-
Net income per diluted share for the quarter of
$0.58 . -
Adjusted net income per diluted share for the quarter of
$0.67 . - Net income per diluted share for the quarter up 35% over first quarter 2016.
- Adjusted net income per diluted share for the quarter up 31% over first quarter 2016.
-
Total revenue for the quarter of
$4.4 billion , up 24% over second quarter 2015. - Aggregate membership up 26% over second quarter 2015.
“The results we have reported today reflect meaningful progress from the
first quarter of 2016,” said
Update on Financial Performance
Second Quarter 2016 Compared With First Quarter 2016
Second quarter 2016 financial performance improved significantly when
compared with the first quarter of 2016. Earnings per diluted share
increased to
Higher profitability in the second quarter was primarily the result of
improvements at the
In total, out-of-period adjustments related to 2015 dates of service were not significant to second quarter performance. Out-of-period adjustments were significant, however, on a geographic and program basis. Out-of-period adjustments were the result of changes in accounting estimates made as new information became available to the Company. The table below will help the reader to understand the discussion that follows.
Summary of Significant Out-of-Period Adjustments Affecting 2016 Financial Results |
||||||||||||||||||||
Three Months Ended | Six Months Ended | |||||||||||||||||||
June 30, 2016 | June 30, 2016 | |||||||||||||||||||
(In millions, except per diluted share amounts) | ||||||||||||||||||||
Amount |
Per Diluted Share |
Amount |
Per Diluted Share |
|||||||||||||||||
Marketplace adjustments for 2015 dates of service | $ | (37 | ) | $ | (0.42 | ) | $ | (68 | ) | $ | (0.76 | ) | ||||||||
Texas quality revenue adjustment for 2014/2015 dates of service |
44 | 0.50 | 44 | 0.49 | ||||||||||||||||
Texas quality revenue adjustment for 1Q 2016 dates of service | 7 | 0.08 | N/A | N/A | ||||||||||||||||
Puerto Rico premium revenue adjustment for 2015 dates of service | (11 | ) | (0.12 | ) | (11 | ) | (0.12 | ) | ||||||||||||
Florida premium revenue adjustment for 2014/2015 dates of service | — | — | 18 | 0.20 | ||||||||||||||||
Total out-of-period adjustments, net | $ | 3 | $ | 0.04 | $ | (17 | ) | $ | (0.19 | ) | ||||||||||
Out-of-period adjustments increased pretax income by approximately
-
Adjustments related to 2015 dates of service reduced Marketplace
pretax income by approximately
$37 million (or approximately$0.42 per diluted share) in the second quarter. OnJune 30, 2016 , theCenters for Medicare and Medicaid Services released the final update on risk adjustment and reinsurance payments for the 2015 benefit year, and we adjusted our accruals accordingly. -
During the second quarter, we were informed by the
Texas Department of Health and Human Services that it will not recoup any quality revenue for calendar years 2014, 2015, and 2016. Therefore, we recognized previously deferred quality revenue amounting to approximately$51 million (or approximately$0.58 per diluted share) in the second quarter of 2016. Of the$51 million adjustment,$44 million related to 2015 and 2014 dates of service, and$7 million related to the first quarter of 2016. -
Reductions to revenue previously recorded for 2015 dates of service in
Puerto Rico decreased pretax income by approximately$11 million (or approximately$0.12 per diluted share) in the second quarter.
Understanding the First Half of 2016
We reported pretax income of
-
Adjustments related to 2015 dates of service reduced Marketplace
pretax income by approximately
$68 million (or approximately$0.76 per diluted share) in the first half of 2016. We now estimate that the medical care ratio for our Marketplace program for all of 2015 was approximately 80%. ThroughJune 30, 2016 , the medical care ratio of our Marketplace program for months of service in the first half of 2016 alone (exclusive of out-of-period adjustments) was approximately 78%. -
As described above, the recognition of
Texas quality revenue associated with calendar years 2014 and 2015 increased pretax income in the first half of 2016 by approximately$44 million (or approximately$0.49 per diluted share). -
Also as noted above, reductions to 2015 premium revenue in
Puerto Rico reduced pretax income by approximately$11 million (or approximately$0.12 per diluted share) in the first half of 2016. -
Retroactive adjustments to premium revenue in
Florida for dates of service in 2014 and 2015 increased pretax income by approximately$18 million (or approximately$0.20 per diluted share) in the first half of 2016. Prior to reporting first quarter 2016 results, we were informed by theFlorida Agency for Health Care Administration that we were due a retroactive increase toMedicaid premium revenue relating to dates of service prior to 2016. We reported this development in our first quarter 2016 results.
Net Income per Share Guidance
Our net income per share guidance for fiscal year 2016 remains unchanged. We expect the following factors, among others, to affect our financial performance in the second half of 2016:
- The ultimate savings to be realized from various cost savings initiatives and the speed at which such savings will be realized.
