Delaware
|
1-31719
|
13-4204626
|
||
(State of incorporation)
|
(Commission File Number)
|
(I.R.S. Employer Identification Number)
|
(d) Exhibits:
|
|
Exhibit
|
|
No.
|
Description
|
99.1
|
Press release of Molina Healthcare, Inc. issued April 30, 2012, as to financial results for the first quarter ended March 31, 2012.
|
MOLINA HEALTHCARE, INC.
|
||
Date: April 30, 2012
|
By: /s/ Jeff D. Barlow
|
|
Jeff D. Barlow
Sr. Vice President – General Counsel, and Secretary
|
Exhibit
|
|
No.
|
Description
|
99.1
|
Press release of Molina Healthcare, Inc. issued April 30, 2012, as to financial results for the first quarter ended March 31, 2012.
|
●
|
Earnings per diluted share for first quarter 2012 of $0.39
|
●
|
Quarterly EBITDA of $51.8 million, up 5% over 2011
|
●
|
Quarterly premium revenues of $1.3 billion, up 23% over 2011
|
●
|
Quarterly operating income of $33.4 million, up 7% over 2011
|
●
|
Aggregate membership up 11% over 2011
|
●
|
A shift in member mix to more costly members that are transitioning to a managed care environment, including Texas and California ABD members. These members start out with higher medical care ratios; and
|
●
|
Rate decreases of approximately 2% in Ohio effective January 1, 2012, and approximately 3% in California effective July 1, 2011.
|
Three Months Ended
March 31,
|
||||||||
2012
|
2011
|
|||||||
(In thousands)
|
||||||||
Service revenue before amortization
|
$ | 42,358 | $ | 38,860 | ||||
Amortization recorded as reduction of service revenue
|
(153 | ) | (2,186 | ) | ||||
Service revenue
|
42,205 | 36,674 | ||||||
Cost of service revenue
|
30,494 | 31,221 | ||||||
General and administrative costs
|
2,020 | 2,477 | ||||||
Amortization of customer relationship intangibles recorded as amortization
|
1,282 | 1,282 | ||||||
Operating income
|
$ | 8,409 | $ | 1,694 |
Three Months Ended March 31,
|
||||||||
2012
|
2011
|
|||||||
(In thousands)
|
||||||||
Net income
|
$ | 18,089 | $ | 17,388 | ||||
Add back:
|
||||||||
Depreciation and amortization reported in the consolidated statements of cash flows
|
18,339 | 18,094 | ||||||
Interest expense
|
4,298 | 3,603 | ||||||
Provision for income taxes
|
11,033 | 10,309 | ||||||
EBITDA
|
$ | 51,759 | $ | 49,394 |
(1)
|
GAAP stands for U.S. generally accepted accounting principles.
|
(2)
|
EBITDA is not prepared in conformity with GAAP because it excludes depreciation and amortization, as well as interest expense, and the provision for income taxes. This non-GAAP financial measure should not be considered as an alternative to the GAAP measures of net income, operating income, operating margin, or cash provided by operating activities, nor should EBITDA be considered in isolation from these GAAP measures of operating performance. Management uses EBITDA as a supplemental metric in evaluating our financial performance, in evaluating financing and business development decisions, and in forecasting and analyzing future periods. For these reasons, management believes that EBITDA is a useful supplemental measure to investors in evaluating our performance and the performance of other companies in our industry.
