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) |
Emerging growth company | ¨ |
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section13(a) of the Exchange Act. | |
¨ |
Exhibit No. | Description |
99.1 | Press release of Molina Healthcare, Inc., issued November 2, 2017, as to financial results for the third quarter ended September 30, 2017. |
MOLINA HEALTHCARE, INC. | |||
Date: | November 2, 2017 | By: | /s/ Jeff D. Barlow |
Jeff D. Barlow | |||
Chief Legal Officer and Secretary |
• | Net loss of $1.70 per diluted share for the quarter. |
• | Results for the quarter include $3.16 per diluted share in impairment and restructuring costs. |
• | Medical care ratio for the quarter of 88.3%. |
• | $200 million of annualized run-rate savings to be effective January 1, 2018, achieved in Q3 under restructuring plan. |
• | $300 million to $400 million of total annualized run-rate savings expected by end of 2018. |
• | Joseph M. Zubretsky appointed President, Chief Executive Officer and Director, effective November 6, 2017. |
• | Medical care costs measured as a percentage of premium revenue (the “medical care ratio”) declined to 88.3% in the third quarter of 2017 from 89.4% in the third quarter of 2016 and from 94.8% in the second quarter of 2017. Improved medical cost performance in the third quarter of 2017 was the result of: |
◦ | Improved sequential performance at our Illinois, New Mexico, Ohio, Puerto Rico, Texas, and Washington health plans, exclusive of the Marketplace program. |
◦ | Improved performance of our Marketplace program, including a reduction to the premium deficiency reserve of $30 million ($0.33 per diluted share, net of tax). The reserve, which was $100 million at June 30, 2017, decreased to $70 million as of September 30, 2017. |
• | General and administrative costs, measured as a percentage of total revenue (the “administrative cost ratio”), were 7.6% in the third quarter of 2017, consistent with the third quarter of 2016, and 50 basis points lower than the second quarter of 2017. Excluding Marketplace broker commission and exchange fees, the administrative cost ratio decreased 30 basis points from the third quarter of 2016. |
• | We recorded $118 million ($1.39 per diluted share, net of tax) of restructuring costs in the third quarter of 2017. Restructuring costs incurred to date consist primarily of termination benefits, write-offs of capitalized software due to the re-design of our core operating processes, restructuring of our direct delivery operations, and consulting fees. |
• | We recorded $129 million ($1.77 per diluted share, net of tax) in non-cash goodwill impairment losses for our Pathways behavioral health subsidiary and our Molina Medicaid Solutions (MMS) segment. In the third quarter of 2017, management determined that neither business will provide future benefits relating to the integration of their operations with the Health Plans segment to the extent previously expected. |
Summary of Significant Items Affecting 2017 Financial Results | |||||||||||||||
Three Months Ended | Nine Months Ended | ||||||||||||||
September 30, 2017 | September 30, 2017 | ||||||||||||||
(In millions, except per diluted share amounts) | |||||||||||||||
Amount | Per Diluted Share (1) | Amount | Per Diluted Share (1) | ||||||||||||
Restructuring and separation costs | $ | 118 | $ | 1.39 | $ | 161 | $ | 1.92 | |||||||
Impairment losses | 129 | 1.77 | 201 | 2.77 | |||||||||||
Change in Marketplace premium deficiency reserve for 2017 service dates | (30 | ) | (0.33 | ) | 40 | 0.45 | |||||||||
Termination fee received for terminated Medicare acquisition | — | — | (75 | ) | (0.84 | ) | |||||||||
$ | 217 | $ | 2.83 | $ | 327 | $ | 4.30 |
(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. |
1. | As previously announced, we will exit the Utah and Wisconsin ACA Marketplaces effective December 31, 2017. |
2. | In our remaining Marketplace plans, we are increasing 2018 premiums by 55% to take into account the absence of cost sharing reduction (CSR) subsidies and other risks related to ACA Marketplace uncertainties. |