-
Medicaid rate increases (excluding Medicaid Expansion) of approximately 3.0% inCalifornia (effectiveJuly 1, 2016 ); approximately 2.5% inPuerto Rico (effectiveJuly 1, 2016 ); and approximately 3.0% inTexas (effectiveSeptember 1, 2016 ). All rate changes are consistent with our previous expectations. -
Medicaid Expansion rate decreases of approximately 11.0% in
California (effectiveJuly 1, 2016 ) and approximately 2.0% inOhio (effectiveJuly 1, 2016 ). All rate changes are consistent with our previous expectations. -
The implementation of a medical care ratio floor of 86.0% for the
South Carolina Medicaid program effective
July 1, 2016 . - Declining margins for our Marketplace business during the second half of 2016 due to normal membership attrition; the addition of higher cost members through the special enrollment process; higher costs as members reach the limits of the cost-sharing provisions of their insurance coverage; and increasing utilization as members become more engaged with our care networks. This is consistent with our previous expectations.
Conference Call
Management will host a conference call and webcast to discuss
About
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995: This earnings release contains “forward-looking statements” regarding our plans, expectations, and anticipated future events. Actual results could differ materially due to numerous known and unknown risks and uncertainties. Those known risks and uncertainties include, but are not limited to, the following:
- the success of our profit improvement and cost-cutting initiatives;
-
uncertainties and evolving market and provider economics associated
with the implementation of the Affordable Care Act (the “ACA”), the
Medicaid expansion, the insurance marketplaces, the effect of various implementing regulations, and uncertainties regarding the Medicare-Medicaid dual eligible demonstration programs inCalifornia ,Illinois ,Michigan ,Ohio ,South Carolina , andTexas ; - management of our medical costs, including our ability to reduce over time the high medical costs commonly associated with new patient populations;
- our ability to predict with a reasonable degree of accuracy utilization rates, including utilization rates in new plans, geographies, and programs where we have less experience with patient and provider populations, and also including utilization rates associated with seasonal flu patterns or other newly emergent diseases;
- our ability to manage growth, including maintaining and creating adequate internal systems and controls relating to authorizations, approvals, provider payments, and the overall success of our care management initiatives designed to control costs;
- 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;
- the interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures, and our ability to recognize revenue amounts associated therewith;
- the interpretation and implementation of state contract performance requirements regarding the achievement of certain quality measures, and our ability to avoid liquidated damages associated therewith;
- cyber-attacks or other privacy or data security incidents resulting in an inadvertent unauthorized disclosure of protected health information;
-
the success of our health plan in
Puerto Rico , including the resolution of thePuerto Rico debt crisis, payment of all amounts due under ourMedicaid contract, the effect of the newly enacted PROMESA law, and our efforts to better manage the health care costs of ourPuerto Rico health plan; -
significant budget pressures on state governments and their
potential inability to maintain current rates, to implement expected
rate increases, or to maintain existing benefit packages or membership
eligibility thresholds or criteria, including the resolution of the
Illinois budget impasse and continued payment of all amounts due to ourIllinois health plan; - the accurate estimation of incurred but not reported or paid medical costs across our health plans;
- subsequent adjustments to reported premium revenue based upon subsequent developments or new information, including changes to estimated amounts due to or receivable from CMS under the ACA's “three R’s” marketplace premium stabilization programs;
-
efforts by states to recoup previously paid amounts, including our
dispute with the state of
New Mexico related to reimbursement for retroactively enrolled members in 2014; - the success of our efforts to retain existing government contracts and to obtain new government contracts in connection with state requests for proposals (RFPs) in both existing and new states;
- the continuation and renewal of the government contracts of our health plans, Molina Medicaid Solutions, and Pathways, and the terms under which such contracts are renewed;
-
complications, member confusion, or enrollment backlogs related to
the annual renewal of
