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 October 31, 2018, as to financial results for the third quarter ended September 30, 2018, and increases to the Company’s fiscal year 2018 guidance. |
MOLINA HEALTHCARE, INC. | |||
Date: | October 31, 2018 | By: | /s/ Jeff D. Barlow |
Jeff D. Barlow | |||
Chief Legal Officer and Secretary |
• | Net income of $2.90 per diluted share on a GAAP basis for the third quarter of 2018, and $7.60 for the nine months ended September 30, 2018 |
• | Third quarter 2018 results include a net charge of $0.35 per diluted share, and year-to-date results include a net benefit of $0.59 per diluted share, for non-run rate items |
• | The overall medical care ratio improved to 86.4% from 87.0%, sequentially, when excluding non-run rate items |
• | Net profit margin of 4.2% in the quarter, and 3.6% year to date |
• | 2018 guidance increases by $1.65 per diluted share at the midpoint, to a range of $8.80 - $9.00 net income per diluted share on a GAAP basis |
• | The Medicaid MCR increased to 90.5%, from 89.8% in the second quarter of 2018. Excluding the recognition of the $57 million retroactive California Medicaid Expansion risk corridor adjustment, the Medicaid MCR would have been 89.0% in the third quarter of 2018. The sequential decrease was mainly due to improved performance in the Aged, Blind or Disabled (ABD) and Expansion programs, partially offset by a decline in performance in the Temporary Assistance for Needy Families program (TANF). |
• | The Marketplace MCR increased to 64.1%, from 57.4% in the second quarter of 2018. Excluding the benefit of the 2017 CSR, the MCR would have been 65.3% in the third quarter of 2018. Excluding the combined benefit of the 2017 risk adjustment and CSR, the Marketplace MCR would have been 68.4% in the second quarter of 2018. The sequential improvement was mainly due to lower medical costs and higher revenue. |
• | The Medicare MCR increased to 87.3%, from 85.0% in the second quarter of 2018, mainly due to certain premium adjustments and higher inpatient costs in our Medicare-Medicaid Integrated plans. |
Premium revenue | ~ $17.5B | ||
Service revenue | ~ $390M | ||
Premium tax revenue | ~ $420M | ||
Health insurer fees reimbursed | ~ $325M | ||
Investment income and other revenue | ~ $125M | ||
Total revenue | ~ $18.8B | ||
Medical care costs | ~ $15.1B | ||
Medical care ratio (2) | ~ 86% | ||
Cost of service revenue | ~ $350M | ||
General and administrative expenses | ~ $1.4B | ||
G&A ratio (3) | ~ 7.3% | ||
Premium tax expenses | ~ $420M | ||
Health insurer fees | ~ $350M | ||
Depreciation and amortization | ~ $100M | ||
Restructuring and separation costs | ~ $40M - $45M | ||
Losses on sale of subsidiaries, net | ~ $15M | ||
Interest expense and other expenses, net | ~ $145M | ||
Income before income taxes | $870M - $890M | ||
Net income | $585M - $600M | ||
EBITDA (4) | $1,105M - $1,125M | ||
Effective tax rate | 32% - 33% | ||
Net profit margin (3) | 3.1% - 3.2% | ||
Diluted weighted average shares | ~ 66.7M | ||
Net income per share | $8.80 - $9.00 | ||
Adjusted net income per share (4) | $9.05 - $9.25 | ||
End-of-year Marketplace membership | 340,000 | ||
End-of-year Medicaid and Medicare membership | 3,510,000 |
(1) | All amounts are estimates; actual results may differ materially. See the Company’s risk factors as discussed in its 2017 Form 10-K and other filings and the statements below in this press release after the heading “Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995.” |
(2) | Medical care ratio represents medical care costs as a percentage of premium revenue. |
(3) | G&A ratio represents general and administrative expenses as a percentage of total revenue. Net profit margin represents net income as a percentage of total revenue. |
(4) | See reconciliation of non-GAAP financial measures at the end of this release. |
• | the success of the Company’s profit improvement and maintenance initiatives, including the timing and amounts of the benefits realized, and administrative and medical cost savings achieved; |
• | the numerous political and market-based uncertainties associated with the Affordable Care Act (the “ACA”) or “Obamacare;” |