3. | We have reduced the scope of our 2018 participation in the state of Washington Marketplace. |
4. | We continue to monitor the current political and programmatic developments pertaining to the ACA Marketplace. |
• | the success of our previously announced restructuring plan, including the timing and amounts 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 discontinuation of premium tax credits, the adequacy of agreed rates, and potential disruption associated with market withdrawal from Utah, Wisconsin, or other states; |
• | 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 the Illinois budget impasse; |
• | the success of our efforts to retain existing government contracts, including those in Florida, New Mexico, Puerto Rico, and Texas, 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 in California, New Mexico, and Washington, 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 the Puerto Rico debt crisis, payment of all amounts due under our Medicaid contract, the effect of the PROMESA law, the impact of Hurricane Maria and our efforts to better manage the health care costs of our Puerto Rico health plan; |
• | the success and renewal of our duals demonstration programs in California, Illinois, Michigan, Ohio, South Carolina, and Texas; |
• | 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; |
• | 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; |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
(Dollar amounts in millions, except per-share amounts) | |||||||||||||||
Revenue: | |||||||||||||||
Premium revenue | $ | 4,777 | $ | 4,191 | $ | 14,165 | $ | 12,215 | |||||||
Service revenue | 130 | 133 | 390 | 408 | |||||||||||
Premium tax revenue | 106 | 127 | 331 | 345 | |||||||||||
Health insurer fee revenue | — | 85 | — | 251 | |||||||||||
Investment income and other revenue | 18 | 10 | 48 | 29 | |||||||||||
Total revenue | 5,031 | 4,546 | 14,934 | 13,248 | |||||||||||
Operating expenses: | |||||||||||||||
Medical care costs | 4,220 | 3,748 | 12,822 | 10,930 | |||||||||||
Cost of service revenue | 123 | 119 | 369 | 362 | |||||||||||
General and administrative expenses | 383 | 343 | 1,227 | 1,034 | |||||||||||
Premium tax expenses | 106 | 127 | 331 | 345 | |||||||||||
Health insurer fee expenses | — | 55 | — | 163 | |||||||||||
Depreciation and amortization | 33 | 36 | 109 | 102 | |||||||||||
Impairment losses | 129 | — | 201 | — | |||||||||||
Restructuring and separation costs | 118 | — | 161 | — | |||||||||||
Total operating expenses | 5,112 | 4,428 | 15,220 | 12,936 | |||||||||||
Operating (loss) income | (81 | ) | 118 | (286 | ) | 312 | |||||||||
Other expenses, net: | |||||||||||||||
Interest expense | 32 | 26 | 85 | 76 | |||||||||||
Other income, net | — | — | (75 | ) | — | ||||||||||
Total other expenses, net | 32 | 26 | 10 | 76 | |||||||||||
(Loss) income before income tax (benefit) expense | (113 | ) | 92 | (296 | ) | 236 | |||||||||
Income tax (benefit) expense | (16 | ) | 50 | (46 | ) | 137 | |||||||||
Net (loss) income | $ | (97 | ) | $ | 42 | $ | (250 | ) | $ | 99 | |||||
Net (loss) income per diluted share | $ | (1.70 | ) | $ | 0.76 | $ | (4.44 | ) | $ | 1.77 | |||||
Diluted weighted average shares outstanding | 56.5 | 56.1 | 56.2 | 56.2 | |||||||||||
Operating Statistics: | |||||||||||||||
Medical care ratio (1) | 88.3 | % | 89.4 | % | 90.5 | % | 89.5 | % | |||||||
G&A ratio (2) | 7.6 | % | 7.6 | % | 8.2 | % | 7.8 | % | |||||||
Premium tax ratio (1) | 2.2 | % | 2.9 | % | 2.3 | % | 2.7 | % | |||||||
Effective tax rate | 14.6 | % | 54.0 | % | 15.5 | % | 58.0 | % | |||||||
Net profit margin (2) | (1.9 | )% | 0.9 | % | (1.7 | )% | 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. |
September 30, | December 31, | ||||||
2017 | 2016 | ||||||
(In millions, except per-share data) | |||||||
ASSETS | |||||||
Current assets: | |||||||
Cash and cash equivalents | $ | 3,934 | $ | 2,819 | |||
Investments | 1,787 | 1,758 | |||||
Restricted investments | 326 | — | |||||
Receivables | 1,002 | 974 | |||||
Income taxes refundable | 60 | 39 | |||||
Prepaid expenses and other current assets | 174 | 131 | |||||
Derivative asset | 425 | 267 | |||||