Medicaid coverage; - government audits and reviews, and any fine, enrollment freeze, or monitoring program that may result therefrom;
- changes with respect to our provider contracts and the loss of providers;
- approval by state regulators of dividends and distributions by our health plan subsidiaries;
- changes in funding under our contracts as a result of regulatory changes, programmatic adjustments, or other reforms;
- high dollar claims related to catastrophic illness;
- the favorable resolution of litigation, arbitration, or administrative proceedings;
- the relatively small number of states in which we operate health plans;
-
the effect on our
Los Angeles County subcontract ofCentene Corporation’s acquisition ofHealth Net Inc. ; - the availability of adequate financing on acceptable terms to fund and capitalize our expansion and growth, repay our outstanding indebtedness at maturity and meet our liquidity needs, including the interest expense and other costs associated with such financing;
-
the failure of a state in which we operate to renew its federal
Medicaid waiver; -
changes generally affecting the managed care or
Medicaid management information systems industries; - increases in government surcharges, taxes, and assessments, including but not limited to the deductibility of certain compensation costs;
- newly emergent viruses or widespread epidemics, including the Zika virus, public catastrophes or terrorist attacks, and associated public alarm;
- changes in general economic conditions, including unemployment rates;
- the sufficiency of our funds on hand to pay the amounts due upon conversion of our outstanding notes;
-
increasing competition and consolidation in the
Medicaid industry;
and numerous other risk factors, including those discussed in our
periodic reports and filings with the
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED STATEMENTS OF INCOME |
||||||||||||||||||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||||||
2016 | 2015 | 2016 | 2015 | |||||||||||||||||
(Dollar amounts in millions, except net income per share) | ||||||||||||||||||||
Revenue: | ||||||||||||||||||||
Premium revenue | $ | 4,029 | $ | 3,304 | $ | 8,024 | $ | 6,275 | ||||||||||||
Service revenue | 135 | 47 | 275 | 99 | ||||||||||||||||
Premium tax revenue | 109 | 95 | 218 | 190 | ||||||||||||||||
Health insurer fee revenue | 76 | 74 | 166 | 122 | ||||||||||||||||
Investment income | 8 | 4 | 16 | 7 | ||||||||||||||||
Other revenue | 2 | 1 | 3 | 3 | ||||||||||||||||
Total revenue | 4,359 | 3,525 | 8,702 | 6,696 | ||||||||||||||||
Operating expenses: | ||||||||||||||||||||
Medical care costs | 3,594 | 2,929 | 7,182 | 5,565 | ||||||||||||||||
Cost of service revenue | 116 | 33 | 243 | 69 | ||||||||||||||||
General and administrative expenses | 351 | 287 | 691 | 543 | ||||||||||||||||
Premium tax expenses | 109 | 95 | 218 | 190 | ||||||||||||||||
Health insurer fee expenses | 50 | 40 | 108 | 81 | ||||||||||||||||
Depreciation and amortization | 34 | 25 | 66 | 50 | ||||||||||||||||
Total operating expenses | 4,254 | 3,409 | 8,508 | 6,498 | ||||||||||||||||
Operating income | 105 | 116 | 194 | 198 | ||||||||||||||||
Interest expense | 25 | 15 | 50 | 30 | ||||||||||||||||
Income before income tax expense | 80 | 101 | 144 | 168 | ||||||||||||||||
Income tax expense | 47 | 62 | 87 | 101 | ||||||||||||||||
Net income | $ | 33 | $ | 39 | $ | 57 | $ | 67 | ||||||||||||
Diluted net income per share | $ | 0.58 | $ | 0.72 | $ | 1.01 | $ | 1.29 | ||||||||||||
Diluted weighted average shares outstanding | 55.5 | 53.9 | 56.3 | 52.0 | ||||||||||||||||
Operating Statistics: | ||||||||||||||||||||
Medical care ratio (1) | 89.2 | % | 88.7 | % | 89.5 | % | 88.7 | % | ||||||||||||
General and administrative expense ratio (2) | 8.1 | % | 8.1 | % | 7.9 | % | 8.1 | % | ||||||||||||
Premium tax ratio (1) | 2.6 | % | 2.8 | % | 2.6 | % | 2.9 | % | ||||||||||||
Effective tax rate | 59.8 | % | 61.3 | % | 60.7 | % | 60.1 | % | ||||||||||||
Net profit margin (2) | 0.7 | % | 1.1 | % | 0.7 | % | 1.0 | % | ||||||||||||
(1) Medical care ratio represents medical care costs as a percentage of premium revenue; premium tax ratio represents premium tax expenses as a percentage of premium revenue plus premium tax revenue. | ||||||||||||||||||||
(2) Computed as a percentage of total revenue. | ||||||||||||||||||||
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED BALANCE SHEETS |
||||||||||
June 30, | December 31, | |||||||||
2016 | 2015 | |||||||||
(Unaudited) | ||||||||||
(Amounts in millions, except per-share data) |
||||||||||
ASSETS | ||||||||||
Current assets: | ||||||||||
Cash and cash equivalents | $ | 2,345 | $ | 2,329 | ||||||
Investments | 1,968 | 1,801 | ||||||||
Receivables | 1,012 | 597 | ||||||||
Income taxes refundable | 23 | 13 | ||||||||
Prepaid expenses and other current assets | 197 | 192 | ||||||||
Derivative asset | — | 374 | ||||||||
Total current assets | 5,545 | 5,306 | ||||||||