• | the market dynamics surrounding the ACA Marketplaces, including but not limited to uncertainties associated with risk adjustment requirements, the potential for disproportionate enrollment of higher acuity members, the discontinuation of premium tax credits, and the adequacy of agreed rates; |
• | 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; |
• | effective management of the Company’s medical costs; |
• | the Company’s 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; |
• | the full reimbursement of the ACA health insurer fee, or HIF; |
• | the success of the Company’s efforts to retain existing or awarded government contracts, including the success of any protest filings or defenses; |
• | the Company’s ability to manage its operations, including maintaining and creating adequate internal systems and controls relating to authorizations, approvals, provider payments, and the overall success of its care management initiatives; |
• | the Company’s ability to consummate and realize benefits from divestitures and acquisitions, including the recently consummated MMS and Pathways divestitures; |
• | the Company’s 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; |
• | the Company’s 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 and requirements; |
• | the Company’s 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 medical 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 the Company’s 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 the Company’s health plan in Puerto Rico, including the resolution of the debt crisis and the effect of the PROMESA law, and the impact of any future significant weather events; |
• | the success and renewal of the Company’s 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 the Company’s 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; |
• | changes with respect to the Company’s provider contracts and the loss of providers; |
• | approval by state regulators of dividends and distributions by the Company’s health plan subsidiaries; |
• | changes in funding under the Company’s 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, including litigation involving the ACA to which we ourselves are not a direct party; |
• | the relatively small number of states in which we operate health plans, including the greater scale and revenues of the Company’s California, Ohio, Texas, and Washington health plans; |
• | the availability of adequate financing on acceptable terms to fund and capitalize the Company’s expansion and growth, repay the Company’s outstanding indebtedness at maturity and meet its liquidity needs, including the interest expense and other costs associated with such financing; |
• | the Company’s failure to comply with the financial or other covenants in its credit agreement or the indentures governing its outstanding notes; |
• | the sufficiency of the Company’s funds on hand to pay the amounts due upon conversion or maturity of its 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; |
• | the unexpected loss of the leadership of one or more of our senior executives; |
• | increasing competition and consolidation in the Medicaid industry; |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||
2018 | 2017 | 2018 | 2017 | ||||||||||||
(Dollar amounts in millions, except per-share amounts) | |||||||||||||||
Revenue: | |||||||||||||||
Premium revenue | $ | 4,337 | $ | 4,777 | $ | 13,174 | $ | 14,165 | |||||||
Service revenue | 130 | 130 | 391 | 390 | |||||||||||
Premium tax revenue | 110 | 106 | 320 | 331 | |||||||||||
Health insurer fees reimbursed | 83 | — | 248 | — | |||||||||||
Investment income and other revenue | 37 | 18 | 93 | 48 | |||||||||||
Total revenue | 4,697 | 5,031 | 14,226 | 14,934 | |||||||||||
Operating expenses: | |||||||||||||||
Medical care costs | 3,790 | 4,220 | 11,362 | 12,822 | |||||||||||
Cost of service revenue | 111 | 123 | 349 | 369 | |||||||||||
General and administrative expenses | 311 | 383 | 998 | 1,227 | |||||||||||
Premium tax expenses | 110 | 106 | 320 | 331 | |||||||||||
Health insurer fees | 87 | — | 261 | — | |||||||||||