Total current assets | 7,708 | 5,988 | |||||
Property, equipment, and capitalized software, net | 397 | 454 | |||||
Deferred contract costs | 97 | 86 | |||||
Intangible assets, net | 101 | 140 | |||||
Goodwill | 430 | 620 | |||||
Restricted investments | 117 | 110 | |||||
Deferred income taxes | 62 | 10 | |||||
Other assets | 42 | 41 | |||||
$ | 8,954 | $ | 7,449 | ||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | |||||||
Current liabilities: | |||||||
Medical claims and benefits payable | $ | 2,478 | $ | 1,929 | |||
Amounts due government agencies | 1,324 | 1,202 | |||||
Accounts payable and accrued liabilities | 485 | 385 | |||||
Deferred revenue | 468 | 315 | |||||
Current portion of long-term debt | 782 | 472 | |||||
Derivative liability | 425 | 267 | |||||
Total current liabilities | 5,962 | 4,570 | |||||
Long-term debt | 1,317 | 975 | |||||
Lease financing obligations | 198 | 198 | |||||
Deferred income taxes | — | 15 | |||||
Other long-term liabilities | 48 | 42 | |||||
Total liabilities | 7,525 | 5,800 | |||||
Stockholders’ equity: | |||||||
Common stock, $0.001 par value; 150 shares authorized; outstanding: 57 shares at September 30, 2017 and December 31, 2016 | — | — | |||||
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding | — | — | |||||
Additional paid-in capital | 870 | 841 | |||||
Accumulated other comprehensive loss | (1 | ) | (2 | ) | |||
Retained earnings | 560 | 810 | |||||
Total stockholders’ equity | 1,429 | 1,649 | |||||
$ | 8,954 | $ | 7,449 |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
(In millions) | |||||||||||||||
Operating activities: | |||||||||||||||
Net (loss) income | $ | (97 | ) | $ | 42 | $ | (250 | ) | $ | 99 | |||||
Adjustments to reconcile net (loss) income to net cash provided by operating activities: | |||||||||||||||
Depreciation and amortization | 43 | 46 | 139 | 135 | |||||||||||
Impairment losses | 129 | — | 201 | — | |||||||||||
Deferred income taxes | (27 | ) | (19 | ) | (68 | ) | 20 | ||||||||
Share-based compensation, including accelerated share-based compensation | 3 | 8 | 38 | 24 | |||||||||||
Non-cash restructuring charges | 49 | — | 49 | — | |||||||||||
Amortization of convertible senior notes and lease financing obligations | 8 | 8 | 24 | 23 | |||||||||||
Other, net | 6 | 3 | 13 | 14 | |||||||||||
Changes in operating assets and liabilities: | |||||||||||||||
Receivables | 4 | (12 | ) | (28 | ) | (427 | ) | ||||||||
Prepaid expenses and other assets | (15 | ) | 27 | (53 | ) | (116 | ) | ||||||||
Medical claims and benefits payable | 401 | 86 | 549 | 168 | |||||||||||
Amounts due government agencies | (520 | ) | (6 | ) | 122 | 503 | |||||||||
Accounts payable and accrued liabilities | 108 | (146 | ) | 90 | 1 | ||||||||||
Deferred revenue | 185 | 276 | 153 | 157 | |||||||||||
Income taxes | 8 | 42 | (22 | ) | 32 | ||||||||||
Net cash provided by operating activities | 285 | 355 | 957 | 633 | |||||||||||
Investing activities: | |||||||||||||||
Purchases of investments | (260 | ) | (470 | ) | (1,896 | ) | (1,444 | ) | |||||||
Proceeds from sales and maturities of investments | 664 | 700 | 1,538 | 1,512 | |||||||||||
Purchases of property, equipment, and capitalized software | (25 | ) | (41 | ) | (85 | ) | (143 | ) | |||||||
(Increase) decrease in restricted investments held-to-maturity | — | (1 | ) | (10 | ) | 4 | |||||||||
Net cash paid in business combinations | — | (40 | ) | — | (48 | ) | |||||||||
Other, net | (8 | ) | (6 | ) | (21 | ) | (12 | ) | |||||||
Net cash provided by (used in) investing activities | 371 | 142 | (474 | ) | (131 | ) | |||||||||
Financing activities: | |||||||||||||||
Proceeds from senior notes offering, net of issuance costs | — | — | 325 | — | |||||||||||
Proceeds from borrowings under credit facility | 300 | — | 300 | — | |||||||||||
Proceeds from employee stock plans | — | — | 11 | 10 | |||||||||||
Other, net | (1 | ) | — | (4 | ) | 1 | |||||||||
Net cash provided by financing activities | 299 | — | 632 | 11 | |||||||||||
Net increase in cash and cash equivalents | 955 | 497 | 1,115 | 513 | |||||||||||