|
●
|
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;
|
●
|
uncertainties regarding the impact of the Patient Protection and Affordable Care Act, including its possible repeal, judicial overturning of the individual insurance mandate or Medicaid expansion, the effect of various implementing regulations, and uncertainties regarding the impact of other federal or state health care and insurance reform measures;
|
●
|
management of our medical costs, including seasonal flu patterns and rates of utilization that are consistent with our expectations, and the reduction over time of the high medical costs associated with new populations;
|
●
|
the success of our efforts to retain existing government contracts and to obtain new government contracts in connection with state requests for proposals (RFPs) in both existing and new states, and our ability to grow our revenues consistent with our expectations;
|
●
|
the accurate estimation of incurred but not reported medical costs across our health plans;
|
●
|
risks associated with the continued growth in new Medicaid and Medicare enrollees, and the development of actuarially sound rates with respect to such new enrollees;
|
●
|
retroactive adjustments to premium revenue or accounting estimates which require adjustment based upon subsequent developments, including Medicaid pharmaceutical rebates;
|
●
|
the continuation and renewal of the government contracts of both our health plans and Molina Medicaid Solutions and the terms under which such contracts are renewed;
|
●
|
the timing of receipt and recognition of revenue and the amortization of expense under the state contracts of Molina Medicaid Solutions in Maine and Idaho;
|
●
|
additional administrative costs and the potential payment of additional amounts to providers and/or the state by Molina Medicaid Solutions as a result of MMIS implementation issues in Maine or Idaho;
|
●
|
government audits and reviews, and any enrollment freeze or monitoring program that may result therefrom;
|
●
|
changes with respect to our provider contracts and the loss of providers;
|
●
|
the establishment of a federal or state medical cost expenditure floor as a percentage of the premiums we receive, and the interpretation and implementation of medical cost expenditure floors, administrative cost and profit ceilings, and profit sharing arrangements;
|
●
|
the interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures;
|
●
|
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;
|
●
|
restrictions and covenants in our credit facility;
|
●
|
the relatively small number of states in which we operate health plans;
|
●
|
the availability of financing to fund and capitalize our acquisitions and start-up activities and to meet our liquidity needs;
|
●
|
a state’s failure to renew its federal Medicaid waiver;
|
●
|
an inadvertent unauthorized disclosure of protected health information;
|
●
|
changes generally affecting the managed care or Medicaid management information systems industries;
|
●
|
increases in government surcharges, taxes, and assessments;
|
●
|
changes in general economic conditions, including unemployment rates;
|
Three Months Ended
March 31,
|
||||||||
2012
|
2011
|
|||||||
(In thousands,
except per-share data)
|
||||||||
Revenue:
|
||||||||
Premium revenue
|
$ | 1,327,449 | $ | 1,081,438 | ||||
Service revenue
|
42,205 | 36,674 | ||||||
Investment income
|
1,717 | 1,594 | ||||||
Rental income
|
2,209 | – | ||||||
Total revenue
|
1,373,580 | 1,119,706 | ||||||
Expenses:
|
||||||||
Medical care costs
|
1,130,988 | 913,532 | ||||||
Cost of service revenue
|
30,494 | 31,221 | ||||||
General and administrative expenses
|
120,223 | 94,436 | ||||||
Premium tax expenses
|
43,430 | 36,550 | ||||||
Depreciation and amortization
|
15,025 | 12,667 | ||||||
Total expenses
|
1,340,160 | 1,088,406 | ||||||
Operating income
|
33,420 | 31,300 | ||||||
Interest expense
|
4,298 | 3,603 | ||||||
Income before income taxes
|
29,122 | 27,697 | ||||||
Provision for income taxes
|
11,033 | 10,309 | ||||||
Net income
|
$ | 18,089 | $ | 17,388 | ||||
Net income per share(1):
|
||||||||
Basic
|
$ | 0.39 | $ | 0.38 | ||||
Diluted
|
$ | 0.39 | $ | 0.38 | ||||
Weighted average shares outstanding(1):
|
||||||||
Basic
|
45,998 | 45,588 | ||||||
Diluted
|
46,887 | 46,257 | ||||||
Operating Statistics:
|
||||||||
Ratio of medical care costs paid directly to providers to premium revenue
|
82.8 | % | 82.2 | % | ||||
Ratio of medical care costs not paid directly to providers to premium revenue
|
2.4 | % | 2.3 | % | ||||
Medical care ratio(2)
|
85.2 | % | 84.5 | % | ||||
General and administrative expense ratio(3)
|
8.8 | % | 8.4 | % | ||||
Premium tax ratio(2)
|
3.3 | % | 3.4 | % | ||||
Effective tax rate
|
37.9 | % | 37.2 | % |
(1)
|
All applicable share and per-share amounts reflect the retroactive effects of the three-for-two common stock split in the form of a stock dividend that was effective May 20, 2011.
|
(2)
|
Medical care ratio represents medical care costs as a percentage of premium revenue; premium tax ratio represents premium taxes as a percentage of premium revenue.
|
(3)
|
Computed as a percentage of total operating revenue.