Depreciation and amortization | 25 | 33 | 76 | 109 | |||||||||||
Restructuring and separation costs | 5 | 118 | 38 | 161 | |||||||||||
Impairment losses | — | 129 | — | 201 | |||||||||||
Total operating expenses | 4,439 | 5,112 | 13,404 | 15,220 | |||||||||||
Gain on sale of subsidiary | 37 | — | 37 | — | |||||||||||
Operating income (loss) | 295 | (81 | ) | 859 | (286 | ) | |||||||||
Other expenses, net: | |||||||||||||||
Interest expense | 26 | 32 | 91 | 85 | |||||||||||
Other expense (income), net | 10 | — | 25 | (75 | ) | ||||||||||
Total other expenses, net | 36 | 32 | 116 | 10 | |||||||||||
Income (loss) before income tax expense (benefit) | 259 | (113 | ) | 743 | (296 | ) | |||||||||
Income tax expense (benefit) | 62 | (16 | ) | 237 | (46 | ) | |||||||||
Net income (loss) | $ | 197 | $ | (97 | ) | $ | 506 | $ | (250 | ) | |||||
Net income (loss) per diluted share | $ | 2.90 | $ | (1.70 | ) | $ | 7.60 | $ | (4.44 | ) | |||||
Diluted weighted average shares outstanding | 67.9 | 56.5 | 66.6 | 56.2 | |||||||||||
Operating Statistics: | |||||||||||||||
Medical care ratio | 87.4 | % | 88.3 | % | 86.2 | % | 90.5 | % | |||||||
G&A ratio | 6.6 | % | 7.6 | % | 7.0 | % | 8.2 | % | |||||||
Premium tax ratio | 2.5 | % | 2.2 | % | 2.4 | % | 2.3 | % | |||||||
Effective income tax rate | 24.0 | % | 14.6 | % | 31.9 | % | 15.5 | % | |||||||
Net profit (loss) margin | 4.2 | % | (1.9 | )% | 3.6 | % | (1.7 | )% |
September 30, | December 31, | ||||||
2018 | 2017 | ||||||
(In millions, except per-share data) | |||||||
ASSETS | |||||||
Current assets: | |||||||
Cash and cash equivalents | $ | 2,814 | $ | 3,186 | |||
Investments | 1,812 | 2,524 | |||||
Restricted investments | — | 169 | |||||
Receivables | 1,346 | 871 | |||||
Prepaid expenses and other current assets | 486 | 239 | |||||
Derivative asset | 843 | 522 | |||||
Total current assets | 7,301 | 7,511 | |||||
Property, equipment, and capitalized software, net | 264 | 342 | |||||
Goodwill and intangible assets, net | 195 | 255 | |||||
Restricted investments | 118 | 119 | |||||
Deferred income taxes | 143 | 103 | |||||
Other assets | 30 | 141 | |||||
$ | 8,051 | $ | 8,471 | ||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | |||||||
Current liabilities: | |||||||
Medical claims and benefits payable | $ | 2,042 | $ | 2,192 | |||
Amounts due government agencies | 1,030 | 1,542 | |||||
Accounts payable and accrued liabilities | 824 | 366 | |||||
Deferred revenue | 178 | 282 | |||||
Current portion of long-term debt | 296 | 653 | |||||
Derivative liability | 843 | 522 | |||||
Total current liabilities | 5,213 | 5,557 | |||||
Long-term debt | 1,019 | 1,318 | |||||
Lease financing obligations | 198 | 198 | |||||
Other long-term liabilities | 60 | 61 | |||||
Total liabilities | 6,490 | 7,134 | |||||
Stockholders’ equity: | |||||||
Common stock, $0.001 par value, 150 shares authorized; outstanding: 62 shares at September 30, 2018 and 60 shares at December 31, 2017 | — | — | |||||
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding | — | — | |||||
Additional paid-in capital | 760 | 1,044 | |||||
Accumulated other comprehensive loss | (10 | ) | (5 | ) | |||
Retained earnings | 811 | 298 | |||||
Total stockholders’ equity | 1,561 | 1,337 | |||||
$ | 8,051 | $ | 8,471 |
Three Months Ended | Nine Months Ended | ||||||||||||||
September 30, | September 30, | ||||||||||||||
2018 | 2017 | 2018 | 2017 | ||||||||||||
(In millions) | |||||||||||||||
Operating activities: | |||||||||||||||
Net income (loss) | $ | 197 | $ | (97 | ) | $ | 506 | $ | (250 | ) | |||||
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities: | |||||||||||||||
Depreciation and amortization | 31 | 43 | 104 | 139 | |||||||||||
Deferred income taxes | (26 | ) | (27 | ) | (32 | ) | (68 | ) | |||||||
Share-based compensation | 7 | 3 | 20 | 38 | |||||||||||
Non-cash restructuring costs | — | 49 | 17 | 49 | |||||||||||
Amortization of convertible senior notes and lease financing obligations | 5 | 8 | 18 | 24 | |||||||||||
Gain on sale of subsidiary | (37 | ) | — | (37 | ) | — | |||||||||
Loss on debt extinguishment | 10 | — | 25 | — | |||||||||||
Impairment losses | — | 129 | — | 201 | |||||||||||