Cash and cash equivalents at beginning of period | 2,979 | 2,345 | 2,819 | 2,329 | |||||||||||
Cash and cash equivalents at end of period | $ | 3,934 | $ | 2,842 | $ | 3,934 | $ | 2,842 |
September 30, 2017 | December 31, 2016 | September 30, 2016 | ||||||
Ending Membership by Program: | ||||||||
Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) | 2,451,000 | 2,536,000 | 2,529,000 | |||||
Marketplace | 877,000 | 526,000 | 568,000 | |||||
Medicaid Expansion | 662,000 | 673,000 | 658,000 | |||||
Aged, Blind or Disabled (ABD) | 411,000 | 396,000 | 395,000 | |||||
Medicare-Medicaid Plan (MMP) - Integrated | 58,000 | 51,000 | 51,000 | |||||
Medicare Special Needs Plans | 44,000 | 45,000 | 45,000 | |||||
4,503,000 | 4,227,000 | 4,246,000 | ||||||
Ending Membership by Health Plan: | ||||||||
California | 751,000 | 683,000 | 683,000 | |||||
Florida | 641,000 | 553,000 | 563,000 | |||||
Illinois | 163,000 | 195,000 | 195,000 | |||||
Michigan | 399,000 | 391,000 | 387,000 | |||||
New Mexico | 256,000 | 254,000 | 253,000 | |||||
New York | 33,000 | 35,000 | 37,000 | |||||
Ohio | 343,000 | 332,000 | 339,000 | |||||
Puerto Rico | 306,000 | 330,000 | 331,000 | |||||
South Carolina | 113,000 | 109,000 | 109,000 | |||||
Texas | 444,000 | 337,000 | 352,000 | |||||
Utah | 160,000 | 146,000 | 150,000 | |||||
Washington | 770,000 | 736,000 | 716,000 | |||||
Wisconsin | 124,000 | 126,000 | 131,000 | |||||
4,503,000 | 4,227,000 | 4,246,000 |
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
TANF and CHIP | 7.5 | $ | 1,392 | $ | 185.95 | $ | 1,242 | $ | 165.76 | 89.1 | % | $ | 150 | ||||||||||||
Medicaid Expansion | 2.0 | 773 | 385.58 | 667 | 332.99 | 86.4 | 106 | ||||||||||||||||||
ABD | 1.2 | 1,288 | 1,038.85 | 1,259 | 1,016.06 | 97.8 | 29 | ||||||||||||||||||
Total Medicaid | 10.7 | 3,453 | 321.77 | 3,168 | 295.23 | 91.8 | 285 | ||||||||||||||||||
MMP | 0.2 | 378 | 2,263.07 | 336 | 2,013.67 | 89.0 | 42 | ||||||||||||||||||
Medicare | 0.1 | 163 | 1,231.61 | 126 | 951.01 | 77.2 | 37 | ||||||||||||||||||
Total Medicare | 0.3 | 541 | 1,806.26 | 462 | 1,543.05 | 85.4 | 79 | ||||||||||||||||||
Excluding Marketplace | 11.0 | 3,994 | 362.04 | 3,630 | 329.08 | 90.9 | 364 | ||||||||||||||||||
Marketplace | 2.7 | 783 | 301.72 | 590 | 227.22 | 75.3 | 193 | ||||||||||||||||||
13.7 | $ | 4,777 | $ | 350.55 | $ | 4,220 | $ | 309.68 | 88.3 | % | $ | 557 |
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 | ||||||||||||||||||
ABD | 1.1 | 1,186 | 1,008.28 | 1,094 | 929.93 | 92.2 | 92 | ||||||||||||||||||
Total Medicaid | 10.7 | 3,322 | 309.19 | 2,982 | 277.55 | 89.8 | 340 | ||||||||||||||||||
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 | ||||||||||||||||||
Total Medicare | 0.3 | 470 | 1,633.62 | 414 | 1,440.73 | 88.2 | 56 | ||||||||||||||||||
Excluding Marketplace | 11.0 | 3,792 | 343.68 | 3,396 | 307.84 | 89.6 | 396 | ||||||||||||||||||
Marketplace | 1.7 | 399 | 238.86 | 352 | 210.38 | 88.1 | 47 | ||||||||||||||||||
12.7 | $ | 4,191 | $ | 329.88 | $ | 3,748 | $ | 295.01 | 89.4 | % | $ | 443 |
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. |
(2) | The MCR represents medical costs as a percentage of premium revenue. |
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
TANF and CHIP | 22.8 | $ | 4,185 | $ | 183.69 | $ | 3,861 | $ | 169.44 | 92.2 | % | $ | 324 | ||||||||||||
Medicaid Expansion | 6.1 | 2,376 | 389.14 | 2,045 | 334.93 | 86.1 | 331 | ||||||||||||||||||
ABD | 3.6 | 3,769 | 1,033.45 | 3,634 | 996.58 | 96.4 | 135 | ||||||||||||||||||
Total Medicaid | 32.5 | 10,330 | 317.49 | 9,540 | 293.21 | 92.4 | 790 | ||||||||||||||||||
MMP | 0.5 | 1,083 | 2,189.96 | 976 | 1,974.22 | 90.1 | 107 | ||||||||||||||||||
Medicare | 0.4 | 449 | 1,142.68 | 369 | 939.21 | 82.2 | 80 | ||||||||||||||||||
Total Medicare | 0.9 | 1,532 | 1,726.39 | 1,345 | 1,516.09 | 87.8 | 187 | ||||||||||||||||||
Excluding Marketplace | 33.4 | 11,862 | 354.88 | 10,885 | 325.66 | 91.8 | 977 | ||||||||||||||||||
Marketplace | 8.4 | 2,303 | 276.27 | 1,937 | 232.31 | 84.1 | 366 | ||||||||||||||||||
41.8 | $ | 14,165 | $ | 339.19 | $ | 12,822 | $ | 307.03 | 90.5 | % | $ | 1,343 |
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 | ||||||||||||||||||