|
March 31,
2012
|
Dec. 31,
2011
|
|||||||
(In thousands,
except per-share data)
|
||||||||
ASSETS
|
||||||||
Current assets:
|
||||||||
Cash and cash equivalents
|
$ | 517,723 | $ | 493,827 | ||||
Investments
|
357,981 | 336,916 | ||||||
Receivables
|
222,254 | 167,898 | ||||||
Income tax refundable
|
15,315 | 11,679 | ||||||
Deferred income taxes
|
14,025 | 18,327 | ||||||
Prepaid expenses and other current assets
|
24,715 | 19,435 | ||||||
Total current assets
|
1,152,013 | 1,048,082 | ||||||
Property, equipment, and capitalized software, net
|
198,564 | 190,934 | ||||||
Deferred contract costs
|
64,414 | 54,582 | ||||||
Intangible assets, net
|
96,090 | 101,796 | ||||||
Goodwill and indefinite-lived intangible assets
|
151,088 | 153,954 | ||||||
Auction rate securities
|
16,129 | 16,134 | ||||||
Restricted investments
|
41,947 | 46,164 | ||||||
Receivable for ceded life and annuity contracts
|
– | 23,401 | ||||||
Other assets
|
19,759 | 17,099 | ||||||
$ | 1,740,004 | $ | 1,652,146 | |||||
LIABILITIES AND STOCKHOLDERS’ EQUITY
|
||||||||
Current liabilities:
|
||||||||
Medical claims and benefits payable
|
$ | 455,833 | $ | 402,476 | ||||
Accounts payable and accrued liabilities
|
124,649 | 147,214 | ||||||
Deferred revenue
|
95,490 | 50,947 | ||||||
Current maturities of long-term debt
|
1,118 | 1,197 | ||||||
Total current liabilities
|
677,090 | 601,834 | ||||||
Long-term debt
|
228,150 | 216,929 | ||||||
Deferred income taxes
|
37,209 | 33,127 | ||||||
Liability for ceded life and annuity contracts
|
– | 23,401 | ||||||
Other long-term liabilities
|
22,243 | 21,782 | ||||||
Total liabilities
|
964,692 | 897,073 | ||||||
Stockholders’ equity:
|
||||||||
Common stock, $0.001 par value; 80,000 shares authorized; outstanding: 46,347 shares at March 31, 2012, and 45,815 shares at December 31, 2011
|
46 | 46 | ||||||
Preferred stock, $0.001 par value; 20,000 shares authorized, no shares issued and outstanding
|
– | – | ||||||
Additional paid-in capital
|
267,876 | 266,022 | ||||||
Accumulated other comprehensive loss
|
(1,109 | ) | (1,405 | ) | ||||
Retained earnings
|
508,499 | 490,410 | ||||||
Total stockholders’ equity
|
775,312 | 755,073 | ||||||
$ | 1,740,004 | $ | 1,652,146 |
Three Months Ended
March 31,
|
||||||||
2012
|
2011
|
|||||||
(In thousands)
|
||||||||
Operating activities:
|
||||||||
Net income
|
$ | 18,089 | $ | 17,388 | ||||
Adjustments to reconcile net income to net cash provided by operating activities:
|
||||||||
Depreciation and amortization
|
18,339 | 18,094 | ||||||
Deferred income taxes
|
8,906 | 1,619 | ||||||
Stock-based compensation
|
4,666 | 4,064 | ||||||
Gain on sale of subsidiary
|
(2,390 | ) | – | |||||
Non-cash interest on convertible senior notes
|
1,443 | 1,340 | ||||||
Amortization of premium/discount on investments
|
1,850 | 1,644 | ||||||
Amortization of deferred financing costs
|
258 | 503 | ||||||
Tax deficiency from employee stock compensation
|
(31 | ) | (264 | ) | ||||
Changes in operating assets and liabilities:
|
||||||||
Receivables
|
(54,356 | ) | (2,168 | ) | ||||
Prepaid expenses and other current assets
|
(5,287 | ) | (8,069 | ) | ||||
Medical claims and benefits payable
|
53,357 | (2,974 | ) | |||||
Accounts payable and accrued liabilities
|
(35,149 | ) | (25,796 | ) | ||||
Deferred revenue
|
44,543 | 84,172 | ||||||
Income taxes
|
(3,663 | ) | (5,430 | ) | ||||
Net cash provided by operating activities
|
50,575 | 84,123 | ||||||
Investing activities:
|
||||||||
Purchases of equipment
|
(13,505 | ) | (14,941 | ) | ||||
Purchases of investments
|
(88,199 | ) | (104,984 | ) | ||||
Sales and maturities of investments
|
65,767 | 61,275 | ||||||
Proceeds from sale of subsidiary, net of cash surrendered
|
9,162 | – | ||||||
Net cash paid in business combinations
|
– | (3,253 | ) | |||||
Increase in deferred contract costs
|
(12,993 | ) | (9,635 | ) | ||||
Increase in restricted investments
|
(493 | ) | (7,207 | ) | ||||
Change in other noncurrent assets and liabilities
|
(2,457 | ) | (1,010 | ) | ||||
Net cash used in investing activities
|
(42,718 | ) | (79,755 | ) | ||||
Financing activities:
|
||||||||
Amount borrowed under credit facility
|
10,000 | – | ||||||
Principal payments on term loan
|
(301 | ) | – | |||||
Proceeds from employee stock plans
|
2,748 | 2,462 | ||||||
Excess tax benefits from employee stock compensation
|
3,592 | 1,076 | ||||||
Net cash provided by financing activities
|
16,039 | 3,538 | ||||||
Net increase in cash and cash equivalents
|
23,896 | 7,906 | ||||||
Cash and cash equivalents at beginning of period
|
493,827 | 455,886 | ||||||
Cash and cash equivalents at end of period
|
$ | 517,723 | $ | 463,792 |
●
|
Amortization of purchased intangibles relating to customer relationships is reported as amortization within the heading “Depreciation and Amortization;”
|
●
|
Amortization of purchased intangibles relating to contract backlog is recorded as a reduction of “Service Revenue;” and
|
●
|
Depreciation is recorded within the heading “Cost of Service Revenue.”