Property, equipment, and capitalized software, net | 448 | 393 | ||||||||
Deferred contract costs | 80 | 81 | ||||||||
Intangible assets, net | 146 | 122 | ||||||||
Goodwill | 611 | 519 | ||||||||
Restricted investments | 107 | 109 | ||||||||
Deferred income taxes | — | 18 | ||||||||
Derivative asset | 226 | — | ||||||||
Other assets | 39 | 28 | ||||||||
$ | 7,202 | $ | 6,576 | |||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||||
Current liabilities: | ||||||||||
Medical claims and benefits payable | $ | 1,766 | $ | 1,685 | ||||||
Amounts due government agencies | 1,238 | 729 | ||||||||
Accounts payable and accrued liabilities | 537 | 362 | ||||||||
Deferred revenue | 104 | 223 | ||||||||
Current portion of long-term debt | 1 | 449 | ||||||||
Derivative liability | — | 374 | ||||||||
Total current liabilities | 3,646 | 3,822 | ||||||||
Senior notes | 1,428 | 962 | ||||||||
Lease financing obligations | 198 | 198 | ||||||||
Deferred income taxes | 25 | — | ||||||||
Derivative liability | 226 | — | ||||||||
Other long-term liabilities | 38 | 37 | ||||||||
Total liabilities | 5,561 | 5,019 | ||||||||
Stockholders’ equity: | ||||||||||
Common stock, $0.001 par value; 150 shares authorized; outstanding: 57 shares at June 30, 2016 and 56 shares at December 31, 2015 | — | — | ||||||||
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding | — | — | ||||||||
Additional paid-in capital | 822 | 803 | ||||||||
Accumulated other comprehensive gain (loss) | 4 | (4 | ) | |||||||
Retained earnings | 815 | 758 | ||||||||
Total stockholders’ equity | 1,641 | 1,557 | ||||||||
$ | 7,202 | $ | 6,576 |
MOLINA HEALTHCARE, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS |
||||||||||||||||||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||||||
2016 | 2015 | 2016 | 2015 | |||||||||||||||||
(Amounts in millions) | ||||||||||||||||||||
Operating activities: | ||||||||||||||||||||
Net income | $ | 33 | $ | 39 | $ | 57 | $ | 67 | ||||||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||||||||||||
Depreciation and amortization | 45 | 29 | 89 | 62 | ||||||||||||||||
Deferred income taxes | 9 | 6 | 39 | 7 | ||||||||||||||||
Share-based compensation | 9 | 3 | 16 | 9 | ||||||||||||||||
Amortization of convertible senior notes and lease financing obligations | 7 | 8 | 15 | 15 | ||||||||||||||||
Other, net | 5 | 6 | 11 | 9 | ||||||||||||||||
Changes in operating assets and liabilities: | ||||||||||||||||||||
Receivables | (149 | ) | (140 | ) | (415 | ) | (35 | ) | ||||||||||||
Prepaid expenses and other assets | 59 | 40 | (143 | ) | (97 | ) | ||||||||||||||
Medical claims and benefits payable | (173 | ) | 44 | 82 | 292 | |||||||||||||||
Amounts due government agencies | 328 | 203 | 509 | 298 | ||||||||||||||||
Accounts payable and accrued liabilities | (58 | ) | (31 | ) | 147 | 158 | ||||||||||||||
Deferred revenue | 10 | (112 | ) | (119 | ) | (138 | ) | |||||||||||||
Income taxes | 14 | (1 | ) | (10 | ) | 1 | ||||||||||||||
Net cash provided by operating activities | 139 | 94 | 278 | 648 | ||||||||||||||||
Investing activities: | ||||||||||||||||||||
Purchases of investments | (363 | ) | (555 | ) | (974 | ) | (993 | ) | ||||||||||||
Proceeds from sales and maturities of investments | 464 | 286 | 812 | 541 | ||||||||||||||||
Purchases of property, equipment, and capitalized software | (56 | ) | (41 | ) | (102 | ) | (66 | ) | ||||||||||||
Change in restricted investments |
9 | (9 | ) | 5 | (14 | ) | ||||||||||||||
Net cash paid in business combinations | (6 | ) | — | (8 | ) | (8 | ) | |||||||||||||
Other, net | (7 | ) | (10 | ) | (6 | ) | (17 | ) | ||||||||||||
Net cash provided by (used in) investing activities | 41 | (329 | ) | (273 | ) | (557 | ) | |||||||||||||
Financing activities: | ||||||||||||||||||||
Proceeds from common stock offering, net of issuance costs | — | 373 | — | 373 | ||||||||||||||||
Proceeds from employee stock plans | 10 | 7 | 10 | 8 | ||||||||||||||||
Other, net | (1 | ) | (1 | ) | 1 | 3 | ||||||||||||||
Net cash provided by financing activities | 9 | 379 | 11 | 384 | ||||||||||||||||
Net increase in cash and cash equivalents | 189 | 144 | 16 | 475 | ||||||||||||||||
Cash and cash equivalents at beginning of period | 2,156 | 1,870 | 2,329 | 1,539 | ||||||||||||||||
Cash and cash equivalents at end of period | $ | 2,345 | $ | 2,014 | $ | 2,345 | $ | 2,014 | ||||||||||||
UNAUDITED NON-GAAP FINANCIAL
MEASURES
We use two non-GAAP financial measures as supplemental metrics in evaluating our financial performance, making financing and business decisions, and forecasting and planning for future periods. For these reasons, management believes such measures are useful supplemental measures to investors in comparing our performance to the performance of other public companies in the health care industry. These non-GAAP financial measures should be considered as supplements to, and not as substitutes for or superior to, GAAP measures.