ABD | 3.5 | 3,466 | 987.20 | 3,173 | 903.85 | 91.6 | 293 | ||||||||||||||||||
Total Medicaid | 31.8 | 9,649 | 303.23 | 8,669 | 272.46 | 89.9 | 980 | ||||||||||||||||||
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 | ||||||||||||||||||
Total Medicare | 0.9 | 1,385 | 1,633.26 | 1,252 | 1,476.57 | 90.4 | 133 | ||||||||||||||||||
Excluding Marketplace | 32.7 | 11,034 | 337.76 | 9,921 | 303.72 | 89.9 | 1,113 | ||||||||||||||||||
Marketplace | 5.1 | 1,181 | 231.69 | 1,009 | 197.77 | 85.4 | 172 | ||||||||||||||||||
37.8 | $ | 12,215 | $ | 323.44 | $ | 10,930 | $ | 289.41 | 89.5 | % | $ | 1,285 |
(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. |
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.9 | $ | 601 | $ | 322.97 | $ | 563 | $ | 302.67 | 93.7 | % | $ | 38 | ||||||||||||
Florida | 1.0 | 388 | 355.59 | 390 | 356.83 | 100.3 | (2 | ) | |||||||||||||||||
Illinois | 0.5 | 137 | 287.69 | 138 | 289.36 | 100.6 | (1 | ) | |||||||||||||||||
Michigan | 1.2 | 390 | 337.17 | 345 | 298.83 | 88.6 | 45 | ||||||||||||||||||
New Mexico | 0.7 | 304 | 429.07 | 277 | 390.91 | 91.1 | 27 | ||||||||||||||||||
New York (3) | 0.1 | 43 | 435.00 | 41 | 413.02 | 94.9 | 2 | ||||||||||||||||||
Ohio | 0.9 | 549 | 560.06 | 483 | 492.61 | 88.0 | 66 | ||||||||||||||||||
Puerto Rico | 1.0 | 191 | 202.59 | 159 | 168.25 | 83.1 | 32 | ||||||||||||||||||
South Carolina | 0.3 | 113 | 332.48 | 101 | 297.74 | 89.6 | 12 | ||||||||||||||||||
Texas | 0.7 | 541 | 778.50 | 506 | 728.19 | 93.5 | 35 | ||||||||||||||||||
Utah | 0.2 | 89 | 318.98 | 71 | 254.99 | 79.9 | 18 | ||||||||||||||||||
Washington | 2.3 | 612 | 276.73 | 522 | 236.11 | 85.3 | 90 | ||||||||||||||||||
Wisconsin | 0.2 | 34 | 175.77 | 27 | 141.78 | 80.7 | 7 | ||||||||||||||||||
Other (4) | — | 2 | — | 7 | — | — | (5 | ) | |||||||||||||||||
11.0 | $ | 3,994 | $ | 362.04 | $ | 3,630 | $ | 329.08 | 90.9 | % | $ | 364 | |||||||||||||
Three Months Ended September 30, 2016 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.8 | $ | 575 | $ | 310.64 | $ | 493 | $ | 266.81 | 85.9 | % | $ | 82 | ||||||||||||
Florida | 1.0 | 335 | 323.98 | 317 | 305.71 | 94.4 | 18 | ||||||||||||||||||
Illinois | 0.6 | 163 | 275.26 | 145 | 244.86 | 89.0 | 18 | ||||||||||||||||||
Michigan | 1.2 | 385 | 335.34 | 335 | 291.69 | 87.0 | 50 | ||||||||||||||||||
New Mexico | 0.7 | 323 | 451.06 | 293 | 409.24 | 90.7 | 30 | ||||||||||||||||||
New York (3) | 0.1 | 32 | 427.40 | 30 | 403.71 | 94.5 | 2 | ||||||||||||||||||
Ohio | 1.0 | 492 | 497.08 | 417 | 421.95 | 84.9 | 75 | ||||||||||||||||||
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 | 0.7 | 534 | 728.84 | 484 | 662.79 | 90.9 | 50 | ||||||||||||||||||
Utah | 0.3 | 83 | 288.59 | 71 | 242.77 | 84.1 | 12 | ||||||||||||||||||
Washington | 2.0 | 546 | 264.01 | 500 | 241.49 | 91.5 | 46 | ||||||||||||||||||
Wisconsin | 0.3 | 35 | 166.82 | 26 | 125.86 | 75.4 | 9 | ||||||||||||||||||
Other (4) | — | 3 | — | 24 | — | — | (21 | ) | |||||||||||||||||
11.0 | $ | 3,792 | $ | 343.68 | $ | 3,396 | $ | 307.84 | 89.6 | % | $ | 396 |
(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. |
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 5.6 | $ | 1,771 | $ | 316.83 | $ | 1,586 | $ | 283.82 | 89.6 | % | $ | 185 | ||||||||||||
Florida | 3.2 | 1,132 | 347.41 | 1,112 | 341.15 | 98.2 | 20 | ||||||||||||||||||
Illinois | 1.6 | 447 | 284.18 | 492 | 312.54 | 110.0 | (45 | ) | |||||||||||||||||
Michigan | 3.5 | 1,162 | 332.60 | 1,035 | 296.28 | 89.1 | 127 | ||||||||||||||||||
New Mexico | 2.2 | 933 | 431.70 | 887 | 410.24 | 95.0 | 46 | ||||||||||||||||||
New York (3) | 0.3 | 135 | 444.77 | 128 | 421.58 | 94.8 | 7 | ||||||||||||||||||
Ohio | 2.9 | 1,598 | 541.56 | 1,434 | 486.02 | 89.7 | 164 | ||||||||||||||||||
Puerto Rico | 2.9 | 553 | 190.99 | 513 | 177.01 | 92.7 | 40 | ||||||||||||||||||
South Carolina | 1.0 | 329 | 325.43 | 301 | 298.43 | 91.7 | 28 | ||||||||||||||||||
Texas | 2.1 | 1,592 | 760.76 | 1,468 | 701.32 | 92.2 | 124 | ||||||||||||||||||
Utah | 0.8 | 267 | 315.35 | 219 | 258.64 | 82.0 | 48 | ||||||||||||||||||
Washington | 6.7 | 1,835 | 275.60 | 1,603 | 240.83 | 87.4 | 232 | ||||||||||||||||||
