-
Net loss of
$230 million for the quarter, or$4.10 per diluted share. -
Restructuring plan now underway is expected to reduce annualized
run-rate expenses by
$300 million to $400 million upon completion in 2018. $200 million total reduction to annualized run-rate expenses resulting from staff reductions expected to be achieved by the end of 2017 in time for full realization in 2018.-
Annualized salary eliminations of
$55 million achieved so far in the third quarter of 2017. - Direct delivery operations will be restructured during the second half of 2017.
-
2018 Marketplace participation to be terminated in
Utah andWisconsin ; additional states in review. - 2017 earnings per share guidance withdrawn.
“We are disappointed with our bottom-line results for this quarter and
have taken aggressive and urgent steps to substantially improve our
financial performance going forward,” said
Second Quarter 2017 Compared with Second Quarter 2016
Net loss per diluted share was
Certain significant items increased loss before income tax benefit in
the second quarter of 2017 by approximately
-
We recorded
$72 million in non-cash impairment losses for goodwill and intangibles, primarily relating to our Pathways subsidiary. In the course of developing our restructuring and profitability improvement plan, we determined that future benefits to be derived from Pathways (including integration with our health plans) will be less than previously anticipated. While such impairment losses have a short-term impact on profitability, there is no impact to our cash flows. Pathways experienced operating losses of$8 million for the quarter endedJune 30, 2017 and$12 million for the six months endedJune 30, 2017 .
-
Medical care costs related to 2016 service dates were significantly in
excess of what the Company usually experiences for out-of-period
claims development, particularly at the
Florida ,Illinois ,New Mexico , andPuerto Rico health plans. In total, we experienced out-of-period claims development that was approximately$85 million higher than expected atDecember 31, 2016 . -
We recorded
$44 million for Marketplace changes in estimates, including risk transfer and cost sharing subsidies, related to 2016 service dates. Liabilities for risk transfer payments and cost sharing subsidies that were estimated atDecember 31, 2016 were finalized during the second quarter of 2017. -
Loss before income tax benefit increased by
$78 million as a result of an increase to the premium deficiency reserve established for the Marketplace program. The reserve, which was$22 million atMarch 31, 2017 , increased to$100 million as ofJune 30, 2017 . Based upon revenue and cost trends observed in the second quarter of 2017, we now believe that Marketplace performance in the second half of 2017 will fall substantially short of previous expectations. Marketplace performance has been most disappointing inFlorida ,Utah ,Washington , andWisconsin . -
We recorded
$43 million in restructuring and separation costs in the second quarter of 2017 related primarily to contractually required termination benefits paid to our former chief executive officer and chief financial officer. Also included in these costs are consulting fees incurred for the development and implementation of our corporate restructuring initiatives.
In addition to the items noted above, ongoing poor performance at our
The table below summarizes the impact of these significant items on the Company’s financial performance.
Summary of Significant Items Affecting 2017 Financial Results |
||||||||||||||||||||
Three Months Ended | Six Months Ended | |||||||||||||||||||
June 30, 2017 | June 30, 2017 | |||||||||||||||||||
(In millions, except per diluted share amounts) | ||||||||||||||||||||
Amount |
Per Diluted |
Amount |
Per Diluted |
|||||||||||||||||
Impairment losses | $ | 72 | $ | 1.01 | $ | 72 | $ | 1.02 | ||||||||||||
Losses at behavioral health subsidiary exclusive of impairment | 8 | 0.09 | 12 | 0.14 | ||||||||||||||||
Medical care costs related to prior year service dates that were in excess of historical expectations | 85 | 0.95 | 74 | 0.84 | ||||||||||||||||
Marketplace adjustments related to risk transfer, cost sharing subsidies, and other items for 2016 service dates | 44 | 0.49 | 47 | 0.53 | ||||||||||||||||
Marketplace premium deficiency reserve for 2017 service dates | 78 | 0.87 | 70 | 0.79 | ||||||||||||||||
Restructuring and separation costs | 43 | 0.68 | 43 | 0.68 | ||||||||||||||||
Termination fee received for Terminated Medicare acquisition | — | — | (75 | ) | (0.84 | ) | ||||||||||||||
$ | 330 | $ | 4.09 | $ | 243 | $ | 3.16 |
____________________ | |
(1) |
Except for certain items that are not deductible for tax purposes, per diluted share amounts are generally calculated at our statutory income tax rate of 37%, which is in excess of the effective tax rate recorded in our consolidated statements of operations. |
Income Tax (Benefit) Expense
The effective tax rate benefit for 2017 was less than the statutory tax rate benefit due to the relatively large amount of our reported expenses that are not deductible for tax purposes.
Restructuring and Profit Improvement Plan
As a result of our poor operating performance and catalyzed by our change in management, we accelerated the implementation of a comprehensive restructuring and profitability improvement plan (the Restructuring Plan). Under the Restructuring Plan, we are taking the following actions:
- We are streamlining our organizational structure, including the elimination of redundant layers of management, the consolidation of regional support services, and other reductions to our workforce, to improve efficiency as well as the speed and quality of our decision-making.
- We are re-designing core operating processes such as provider payment, utilization management, quality monitoring and improvement, and information technology to achieve more effective and cost efficient outcomes.
- We are remediating high cost provider contracts and building around high quality, cost-effective networks.
- We are restructuring our existing direct delivery operations.
- We are reviewing our vendor base to ensure that we are partnering with the lowest-cost, most-effective vendors.
- Throughout this process, we are taking precautions to ensure that our actions do not impede our ability to continue to deliver quality health care, retain existing managed care contracts, and to secure new managed care contracts.
In total, we estimate that the Restructuring Plan will reduce annualized
run-rate expenses by approximately
We estimate that total pre-tax costs associated with the Restructuring
Plan will be approximately
As part of the Restructuring Plan, we are reducing our corporate and health plans workforce by approximately 10%, or 1,500 full-time-equivalent employees. This workforce rightsizing, which represents 7% of the total number of our employees, is expected to be completed by the end of 2017. Affected employees will be offered severance and outplacement assistance.
“This reduction in our workforce is a difficult, but necessary, step as we concentrate our efforts on achieving operational excellence and improved efficiency. By transforming the entire enterprise into a leaner, more streamlined organization, we can enhance our decision-making, improve our operating performance, and grow our margins,” said Mr. White.
Actions Taken to Remediate 2018 Marketplace Performance
In addition to the Restructuring Plan, we are taking these further steps to improve profitability in 2018:
-
We are exiting the
Utah and Wisconsin ACA Marketplaces effectiveDecember 31, 2017 . For the three months endedJune 30, 2017 , these two health plans reported a total of$127 million in Marketplace premium revenue (16% of consolidated Marketplace premium revenue), and a combined Marketplace medical care ratio of 128%. - In our remaining Marketplace plans, we are increasing 2018 premiums by 55%. The increase takes into account the absence of cost sharing reduction subsidies. Had we assumed that cost sharing reduction subsidies would be funded for 2018, the premium increase would have been 30%.
- We are also reducing the scope of our 2018 participation in the Washington Marketplace.
- We continue to closely monitor the current political and programmatic developments pertaining to our 2018 participation in other Marketplace states, and subject to those developments, will withdraw from 2018 participation as may be necessary.
Withdrawing 2017 Outlook
We are withdrawing our previously issued 2017 full-year earnings per diluted share and adjusted earnings per diluted share guidance. Among the reasons for withdrawing guidance are:
-
Our results for the quarter ended
June 30, 2017 . -
Uncertain medical cost trends in the
Florida ,Illinois ,New Mexico , andPuerto Rico health plans. - Uncertainty around the funding of Marketplace cost sharing subsidies.