The first of these non-GAAP measures is earnings before interest, taxes, depreciation and amortization (EBITDA). We believe that EBITDA is particularly helpful in assessing our ability to meet the cash demands of our operating units. The following table reconciles net income, which we believe to be the most comparable GAAP measure, to EBITDA.
Three Months Ended June 30, | Six Months Ended June 30, | ||||||||||||||||||
2016 | 2015 | 2016 | 2015 | ||||||||||||||||
(Amounts in millions) | |||||||||||||||||||
Net income | $ | 33 | $ | 39 | $ | 57 | $ | 67 | |||||||||||
Adjustments: | |||||||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 39 | 29 | 76 | 58 | |||||||||||||||
Interest expense | 25 | 15 | 50 | 30 | |||||||||||||||
Income tax expense | 47 | 62 | 87 | 101 | |||||||||||||||
EBITDA | $ | 144 | $ | 145 | $ | 270 | $ | 256 | |||||||||||
The second of these non-GAAP measures is adjusted net income (including adjusted net income per diluted share). We believe that adjusted net income per diluted share is very helpful in assessing our financial performance exclusive of the non-cash impact of the amortization of purchased intangibles. The following table reconciles net income, which we believe to be the most comparable GAAP measure, to adjusted net income.
Three Months Ended June 30, | Six Months Ended June 30, | ||||||||||||||||||||||||||||||||||||||
2016 | 2015 | 2016 | 2015 | ||||||||||||||||||||||||||||||||||||
(In millions, except per diluted share amounts) | |||||||||||||||||||||||||||||||||||||||
Amount | Per share | Amount | Per share | Amount | Per share | Amount | Per share | ||||||||||||||||||||||||||||||||
Net income | $ | 33 | $ | 0.58 | $ | 39 | $ | 0.72 | $ | 57 | $ | 1.01 | $ | 67 | $ | 1.29 | |||||||||||||||||||||||
Adjustment, net of tax: | |||||||||||||||||||||||||||||||||||||||
Amortization of intangible assets | 5 | 0.09 | 3 | 0.05 | 10 | 0.17 | 6 | 0.10 | |||||||||||||||||||||||||||||||
Adjusted net income | $ | 38 | $ | 0.67 | $ | 42 | $ | 0.77 | $ | 67 | $ | 1.18 | $ | 73 | $ | 1.39 | |||||||||||||||||||||||
MOLINA HEALTHCARE, INC. UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP |
|||||||||||||||
June 30, | March 31, | December 31, | June 30, | ||||||||||||
2016 | 2016 | 2015 | 2015 | ||||||||||||
Ending Membership by Health Plan: | |||||||||||||||
California | 680,000 | 676,000 | 620,000 | 593,000 | |||||||||||
Florida | 565,000 | 576,000 | 440,000 | 348,000 | |||||||||||
Illinois | 201,000 | 206,000 | 98,000 | 101,000 | |||||||||||
Michigan | 393,000 | 399,000 | 328,000 | 260,000 | |||||||||||
New Mexico | 251,000 | 246,000 | 231,000 | 225,000 | |||||||||||
Ohio | 341,000 | 336,000 | 327,000 | 332,000 | |||||||||||
Puerto Rico |
336,000 | 339,000 | 348,000 | 361,000 | |||||||||||
South Carolina | 105,000 | 102,000 | 99,000 | 114,000 | |||||||||||
Texas | 367,000 | 380,000 | 260,000 | 266,000 | |||||||||||
Utah | 151,000 | 151,000 | 102,000 | 92,000 | |||||||||||
Washington | 709,000 | 672,000 | 582,000 | 553,000 | |||||||||||
Wisconsin | 134,000 | 137,000 | 98,000 | 107,000 | |||||||||||
4,233,000 | 4,220,000 | 3,533,000 | 3,352,000 | ||||||||||||
Ending Membership by Program: | |||||||||||||||
Temporary Assistance for Needy Families (TANF), CHIP(1) |
2,500,000 | 2,485,000 | 2,312,000 | 2,180,000 | |||||||||||
Medicaid Expansion | 654,000 | 632,000 | 557,000 | 475,000 | |||||||||||
Marketplace | 597,000 | 630,000 | 205,000 | 261,000 | |||||||||||
Aged, Blind or Disabled (ABD) | 387,000 | 380,000 | 366,000 | 353,000 | |||||||||||