|
Three Months Ended March 31,
|
||||||||||||||||
2012
|
2011
|
|||||||||||||||
Amount
|
% of Total
Revenue
|
Amount
|
% of Total
Revenue
|
|||||||||||||
Depreciation, and amortization of capitalized software
|
$ | 9,472 | 0.7 | % | $ | 7,401 | 0.7 | % | ||||||||
Amortization of intangible assets
|
5,553 | 0.4 | 5,266 | 0.4 | ||||||||||||
Depreciation and amortization reported as such in the consolidated statements of income
|
15,025 | 1.1 | 12,667 | 1.1 | ||||||||||||
Amortization recorded as reduction of service revenue
|
153 | – | 2,186 | 0.2 | ||||||||||||
Amortization of capitalized software recorded as cost of service revenue
|
3,161 | 0.2 | 3,241 | 0.3 | ||||||||||||
Total
|
$ | 18,339 | 1.3 | % | $ | 18,094 | 1.6 | % |
March 31,
2012
|
Dec. 31,
2011
|
March 31,
2011
|
||||||||||
Total Ending Membership by Health Plan:
|
||||||||||||
California
|
351,000 | 355,000 | 347,000 | |||||||||
Florida
|
69,000 | 69,000 | 66,000 | |||||||||
Michigan
|
222,000 | 222,000 | 225,000 | |||||||||
Missouri(1)
|
81,000 | 79,000 | 82,000 | |||||||||
New Mexico
|
89,000 | 88,000 | 90,000 | |||||||||
Ohio(2)
|
249,000 | 248,000 | 248,000 | |||||||||
Texas
|
280,000 | 155,000 | 128,000 | |||||||||
Utah
|
86,000 | 84,000 | 80,000 | |||||||||
Washington
|
356,000 | 355,000 | 341,000 | |||||||||
Wisconsin
|
42,000 | 42,000 | 40,000 | |||||||||
Total
|
1,825,000 | 1,697,000 | 1,647,000 | |||||||||
Total Ending Membership by State for our Medicare Advantage Plans:
|
||||||||||||
California
|
6,900 | 6,900 | 5,300 | |||||||||
Florida
|
800 | 800 | 600 | |||||||||
Michigan
|
8,500 | 8,200 | 6,700 | |||||||||
New Mexico
|
900 | 800 | 700 | |||||||||
Ohio(2)
|
200 | 200 | 400 | |||||||||
Texas
|
800 | 700 | 600 | |||||||||
Utah
|
8,100 | 8,400 | 6,700 | |||||||||
Washington
|
5,200 | 5,000 | 3,300 | |||||||||
Total
|
31,400 | 31,000 | 24,300 | |||||||||
Total Ending Membership by State for our Aged, Blind or Disabled Population:
|
||||||||||||
California
|
37,300 | 31,500 | 14,100 | |||||||||
Florida
|
10,500 | 10,400 | 10,300 | |||||||||
Michigan
|
38,800 | 37,500 | 32,000 | |||||||||
New Mexico
|
5,600 | 5,600 | 5,600 | |||||||||
Ohio(2)
|
29,700 | 29,100 | 28,200 | |||||||||
Texas
|
109,000 | 63,700 | 51,200 | |||||||||
Utah
|
8,700 | 8,500 | 8,200 | |||||||||
Washington
|
4,700 | 4,800 | 4,300 | |||||||||
Wisconsin
|
1,700 | 1,700 | 1,700 | |||||||||
Total
|
246,000 | 192,800 | 155,600 |
(1)
|
Our existing contract with the state of Missouri is scheduled to expire without renewal on June 30, 2012.