- Potential variability in the timing of benefits achieved and costs incurred as a result of the Restructuring Plan.
Update on Search for Permanent Chief Executive Officer
Our search for a permanent chief executive officer is well underway and we are encouraged by the response.
Conference Call
Management will host a conference call and webcast to discuss Molina
Healthcare’s second quarter results at
About
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 the Restructuring Plan, including the timing of the benefits realized;
- the numerous political and market-based uncertainties associated
with the Affordable Care Act (the “ACA”) or “Obamacare,” including any
potential repeal and replacement of the law, amendment of the law, or
move to state block grants for
Medicaid ; - the market dynamics surrounding the ACA Marketplaces, including but not limited to uncertainties associated with risk transfer requirements, the potential for disproportionate enrollment of higher acuity members, the withdrawal of cost sharing subsidies and/or premium tax credits, the adequacy of agreed rates, and potential disruption associated with market withdrawal;
- 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;
- effective management of our medical costs;
- our ability to predict with a reasonable degree of accuracy utilization rates, including utilization rates associated with seasonal flu patterns or other newly emergent diseases;
- 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 payment of all
amounts due to our
Illinois health plan following the resolution of theIllinois budget impasse; - the success of our efforts to retain existing government contracts,
including those in
Florida ,Illinois ,New Mexico ,Puerto Rico , andTexas , and to obtain new government contracts in connection with state requests for proposals (RFPs) in both existing and new states; - any adverse impact resulting from the significant changes to our executive leadership team and the rightsizing of our workforce;
- the impact of our decision to exit the
Utah and Wisconsin ACA Marketplace markets effective December 31, 2017; - our ability to manage our operations, 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 acquisitions or divestitures;
- 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;
- the
Medicaid expansion cost corridors inCalifornia ,New Mexico , andWashington , and any other retroactive adjustment to revenue where methodologies and procedures are subject to interpretation or dependent upon information about the health status of participants other than Molina members; - the interpretation and implementation of at-risk premium rules and state contract performance requirements regarding the achievement of certain quality measures, and our ability to recognize revenue amounts 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 thePuerto Rico debt crisis, payment of all amounts due under ourMedicaid contract, the effect of the PROMESA law, and our efforts to better manage the health care costs of ourPuerto Rico health plan; - the success and renewal of our duals demonstration programs in
California ,Illinois ,Michigan ,Ohio ,South Carolina , andTexas ; - the accurate estimation of incurred but not reported or paid medical costs across our health plans;
- efforts by states to recoup previously paid and recognized premium amounts;
- 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, or potential investigations, and any
fine, sanction, enrollment freeze, monitoring program, or premium
recovery that may result therefrom, including any potential demand by
the state of
New Mexico to recover purportedly underpaid premium taxes; - 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;
- our failure to comply with the financial or other covenants in our credit agreement or the indentures governing our outstanding notes;
- the sufficiency of our funds on hand to pay the amounts due upon conversion or maturity of our outstanding notes;
- 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, including but not limited to the deductibility of certain compensation costs;
- newly emergent viruses or widespread epidemics, public catastrophes or terrorist attacks, and associated public alarm;
- increasing competition and consolidation in the
Medicaid industry;
and numerous other risk factors, including those discussed in our
periodic reports and filings with the
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED STATEMENTS OF OPERATIONS |
||||||||||||||||||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||||||
2017 | 2016 | 2017 | 2016 | |||||||||||||||||
(Dollar amounts in millions, except per-share amounts) | ||||||||||||||||||||
Revenue: | ||||||||||||||||||||
Premium revenue | $ | 4,740 | $ | 4,029 | $ | 9,388 | $ | 8,024 | ||||||||||||
Service revenue | 129 | 135 | 260 | 275 | ||||||||||||||||
Premium tax revenue | 114 | 109 | 225 | 218 | ||||||||||||||||
Health insurer fee revenue | — | 76 | — | 166 | ||||||||||||||||
Investment income and other revenue | 16 | 10 | 30 | 19 | ||||||||||||||||
Total revenue | 4,999 | 4,359 | 9,903 | 8,702 | ||||||||||||||||
Operating expenses: | ||||||||||||||||||||
Medical care costs | 4,491 | 3,594 | 8,602 | 7,182 | ||||||||||||||||
Cost of service revenue | 124 | 116 | 246 | 243 | ||||||||||||||||
General and administrative expenses | 405 | 351 | 844 | 691 | ||||||||||||||||
Premium tax expenses | 114 | 109 | 225 | 218 | ||||||||||||||||
Health insurer fee expenses | — | 50 | — | 108 | ||||||||||||||||
Depreciation and amortization | 37 | 34 | 76 | 66 | ||||||||||||||||
Impairment losses | 72 | — | 72 | — | ||||||||||||||||
Restructuring and separation costs | 43 | — | 43 | — | ||||||||||||||||
Total operating expenses | 5,286 | 4,254 | 10,108 | 8,508 | ||||||||||||||||
Operating (loss) income | (287 | ) | 105 | (205 | ) | 194 | ||||||||||||||
Other expenses (income), net: | ||||||||||||||||||||
Interest expense | 27 | 25 | 53 | 50 | ||||||||||||||||