Medicare-Medicaid Plan (MMP) - Integrated | 51,000 | 50,000 | 51,000 | 39,000 | |||||||||||
Medicare Special Needs Plans | 44,000 | 43,000 | 42,000 | 44,000 | |||||||||||
4,233,000 | 4,220,000 | 3,533,000 | 3,352,000 | ||||||||||||
(1) CHIP stands for Children’s Health Insurance Program. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Three Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 2.0 | $ | 554 | $ | 268.95 | $ | 493 | $ | 239.63 | 89.1 | % | $ | 61 | ||||||||||||||||||||
Florida | 1.8 | 464 | 273.90 | 426 | 251.69 | 91.9 | 38 | ||||||||||||||||||||||||||
Illinois | 0.6 | 154 | 256.17 | 137 | 227.71 | 88.9 | 17 | ||||||||||||||||||||||||||
Michigan | 1.2 | 369 | 312.18 | 334 | 282.86 | 90.6 | 35 | ||||||||||||||||||||||||||
New Mexico | 0.8 | 342 | 451.72 | 305 | 403.52 | 89.3 | 37 | ||||||||||||||||||||||||||
Ohio | 1.0 | 483 | 473.91 | 433 | 424.87 | 89.7 | 50 | ||||||||||||||||||||||||||
Puerto Rico | 1.0 | 170 | 169.04 | 175 | 173.49 | 102.6 | (5 | ) | |||||||||||||||||||||||||
South Carolina | 0.3 | 87 | 277.22 | 71 | 226.27 | 81.6 | 16 | ||||||||||||||||||||||||||
Texas | 1.1 | 635 | 571.14 | 499 | 448.23 | 78.5 | 136 | ||||||||||||||||||||||||||
Utah | 0.5 | 110 | 240.26 | 106 | 233.12 | 97.0 | 4 | ||||||||||||||||||||||||||
Washington | 2.1 | 559 | 264.40 | 500 | 236.32 | 89.4 | 59 | ||||||||||||||||||||||||||
Wisconsin | 0.4 | 99 | 244.88 | 96 | 235.88 | 96.3 | 3 | ||||||||||||||||||||||||||
Other(3) | — | 3 | — | 19 | — | — | (16 | ) | |||||||||||||||||||||||||
12.8 | $ | 4,029 | $ | 316.72 | $ | 3,594 | $ | 282.54 | 89.2 | % | $ | 435 | |||||||||||||||||||||
Three Months Ended June 30, 2015 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 1.7 | $ | 503 | $ | 285.14 | $ | 459 | $ | 259.85 | 91.1 | % | $ | 44 | ||||||||||||||||||||
Florida | 1.1 | 257 | 244.35 | 217 | 205.97 | 84.3 | 40 | ||||||||||||||||||||||||||
Illinois | 0.3 | 102 | 337.55 | 98 | 325.91 | 96.6 | 4 | ||||||||||||||||||||||||||
Michigan | 0.8 | 237 | 307.27 | 200 | 258.67 | 84.2 | 37 | ||||||||||||||||||||||||||
New Mexico | 0.7 | 322 | 466.46 | 276 | 400.27 | 85.8 | 46 | ||||||||||||||||||||||||||
Ohio | 1.1 | 509 | 510.30 | 432 | 433.75 | 85.0 | 77 | ||||||||||||||||||||||||||
Puerto Rico | 1.1 | 194 | 179.33 | 184 | 170.32 | 95.0 | 10 | ||||||||||||||||||||||||||
South Carolina | 0.4 | 93 | 276.36 | 67 | 196.92 | 71.3 | 26 | ||||||||||||||||||||||||||
Texas | 0.8 | 512 | 635.74 | 468 | 581.42 | 91.5 | 44 | ||||||||||||||||||||||||||
Utah | 0.2 | 80 | 288.60 | 72 | 258.88 | 89.7 | 8 | ||||||||||||||||||||||||||
Washington | 1.6 | 410 | 249.39 | 371 | 225.46 | 90.4 | 39 | ||||||||||||||||||||||||||
Wisconsin | 0.3 | 75 | 233.15 | 56 | 175.62 | 75.3 | 19 | ||||||||||||||||||||||||||
Other(3) | — | 10 | — | 29 | — | — | (19 | ) | |||||||||||||||||||||||||
10.1 | $ | 3,304 | $ | 328.96 | $ | 2,929 | $ | 291.65 | 88.7 | % | $ | 375 | |||||||||||||||||||||
(1) A member month is defined as the aggregate of each month’s ending membership for the period presented. | |||||||||||||||||||||||||||||||||
(2) The MCR represents medical costs as a percentage of premium revenue. | |||||||||||||||||||||||||||||||||
(3) “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Six Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 4.0 | $ | 1,095 | $ | 271.14 | $ | 962 | $ | 238.30 | 87.9 | % | $ | 133 | ||||||||||||||||||||
Florida | 3.4 | 953 | 284.53 | 839 | 250.58 | 88.1 | 114 | ||||||||||||||||||||||||||
