortization of purchased intangibles. The following table reconciles net income, which we believe to be the most comparable GAAP measure, to adjusted net income.
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
2016
 
2015
 
2016
 
2015
 
(In millions, except per diluted share amounts)
 
Amount
 
Per share
 
Amount
 
Per share
 
Amount
 
Per share
 
Amount
 
Per share
Net income
$
42

 
$
0.76

 
$
46

 
$
0.77

 
$
99

 
$
1.77

 
$
113

 
$
2.07

Adjustment, net of tax:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Amortization of intangible assets
5

 
0.09

 
2

 
0.04

 
15

 
0.26

 
8

 
0.15

Adjusted net income
$
47

 
$
0.85

 
$
48

 
$
0.81

 
$
114

 
$
2.03

 
$
121

 
$
2.22




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MOH Reports Third Quarter 2016 Results
Page 9
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP
 
September 30,
 
December 31,
 
September 30,
 
2016
 
2015
 
2015
Ending Membership by Health Plan:
 
 
 
 
 
California
683,000

 
620,000

 
611,000

Florida
563,000

 
440,000

 
349,000

Illinois
195,000

 
98,000

 
101,000

Michigan
387,000

 
328,000

 
340,000

New Mexico
253,000

 
231,000

 
231,000

New York (1)
37,000

 

 

Ohio
339,000

 
327,000

 
344,000

Puerto Rico
331,000

 
348,000

 
356,000

South Carolina
109,000

 
99,000

 
102,000

Texas
352,000

 
260,000

 
263,000

Utah
150,000

 
102,000

 
102,000

Washington
716,000

 
582,000

 
568,000

Wisconsin
131,000

 
98,000

 
103,000

 
4,246,000

 
3,533,000

 
3,470,000

Ending Membership by Program:
 
 
 
 
 
Temporary Assistance for Needy Families (TANF) and Children's Health Insurance Program (CHIP)
2,529,000

 
2,312,000

 
2,249,000

Medicaid Expansion
658,000

 
557,000

 
540,000

Marketplace
568,000

 
205,000

 
226,000

Aged, Blind or Disabled (ABD)
395,000

 
366,000

 
359,000

Medicare-Medicaid Plan (MMP) - Integrated
51,000

 
51,000

 
56,000

Medicare Special Needs Plans
45,000

 
42,000

 
40,000

 
4,246,000

 
3,533,000

 
3,470,000

____________________________

(1)
The New York health plan was acquired on August 1, 2016.

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MOH Reports Third Quarter 2016 Results
Page 10
October 27, 2016


MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA
(In millions, except percentages and per-member per-month amounts)
 
Three Months Ended September 30, 2016
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
 
Total
 
PMPM
 
Total
 
PMPM
 
 
California
2.1

 
$
612

 
$
298.05

 
$
523

 
$
254.11

 
85.3
%
 
$
89

Florida
1.6

 
494

 
297.24

 
462

 
277.79

 
93.5

 
32

Illinois
0.6

 
163

 
275.26

 
145

 
244.86

 
89.0

 
18

Michigan
1.2

 
387

 
334.25

 
337

 
290.16

 
86.8

 
50

New Mexico
0.8

 
338

 
440.12

 
304

 
396.35

 
90.1

 
34

New York(3)
0.1

 
32

 
427.40

 
30

 
403.71

 
94.5

 
2

Ohio
1.0

 
501

 
491.51

 
424

 
415.87

 
84.6

 
77

Puerto Rico
1.0

 
184

 
183.46

 
167

 
167.44

 
91.3

 
17

South Carolina
0.3

 
102

 
312.28

 
94

 
285.97

 
91.6

 
8

Texas
1.1

 
597

 
559.98

 
525

 
493.07

 
88.1

 
72

Utah
0.4

 
106

 
236.31

 
104

 
230.53

 
97.6

 
2

Washington
2.1

 
569

 
265.48

 
521

 
243.49

 
91.7

 
48

Wisconsin
0.4

 
103

 
262.32

 
90

 
231.86

 
88.4

 
13

Other(4)

 
3

 

 
22

 

 

 
(19
)
 
12.7

 
$
4,191

 
$
329.88

 
$
3,748

 
$
295.01

 
89.4
%
 
$
443

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Three Months Ended September 30, 2015
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
Total
 