Other income, net | — | — | (75 | ) | — | |||||||||||||||
Total other expenses (income), net | 27 | 25 | (22 | ) | 50 | |||||||||||||||
(Loss) income before income tax (benefit) expense | (314 | ) | 80 | (183 | ) | 144 | ||||||||||||||
Income tax (benefit) expense | (84 | ) | 47 | (30 | ) | 87 | ||||||||||||||
Net (loss) income | $ | (230 | ) | $ | 33 | $ | (153 | ) | $ | 57 | ||||||||||
Net (loss) income per diluted share | $ | (4.10 | ) | $ | 0.58 | $ | (2.74 | ) | $ | 1.01 | ||||||||||
Diluted weighted average shares outstanding | 56.2 | 55.5 | 56.1 | 56.3 | ||||||||||||||||
Operating Statistics: | ||||||||||||||||||||
Medical care ratio (1) | 94.8 | % | 89.2 | % | 91.6 | % | 89.5 | % | ||||||||||||
G&A ratio (2) | 8.1 | % | 8.1 | % | 8.5 | % | 7.9 | % | ||||||||||||
Premium tax ratio (1) | 2.4 | % | 2.6 | % | 2.3 | % | 2.6 | % | ||||||||||||
Effective tax rate | 26.8 | % | 59.8 | % | 16.0 | % | 60.7 | % | ||||||||||||
Net profit margin (2) | (4.6 | )% | 0.7 | % | (1.5 | )% | 0.7 | % |
__________________ | |
(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) | G&A ratio represents general and administrative expenses as a percentage of total revenue. Net profit margin represents net (loss) income as a percentage of total revenue. |
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED BALANCE SHEETS |
||||||||||
June 30, | December 31, | |||||||||
2017 | 2016 | |||||||||
(In millions, |
||||||||||
ASSETS | ||||||||||
Current assets: | ||||||||||
Cash and cash equivalents | $ | 2,979 | $ | 2,819 | ||||||
Investments | 2,192 | 1,758 | ||||||||
Restricted investments | 325 | — | ||||||||
Receivables | 1,006 | 974 | ||||||||
Income taxes refundable |
68 |
39 | ||||||||
Prepaid expenses and other current assets | 159 | 131 | ||||||||
Derivative asset | 440 | 267 | ||||||||
Total current assets | 7,169 | 5,988 | ||||||||
Property, equipment, and capitalized software, net | 449 | 454 | ||||||||
Deferred contract costs | 93 | 86 | ||||||||
Intangible assets, net | 112 | 140 | ||||||||
Goodwill | 559 | 620 | ||||||||
Restricted investments | 118 | 110 | ||||||||
Deferred income taxes | 36 | 10 | ||||||||
Other assets | 47 | 41 | ||||||||
$ | 8,583 | $ | 7,449 | |||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||||
Current liabilities: | ||||||||||
Medical claims and benefits payable | $ | 2,077 | $ | 1,929 | ||||||
Amounts due government agencies | 1,844 | 1,202 | ||||||||
Accounts payable and accrued liabilities | 375 | 385 | ||||||||
Deferred revenue | 284 | 315 | ||||||||
Current portion of long-term debt | 773 | 472 | ||||||||
Derivative liability | 440 | 267 | ||||||||
Total current liabilities | 5,793 | 4,570 | ||||||||
Senior notes | 1,017 | 975 | ||||||||
Lease financing obligations | 198 | 198 | ||||||||
Deferred income taxes | — | 15 | ||||||||
Other long-term liabilities | 54 | 42 | ||||||||
Total liabilities | 7,062 | 5,800 | ||||||||
Stockholders’ equity: | ||||||||||
Common stock, $0.001 par value; 150 shares authorized; outstanding: 57 shares at June 30, 2017 and December 31, 2016 | — | — | ||||||||
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding | — | — | ||||||||
Additional paid-in capital | 865 | 841 | ||||||||
Accumulated other comprehensive loss | (1 | ) | (2 | ) | ||||||
Retained earnings | 657 | 810 | ||||||||
Total stockholders’ equity | 1,521 | 1,649 | ||||||||
$ | 8,583 | $ | 7,449 | |||||||
MOLINA HEALTHCARE, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS |
||||||||||||||||||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||||||
2017 | 2016 | 2017 | 2016 | |||||||||||||||||
(In millions) | ||||||||||||||||||||
Operating activities: | ||||||||||||||||||||
Net (loss) income | $ | (230 | ) | $ | 33 | $ | (153 | ) | $ | 57 | ||||||||||
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities: | ||||||||||||||||||||
Depreciation and amortization | 47 | 45 | 96 | 89 | ||||||||||||||||
Impairment losses | 72 | — | 72 | — | ||||||||||||||||
Deferred income taxes | (36 | ) | 9 | (41 | ) | 39 | ||||||||||||||
Share-based compensation, including accelerated share-based compensation | 29 | 9 | 35 | 16 | ||||||||||||||||
Amortization of convertible senior notes and lease financing obligations | 8 | 7 | 16 | 15 | ||||||||||||||||
Other, net | 4 | 5 | 7 | 11 | ||||||||||||||||
Changes in operating assets and liabilities: | ||||||||||||||||||||
Receivables | — | (149 | ) | (32 | ) | (415 | ) | |||||||||||||
Prepaid expenses and other assets | (26 | ) | 59 | (38 | ) | (143 | ) | |||||||||||||
Medical claims and benefits payable | 151 | (173 | ) | 148 | 82 | |||||||||||||||
Amounts due government agencies | 269 | 328 | 642 | 509 | ||||||||||||||||
Accounts payable and accrued liabilities | (68 | ) | (58 | ) | (18 | ) | 147 | |||||||||||||
Deferred revenue | (178 | ) | 10 | (32 | ) | (119 | ) | |||||||||||||
Income taxes | (89 | ) | 14 | (30 | ) | (10 | ) | |||||||||||||
Net cash (used in) provided by operating activities | (47 | ) | 139 | 672 | 278 | |||||||||||||||
Investing activities: | ||||||||||||||||||||
Purchases of investments | (903 | ) | (363 | ) | (1,636 | ) | (974 | ) | ||||||||||||
Proceeds from sales and maturities of investments | 441 | 464 | 874 | 812 | ||||||||||||||||
Purchases of property, equipment, and capitalized software | (34 | ) | (56 | ) | (60 | ) | (102 | ) | ||||||||||||
(Increase) decrease in restricted investments held-to-maturity | (3 | ) | 9 | (10 | ) | 5 | ||||||||||||||
Net cash paid in business combinations | — | (6 | ) | — | (8 | ) | ||||||||||||||
Other, net | (7 | ) | (7 | ) | (13 | ) | (6 | ) | ||||||||||||
Net cash (used in) provided by investing activities | (506 | ) | 41 | (845 | ) | (273 | ) | |||||||||||||
Financing activities: | ||||||||||||||||||||
Proceeds from senior notes offerings, net of issuance costs | 325 | — | 325 | — | ||||||||||||||||
Proceeds from employee stock plans | 10 | 10 | 11 | 10 | ||||||||||||||||