Wisconsin | 0.6 | 101 | 170.64 | 80 | 136.04 | 79.7 | 21 | ||||||||||||||||||
Other (4) | — | 7 | — | 27 | — | — | (20 | ) | |||||||||||||||||
33.4 | $ | 11,862 | $ | 354.88 | $ | 10,885 | $ | 325.66 | 91.8 | % | $ | 977 | |||||||||||||
Nine Months Ended September 30, 2016 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 5.5 | $ | 1,603 | $ | 291.20 | $ | 1,411 | $ | 256.41 | 88.1 | % | $ | 192 | ||||||||||||
Florida | 3.0 | 974 | 322.69 | 892 | 295.43 | 91.6 | 82 | ||||||||||||||||||
Illinois | 1.8 | 466 | 266.11 | 414 | 236.39 | 88.8 | 52 | ||||||||||||||||||
Michigan | 3.6 | 1,136 | 323.08 | 1,013 | 288.13 | 89.2 | 123 | ||||||||||||||||||
New Mexico | 2.1 | 974 | 460.71 | 873 | 412.92 | 89.6 | 101 | ||||||||||||||||||
New York (3) | 0.1 | 32 | 427.40 | 30 | 403.71 | 94.5 | 2 | ||||||||||||||||||
Ohio | 2.9 | 1,444 | 489.63 | 1,286 | 435.99 | 89.0 | 158 | ||||||||||||||||||
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 | 2.2 | 1,650 | 744.71 | 1,466 | 662.01 | 88.9 | 184 | ||||||||||||||||||
Utah | 0.9 | 255 | 293.33 | 221 | 253.79 | 86.5 | 34 | ||||||||||||||||||
Washington | 6.0 | 1,576 | 261.23 | 1,431 | 237.20 | 90.8 | 145 | ||||||||||||||||||
Wisconsin | 0.7 | 107 | 165.53 | 78 | 120.82 | 73.0 | 29 | ||||||||||||||||||
Other (4) | — | 9 | — | 58 | — | — | (49 | ) | |||||||||||||||||
32.7 | $ | 11,034 | $ | 337.76 | $ | 9,921 | $ | 303.72 | 89.9 | % | $ | 1,113 |
(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. |
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 0.3 | $ | 88 | $ | 208.19 | $ | 63 | $ | 147.87 | 71.0 | % | $ | 25 | ||||||||||||
Florida | 0.9 | 260 | 313.36 | 235 | 283.13 | 90.4 | 25 | ||||||||||||||||||
Michigan | — | 14 | 212.08 | 10 | 150.24 | 70.8 | 4 | ||||||||||||||||||
New Mexico | 0.1 | 29 | 383.58 | 20 | 269.28 | 70.2 | 9 | ||||||||||||||||||
Ohio | 0.1 | 23 | 386.09 | 20 | 364.31 | 94.4 | 3 | ||||||||||||||||||
Texas | 0.7 | 183 | 291.14 | 109 | 172.70 | 59.3 | 74 | ||||||||||||||||||
Utah | 0.3 | 49 | 241.65 | 31 | 155.13 | 64.2 | 18 | ||||||||||||||||||
Washington | 0.1 | 42 | 327.40 | 33 | 256.52 | 78.3 | 9 | ||||||||||||||||||
Wisconsin | 0.2 | 95 | 527.17 | 70 | 385.65 | 73.2 | 25 | ||||||||||||||||||
Other (3) | — | — | — | (1 | ) | — | — | 1 | |||||||||||||||||
2.7 | $ | 783 | $ | 301.72 | $ | 590 | $ | 227.22 | 75.3 | % | $ | 193 | |||||||||||||
Three Months Ended September 30, 2016 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 0.3 | $ | 37 | $ | 185.04 | $ | 30 | $ | 140.10 | 75.7 | % | $ | 7 | ||||||||||||
Florida | 0.6 | 159 | 253.16 | 145 | 231.78 | 91.6 | 14 | ||||||||||||||||||
Michigan | — | 2 | 221.84 | 2 | 132.62 | 59.8 | — | ||||||||||||||||||
New Mexico | 0.1 | 15 | 290.63 | 11 | 220.32 | 75.8 | 4 | ||||||||||||||||||
Ohio | — | 9 | 307.24 | 7 | 215.01 | 70.0 | 2 | ||||||||||||||||||
Texas | 0.4 | 63 | 189.85 | 41 | 121.06 | 63.8 | 22 | ||||||||||||||||||
Utah | 0.1 | 23 | 142.10 | 33 | 208.48 | 146.7 | (10 | ) | |||||||||||||||||
Washington | 0.1 | 23 | 307.55 | 21 | 300.71 | 97.8 | 2 | ||||||||||||||||||
Wisconsin | 0.1 | 68 | 375.60 | 64 | 357.60 | 95.2 | 4 | ||||||||||||||||||
Other (3) | — | — | — | (2 | ) | — | — | 2 | |||||||||||||||||
1.7 | $ | 399 | $ | 238.86 | $ | 352 | $ | 210.38 | 88.1 | % | $ | 47 |
(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. |
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.2 | $ | 241 | $ | 193.33 | $ | 156 | $ | 124.32 | 64.3 | % | $ | 85 | ||||||||||||
Florida | 2.8 | 821 | 296.14 | 758 | 273.55 | 92.4 | 63 | ||||||||||||||||||
Michigan | 0.2 | 41 | 187.96 | 27 | 126.76 | 67.4 | 14 | ||||||||||||||||||
New Mexico | 0.2 | 82 | 338.18 | 62 | 256.05 | 75.7 | 20 | ||||||||||||||||||
Ohio | 0.2 | 68 | 365.35 | 64 | 346.93 | 95.0 | 4 | ||||||||||||||||||
Texas | 2.1 | 517 | 252.32 | 351 | 171.57 | 68.0 | 166 | ||||||||||||||||||
Utah | 0.7 | 135 | 209.43 | 135 | 209.13 | 99.9 | — | ||||||||||||||||||
Washington | 0.4 | 123 | 315.95 | 128 | 327.51 | 103.7 | (5 | ) | |||||||||||||||||
Wisconsin | 0.6 | 275 | 469.44 | 260 | 443.41 | 94.5 | 15 | ||||||||||||||||||