PMPM
 
Total
 
PMPM
 
 
California
1.9

 
$
524

 
$
288.45

 
$
438

 
$
241.09

 
83.6
%
 
$
86

Florida
0.9

 
300

 
299.33

 
265

 
264.39

 
88.3

 
35

Illinois
0.3

 
106

 
347.34

 
100

 
327.61

 
94.3

 
6

Michigan
0.9

 
281

 
330.00

 
236

 
276.61

 
83.8

 
45

New Mexico
0.7

 
297

 
421.76

 
275

 
390.26

 
92.5

 
22

New York(3)

 

 

 

 

 

 

Ohio
1.0

 
510

 
498.36

 
436

 
425.98

 
85.5

 
74

Puerto Rico
1.0

 
181

 
170.91

 
162

 
152.69

 
89.3

 
19

South Carolina
0.3

 
86

 
264.37

 
68

 
211.76

 
80.1

 
18

Texas
0.8

 
524

 
661.69

 
493

 
622.84

 
94.1

 
31

Utah
0.3

 
85

 
276.72

 
77

 
250.50

 
90.5

 
8

Washington
1.7

 
400

 
238.03

 
371

 
221.14

 
92.9

 
29

Wisconsin
0.3

 
71

 
232.32

 
57

 
184.94

 
79.6

 
14

Other(4)

 
12

 

 
38

 

 

 
(26
)
 
10.1

 
$
3,377

 
$
332.05

 
$
3,016

 
$
296.49

 
89.3
%
 
$
361

____________
(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 New York health plan was acquired on August 1, 2016.
(4)
“Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.



-MORE-


MOH Reports Third Quarter 2016 Results
Page 11
October 27, 2016


MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA
(In millions, except percentages and per-member per-month amounts)
 
Nine Months Ended September 30, 2016
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
 
Total
 
PMPM
 
Total
 
PMPM
 
 
California
6.1

 
$
1,707

 
$
280.21

 
$
1,485

 
$
243.64

 
86.9
%
 
$
222

Florida
5.0

 
1,447

 
288.74

 
1,301

 
259.60

 
89.9

 
146

Illinois
1.8

 
466

 
266.11

 
414

 
236.39

 
88.8

 
52

Michigan
3.6

 
1,143

 
322.08

 
1,018

 
286.77

 
89.0

 
125

New Mexico
2.3

 
1,016

 
447.07

 
905

 
398.22

 
89.1

 
111

New York(3)
0.1

 
32

 
427.40

 
30

 
403.71

 
94.5

 
2

Ohio
3.0

 
1,472

 
484.82

 
1,306

 
430.14

 
88.7

 
166

Puerto Rico
3.0

 
535

 
176.44

 
516

 
170.46

 
96.6

 
19

South Carolina
0.9

 
273

 
288.93

 
232

 
245.13

 
84.8

 
41

Texas
3.3

 
1,852

 
570.65

 
1,599

 
492.79

 
86.4

 
253

Utah
1.3

 
330

 
246.78

 
312

 
233.14

 
94.5

 
18

Washington
6.2

 
1,634

 
261.91

 
1,479

 
237.15

 
90.5

 
155

Wisconsin
1.2

 
299

 
252.45

 
278

 
235.25

 
93.2

 
21

Other(4)

 
9

 

 
55

 

 

 
(46
)
 
37.8

 
$
12,215

 
$
323.44

 
$
10,930

 
$
289.41

 
89.5
%
 
$
1,285

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nine Months Ended September 30, 2015
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
Total
 
PMPM
 
Total
 
PMPM
 
 
California
5.3

 
$
1,538

 
$
292.64

 
$
1,349

 
$
256.71

 
87.7
%
 
$
189

Florida
2.9

 
868

 
294.05

 
763

 
258.49

 
87.9

 
105

Illinois
0.9

 
312

 
342.27

 
288

 
315.68

 
92.2

 
24

Michigan
2.4

 
738

 
310.01

 
621

 
260.53

 
84.0

 
117

New Mexico
2.1

 
933

 
448.75

 
843

 
405.60

 
90.4

 
90

New York(3)

 

 

 

 

 

 

Ohio
3.1

 
1,534

 
498.76

 
1,281

 
416.69

 
83.5

 
253

Puerto Rico
2.1

 
375

 
175.17

 
346

 
161.60

 
92.3

 
29

South Carolina
1.0

 
270

 
269.11

 
209

 
208.45

 
77.5

 
61

Texas
2.4

 
1,418

 
597.53

 
1,313

 
553.35

 
92.6

 
105

Utah
0.8

 
242

 
284.83

 
223

 
262.14

 
92.0

 
19

Washington
4.9

 
1,186

 
242.75

 
1,094

 
223.99

 
92.3

 
92

Wisconsin
0.9

 
206

 
221.97

 
162

 
173.99

 
78.4

 
44

Other(4)

 
32

 

 
89

 

 

 
(57
)
 
28.8

 
$
9,652

 
$
334.74

 
$
8,581

 
$
297.58

 
88.9
%
 
$
1,071

____________
(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 New York health plan was acquired on August 1, 2016.
(4)
“Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.