Other, net | 2 | 6 | 6 | 13 | |||||||||||
Changes in operating assets and liabilities: | |||||||||||||||
Receivables | (192 | ) | 4 | (507 | ) | (28 | ) | ||||||||
Prepaid expenses and other current assets | 64 | (15 | ) | (117 | ) | (53 | ) | ||||||||
Medical claims and benefits payable | 123 | 401 | (144 | ) | 549 | ||||||||||
Amounts due government agencies | (716 | ) | (520 | ) | (511 | ) | 122 | ||||||||
Accounts payable and accrued liabilities | 49 | 108 | 398 | 90 | |||||||||||
Deferred revenue | (13 | ) | 185 | (55 | ) | 153 | |||||||||
Income taxes | (9 | ) | 8 | 118 | (22 | ) | |||||||||
Net cash (used in) provided by operating activities | (505 | ) | 285 | (191 | ) | 957 | |||||||||
Investing activities: | |||||||||||||||
Purchases of investments | (288 | ) | (258 | ) | (1,202 | ) | (1,894 | ) | |||||||
Proceeds from sales and maturities of investments | 735 | 662 | 2,070 | 1,536 | |||||||||||
Purchases of property, equipment, and capitalized software | (10 | ) | (25 | ) | (24 | ) | (85 | ) | |||||||
Other, net | (14 | ) | (9 | ) | (23 | ) | (33 | ) | |||||||
Net cash provided by (used in) investing activities | 423 | 370 | 821 | (476 | ) | ||||||||||
Financing activities: | |||||||||||||||
Repayment of credit facility | — | — | (300 | ) | — | ||||||||||
Repayment of principal amount of 1.125% Notes | (140 | ) | — | (236 | ) | — | |||||||||
Cash paid for partial settlement of 1.125% Conversion Option | (343 | ) | — | (477 | ) | — | |||||||||
Cash received for partial termination of 1.125% Call Option | 343 | — | 477 | — | |||||||||||
Cash paid for partial termination of 1.125% Warrants | (306 | ) | — | (419 | ) | — | |||||||||
Repayment of principal amount of 1.625% Notes | (64 | ) | — | (64 | ) | — | |||||||||
Proceeds from senior notes offerings, net of issuance costs | — | — | — | 325 | |||||||||||
Proceeds from borrowings under credit facility | — | 300 | — | 300 | |||||||||||
Other, net | 1 | (1 | ) | 7 | 7 | ||||||||||
Net cash (used in) provided by financing activities | (509 | ) | 299 | (1,012 | ) | 632 | |||||||||
Net (decrease) increase in cash, cash equivalents, and restricted cash and cash equivalents | (591 | ) | 954 | (382 | ) | 1,113 | |||||||||
Cash, cash equivalents, and restricted cash and cash equivalents at beginning of period | 3,499 | 3,071 | 3,290 | 2,912 | |||||||||||
Cash, cash equivalents, and restricted cash and cash equivalents at end of period | $ | 2,908 | $ | 4,025 | $ | 2,908 | $ | 4,025 |
September 30, | December 31, | September 30, | ||||||
2018 | 2017 | 2017 | ||||||
Ending Membership by Program: | ||||||||
Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) | 2,436,000 | 2,457,000 | 2,451,000 | |||||
Medicaid Expansion | 664,000 | 668,000 | 662,000 | |||||
Aged, Blind or Disabled (ABD) | 415,000 | 412,000 | 411,000 | |||||
Total Medicaid | 3,515,000 | 3,537,000 | 3,524,000 | |||||
Medicare-Medicaid Plan (MMP) - Integrated | 55,000 | 57,000 | 58,000 | |||||
Medicare Special Needs Plans | 45,000 | 44,000 | 44,000 | |||||
Total Medicare | 100,000 | 101,000 | 102,000 | |||||
Total Medicaid and Medicare | 3,615,000 | 3,638,000 | 3,626,000 | |||||
Marketplace | 384,000 | 815,000 | 877,000 | |||||
3,999,000 | 4,453,000 | 4,503,000 | ||||||
Ending Membership by Health Plan: | ||||||||
California | 623,000 | 746,000 | 751,000 | |||||
Florida | 395,000 | 625,000 | 641,000 | |||||
Illinois | 223,000 | 165,000 | 163,000 | |||||
Michigan | 394,000 | 398,000 | 399,000 | |||||
New Mexico | 234,000 | 253,000 | 256,000 | |||||
Ohio | 315,000 | 327,000 | 343,000 | |||||
Puerto Rico | 320,000 | 314,000 | 306,000 | |||||
South Carolina | 117,000 | 116,000 | 113,000 | |||||
Texas | 436,000 | 430,000 | 444,000 | |||||
Washington | 770,000 | 777,000 | 770,000 | |||||
Other (1) | 172,000 | 302,000 | 317,000 | |||||
3,999,000 | 4,453,000 | 4,503,000 |
(1) | “Other” includes the Idaho, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results. |
Three Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months (1) | Premium Revenue | Medical Care Costs | MCR (2) | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
TANF and CHIP | 7.4 | $ | 1,379 | $ | 187.03 | $ | 1,228 | $ | 166.41 | 89.0 | % | $ | 151 | ||||||||||||