Other (3) | — | — | — | (4 | ) | — | — | 4 | |||||||||||||||||
8.4 | $ | 2,303 | $ | 276.27 | $ | 1,937 | $ | 232.31 | 84.1 | % | $ | 366 | |||||||||||||
Nine Months Ended September 30, 2016 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 0.6 | $ | 104 | $ | 177.57 | $ | 74 | $ | 124.29 | 70.0 | % | $ | 30 | ||||||||||||
Florida | 2.0 | 473 | 237.37 | 409 | 205.37 | 86.5 | 64 | ||||||||||||||||||
Michigan | — | 7 | 213.35 | 5 | 138.37 | 64.9 | 2 | ||||||||||||||||||
New Mexico | 0.2 | 42 | 264.76 | 32 | 201.73 | 76.2 | 10 | ||||||||||||||||||
Ohio | 0.1 | 28 | 322.36 | 20 | 232.44 | 72.1 | 8 | ||||||||||||||||||
Texas | 1.1 | 202 | 196.45 | 133 | 128.97 | 65.7 | 69 | ||||||||||||||||||
Utah | 0.4 | 75 | 160.33 | 91 | 194.78 | 121.5 | (16 | ) | |||||||||||||||||
Washington | 0.2 | 58 | 281.80 | 48 | 235.78 | 83.7 | 10 | ||||||||||||||||||
Wisconsin | 0.5 | 192 | 357.80 | 200 | 373.94 | 104.5 | (8 | ) | |||||||||||||||||
Other (3) | — | — | — | (3 | ) | — | — | 3 | |||||||||||||||||
5.1 | $ | 1,181 | $ | 231.69 | $ | 1,009 | $ | 197.77 | 85.4 | % | $ | 172 |
(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. |
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 2.2 | $ | 689 | $ | 301.64 | $ | 626 | $ | 273.90 | 90.8 | % | $ | 63 | ||||||||||||
Florida | 1.9 | 648 | 337.40 | 625 | 325.09 | 96.4 | 23 | ||||||||||||||||||
Illinois | 0.5 | 137 | 287.69 | 138 | 289.36 | 100.6 | (1 | ) | |||||||||||||||||
Michigan | 1.2 | 404 | 330.27 | 355 | 290.63 | 88.0 | 49 | ||||||||||||||||||
New Mexico | 0.8 | 333 | 424.61 | 297 | 378.98 | 89.3 | 36 | ||||||||||||||||||
New York (3) | 0.1 | 43 | 435.00 | 41 | 413.02 | 94.9 | 2 | ||||||||||||||||||
Ohio | 1.0 | 572 | 550.75 | 503 | 485.61 | 88.2 | 69 | ||||||||||||||||||
Puerto Rico | 1.0 | 191 | 202.59 | 159 | 168.25 | 83.1 | 32 | ||||||||||||||||||
South Carolina | 0.3 | 113 | 332.48 | 101 | 297.74 | 89.6 | 12 | ||||||||||||||||||
Texas | 1.4 | 724 | 546.57 | 615 | 463.83 | 84.9 | 109 | ||||||||||||||||||
Utah | 0.5 | 138 | 286.39 | 102 | 212.91 | 74.3 | 36 | ||||||||||||||||||
Washington | 2.4 | 654 | 279.52 | 555 | 237.23 | 84.9 | 99 | ||||||||||||||||||
Wisconsin | 0.4 | 129 | 345.63 | 97 | 259.66 | 75.1 | 32 | ||||||||||||||||||
Other (4) | — | 2 | — | 6 | — | — | (4 | ) | |||||||||||||||||
13.7 | $ | 4,777 | $ | 350.55 | $ | 4,220 | $ | 309.68 | 88.3 | % | $ | 557 | |||||||||||||
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 |
(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. |
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 6.8 | $ | 2,012 | $ | 294.26 | $ | 1,742 | $ | 254.67 | 86.5 | % | $ | 270 | ||||||||||||
Florida | 6.0 | 1,953 | 323.86 | 1,870 | 310.09 | 95.7 | 83 | ||||||||||||||||||
Illinois | 1.6 | 447 | 284.18 | 492 | 312.54 | 110.0 | (45 | ) | |||||||||||||||||
Michigan | 3.7 | 1,203 | 324.12 | 1,062 | 286.35 | 88.3 | 141 | ||||||||||||||||||
New Mexico | 2.4 | 1,015 | 422.25 | 949 | 394.66 | 93.5 | 66 | ||||||||||||||||||
New York (3) | 0.3 | 135 | 444.77 | 128 | 421.58 | 94.8 | 7 | ||||||||||||||||||
Ohio | 3.1 | 1,666 | 531.17 | 1,498 | 477.81 | 90.0 | 168 | ||||||||||||||||||
Puerto Rico | 2.9 | 553 | 190.99 | 513 | 177.01 | 92.7 | 40 | ||||||||||||||||||
South Carolina | 1.0 | 329 | 325.43 | 301 | 298.43 | 91.7 | 28 | ||||||||||||||||||
Texas | 4.2 | 2,109 | 509.09 | 1,819 | 439.11 | 86.3 | 290 | ||||||||||||||||||
Utah | 1.5 | 402 | 269.48 | 354 | 237.20 | 88.0 | 48 | ||||||||||||||||||
Washington | 7.1 | 1,958 | 277.83 | 1,731 | 245.62 | 88.4 | 227 | ||||||||||||||||||
Wisconsin | 1.2 | 376 | 319.57 | 340 | 289.24 | 90.5 | 36 | ||||||||||||||||||
Other (4) | — | 7 | — | 23 | — | — | (16 | ) | |||||||||||||||||
41.8 | $ | 14,165 | $ | 339.19 | $ | 12,822 | $ | 307.03 | 90.5 | % | $ | 1,343 | |||||||||||||
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 |
(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. |
Three Months Ended September 30, | |||||||||||||||||||||
2017 | 2016 | ||||||||||||||||||||
Amount | PMPM | % of Total | Amount | PMPM | % of Total | ||||||||||||||||
Fee for service | $ | 3,196 | $ | 234.51 | 75.8 | % | $ | 2,799 | $ | 220.29 | 74.7 | % | |||||||||