Other, net | (1 | ) | (1 | ) | (3 | ) | 1 | |||||||||||||
Net cash provided by financing activities | 334 | 9 | 333 | 11 | ||||||||||||||||
Net (decrease) increase in cash and cash equivalents | (219 | ) | 189 | 160 | 16 | |||||||||||||||
Cash and cash equivalents at beginning of period | 3,198 | 2,156 | 2,819 | 2,329 | ||||||||||||||||
Cash and cash equivalents at end of period | $ | 2,979 | $ | 2,345 | $ | 2,979 | $ | 2,345 | ||||||||||||
MOLINA HEALTHCARE, INC. UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP |
|||||||||||
June 30, |
December 31, |
June 30, |
|||||||||
Ending Membership by Program: | |||||||||||
Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) | 2,517,000 | 2,536,000 | 2,500,000 | ||||||||
Marketplace | 949,000 | 526,000 | 597,000 | ||||||||
Medicaid Expansion | 678,000 | 673,000 | 654,000 | ||||||||
Aged, Blind or Disabled (ABD) | 408,000 | 396,000 | 387,000 | ||||||||
Medicare-Medicaid Plan (MMP) - Integrated | 54,000 | 51,000 | 51,000 | ||||||||
Medicare Special Needs Plans | 44,000 | 45,000 | 44,000 | ||||||||
4,650,000 | 4,227,000 | 4,233,000 | |||||||||
Ending Membership by Health Plan: | |||||||||||
California | 766,000 | 683,000 | 680,000 | ||||||||
Florida | 672,000 | 553,000 | 565,000 | ||||||||
Illinois | 163,000 | 195,000 | 201,000 | ||||||||
Michigan | 414,000 | 391,000 | 393,000 | ||||||||
New Mexico | 266,000 | 254,000 | 251,000 | ||||||||
New York (1) | 34,000 | 35,000 | — | ||||||||
Ohio | 351,000 | 332,000 | 341,000 | ||||||||
Puerto Rico | 322,000 | 330,000 | 336,000 | ||||||||
South Carolina | 112,000 | 109,000 | 105,000 | ||||||||
Texas | 465,000 | 337,000 | 367,000 | ||||||||
Utah | 167,000 | 146,000 | 151,000 | ||||||||
Washington | 788,000 | 736,000 | 709,000 | ||||||||
Wisconsin | 130,000 | 126,000 | 134,000 | ||||||||
4,650,000 | 4,227,000 | 4,233,000 |
____________________ | |
(1) | The New York health plan was acquired on August 1, 2016. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Three Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
TANF and CHIP | 7.6 | $ | 1,391 | $ | 182.47 | $ | 1,315 | $ | 172.48 | 94.5 | % | $ | 76 | ||||||||||||||||||||
Medicaid Expansion | 2.1 | 786 | 383.07 | 689 | 335.26 | 87.5 | 97 | ||||||||||||||||||||||||||
ABD | 1.2 | 1,285 | 1,053.89 | 1,245 | 1,020.85 | 96.9 | 40 | ||||||||||||||||||||||||||
Total Medicaid | 10.9 | 3,462 | 317.79 | 3,249 | 298.10 | 93.8 | 213 | ||||||||||||||||||||||||||
MMP | 0.1 | 361 | 2,217.44 | 333 | 2,050.20 | 92.5 | 28 | ||||||||||||||||||||||||||
Medicare | 0.2 | 148 | 1,126.14 | 126 | 963.34 | 85.5 | 22 | ||||||||||||||||||||||||||
Total Medicare | 0.3 | 509 | 1,730.91 | 459 | 1,565.65 | 90.5 | 50 | ||||||||||||||||||||||||||
Excluding Marketplace | 11.2 | 3,971 | 354.87 | 3,708 | 331.36 | 93.4 | 263 | ||||||||||||||||||||||||||
Marketplace | 2.8 | 769 | 267.37 | 783 | 272.37 | 101.9 | (14 | ) | |||||||||||||||||||||||||
14.0 | $ | 4,740 | $ | 336.98 | $ | 4,491 | $ | 319.29 | 94.8 | % | $ | 249 | |||||||||||||||||||||
Three Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
TANF and CHIP | 7.5 | $ | 1,302 | $ | 173.57 | $ | 1,202 | $ | 160.26 | 92.3 | % | $ | 100 | ||||||||||||||||||||
Medicaid Expansion | 1.9 | 742 | 378.19 | 634 | 323.56 | 85.6 | 108 | ||||||||||||||||||||||||||
ABD | 1.2 | 1,168 | 991.38 | 1,038 | 881.80 | 88.9 | 130 | ||||||||||||||||||||||||||
Total Medicaid | 10.6 | 3,212 | 301.86 | 2,874 | 270.27 | 89.5 | 338 | ||||||||||||||||||||||||||
MMP | 0.2 | 315 | 2,093.29 | 270 | 1,792.78 | 85.6 | 45 | ||||||||||||||||||||||||||
Medicare | 0.2 | 129 | 997.44 | 127 | 974.30 | 97.7 | 2 | ||||||||||||||||||||||||||
Total Medicare | 0.4 | 444 | 1,584.77 | 397 | 1,412.96 | 89.2 | 47 | ||||||||||||||||||||||||||
Excluding Marketplace | 11.0 | 3,656 | 334.86 | 3,271 | 299.67 | 89.5 | 385 | ||||||||||||||||||||||||||
Marketplace | 1.8 | 373 | 206.88 | 323 | 178.79 | 86.4 | 50 | ||||||||||||||||||||||||||
12.8 | $ | 4,029 | $ | 316.72 | $ | 3,594 | $ | 282.54 | 89.2 | % | $ | 435 |
____________________ | |
(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. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
||||||||||||||||||||||||||||||||
Six Months Ended June 30, 2017 | ||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||||||
TANF and CHIP | 15.3 | $ | 2,793 | $ | 182.58 | $ | 2,619 | $ | 171.25 | 93.8 | % | $ | 174 | |||||||||||||||||||
Medicaid Expansion | 4.1 | 1,603 | 390.88 | 1,378 | 335.88 | 85.9 | 225 | |||||||||||||||||||||||||
ABD | 2.4 | 2,481 | 1,030.68 | 2,375 | 986.54 | 95.7 | 106 | |||||||||||||||||||||||||
Total Medicaid | 21.8 | 6,877 | 315.39 | 6,372 | 292.22 | 92.7 | 505 | |||||||||||||||||||||||||
MMP | 0.3 | 705 | 2,152.75 | 640 | 1,954.15 | 90.8 | 65 | |||||||||||||||||||||||||
Medicare | 0.3 | 286 | 1,097.36 | 243 | 933.20 | 85.0 | 43 | |||||||||||||||||||||||||
Total Medicare | 0.6 | 991 | 1,685.72 | 883 | 1,502.36 | 89.1 | 108 | |||||||||||||||||||||||||
Excluding Marketplace | 22.4 | 7,868 | 351.35 | 7,255 | 323.98 | 92.2 | 613 | |||||||||||||||||||||||||
Marketplace | 5.7 | 1,520 | 264.77 | 1,347 | 234.62 | 88.6 | 173 | |||||||||||||||||||||||||
28.1 | $ | 9,388 | $ | 333.68 | $ | 8,602 | $ | 305.74 | 91.6 | % | $ | 786 | ||||||||||||||||||||
Six Months Ended June 30, 2016 | ||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||||||
TANF and CHIP | 14.9 | $ | 2,626 | $ | 176.00 | $ | 2,400 | $ | 160.85 | 91.4 | % | $ | 226 | |||||||||||||||||||
Medicaid Expansion | 3.8 | 1,421 | 371.82 | 1,208 | 316.13 | 85.0 | 213 | |||||||||||||||||||||||||
ABD | 2.4 | 2,280 | 976.58 | 2,079 | 890.71 | 91.2 | 201 | |||||||||||||||||||||||||
Total Medicaid | 21.1 | 6,327 | 300.19 | 5,687 | 269.86 | 89.9 | 640 | |||||||||||||||||||||||||
MMP | 0.3 | 655 | 2,157.55 | 587 | 1,932.73 | 89.6 | 68 | |||||||||||||||||||||||||
Medicare | 0.3 | 260 | 1,013.04 | 251 | 977.35 | 96.5 | 9 | |||||||||||||||||||||||||
Total Medicare | 0.6 | 915 | 1,633.08 | 838 | 1,494.92 | 91.5 | 77 | |||||||||||||||||||||||||