|
(2)
|
Our existing contract with the state of Ohio is scheduled to expire without renewal on December 31, 2012.
|
Three Months Ended March 31, 2012
|
||||||||||||||||||||||||||||
Member
Months(1)
|
Premium Revenue
|
Medical Care Costs
|
Medical
Care
Ratio
|
Premium
Tax
Expense
|
||||||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
|||||||||||||||||||||||||
California
|
1,059 | $ | 161,685 | $ | 152.65 | $ | 141,349 | $ | 133.45 | 87.4 | % | $ | 2,309 | |||||||||||||||
Florida
|
208 | 56,190 | 269.87 | 49,569 | 238.07 | 88.2 | 7 | |||||||||||||||||||||
Michigan
|
665 | 167,906 | 252.49 | 134,211 | 201.82 | 79.9 | 9,084 | |||||||||||||||||||||
Missouri(2)
|
243 | 56,613 | 233.32 | 53,120 | 218.93 | 93.8 | – | |||||||||||||||||||||
New Mexico
|
266 | 83,261 | 313.29 | 67,111 | 252.52 | 80.6 | 1,953 | |||||||||||||||||||||
Ohio(3)
|
746 | 293,525 | 393.73 | 236,701 | 317.51 | 80.6 | 22,853 | |||||||||||||||||||||
Texas
|
592 | 198,236 | 334.61 | 180,089 | 303.97 | 90.8 | 3,197 | |||||||||||||||||||||
Utah
|
252 | 75,138 | 297.59 | 57,881 | 229.24 | 77.0 | – | |||||||||||||||||||||
Washington
|
1,067 | 215,610 | 202.08 | 181,425 | 170.04 | 84.1 | 3,912 | |||||||||||||||||||||
Wisconsin
|
125 | 17,142 | 136.97 | 16,886 | 134.92 | 98.5 | – | |||||||||||||||||||||
Other(4)
|
– | 2,143 | – | 12,646 | – | – | 115 | |||||||||||||||||||||
5,223 | $ | 1,327,449 | $ | 254.14 | $ | 1,130,988 | $ | 216.53 | 85.2 | % | $ | 43,430 |
Three Months Ended March 31, 2011
|
||||||||||||||||||||||||||||
Member
Months(1)
|
Premium Revenue
|
Medical Care Costs
|
Medical
Care
Ratio
|
Premium
Tax
Expense
|
||||||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
|||||||||||||||||||||||||
California
|
1,041 | $ | 134,976 | $ | 129.63 | $ | 113,737 | $ | 109.24 | 84.3 | % | $ | 1,902 | |||||||||||||||
Florida
|
192 | 49,222 | 256.63 | 47,568 | 248.01 | 96.6 | 17 | |||||||||||||||||||||
Michigan
|
678 | 164,760 | 243.06 | 133,728 | 197.28 | 81.2 | 9,846 | |||||||||||||||||||||
Missouri(2)
|
245 | 55,166 | 225.33 | 51,608 | 210.79 | 93.6 | – | |||||||||||||||||||||
New Mexico
|
271 | 84,606 | 311.93 | 70,038 | 258.21 | 82.8 | 1,965 | |||||||||||||||||||||
Ohio(3)
|
737 | 230,340 | 312.68 | 171,752 | 233.15 | 74.6 | 17,775 | |||||||||||||||||||||
Texas
|
349 | 80,811 | 231.49 | 73,615 | 210.88 | 91.1 | 1,340 | |||||||||||||||||||||
Utah
|
236 | 67,935 | 287.77 | 53,839 | 228.06 | 79.3 | – | |||||||||||||||||||||
Washington
|
1,034 | 195,272 | 188.81 | 169,116 | 163.52 | 86.6 | 3,642 | |||||||||||||||||||||
Wisconsin
|
120 | 16,417 | 137.25 | 19,380 | 162.02 | 118.1 | – | |||||||||||||||||||||
Other(4)
|
– | 1,933 | – | 9,151 | – | – | 63 | |||||||||||||||||||||
4,903 | $ | 1,081,438 | $ | 220.58 | $ | 913,532 | $ | 186.34 | 84.5 | % | $ | 36,550 |
(1)
|
A member month is defined as the aggregate of each month’s ending membership for the period presented.