Medicaid Expansion | 2.0 | 671 | 333.11 | 640 | 317.62 | 95.3 | 31 | ||||||||||||||||||
ABD | 1.2 | 1,322 | 1,054.92 | 1,186 | 946.38 | 89.7 | 136 | ||||||||||||||||||
Total Medicaid | 10.6 | 3,372 | 316.86 | 3,054 | 286.86 | 90.5 | 318 | ||||||||||||||||||
MMP | 0.2 | 353 | 2,159.72 | 323 | 1,981.45 | 91.7 | 30 | ||||||||||||||||||
Medicare | 0.1 | 156 | 1,157.71 | 121 | 895.25 | 77.3 | 35 | ||||||||||||||||||
Total Medicare | 0.3 | 509 | 1,706.95 | 444 | 1,490.63 | 87.3 | 65 | ||||||||||||||||||
Total Medicaid and Medicare | 10.9 | 3,881 | 354.70 | 3,498 | 319.63 | 90.1 | 383 | ||||||||||||||||||
Marketplace | 1.2 | 456 | 394.02 | 292 | 252.61 | 64.1 | 164 | ||||||||||||||||||
12.1 | $ | 4,337 | $ | 358.46 | $ | 3,790 | $ | 313.23 | 87.4 | % | $ | 547 |
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 | ||||||||||||||||||
Total Medicaid and Medicare | 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 |
(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, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
TANF and CHIP | 22.3 | $ | 4,145 | $ | 186.12 | $ | 3,705 | $ | 166.35 | 89.4 | % | $ | 440 | ||||||||||||
Medicaid Expansion | 6.1 | 2,184 | 359.37 | 1,957 | 322.01 | 89.6 | 227 | ||||||||||||||||||
ABD | 3.7 | 3,864 | 1,034.25 | 3,550 | 950.11 | 91.9 | 314 | ||||||||||||||||||
Total Medicaid | 32.1 | 10,193 | 317.70 | 9,212 | 287.10 | 90.4 | 981 | ||||||||||||||||||
MMP | 0.5 | 1,077 | 2,173.90 | 941 | 1,899.26 | 87.4 | 136 | ||||||||||||||||||
Medicare | 0.4 | 470 | 1,171.59 | 385 | 959.54 | 81.9 | 85 | ||||||||||||||||||
Total Medicare | 0.9 | 1,547 | 1,725.71 | 1,326 | 1,479.06 | 85.7 | 221 | ||||||||||||||||||
Total Medicaid and Medicare | 33.0 | 11,740 | 355.96 | 10,538 | 319.50 | 89.8 | 1,202 | ||||||||||||||||||
Marketplace | 3.8 | 1,434 | 379.91 | 824 | 218.44 | 57.5 | 610 | ||||||||||||||||||
36.8 | $ | 13,174 | $ | 358.42 | $ | 11,362 | $ | 309.12 | 86.2 | % | $ | 1,812 |
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
Total Medicaid and Medicare | 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 |
Three Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.7 | $ | 435 | $ | 249.00 | $ | 446 | $ | 255.22 | 102.5 | % | $ | (11 | ) | |||||||||||
Florida | 1.0 | 388 | 363.16 | 362 | 339.33 | 93.4 | 26 | ||||||||||||||||||
Illinois | 0.7 | 207 | 312.72 | 182 | 274.98 | 87.9 | 25 | ||||||||||||||||||
Michigan | 1.1 | 397 | 350.05 | 321 | 282.49 | 80.7 | 76 | ||||||||||||||||||
New Mexico | 0.6 | 304 | 471.66 | 275 | 426.69 | 90.5 | 29 | ||||||||||||||||||
Ohio | 0.9 | 584 | 624.84 | 532 | 568.93 | 91.1 | 52 | ||||||||||||||||||
Puerto Rico | 1.0 | 179 | 189.65 | 162 | 171.96 | 90.7 | 17 | ||||||||||||||||||
South Carolina | 0.4 | 124 | 354.53 | 112 | 318.56 | 89.9 | 12 | ||||||||||||||||||
Texas | 0.7 | 577 | 848.47 | 525 | 772.14 | 91.0 | 52 | ||||||||||||||||||
Washington | 2.3 | 511 | 226.77 | 444 | 197.04 | 86.9 | 67 | ||||||||||||||||||
Other (1) | 0.5 | 175 | 334.29 | 137 | 261.49 | 78.2 | 38 | ||||||||||||||||||
10.9 | $ | 3,881 | $ | 354.70 | $ | 3,498 | $ | 319.63 | 90.1 | % | $ | 383 | |||||||||||||
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
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 | ||||||||||||||||||
Washington | 2.3 | 612 | 276.73 | 522 | 236.11 | 85.3 | 90 | ||||||||||||||||||
Other (1) | 0.5 | 168 | 294.99 | 146 | 256.99 | 87.1 | 22 | ||||||||||||||||||
11.0 | $ | 3,994 | $ | 362.04 | $ | 3,630 | $ | 329.08 | 90.9 | % | $ | 364 |
(1) | “Other” includes the Idaho, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results. |
Nine Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 5.3 | $ | 1,446 | $ | 270.63 | $ | 1,299 | $ | 243.14 | 89.8 | % | $ | 147 | ||||||||||||
Florida | 3.2 | 1,147 | 356.15 | 1,069 | 331.93 | 93.2 | 78 | ||||||||||||||||||
Illinois | 1.8 | 551 | 308.45 | 474 | 265.47 | 86.1 | 77 | ||||||||||||||||||
Michigan | 3.4 | 1,161 | 343.08 | 983 | 290.26 | 84.6 | 178 | ||||||||||||||||||
New Mexico | 2.0 | 936 | 469.19 | 875 | 438.70 | 93.5 | 61 | ||||||||||||||||||
Ohio | 2.8 | 1,670 | 590.71 | 1,474 | 521.26 | 88.2 | 196 | ||||||||||||||||||