Excluding Marketplace | 21.7 | 7,242 | 334.74 | 6,525 | 301.61 | 90.1 | 717 | |||||||||||||||||||||||||
Marketplace | 3.4 | 782 | 228.19 | 657 | 191.62 | 84.0 | 125 | |||||||||||||||||||||||||
25.1 | $ | 8,024 | $ | 320.17 | $ | 7,182 | $ | 286.57 | 89.5 | % | $ | 842 |
____________________ | |
(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. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—NON-MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Three Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 1.9 | $ | 598 | $ | 318.89 | $ | 539 | $ | 287.36 | 90.1 | % | $ | 59 | ||||||||||||||||||||
Florida | 1.1 | 380 | 347.20 | 370 | 337.92 | 97.3 | 10 | ||||||||||||||||||||||||||
Illinois | 0.5 | 149 | 289.51 | 174 | 336.76 | 116.3 | (25 | ) | |||||||||||||||||||||||||
Michigan | 1.1 | 390 | 333.26 | 358 | 305.40 | 91.6 | 32 | ||||||||||||||||||||||||||
New Mexico | 0.8 | 321 | 443.13 | 311 | 428.58 | 96.7 | 10 | ||||||||||||||||||||||||||
New York (3) | 0.1 | 46 | 457.96 | 45 | 442.16 | 96.5 | 1 | ||||||||||||||||||||||||||
Ohio | 1.0 | 529 | 536.90 | 489 | 496.41 | 92.5 | 40 | ||||||||||||||||||||||||||
Puerto Rico | 0.9 | 179 | 184.28 | 189 | 194.42 | 105.5 | (10 | ) | |||||||||||||||||||||||||
South Carolina | 0.4 | 111 | 326.57 | 102 | 304.14 | 93.1 | 9 | ||||||||||||||||||||||||||
Texas | 0.7 | 524 | 752.01 | 473 | 679.43 | 90.3 | 51 | ||||||||||||||||||||||||||
Utah | 0.3 | 89 | 313.93 | 76 | 267.15 | 85.1 | 13 | ||||||||||||||||||||||||||
Washington | 2.2 | 618 | 276.90 | 546 | 244.58 | 88.3 | 72 | ||||||||||||||||||||||||||
Wisconsin | 0.2 | 34 | 170.98 | 26 | 130.54 | 76.3 | 8 | ||||||||||||||||||||||||||
Other (4) | — | 3 | — | 10 | — | — | (7 | ) | |||||||||||||||||||||||||
11.2 | $ | 3,971 | $ | 354.87 | $ | 3,708 | $ | 331.36 | 93.4 | % | $ | 263 | |||||||||||||||||||||
Three Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 1.9 | $ | 519 | $ | 281.99 | $ | 472 | $ | 256.37 | 90.9 | % | $ | 47 | ||||||||||||||||||||
Florida | 1.0 | 314 | 312.23 | 289 | 287.84 | 92.2 | 25 | ||||||||||||||||||||||||||
Illinois | 0.6 | 154 | 256.17 | 137 | 227.71 | 88.9 | 17 | ||||||||||||||||||||||||||
Michigan | 1.2 | 366 | 312.88 | 332 | 283.89 | 90.7 | 34 | ||||||||||||||||||||||||||
New Mexico | 0.7 | 328 | 468.35 | 296 | 422.37 | 90.2 | 32 | ||||||||||||||||||||||||||
New York (3) | — | — | — | — | — | — | — | ||||||||||||||||||||||||||
Ohio | 0.9 | 474 | 479.41 | 427 | 431.46 | 90.0 | 47 | ||||||||||||||||||||||||||
Puerto Rico | 1.0 | 170 | 169.04 | 175 | 173.49 | 102.6 | (5 | ) | |||||||||||||||||||||||||
South Carolina | 0.3 | 87 | 277.22 | 71 | 226.27 | 81.6 | 16 | ||||||||||||||||||||||||||
Texas | 0.8 | 580 | 784.32 | 470 | 633.94 | 80.8 | 110 | ||||||||||||||||||||||||||
Utah | 0.3 | 86 | 293.39 | 74 | 254.59 | 86.8 | 12 | ||||||||||||||||||||||||||
Washington | 2.1 | 538 | 263.41 | 484 | 237.43 | 90.1 | 54 | ||||||||||||||||||||||||||
Wisconsin | 0.2 | 36 | 166.95 | 27 | 120.69 | 72.3 | 9 | ||||||||||||||||||||||||||
Other (4) | — | 4 | — | 17 | — | — | (13 | ) | |||||||||||||||||||||||||
11.0 | $ | 3,656 | $ | 334.86 | $ | 3,271 | $ | 299.67 | 89.5 | % | $ | 385 |
____________________ | |
(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. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—NON-MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Six Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 3.7 | $ | 1,170 | $ | 313.76 | $ | 1,023 | $ | 274.42 | 87.5 | % | $ | 147 | ||||||||||||||||||||
Florida | 2.2 | 744 | 343.29 | 722 | 333.23 | 97.1 | 22 | ||||||||||||||||||||||||||
Illinois | 1.1 | 310 | 282.66 | 354 | 322.63 | 114.1 | (44 | ) | |||||||||||||||||||||||||
Michigan | 2.3 | 772 | 330.34 | 690 | 295.02 | 89.3 | 82 | ||||||||||||||||||||||||||
New Mexico | 1.5 | 629 | 432.98 | 610 | 419.65 | 96.9 | 19 | ||||||||||||||||||||||||||
New York (3) | 0.2 | 92 | 449.48 | 87 | 425.72 | 94.7 | 5 | ||||||||||||||||||||||||||
Ohio | 2.0 | 1,049 | 532.35 | 951 | 482.73 | 90.7 | 98 | ||||||||||||||||||||||||||
Puerto Rico | 1.9 | 362 | 185.40 | 354 | 181.24 | 97.8 | 8 | ||||||||||||||||||||||||||
South Carolina | 0.7 | 216 | 321.85 | 200 | 298.79 | 92.8 | 16 | ||||||||||||||||||||||||||
Texas | 1.4 | 1,051 | 751.94 | 962 | 687.96 | 91.5 | 89 | ||||||||||||||||||||||||||
Utah | 0.6 | 178 | 313.56 | 148 | 260.43 | 83.1 | 30 | ||||||||||||||||||||||||||
Washington | 4.4 | 1,223 | 275.05 | 1,081 | 243.18 | 88.4 | 142 | ||||||||||||||||||||||||||
Wisconsin | 0.4 | 67 | 168.16 | 53 | 133.25 | 79.2 | 14 | ||||||||||||||||||||||||||
Other (4) | — | 5 | — | 20 | — | — | (15 | ) | |||||||||||||||||||||||||
22.4 | $ | 7,868 | $ | 351.35 | $ | 7,255 | $ | 323.98 | 92.2 | % | $ | 613 | |||||||||||||||||||||
Six Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 3.7 | $ | 1,028 | $ | 281.37 | $ | 918 | $ | 251.15 | 89.3 | % | $ | 110 | ||||||||||||||||||||
Florida | 2.0 | 639 | 322.01 | 575 | 290.08 | 90.1 | 64 | ||||||||||||||||||||||||||
Illinois | 1.2 | 303 | 261.43 | 269 | 232.06 | 88.8 | 34 | ||||||||||||||||||||||||||
Michigan | 2.4 | 751 | 317.13 | 678 | 286.40 | 90.3 | 73 | ||||||||||||||||||||||||||
New Mexico | 1.4 | 651 | 465.65 | 580 | 414.80 | 89.1 | 71 | ||||||||||||||||||||||||||
New York (3) | — | — | — | — | — | — | — | ||||||||||||||||||||||||||
Ohio | 1.9 | 952 | 485.86 | 869 | 443.08 | 91.2 | 83 | ||||||||||||||||||||||||||
Puerto Rico | 2.0 | 351 | 172.98 | 349 | 171.95 | 99.4 | 2 | ||||||||||||||||||||||||||
South Carolina | 0.6 | 171 | 276.61 | 138 | 223.58 | 80.8 | 33 | ||||||||||||||||||||||||||
Texas | 1.5 | 1,116 | 752.54 | 982 | 661.63 | 87.9 | 134 | ||||||||||||||||||||||||||
Utah | 0.6 | 172 | 295.69 | 150 | 259.29 | 87.7 | 22 | ||||||||||||||||||||||||||
Washington | 4.0 | 1,030 | 259.79 | 931 | 234.95 | 90.4 | 99 | ||||||||||||||||||||||||||
Wisconsin | 0.4 | 72 | 164.90 | 52 | 118.37 | 71.8 | 20 | ||||||||||||||||||||||||||
Other (4) | — | 6 | — | 34 | — | — | (28 | ) | |||||||||||||||||||||||||