Pharmacy | 638 | 46.85 | 15.1 | 567 | 44.65 | 15.1 | |||||||||||||||
Capitation | 342 | 25.07 | 8.1 | 302 | 23.83 | 8.1 | |||||||||||||||
Direct delivery | 18 | 1.37 | 0.4 | 21 | 1.66 | 0.5 | |||||||||||||||
Other | 26 | 1.88 | 0.6 | 59 | 4.58 | 1.6 | |||||||||||||||
$ | 4,220 | $ | 309.68 | 100.0 | % | $ | 3,748 | $ | 295.01 | 100.0 | % |
Nine Months Ended September 30, | |||||||||||||||||||||
2017 | 2016 | ||||||||||||||||||||
Amount | PMPM | % of Total | Amount | PMPM | % of Total | ||||||||||||||||
Fee for service | $ | 9,630 | $ | 230.58 | 75.1 | % | $ | 8,156 | $ | 215.96 | 74.6 | % | |||||||||
Pharmacy | 1,904 | 45.60 | 14.8 | 1,621 | 42.93 | 14.8 | |||||||||||||||
Capitation | 1,022 | 24.47 | 8.0 | 901 | 23.86 | 8.3 | |||||||||||||||
Direct delivery | 62 | 1.50 | 0.5 | 55 | 1.46 | 0.5 | |||||||||||||||
Other | 204 | 4.88 | 1.6 | 197 | 5.20 | 1.8 | |||||||||||||||
$ | 12,822 | $ | 307.03 | 100.0 | % | $ | 10,930 | $ | 289.41 | 100.0 | % |
September 30, | December 31, | ||||||
2017 | 2016 | ||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,681 | $ | 1,352 | |||
Pharmacy payable | 125 | 112 | |||||
Capitation payable | 57 | 37 | |||||
Other (1) | 615 | 428 | |||||
$ | 2,478 | $ | 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 September 30, 2017 and December 31, 2016, we had recorded non-risk provider payables of approximately $403 million and $225 million, respectively. |
Nine Months Ended September 30, | Year Ended December 31, 2016 | ||||||||||
2017 | 2016 | ||||||||||
Medical claims and benefits payable, beginning balance | $ | 1,929 | $ | 1,685 | $ | 1,685 | |||||
Components of medical care costs related to: | |||||||||||
Current period | 12,813 | 11,120 | 14,966 | ||||||||
Prior period | 9 | (190 | ) | (192 | ) | ||||||
Total medical care costs | 12,822 | 10,930 | 14,774 | ||||||||
Change in non-risk provider payables | 172 | 70 | 58 | ||||||||
Payments for medical care costs related to: | |||||||||||
Current period | 10,944 | 9,536 | 13,304 | ||||||||
Prior period | 1,501 | 1,278 | 1,284 | ||||||||
Total paid | 12,445 | 10,814 | 14,588 | ||||||||
Medical claims and benefits payable, ending balance | $ | 2,478 | $ | 1,871 | $ | 1,929 | |||||
Benefit from prior period as a percentage of: | |||||||||||
Balance at beginning of period | (0.5 | )% | 11.3 | % | 11.4 | % | |||||
Premium revenue, trailing twelve months | — | % | 1.2 | % | 1.2 | % | |||||
Medical care costs, trailing twelve months | (0.1 | )% | 1.3 | % | 1.3 | % | |||||
Days in claims payable, fee for service (1) | 50 | 47 | 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 $78 million, $88 million and $94 million, as of September 30, 2017, September 30, 2016, and December 31, 2016, respectively. |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Net (loss) income | $ | (97 | ) | $ | 42 | $ | (250 | ) | $ | 99 | |||||
Adjustments: | |||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 39 | 42 | 129 | 118 | |||||||||||
Interest expense | 32 | 26 | 85 | 76 | |||||||||||
Income tax (benefit) expense | (16 | ) | 50 | (46 | ) | 137 | |||||||||
EBITDA | $ | (42 | ) | $ | 160 | $ | (82 | ) | $ | 430 |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||||||||||
Amount | Per Diluted share | Amount | Per Diluted share | Amount | Per Diluted share | Amount | Per Diluted share | ||||||||||||||||||||||||
Net (loss) income | $ | (97 | ) | $ | (1.70 | ) | $ | 42 | $ | 0.76 | $ | (250 | ) | $ | (4.44 | ) | $ | 99 | $ | 1.77 | |||||||||||
Adjustment: | |||||||||||||||||||||||||||||||
Amortization of intangible assets | 7 | 0.13 | 9 | 0.15 | 24 | 0.43 | 24 | 0.42 | |||||||||||||||||||||||
Income tax effect (1) | (3 | ) | (0.05 | ) | (4 | ) | (0.06 | ) | (9 | ) | (0.16 | ) | (9 | ) | (0.16 | ) | |||||||||||||||
Amortization of intangible assets, net of tax effect | 4 | 0.08 | 5 | 0.09 | 15 | 0.27 | 15 | 0.26 | |||||||||||||||||||||||
Adjusted net (loss) income | $ | (93 | ) | $ | (1.62 | ) | $ | 47 | $ | 0.85 | $ | (235 | ) | $ | (4.17 | ) | $ | 114 | $ | 2.03 |
(1) | Income tax effect of adjustment calculated at the blended federal and state statutory tax rate of 37%. |