Puerto Rico | 2.9 | 549 | 190.34 | 501 | 173.83 | 91.3 | 48 | ||||||||||||||||||
South Carolina | 1.1 | 369 | 350.94 | 323 | 306.76 | 87.4 | 46 | ||||||||||||||||||
Texas | 2.1 | 1,715 | 831.21 | 1,554 | 753.31 | 90.6 | 161 | ||||||||||||||||||
Washington | 6.8 | 1,666 | 245.40 | 1,544 | 227.41 | 92.7 | 122 | ||||||||||||||||||
Other | 1.6 | 530 | 323.84 | 442 | 269.98 | 83.4 | 88 | ||||||||||||||||||
33.0 | $ | 11,740 | $ | 355.96 | $ | 10,538 | $ | 319.50 | 89.8 | % | $ | 1,202 | |||||||||||||
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
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 | ||||||||||||||||||
Washington | 6.7 | 1,835 | 275.60 | 1,603 | 240.83 | 87.4 | 232 | ||||||||||||||||||
Other | 1.7 | 510 | 292.93 | 454 | 261.01 | 89.1 | 56 | ||||||||||||||||||
33.4 | $ | 11,862 | $ | 354.88 | $ | 10,885 | $ | 325.66 | 91.8 | % | $ | 977 |
Three Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 0.2 | $ | 49 | $ | 309.04 | $ | 37 | $ | 235.63 | 76.2 | % | $ | 12 | ||||||||||||
Florida | 0.2 | 66 | 548.60 | 45 | 362.39 | 66.1 | 21 | ||||||||||||||||||
Michigan | — | 12 | 233.51 | 7 | 145.13 | 62.1 | 5 | ||||||||||||||||||
New Mexico | 0.1 | 28 | 419.20 | 18 | 249.33 | 59.5 | 10 | ||||||||||||||||||
Ohio | 0.1 | 27 | 485.08 | 18 | 336.86 | 69.4 | 9 | ||||||||||||||||||
Texas | 0.6 | 228 | 357.54 | 134 | 209.80 | 58.7 | 94 | ||||||||||||||||||
Washington | — | 44 | 656.70 | 34 | 518.75 | 79.0 | 10 | ||||||||||||||||||
Other (1) | — | 2 | NM | (1 | ) | NM | NM | 3 | |||||||||||||||||
1.2 | $ | 456 | $ | 394.02 | $ | 292 | $ | 252.61 | 64.1 | % | $ | 164 | |||||||||||||
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
Washington | 0.1 | 42 | 327.40 | 33 | 256.52 | 78.3 | 9 | ||||||||||||||||||
Other (1) | 0.5 | 144 | 375.83 | 100 | 259.15 | 69.0 | 44 | ||||||||||||||||||
2.7 | $ | 783 | $ | 301.72 | $ | 590 | $ | 227.22 | 75.3 | % | $ | 193 |
(1) | “Other” includes the Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results. We terminated Marketplace operations at these plans effective January 1, 2018, so the ratios for 2018 periods are not meaningful (NM). |
Nine Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 0.6 | $ | 171 | $ | 326.82 | $ | 89 | $ | 169.98 | 52.0 | % | $ | 82 | ||||||||||||
Florida | 0.5 | 211 | 491.13 | 67 | 155.24 | 31.6 | 144 | ||||||||||||||||||
Michigan | 0.1 | 40 | 248.24 | 23 | 145.38 | 58.6 | 17 | ||||||||||||||||||
New Mexico | 0.2 | 93 | 426.07 | 55 | 247.57 | 58.1 | 38 | ||||||||||||||||||
Ohio | 0.2 | 84 | 466.75 | 58 | 324.91 | 69.6 | 26 | ||||||||||||||||||
Texas | 2.0 | 679 | 330.92 | 440 | 214.65 | 64.9 | 239 | ||||||||||||||||||
Washington | 0.2 | 139 | 654.78 | 105 | 497.00 | 75.9 | 34 | ||||||||||||||||||
Other | — | 17 | NM | (13 | ) | NM | NM | 30 | |||||||||||||||||
3.8 | $ | 1,434 | $ | 379.91 | $ | 824 | $ | 218.44 | 57.5 | % | $ | 610 | |||||||||||||
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
Washington | 0.4 | 123 | 315.95 | 128 | 327.51 | 103.7 | (5 | ) | |||||||||||||||||
Other | 1.3 | 410 | 333.05 | 391 | 316.86 | 95.1 | 19 | ||||||||||||||||||
8.4 | $ | 2,303 | $ | 276.27 | $ | 1,937 | $ | 232.31 | 84.1 | % | $ | 366 |
Three Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 1.9 | $ | 484 | $ | 253.96 | $ | 483 | $ | 253.60 | 99.9 | % | $ | 1 | ||||||||||||
Florida | 1.2 | 454 | 382.20 | 407 | 341.70 | 89.4 | 47 | ||||||||||||||||||
Illinois | 0.7 | 207 | 312.72 | 182 | 274.98 | 87.9 | 25 | ||||||||||||||||||
Michigan | 1.1 | 409 | 345.28 | 328 | 276.88 | 80.2 | 81 | ||||||||||||||||||
New Mexico | 0.7 | 332 | 466.63 | 293 | 409.68 | 87.8 | 39 | ||||||||||||||||||
Ohio | 1.0 | 611 | 616.95 | 550 | 555.83 | 90.1 | 61 | ||||||||||||||||||
Puerto Rico | 1.0 | 179 | 189.65 | 162 | 171.96 | 90.7 | 17 | ||||||||||||||||||
South Carolina | 0.4 | 124 | 354.53 | 112 | 318.56 | 89.9 | 12 | ||||||||||||||||||
Texas | 1.3 | 805 | 611.01 | 659 | 500.14 | 81.9 | 146 | ||||||||||||||||||
Washington | 2.3 | 555 | 239.25 | 478 | 206.38 | 86.3 | 77 | ||||||||||||||||||
Other (1) | 0.5 | 177 | 336.18 | 136 | 260.19 | 77.4 | 41 | ||||||||||||||||||
12.1 | $ | 4,337 | $ | 358.46 | $ | 3,790 | $ | 313.23 | 87.4 | % | $ | 547 | |||||||||||||