21.7 | $ | 7,242 | $ | 334.74 | $ | 6,525 | $ | 301.61 | 90.1 | % | $ | 717 |
____________________ | |
(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. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Three Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 0.5 | $ | 81 | $ | 186.90 | $ | 67 | $ | 154.23 | 82.5 | % | $ | 14 | ||||||||||||||||||||
Florida | 0.9 | 269 | 284.60 | 317 | 336.78 | 118.3 | (48 | ) | |||||||||||||||||||||||||
Michigan | 0.1 | 16 | 204.15 | 10 | 135.89 | 66.6 | 6 | ||||||||||||||||||||||||||
New Mexico | — | 31 | 367.98 | 23 | 266.91 | 72.5 | 8 | ||||||||||||||||||||||||||
Ohio | — | 24 | 377.94 | 27 | 404.20 | 106.9 | (3 | ) | |||||||||||||||||||||||||
Texas | 0.7 | 177 | 247.49 | 129 | 180.92 | 73.1 | 48 | ||||||||||||||||||||||||||
Utah | 0.2 | 41 | 186.87 | 53 | 239.50 | 128.2 | (12 | ) | |||||||||||||||||||||||||
Washington | 0.2 | 44 | 317.42 | 49 | 359.87 | 113.4 | (5 | ) | |||||||||||||||||||||||||
Wisconsin | 0.2 | 86 | 434.01 | 109 | 550.81 | 126.9 | (23 | ) | |||||||||||||||||||||||||
Other (3) | — | — | — | (1 | ) | — | — | 1 | |||||||||||||||||||||||||
2.8 | $ | 769 | $ | 267.37 | $ | 783 | $ | 272.37 | 101.9 | % | $ | (14 | ) | ||||||||||||||||||||
Three Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 0.1 | $ | 35 | $ | 159.56 | $ | 21 | $ | 99.15 | 62.1 | % | $ | 14 | ||||||||||||||||||||
Florida | 0.8 | 150 | 217.96 | 137 | 198.93 | 91.3 | 13 | ||||||||||||||||||||||||||
Michigan | — | 3 | 235.15 | 2 | 176.34 | 75.0 | 1 | ||||||||||||||||||||||||||
New Mexico | 0.1 | 14 | 240.40 | 9 | 164.00 | 68.2 | 5 | ||||||||||||||||||||||||||
Ohio | 0.1 | 9 | 294.90 | 6 | 210.36 | 71.3 | 3 | ||||||||||||||||||||||||||
Texas | 0.3 | 55 | 146.76 | 29 | 78.56 | 53.5 | 26 | ||||||||||||||||||||||||||
Utah | 0.2 | 24 | 146.37 | 32 | 195.18 | 133.3 | (8 | ) | |||||||||||||||||||||||||
Washington | — | 21 | 291.91 | 16 | 205.59 | 70.4 | 5 | ||||||||||||||||||||||||||
Wisconsin | 0.2 | 63 | 335.32 | 69 | 369.55 | 110.2 | (6 | ) | |||||||||||||||||||||||||
Other (3) | — | (1 | ) | — | 2 | — | — | (3 | ) | ||||||||||||||||||||||||
1.8 | $ | 373 | $ | 206.88 | $ | 323 | $ | 178.79 | 86.4 | % | $ | 50 |
____________________ | |
(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—MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Six Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 0.9 | $ | 153 | $ | 185.68 | $ | 93 | $ | 112.20 | 60.4 | % | $ | 60 | ||||||||||||||||||||
Florida | 1.9 | 561 | 288.81 | 523 | 269.48 | 93.3 | 38 | ||||||||||||||||||||||||||
Michigan | 0.2 | 27 | 177.12 | 17 | 116.21 | 65.6 | 10 | ||||||||||||||||||||||||||
New Mexico | 0.1 | 53 | 317.10 | 42 | 249.90 | 78.8 | 11 | ||||||||||||||||||||||||||
Ohio | 0.1 | 45 | 356.20 | 44 | 339.26 | 95.2 | 1 | ||||||||||||||||||||||||||
Texas | 1.4 | 334 | 235.07 | 242 | 171.07 | 72.8 | 92 | ||||||||||||||||||||||||||
Utah | 0.4 | 86 | 194.68 | 104 | 233.85 | 120.1 | (18 | ) | |||||||||||||||||||||||||
Washington | 0.3 | 81 | 310.26 | 95 | 362.78 | 116.9 | (14 | ) | |||||||||||||||||||||||||
Wisconsin | 0.4 | 180 | 443.86 | 190 | 469.01 | 105.7 | (10 | ) | |||||||||||||||||||||||||
Other (3) | — | — | — | (3 | ) | — | — | 3 | |||||||||||||||||||||||||
5.7 | $ | 1,520 | $ | 264.77 | $ | 1,347 | $ | 234.62 | 88.6 | % | $ | 173 | |||||||||||||||||||||
Six Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 0.3 | $ | 67 | $ | 173.55 | $ | 44 | $ | 115.80 | 66.7 | % | $ | 23 | ||||||||||||||||||||
Florida | 1.4 | 314 | 230.11 | 264 | 193.24 | 84.0 | 50 | ||||||||||||||||||||||||||
Michigan | — | 5 | 208.83 | 3 | 141.43 | 67.7 | 2 | ||||||||||||||||||||||||||
New Mexico | 0.1 | 27 | 251.96 | 21 | 192.53 | 76.4 | 6 | ||||||||||||||||||||||||||
Ohio | 0.1 | 19 | 330.26 | 13 | 241.55 | 73.1 | 6 | ||||||||||||||||||||||||||
Texas | 0.7 | 139 | 199.62 | 92 | 132.77 | 66.5 | 47 | ||||||||||||||||||||||||||
Utah | 0.3 | 52 | 169.84 | 58 | 187.64 | 110.5 | (6 | ) | |||||||||||||||||||||||||
Washington | 0.1 | 35 | 267.82 | 27 | 200.50 | 74.9 | 8 | ||||||||||||||||||||||||||
Wisconsin | 0.4 | 124 | 348.84 | 136 | 382.15 | 109.5 | (12 | ) | |||||||||||||||||||||||||
Other (3) | — | — | — | (1 | ) | — | — | 1 | |||||||||||||||||||||||||
3.4 | $ | 782 | $ | 228.19 | $ | 657 | $ | 191.62 | 84.0 | % | $ | 125 |
____________________ | |
(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—TOTAL (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Three Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 2.4 | $ | 679 | $ | 294.09 | $ | 606 | $ | 262.34 | 89.2 | % | $ | 73 | ||||||||||||||||||||
Florida | 2.0 | 649 | 318.21 | 687 | 337.39 | 106.0 | (38 | ) | |||||||||||||||||||||||||
Illinois | 0.5 | 149 | 289.51 | 174 | 336.76 | 116.3 | (25 | ) | |||||||||||||||||||||||||
Michigan | 1.2 | 406 | 325.38 | 368 | 295.06 | 90.7 | 38 | ||||||||||||||||||||||||||
New Mexico | 0.8 | 352 | 435.34 | 334 | 411.83 | 94.6 | 18 | ||||||||||||||||||||||||||
New York (3) | 0.1 | 46 | 457.96 | 45 | 442.16 | 96.5 | 1 | ||||||||||||||||||||||||||
Ohio | 1.0 | 553 | 527.14 | 516 | 490.75 | 93.1 | 37 | ||||||||||||||||||||||||||
Puerto Rico | 0.9 | 179 | 184.28 | 189 | 194.42 | 105.5 | (10 | ) | |||||||||||||||||||||||||
South Carolina | 0.4 | 111 | 326.57 | 102 | 304.14 | 93.1 | 9 | ||||||||||||||||||||||||||
Texas | 1.4 | 701 | 495.93 | 602 | 426.41 | 86.0 | 99 | ||||||||||||||||||||||||||
Utah | 0.5 | 130 | 258.10 | 129 | 255.00 | 98.8 | 1 | ||||||||||||||||||||||||||
Washington | 2.4 | 662 | 279.21 | 595 | 251.16 | 90.0 | 67 | ||||||||||||||||||||||||||
Wisconsin | 0.4 | 120 | 303.59 | 135 | 342.43 | 112.8 | (15 | ) | |||||||||||||||||||||||||
Other (4) | — | 3 | — | 9 | — | — | (6 | ) | |||||||||||||||||||||||||
14.0 | $ | 4,740 | $ | 336.98 | $ | 4,491 | $ | 319.29 | 94.8 | % | $ | 249 | |||||||||||||||||||||
Three Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 2.0 | $ | 554 | $ | 268.95 | $ | 493 | $ | 239.63 | 89.1 | % | $ | 61 | ||||||||||||||||||||