-MORE-


MOH Reports Third Quarter 2016 Results
Page 12
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA
(In millions, except percentages and per-member per-month amounts)
 
Three Months Ended September 30, 2016
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
 
Total
 
PMPM
 
Total
 
PMPM
 
 
TANF and CHIP
7.6

 
$
1,373

 
$
180.74

 
$
1,246

 
$
164.04

 
90.8
%
 
$
127

Medicaid Expansion
2.0

 
763

 
386.98

 
642

 
325.68

 
84.2

 
121

Marketplace
1.7

 
399

 
238.86

 
352

 
210.38

 
88.1

 
47

ABD
1.1

 
1,186

 
1,008.28

 
1,094

 
929.93

 
92.2

 
92

MMP
0.2

 
334

 
2,165.26

 
280

 
1,818.75

 
84.0

 
54

Medicare
0.1

 
136

 
1,019.19

 
134

 
1,003.85

 
98.5

 
2

 
12.7

 
$
4,191

 
$
329.88

 
$
3,748

 
$
295.01

 
89.4
%
 
$
443

 
Three Months Ended September 30, 2015
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
 
Total
 
PMPM
 
Total
 
PMPM
 
 
TANF and CHIP
6.6

 
$
1,139

 
$
171.16

 
$
1,070

 
$
160.85

 
94.0
%
 
$
69

Medicaid Expansion
1.5

 
565

 
366.80

 
458

 
297.16

 
81.0

 
107

Marketplace
0.6

 
170

 
262.74

 
124

 
192.21

 
73.2

 
46

ABD
1.1

 
1,070

 
1,017.68

 
979

 
931.11

 
91.5

 
91

MMP
0.2

 
310

 
1,975.10

 
271

 
1,718.13

 
87.0

 
39

Medicare
0.1

 
123

 
1,002.50

 
114

 
930.43

 
92.8

 
9

 
10.1

 
$
3,377

 
$
332.05

 
$
3,016

 
$
296.49

 
89.3
%
 
$
361

 
Nine Months Ended September 30, 2016
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
 
Total
 
PMPM
 
Total
 
PMPM
 
 
TANF and CHIP
22.5

 
$
3,999

 
$
177.60

 
$
3,646

 
$
161.93

 
91.2
%
 
$
353

Medicaid Expansion
5.8

 
2,184

 
376.98

 
1,850

 
319.38

 
84.7

 
334

Marketplace
5.1

 
1,181

 
231.69

 
1,009

 
197.77

 
85.4

 
172

ABD
3.5

 
3,466

 
987.20

 
3,173

 
903.85

 
91.6

 
293

MMP
0.5

 
989

 
2,160.14

 
867

 
1,894.38

 
87.7

 
122

Medicare
0.4

 
396

 
1,015.14

 
385

 
986.40

 
97.2

 
11

 
37.8

 
$
12,215

 
$
323.44

 
$
10,930

 
$
289.41

 
89.5
%
 
$
1,285

 
Nine Months Ended September 30, 2015
 
Member
Months(1)
 
Premium Revenue
 
Medical Care Costs
 
MCR(2)
 
Medical Margin
 
 
Total
 
PMPM
 
Total
 
PMPM
 
 
TANF and CHIP
18.6

 
$
3,280

 
$
175.52

 
$
3,030

 
$
162.16

 
92.4
%
 
$
250

Medicaid Expansion
4.2

 
1,654

 
393.71

 
1,325

 
315.33

 
80.1

 
329

Marketplace
2.0

 
525

 
259.97

 
370

 
183.33

 
70.5

 
155

ABD
3.2

 
3,063

 
965.91

 
2,789

 
879.27

 
91.0

 
274

MMP
0.4

 
733

 
1,981.40

 
684

 
1,847.03

 
93.2

 
49

Medicare
0.4

 
397

 
1,026.00

 
383

 
991.53

 
96.6

 
14

 
28.8

 
$
9,652

 
$
334.74

 
$
8,581

 
$
297.58

 
88.9
%
 
$
1,071

_____________________
(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.

-MORE-


MOH Reports Third Quarter 2016 Results
Page 13
October 27, 2016


MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA
(In millions, except percentages and per-member per-month amounts)