|
(2)
|
Our existing contract with the state of Missouri is scheduled to expire without renewal on June 30, 2012.
|
(3)
|
Our existing contract with the state of Ohio is scheduled to expire without renewal on December 31, 2012.
|
(4)
|
“Other” medical care costs also include medically related administrative costs at the parent company.
|
Three Months Ended March 31,
|
||||||||||||||||||||||||
2012
|
2011
|
|||||||||||||||||||||||
Amount
|
PMPM
|
% of
Total
|
Amount
|
PMPM
|
% of
Total
|
|||||||||||||||||||
Fee for service
|
$ | 777,267 | $ | 148.81 | 68.7 | % | $ | 655,884 | $ | 133.78 | 71.8 | % | ||||||||||||
Capitation
|
136,038 | 26.04 | 12.0 | 128,682 | 26.25 | 14.1 | ||||||||||||||||||
Pharmacy
|
173,237 | 33.17 | 15.3 | 91,576 | 18.68 | 10.0 | ||||||||||||||||||
Other
|
44,446 | 8.51 | 4.0 | 37,390 | 7.63 | 4.1 | ||||||||||||||||||
Total
|
$ | 1,130,988 | $ | 216.53 | 100.0 | % | $ | 913,532 | $ | 186.34 | 100.0 | % |
Mar. 31,
2012
|
Dec. 31,
2011
|
Mar. 31,
2011
|
||||||||||
Fee-for-service claims incurred but not paid (IBNP)
|
$ | 347,307 | $ | 301,020 | $ | 273,378 | ||||||
Capitation payable
|
37,289 | 53,532 | 43,738 | |||||||||
Pharmacy
|
38,443 | 26,178 | 16,953 | |||||||||
Other
|
32,794 | 21,746 | 17,313 | |||||||||
$ | 455,833 | $ | 402,476 | $ | 351,382 |
Three Months Ended
March 31,
|
Year Ended
Dec. 31,
|
|||||||||||
2012
|
2011
|
2011
|
||||||||||
Balances at beginning of period
|
$ | 402,476 | $ | 354,356 | $ | 354,356 | ||||||
Components of medical care costs related to:
|
||||||||||||
Current period
|
1,167,580 | 957,909 | 3,911,803 | |||||||||
Prior periods
|
(36,592 | ) | (44,377 | ) | (51,809 | ) | ||||||
Total medical care costs
|
1,130,988 | 913,532 | 3,859,994 | |||||||||
Payments for medical care costs related to:
|
||||||||||||
Current period
|
750,994 | 646,428 | 3,516,994 | |||||||||
Prior periods
|
326,637 | 270,078 | 294,880 | |||||||||
Total paid
|
1,077,631 | 916,506 | 3,811,874 | |||||||||
Balances at end of period
|
$ | 455,833 | $ | 351,382 | $ | 402,476 | ||||||
Benefit from prior period as a percentage of:
|
||||||||||||
Balance at beginning of period
|
9.1 | % | 12.5 | % | 14.6 | % | ||||||
Premium revenue
|
2.8 | % | 4.1 | % | 1.1 | % | ||||||
Total medical care costs
|
3.2 | % | 4.9 | % | 1.3 | % | ||||||
Claims Data:
|
||||||||||||
Days in claims payable, fee for service
|
44 | (1) | 41 | 40 | ||||||||
Number of members at end of period
|
1,825,000 | 1,647,000 | 1,697,000 | |||||||||
Number of claims in inventory at end of period
|
260,800 | 185,300 | 111,100 | |||||||||
Billed charges of claims in inventory at end of period
|
$ | 403,800 | $ | 250,600 | $ | 207,600 | ||||||
Claims in inventory per member at end of period
|
0.14 | 0.11 | 0.07 | |||||||||
Billed charges of claims in inventory per member at end of period
|
$ | 221.26 | $ | 152.16 | $ | 122.33 | ||||||
Number of claims received during the period
|
4,855,600 | 4,342,200 | 17,207,500 | |||||||||
Billed charges of claims received during the period
|
$ | 4,337,000 | $ | 3,386,600 | $ | 14,306,500 |
(1)
|
The increase in the days in claims payable is primarily the result of the increased membership in the Texas health plan and the rise in medical claims reserves associated with that increased membership in the first quarter of 2012. Absent the increased Texas health plan membership, the days in claims payable would have been approximately 41 days.
|