Illinois | 1.2 | 303 | 261.43 | 269 | 232.06 | 88.8 | 34 | ||||||||||||||||||||||||||
Michigan | 2.4 | 756 | 316.18 | 681 | 285.13 | 90.2 | 75 | ||||||||||||||||||||||||||
New Mexico | 1.5 | 678 | 450.62 | 601 | 399.17 | 88.6 | 77 | ||||||||||||||||||||||||||
Ohio | 2.0 | 971 | 481.44 | 882 | 437.35 | 90.8 | 89 | ||||||||||||||||||||||||||
Puerto Rico | 2.0 | 351 | 172.98 | 349 | 171.95 | 99.4 | 2 | ||||||||||||||||||||||||||
South Carolina | 0.6 | 171 | 276.61 | 138 | 223.58 | 80.8 | 33 | ||||||||||||||||||||||||||
Texas | 2.2 | 1,255 | 575.87 | 1,074 | 492.65 | 85.5 | 181 | ||||||||||||||||||||||||||
Utah | 0.9 | 224 | 252.08 | 208 | 234.46 | 93.0 | 16 | ||||||||||||||||||||||||||
Washington | 4.1 | 1,065 | 260.05 | 958 | 233.84 | 89.9 | 107 | ||||||||||||||||||||||||||
Wisconsin | 0.8 | 196 | 247.57 | 188 | 236.92 | 95.7 | 8 | ||||||||||||||||||||||||||
Other(3) | — | 6 | — | 33 | — | — | (27 | ) | |||||||||||||||||||||||||
25.1 | $ | 8,024 | $ | 320.17 | $ | 7,182 | $ | 286.57 | 89.5 | % | $ | 842 | |||||||||||||||||||||
Six Months Ended June 30, 2015 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) | Medical Margin | |||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
California | 3.4 | $ | 1,014 | $ | 294.85 | $ | 911 | $ | 264.97 | 89.9 | % | $ | 103 | ||||||||||||||||||||
Florida | 2.0 | 568 | 291.33 | 498 | 255.45 | 87.7 | 70 | ||||||||||||||||||||||||||
Illinois | 0.6 | 206 | 339.72 | 188 | 309.66 | 91.2 | 18 | ||||||||||||||||||||||||||
Michigan | 1.5 | 457 | 298.87 | 385 | 251.57 | 84.2 | 72 | ||||||||||||||||||||||||||
New Mexico | 1.4 | 636 | 462.62 | 568 | 413.48 | 89.4 | 68 | ||||||||||||||||||||||||||
Ohio | 2.1 | 1,024 | 498.96 | 845 | 412.05 | 82.6 | 179 | ||||||||||||||||||||||||||
Puerto Rico | 1.1 | 194 | 179.33 | 184 | 170.32 | 95.0 | 10 | ||||||||||||||||||||||||||
South Carolina | 0.7 | 184 | 271.35 | 141 | 206.88 | 76.2 | 43 | ||||||||||||||||||||||||||
Texas | 1.6 | 894 | 565.45 | 820 | 518.60 | 91.7 | 74 | ||||||||||||||||||||||||||
Utah | 0.5 | 157 | 289.42 | 146 | 268.72 | 92.8 | 11 | ||||||||||||||||||||||||||
Washington | 3.2 | 786 | 245.22 | 723 | 225.47 | 91.9 | 63 | ||||||||||||||||||||||||||
Wisconsin | 0.6 | 135 | 216.85 | 105 | 168.58 | 77.7 | 30 | ||||||||||||||||||||||||||
Other(3) | — | 20 | — | 51 | — | — | (31 | ) | |||||||||||||||||||||||||
18.7 | $ | 6,275 | $ | 336.21 | $ | 5,565 | $ | 298.18 | 88.7 | % | $ | 710 | |||||||||||||||||||||
(1) A member month is defined as the aggregate of each month’s ending membership for the period presented. | |||||||||||||||||||||||||||||||||
(2) The MCR represents medical costs as a percentage of premium revenue. | |||||||||||||||||||||||||||||||||
(3) “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||||||
Three Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) |
Medical Margin |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
TANF and CHIP | 7.5 | $ | 1,302 | $ | 173.57 | $ | 1,202 | $ | 160.26 | 92.3 | % | $ | 100 | ||||||||||||||||||||
Medicaid Expansion | 1.9 | 742 | 378.19 | 634 | 323.56 | 85.6 | 108 | ||||||||||||||||||||||||||
Marketplace | 1.8 | 373 | 206.88 | 323 | 178.79 | 86.4 | 50 | ||||||||||||||||||||||||||
ABD | 1.2 | 1,168 | 991.38 | 1,038 | 881.80 | 88.9 | 130 | ||||||||||||||||||||||||||
MMP | 0.2 | 315 | 2,093.29 | 270 | 1,792.78 | 85.6 | 45 | ||||||||||||||||||||||||||
Medicare | 0.2 | 129 | 997.44 | 127 | 974.30 | 97.7 | 2 | ||||||||||||||||||||||||||
12.8 | $ | 4,029 | $ | 316.72 | $ | 3,594 | $ | 282.54 | 89.2 | % | $ | 435 | |||||||||||||||||||||