Three Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
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 | ||||||||||||||||||
Washington | 2.4 | 654 | 279.52 | 555 | 237.23 | 84.9 | 99 | ||||||||||||||||||
Other (1) | 1.0 | 312 | 327.47 | 246 | 257.86 | 78.7 | 66 | ||||||||||||||||||
13.7 | $ | 4,777 | $ | 350.55 | $ | 4,220 | $ | 309.68 | 88.3 | % | $ | 557 |
(1) | “Other” includes the Idaho, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results. |
Nine Months Ended September 30, 2018 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | Medical Margin | |||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||
California | 5.9 | $ | 1,617 | $ | 275.64 | $ | 1,388 | $ | 236.61 | 85.8 | % | $ | 229 | ||||||||||||
Florida | 3.7 | 1,358 | 372.07 | 1,136 | 311.09 | 83.6 | 222 | ||||||||||||||||||
Illinois | 1.8 | 551 | 308.45 | 474 | 265.47 | 86.1 | 77 | ||||||||||||||||||
Michigan | 3.5 | 1,201 | 338.83 | 1,006 | 283.77 | 83.7 | 195 | ||||||||||||||||||
New Mexico | 2.2 | 1,029 | 464.92 | 930 | 419.78 | 90.3 | 99 | ||||||||||||||||||
Ohio | 3.0 | 1,754 | 583.29 | 1,532 | 509.52 | 87.4 | 222 | ||||||||||||||||||
Puerto Rico | 2.9 | 549 | 190.34 | 501 | 173.83 | 91.3 | 48 | ||||||||||||||||||
South Carolina | 1.1 | 369 | 350.94 | 323 | 306.76 | 87.4 | 46 | ||||||||||||||||||
Texas | 4.1 | 2,394 | 581.74 | 1,994 | 484.70 | 83.3 | 400 | ||||||||||||||||||
Washington | 7.0 | 1,805 | 257.82 | 1,649 | 235.59 | 91.4 | 156 | ||||||||||||||||||
Other | 1.6 | 547 | 334.26 | 429 | 262.27 | 78.5 | 118 | ||||||||||||||||||
36.8 | $ | 13,174 | $ | 358.42 | $ | 11,362 | $ | 309.12 | 86.2 | % | $ | 1,812 | |||||||||||||
Nine Months Ended September 30, 2017 | |||||||||||||||||||||||||
Member Months | Premium Revenue | Medical Care Costs | MCR | 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 | ||||||||||||||||||
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 | ||||||||||||||||||
Washington | 7.1 | 1,958 | 277.83 | 1,731 | 245.62 | 88.4 | 227 | ||||||||||||||||||
Other | 3.0 | 920 | 309.56 | 845 | 284.16 | 91.8 | 75 | ||||||||||||||||||
41.8 | $ | 14,165 | $ | 339.19 | $ | 12,822 | $ | 307.03 | 90.5 | % | $ | 1,343 |
Three Months Ended September 30, | |||||||||||||||||||||
2018 | 2017 | ||||||||||||||||||||
Amount | PMPM | % of Total | Amount | PMPM | % of Total | ||||||||||||||||
Fee for service | $ | 2,865 | $ | 236.74 | 75.6 | % | $ | 3,196 | $ | 234.51 | 75.8 | % | |||||||||
Pharmacy | 495 | 40.90 | 13.1 | 638 | 46.85 | 15.1 | |||||||||||||||
Capitation | 297 | 24.52 | 7.8 | 342 | 25.07 | 8.1 | |||||||||||||||
Other | 133 | 11.07 | 3.5 | 44 | 3.25 | 1.0 | |||||||||||||||
$ | 3,790 | $ | 313.23 | 100.0 | % | $ | 4,220 | $ | 309.68 | 100.0 | % |
Nine Months Ended September 30, | |||||||||||||||||||||
2018 | 2017 | ||||||||||||||||||||
Amount | PMPM | % of Total | Amount | PMPM | % of Total | ||||||||||||||||
Fee for service | $ | 8,471 | $ | 230.46 | 74.6 | % | $ | 9,630 | $ | 230.58 | 75.1 | % | |||||||||
Pharmacy | 1,645 | 44.76 | 14.5 | 1,904 | 45.60 | 14.8 | |||||||||||||||
Capitation | 891 | 24.23 | 7.8 | 1,022 | 24.47 | 8.0 | |||||||||||||||
Other | 355 | 9.67 | 3.1 | 266 | 6.38 | 2.1 | |||||||||||||||
$ | 11,362 | $ | 309.12 | 100.0 | % | $ | 12,822 | $ | 307.03 | 100.0 | % |
September 30, | December 31, | ||||||
2018 | 2017 | ||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,609 | $ | 1,717 | |||
Pharmacy payable | 121 | 112 | |||||
Capitation payable | 48 | 67 | |||||
Other (1) | 264 | 296 | |||||
$ | 2,042 | $ | 2,192 |
(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, 2018 and December 31, 2017, we had recorded non-risk provider payables of approximately $158 million and $122 million, respectively. |
Nine Months Ended September 30, | Year Ended December 31, 2017 | ||||||||||
2018 | 2017 | ||||||||||
Medical claims and benefits payable, beginning balance | $ | 2,192 | $ | 1,929 | $ | 1,929 | |||||
Components of medical care costs related to: | |||||||||||
Current period | 11,589 | 12,813 | 17,037 | ||||||||
Prior period (1) | (227 | ) | 9 | 36 | |||||||
Total medical care costs | 11,362 | 12,822 | 17,073 | ||||||||
Change in non-risk provider payables | 60 | 172 | (106 | ) | |||||||