Florida | 1.8 | 464 | 273.90 | 426 | 251.69 | 91.9 | 38 | ||||||||||||||||||||||||||
Illinois | 0.6 | 154 | 256.17 | 137 | 227.71 | 88.9 | 17 | ||||||||||||||||||||||||||
Michigan | 1.2 | 369 | 312.18 | 334 | 282.86 | 90.6 | 35 | ||||||||||||||||||||||||||
New Mexico | 0.8 | 342 | 451.72 | 305 | 403.52 | 89.3 | 37 | ||||||||||||||||||||||||||
New York (3) | — | — | — | — | — | — | — | ||||||||||||||||||||||||||
Ohio | 1.0 | 483 | 473.91 | 433 | 424.87 | 89.7 | 50 | ||||||||||||||||||||||||||
Puerto Rico | 1.0 | 170 | 169.04 | 175 | 173.49 | 102.6 | (5 | ) | |||||||||||||||||||||||||
South Carolina | 0.3 | 87 | 277.22 | 71 | 226.27 | 81.6 | 16 | ||||||||||||||||||||||||||
Texas | 1.1 | 635 | 571.14 | 499 | 448.23 | 78.5 | 136 | ||||||||||||||||||||||||||
Utah | 0.5 | 110 | 240.26 | 106 | 233.12 | 97.0 | 4 | ||||||||||||||||||||||||||
Washington | 2.1 | 559 | 264.40 | 500 | 236.32 | 89.4 | 59 | ||||||||||||||||||||||||||
Wisconsin | 0.4 | 99 | 244.88 | 96 | 235.88 | 96.3 | 3 | ||||||||||||||||||||||||||
Other (4) | — | 3 | — | 19 | — | — | (16 | ) | |||||||||||||||||||||||||
12.8 | $ | 4,029 | $ | 316.72 | $ | 3,594 | $ | 282.54 | 89.2 | % | $ | 435 |
____________________ | |
(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. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—TOTAL (In millions, except percentages and per-member per-month amounts) |
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Six Months Ended June 30, 2017 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
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Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 4.6 | $ | 1,323 | $ | 290.56 | $ | 1,116 | $ | 245.02 | 84.3 | % | $ | 207 | ||||||||||||||||||||
Florida | 4.1 | 1,305 | 317.53 | 1,245 | 303.09 | 95.5 | 60 | ||||||||||||||||||||||||||
Illinois | 1.1 | 310 | 282.66 | 354 | 322.63 | 114.1 | (44 | ) | |||||||||||||||||||||||||
Michigan | 2.5 | 799 | 321.10 | 707 | 284.24 | 88.5 | 92 | ||||||||||||||||||||||||||
New Mexico | 1.6 | 682 | 421.11 | 652 | 402.27 | 95.5 | 30 | ||||||||||||||||||||||||||
New York (3) | 0.2 | 92 | 449.48 | 87 | 425.72 | 94.7 | 5 | ||||||||||||||||||||||||||
Ohio | 2.1 | 1,094 | 521.57 | 995 | 473.95 | 90.9 | 99 | ||||||||||||||||||||||||||
Puerto Rico | 1.9 | 362 | 185.40 | 354 | 181.24 | 97.8 | 8 | ||||||||||||||||||||||||||
South Carolina | 0.7 | 216 | 321.85 | 200 | 298.79 | 92.8 | 16 | ||||||||||||||||||||||||||
Texas | 2.8 | 1,385 | 491.46 | 1,204 | 427.48 | 87.0 | 181 | ||||||||||||||||||||||||||
Utah | 1.0 | 264 | 261.42 | 252 | 248.77 | 95.2 | 12 | ||||||||||||||||||||||||||
Washington | 4.7 | 1,304 | 276.99 | 1,176 | 249.79 | 90.2 | 128 | ||||||||||||||||||||||||||
Wisconsin | 0.8 | 247 | 307.50 | 243 | 302.95 | 98.5 | 4 | ||||||||||||||||||||||||||
Other (4) | — | 5 | — | 17 | — | — | (12 | ) | |||||||||||||||||||||||||
28.1 | $ | 9,388 | $ | 333.68 | $ | 8,602 | $ | 305.74 | 91.6 | % | $ | 786 | |||||||||||||||||||||
Six Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months (1) |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
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Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 4.0 | $ | 1,095 | $ | 271.14 | $ | 962 | $ | 238.30 | 87.9 | % | $ | 133 | ||||||||||||||||||||
Florida | 3.4 | 953 | 284.53 | 839 | 250.58 | 88.1 | 114 | ||||||||||||||||||||||||||
Illinois | 1.2 | 303 | 261.43 | 269 | 232.06 | 88.8 | 34 | ||||||||||||||||||||||||||
Michigan | 2.4 | 756 | 316.18 | 681 | 285.13 | 90.2 | 75 | ||||||||||||||||||||||||||
New Mexico | 1.5 | 678 | 450.62 | 601 | 399.17 | 88.6 | 77 | ||||||||||||||||||||||||||
New York (3) | — | — | — | — | — | — | — | ||||||||||||||||||||||||||
Ohio | 2.0 | 971 | 481.44 | 882 | 437.35 | 90.8 | 89 | ||||||||||||||||||||||||||
Puerto Rico | 2.0 | 351 | 172.98 | 349 | 171.95 | 99.4 | 2 | ||||||||||||||||||||||||||
South Carolina | 0.6 | 171 | 276.61 | 138 | 223.58 | 80.8 | 33 | ||||||||||||||||||||||||||
Texas | 2.2 | 1,255 | 575.87 | 1,074 | 492.65 | 85.5 | 181 | ||||||||||||||||||||||||||
Utah | 0.9 | 224 | 252.08 | 208 | 234.46 | 93.0 | 16 | ||||||||||||||||||||||||||
Washington | 4.1 | 1,065 | 260.05 | 958 | 233.84 | 89.9 | 107 | ||||||||||||||||||||||||||
Wisconsin | 0.8 | 196 | 247.57 | 188 | 236.92 | 95.7 | 8 | ||||||||||||||||||||||||||
Other (4) | — | 6 | — | 33 | — | — | (27 | ) | |||||||||||||||||||||||||
25.1 | $ | 8,024 | $ | 320.17 | $ | 7,182 | $ | 286.57 | 89.5 | % | $ | 842 |
____________________ | |
(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. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
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The following tables provide the details of our medical care costs for the periods indicated: |
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Three Months Ended June 30, | |||||||||||||||||||||||||
2017 | 2016 | ||||||||||||||||||||||||
Amount | PMPM | % of Total |
Amount | PMPM | % of Total |
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Fee for service | $ | 3,348 | $ | 238.04 | 74.5 | % | $ | 2,620 | $ | 206.01 | 72.9 | % | |||||||||||||
Pharmacy | 650 | 46.23 | 14.5 | 529 | 41.59 | 14.7 | |||||||||||||||||||
Capitation | 356 | 25.29 | 7.9 | 304 | 23.87 | 8.5 | |||||||||||||||||||
Direct delivery | 22 | 1.54 | 0.5 | 18 | 1.39 | 0.5 | |||||||||||||||||||
Other | 115 | 8.19 | 2.6 | 123 | 9.68 | 3.4 | |||||||||||||||||||
$ | 4,491 | $ | 319.29 | 100.0 | % | $ | 3,594 | $ | 282.54 | 100.0 | % | ||||||||||||||
Six Months Ended June 30, | |||||||||||||||||||||||||
2017 | 2016 | ||||||||||||||||||||||||
Amount | PMPM | % of Total |
Amount | PMPM | % of Total |
||||||||||||||||||||
Fee for service | $ | 6,434 | $ | 228.68 | 74.8 | % | $ | 5,357 | $ | 213.77 | 74.6 | % | |||||||||||||
Pharmacy | 1,266 | 45.00 | 14.7 | 1,054 | 42.05 | 14.7 | |||||||||||||||||||
Capitation | 680 | 24.17 | 7.9 | 599 | 23.87 | 8.3 | |||||||||||||||||||
Direct delivery | 44 | 1.56 | 0.5 | 34 | 1.36 | 0.5 | |||||||||||||||||||