The following tables provide the details of our medical care costs for the periods indicated:
 
Three Months Ended September 30,
 
2016
 
2015
 
Amount
 
PMPM
 
% of
Total
 
Amount
 
PMPM
 
% of
Total
Fee for service
$
2,799

 
$
220.29

 
74.7
%
 
$
2,224

 
$
218.69

 
73.8
%
Pharmacy
567

 
44.65

 
15.1

 
418

 
41.07

 
13.9

Capitation
302

 
23.83

 
8.1

 
260

 
25.57

 
8.6

Direct delivery
21

 
1.66

 
0.5

 
31

 
2.97

 
1.0

Other
59

 
4.58

 
1.6

 
83

 
8.19

 
2.7

 
$
3,748

 
$
295.01

 
100.0
%
 
$
3,016

 
$
296.49

 
100.0
%
 
Nine Months Ended September 30,
 
2016
 
2015
 
Amount
 
PMPM
 
% of
Total
 
Amount
 
PMPM
 
% of
Total
Fee for service
$
8,156

 
$
215.96

 
74.6
%
 
$
6,275

 
$
217.63

 
73.1
%
Pharmacy
1,621

 
42.93

 
14.8

 
1,161

 
40.26

 
13.5

Capitation
901

 
23.86

 
8.3

 
725

 
25.13

 
8.5

Direct delivery
55

 
1.46

 
0.5

 
85

 
2.94

 
1.0

Other
197

 
5.20

 
1.8

 
335

 
11.62

 
3.9

 
$
10,930

 
$
289.41

 
100.0
%
 
$
8,581

 
$
297.58

 
100.0
%

The following table provides the details of our medical claims and benefits payable as of the dates indicated:
 
September 30,
 
December 31,
 
2016
 
2015
Fee-for-service claims incurred but not paid (IBNP)
$
1,333

 
$
1,191

Pharmacy payable
114

 
88

Capitation payable
27

 
140

Other (1)
397

 
266

 
$
1,871

 
$
1,685

______________________
(1)
“Other” medical claims and benefits payable include amounts payable to certain providers for which we act 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. As of September 30, 2016 and December 31, 2015, we had recorded non-risk provider payables of approximately $237 million and $167 million, respectively.

-MORE-


MOH Reports Third Quarter 2016 Results
Page 14
October 27, 2016

MOLINA HEALTHCARE, INC.
UNAUDITED CHANGE IN MEDICAL CLAIMS AND BENEFITS PAYABLE
(Dollars in millions, except per-member amounts)

Our claims liability includes a provision 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. Our 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 our 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 for the periods indicated:

 
 
 
Year Ended
 
Nine Months Ended September 30,
 
December 31,
 
2016
 
2015
 
2015
 
 
 
 
 
 
Medical claims and benefits payable, beginning balance
$
1,685

 
$
1,201

 
$
1,201

Components of medical care costs related to:
 
 
 
 
 
Current period
11,120

 
8,724

 
11,935

Prior period
(190
)
 
(143
)
 
(141
)
Total medical care costs
10,930

 
8,581

 
11,794

 
 
 
 
 
 
Change in non-risk provider payables
70

 
42

 
48

Payments for medical care costs related to:
 
 
 
 
 
Current period
9,536

 
7,372

 
10,448

Prior period
1,278

 
892

 
910

Total paid
10,814

 
8,264

 
11,358

Medical claims and benefits payable, ending balance
$
1,871

 
$
1,560

 
$
1,685

 
 
 
 
 
 
Benefit from prior period as a percentage of:
 
 
 
 
 
Balance at beginning of period
11.3
%
 
11.9
%
 
11.8
%
Premium revenue, trailing twelve months
1.2
%
 
1.2
%
 
1.1
%
Medical care costs, trailing twelve months
1.3
%
 
1.3
%
 
1.2
%
 
 
 
 
 
 
Fee-For-Service Claims Data:
 
 
 
 
 
Days in claims payable, fee for service
47

 
49

 
48

Number of members at end of period
4,246,000

 
3,470,000

 
3,533,000

Number of claims in inventory at end of period
580,200

 
408,100

 
380,800

Billed charges of claims in inventory at end of period
$
1,346

 
$
908

 
$
816

Claims in inventory per member at end of period
0.14

 
0.12

 
0.11

Billed charges of claims in inventory per member at end of period
$
316.89

 
$
261.73

 
$
230.91

Number of claims received during the period
39,683,800

 
29,084,100

 
40,173,300

Billed charges of claims received during the period
$
48,017

 
$
33,517

 
$
46,211




-END-