Payments for medical care costs related to: | |||||||||||
Current period | 9,866 | 10,944 | 15,130 | ||||||||
Prior period | 1,706 | 1,501 | 1,574 | ||||||||
Total paid | 11,572 | 12,445 | 16,704 | ||||||||
Medical claims and benefits payable, ending balance | $ | 2,042 | $ | 2,478 | $ | 2,192 | |||||
Days in claims payable, fee for service (2) | 53 | 50 | 54 |
(1) | Excludes the 2018 benefit of the 2017 Marketplace CSR reimbursement. |
(2) | Claims payable includes primarily IBNP. It also includes certain fee-for-service payables reported in “Other” medical claims and benefits payable amounting to $34 million, $78 million and $99 million, as of September 30, 2018, 2017 and December 31, 2017, respectively. |
Three Months Ended September 30, 2018 | Nine Months Ended September 30, 2018 | ||||||||||||||
Amount | Per Diluted Share (1) | Amount | Per Diluted Share (1) | ||||||||||||
Retroactive California Medicaid Expansion risk corridor for the state fiscal year ended June 30, 2017 | $ | (57 | ) | $ | (0.65 | ) | $ | (57 | ) | $ | (0.67 | ) | |||
Marketplace risk adjustment, for 2017 dates of service | — | — | 56 | 0.66 | |||||||||||
Marketplace CSR subsidies, for 2017 dates of service | 5 | 0.06 | 81 | 0.95 | |||||||||||
Gain on sale of subsidiary | 37 | 0.42 | 37 | 0.43 | |||||||||||
Restructuring costs | (5 | ) | (0.06 | ) | (38 | ) | (0.45 | ) | |||||||
Loss on debt extinguishment | (10 | ) | (0.12 | ) | (25 | ) | (0.33 | ) | |||||||
$ | (30 | ) | $ | (0.35 | ) | $ | 54 | $ | 0.59 |
(1) | Except for certain items that are not deductible for tax purposes, per diluted share amounts are generally calculated at the statutory income tax rate of 22%. |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||
2018 | 2017 | 2018 | 2017 | ||||||||||||
Net income (loss) | $ | 197 | $ | (97 | ) | $ | 506 | $ | (250 | ) | |||||
Adjustments: | |||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 28 | 39 | 95 | 129 | |||||||||||
Interest expense | 26 | 32 | 91 | 85 | |||||||||||
Income tax expense (benefit) | 62 | (16 | ) | 237 | (46 | ) | |||||||||
EBITDA | $ | 313 | $ | (42 | ) | $ | 929 | $ | (82 | ) |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||||||||||
2018 | 2017 | 2018 | 2017 | ||||||||||||||||||||||||||||
Amount | Per Diluted Share | Amount | Per Diluted Share | Amount | Per Diluted Share | Amount | Per Diluted Share | ||||||||||||||||||||||||
Net income (loss) | $ | 197 | $ | 2.90 | $ | (97 | ) | $ | (1.70 | ) | $ | 506 | $ | 7.60 | $ | (250 | ) | $ | (4.44 | ) | |||||||||||
Adjustment: | |||||||||||||||||||||||||||||||
Amortization of intangible assets | 6 | 0.08 | 7 | 0.13 | 16 | 0.23 | 24 | 0.43 | |||||||||||||||||||||||
Income tax effect (1) | (2 | ) | (0.01 | ) | (3 | ) | (0.05 | ) | (4 | ) | (0.05 | ) | (9 | ) | (0.16 | ) | |||||||||||||||
Amortization of intangible assets, net of tax effect | 4 | 0.07 | 4 | 0.08 | 12 | 0.18 | 15 | 0.27 | |||||||||||||||||||||||
Adjusted net income (loss) | $ | 201 | $ | 2.97 | $ | (93 | ) | $ | (1.62 | ) | $ | 518 | $ | 7.78 | $ | (235 | ) | $ | (4.17 | ) |
(1) | Income tax effect of adjustments calculated at the blended federal and state statutory tax rate of 22% and 37% for 2018 and 2017, respectively. |
Low End | High End | ||||||
Net income | $ | 585 | $ | 600 | |||
Adjustments: | |||||||
Depreciation, and amortization of intangible assets and capitalized software | 120 | 120 | |||||
Interest expense | 115 | 115 | |||||
Income tax expense | 285 | 290 | |||||
EBITDA | $ | 1,105 | $ | 1,125 |
Low End | High End | ||||||||||||||
Amount | Per share (2) | Amount | Per share (2) | ||||||||||||
Net income | $ | 585 | $ | 8.80 | $ | 600 | $ | 9.00 | |||||||
Adjustments: | |||||||||||||||
Amortization of intangible assets | 21 | 0.32 | 21 | 0.32 | |||||||||||
Income tax effect (1) | (5 | ) | (0.07 | ) | (5 | ) | (0.07 | ) | |||||||
Amortization of intangible assets, net of tax effect | 16 | 0.25 | 16 | 0.25 | |||||||||||
Adjusted net income | $ | 601 | $ | 9.05 | $ | 616 | $ | 9.25 |
(1) | Income tax effect calculated at the statutory tax rate of 22%. |
(2) | Computation assumes 66.7 million diluted weighted average shares outstanding. |