Other | 178 | 6.33 | 2.1 | 138 | 5.52 | 1.9 | |||||||||||||||||||
$ | 8,602 | $ | 305.74 | 100.0 | % | $ | 7,182 | $ | 286.57 | 100.0 | % | ||||||||||||||
The following table provides the details of our medical claims and benefits payable as of the dates indicated: | |||||||||||||||||||||||||
June 30, | December 31, | ||||||||||||||||||||||||
2017 | 2016 | ||||||||||||||||||||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,478 | $ | 1,352 | |||||||||||||||||||||
Pharmacy payable | 121 | 112 | |||||||||||||||||||||||
Capitation payable | 45 | 37 | |||||||||||||||||||||||
Other (1) | 433 | 428 | |||||||||||||||||||||||
$ | 2,077 | $ | 1,929 | ||||||||||||||||||||||
____________________ | |
(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 operations. As of June 30, 2017 and December 31, 2016, we had recorded non-risk provider payables of approximately $111 million and $225 million, respectively. |
MOLINA HEALTHCARE, INC. UNAUDITED CHANGE IN MEDICAL CLAIMS AND BENEFITS PAYABLE (Dollars in millions, except per-member amounts) |
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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: |
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Six Months Ended June 30, |
Year Ended |
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2017 | 2016 | ||||||||||||||
Medical claims and benefits payable, beginning balance | $ | 1,929 | $ | 1,685 | $ | 1,685 | |||||||||
Components of medical care costs related to: | |||||||||||||||
Current period | 8,633 | 7,371 | 14,966 | ||||||||||||
Prior period | (31 | ) | (189 | ) | (192 | ) | |||||||||
Total medical care costs | 8,602 | 7,182 | 14,774 | ||||||||||||
Change in non-risk provider payables | (114 | ) | 24 | 58 | |||||||||||
Payments for medical care costs related to: | |||||||||||||||
Current period | 6,883 | 5,885 | 13,304 | ||||||||||||
Prior period | 1,457 | 1,240 | 1,284 | ||||||||||||
Total paid | 8,340 | 7,125 | 14,588 | ||||||||||||
Medical claims and benefits payable, ending balance | $ | 2,077 | $ | 1,766 | $ | 1,929 | |||||||||
Benefit from prior period as a percentage of: | |||||||||||||||
Balance at beginning of period | 1.6 | % | 11.3 | % | 11.4 | % | |||||||||
Premium revenue, trailing twelve months | 0.2 | % | 1.3 | % | 1.2 | % | |||||||||
Medical care costs, trailing twelve months | 0.2 | % | 1.4 | % | 1.3 | % | |||||||||
Days in claims payable, fee for service (1) | 46 | 48 | 47 | ||||||||||||
____________________ | |
(1) | Claims payable includes primarily IBNP. Additionally, it includes certain fee-for-service payables reported in “Other” medical claims and benefits payable amounting to $157 million, $74 million and $94 million, as of June 30, 2017, June 30, 2016, and December 31, 2016, respectively. |
MOLINA HEALTHCARE, INC. UNAUDITED NON-GAAP FINANCIAL MEASURES |
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We use 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. See further information regarding non-GAAP measures below the tables (in millions, except per diluted share amounts). |
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Three Months Ended June 30, | Six Months Ended June 30, | ||||||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||||||
Net (loss) income | $ | (230 | ) | $ | 33 | $ | (153 | ) | $ | 57 | |||||||||
Adjustments: | |||||||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 44 | 39 | 90 | 76 | |||||||||||||||
Interest expense | 27 | 25 | 53 | 50 | |||||||||||||||
Income tax (benefit) expense | (84 | ) | 47 | (30 | ) | 87 | |||||||||||||
EBITDA | $ | (243 | ) | $ | 144 | $ | (40 | ) | $ | 270 | |||||||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | |||||||||||||||||||||||||||||||||||||
Amount |
Per |
Amount |
Per share |
Amount |
Per share |
Amount |
Per |
|||||||||||||||||||||||||||||||||
Net (loss) income | $ | (230 | ) | $ | (4.10 | ) | $ | 33 | $ | 0.58 | $ | (153 | ) | $ | (2.74 | ) | $ | 57 | $ | 1.01 | ||||||||||||||||||||
Adjustment: | ||||||||||||||||||||||||||||||||||||||||
Amortization of intangible assets | 8 | 0.14 | 8 | 0.14 | 17 | 0.30 | 15 | 0.27 | ||||||||||||||||||||||||||||||||
Income tax effect (1) | (3 | ) | (0.05 | ) | (3 | ) | (0.05 | ) | (6 | ) | (0.11 | ) | (5 | ) | (0.10 | ) | ||||||||||||||||||||||||
Amortization of intangible assets, net of tax effect | 5 | 0.09 | 5 | 0.09 | 11 | 0.19 | 10 | 0.17 | ||||||||||||||||||||||||||||||||
Adjusted net (loss) income | $ | (225 | ) | $ | (4.01 | ) | $ | 38 | $ | 0.67 | $ | (142 | ) | $ | (2.55 | ) | $ | 67 | $ | 1.18 | ||||||||||||||||||||
____________________ |
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(1) Income tax effect of adjustment calculated at the blended federal and state statutory tax rate of 37%. |
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The following are descriptions of the adjustments made to GAAP measures used to calculate the non-GAAP measures used in this news release:
Earnings before interest, taxes, depreciation and amortization (EBITDA): Net (loss) income (GAAP) less depreciation, and amortization of intangible assets and capitalized software, interest expense and income tax (benefit) expense. We believe that EBITDA is helpful in assessing our ability to meet the cash demands of our operating units.
Adjusted net (loss) income: Net (loss) income (GAAP) less amortization of intangible assets, net of income tax effect calculated at the statutory tax rate of 37%. We believe that adjusted net (loss) income is helpful in assessing our financial performance exclusive of the non-cash impact of the amortization of purchased intangibles.
Adjusted net (loss) income per diluted share: Adjusted net (loss) income divided by weighted average common shares outstanding on a fully diluted basis. |
View source version on businesswire.com: http://www.businesswire.com/news/home/20170802006305/en/
Source:
Molina Healthcare, Inc.
Juan José Orellana, 562-435-3666, ext.
111143
Investor Relations