Three Months Ended June 30, 2015 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) |
Medical Margin |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
TANF and CHIP | 6.5 | $ | 1,169 | $ | 178.38 | $ | 1,063 | $ | 162.24 | 91.0 | % | $ | 106 | ||||||||||||||||||||
Medicaid Expansion | 1.4 | 582 | 419.67 | 474 | 341.67 | 81.4 | 108 | ||||||||||||||||||||||||||
Marketplace | 0.8 | 161 | 204.22 | 90 | 113.21 | 55.4 | 71 | ||||||||||||||||||||||||||
ABD | 1.1 | 1,053 | 984.99 | 947 | 885.84 | 89.9 | 106 | ||||||||||||||||||||||||||
MMP | 0.1 | 198 | 1,784.30 | 214 | 1,934.40 | 108.4 | (16 | ) | |||||||||||||||||||||||||
Medicare | 0.2 | 141 | 1,059.90 | 141 | 1,062.71 | 100.3 | — | ||||||||||||||||||||||||||
10.1 | $ | 3,304 | $ | 328.96 | $ | 2,929 | $ | 291.65 | 88.7 | % | $ | 375 | |||||||||||||||||||||
Six Months Ended June 30, 2016 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) |
Medical Margin |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
TANF and CHIP | 14.9 | $ | 2,626 | $ | 176.00 | $ | 2,400 | $ | 160.85 | 91.4 | % | $ | 226 | ||||||||||||||||||||
Medicaid Expansion | 3.8 | 1,421 | 371.82 | 1,208 | 316.13 | 85.0 | 213 | ||||||||||||||||||||||||||
Marketplace | 3.4 | 782 | 228.19 | 657 | 191.62 | 84.0 | 125 | ||||||||||||||||||||||||||
ABD | 2.4 | 2,280 | 976.58 | 2,079 | 890.71 | 91.2 | 201 | ||||||||||||||||||||||||||
MMP | 0.3 | 655 | 2,157.55 | 587 | 1,932.73 | 89.6 | 68 | ||||||||||||||||||||||||||
Medicare | 0.3 | 260 | 1,013.04 | 251 | 977.35 | 96.5 | 9 | ||||||||||||||||||||||||||
25.1 | $ | 8,024 | $ | 320.17 | $ | 7,182 | $ | 286.57 | 89.5 | % | $ | 842 | |||||||||||||||||||||
Six Months Ended June 30, 2015 | |||||||||||||||||||||||||||||||||
Member
Months(1) |
Premium Revenue | Medical Care Costs | MCR(2) |
Medical Margin |
|||||||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||||||
TANF and CHIP | 12.0 | $ | 2,141 | $ | 177.93 | $ | 1,960 | $ | 162.89 | 91.6 | % | $ | 181 | ||||||||||||||||||||
Medicaid Expansion | 2.7 | 1,089 | 409.29 | 867 | 325.84 | 79.6 | 222 | ||||||||||||||||||||||||||
Marketplace | 1.4 | 355 | 258.66 | 246 | 179.15 | 69.3 | 109 | ||||||||||||||||||||||||||
ABD | 2.1 | 1,993 | 940.23 | 1,810 | 853.56 | 90.8 | 183 | ||||||||||||||||||||||||||
MMP | 0.2 | 423 | 1,986.04 | 413 | 1,942.20 | 97.8 | 10 | ||||||||||||||||||||||||||
Medicare | 0.3 | 274 | 1,036.95 | 269 | 1,020.01 | 98.4 | 5 | ||||||||||||||||||||||||||
18.7 | $ | 6,275 | $ | 336.21 | $ | 5,565 | $ | 298.18 | 88.7 | % | $ | 710 | |||||||||||||||||||||
(1) A member month is defined as the aggregate of each month’s ending membership for the period presented. | |||||||||||||||||||||||||||||||||
(2) The MCR represents medical costs as a percentage of premium revenue. |
MOLINA HEALTHCARE, INC. | ||||||||||||||||||||||||||||
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA | ||||||||||||||||||||||||||||
(In millions, except percentages and per-member per-month amounts) | ||||||||||||||||||||||||||||
The following tables provide the details of our medical care costs for the periods indicated: |
||||||||||||||||||||||||||||
Three Months Ended June 30, | ||||||||||||||||||||||||||||
2016 | 2015 | |||||||||||||||||||||||||||
Amount | PMPM |
% of
Total |
Amount | PMPM |
% of
Total |
|||||||||||||||||||||||
Fee for service | $ | 2,620 | $ | 206.01 | 72.9 | % | $ | 2,103 | $ | 209.34 | 71.8 | % | ||||||||||||||||
Pharmacy | 529 | 41.59 | 14.7 | 392 | 39.01 | 13.3 | ||||||||||||||||||||||
Capitation | 304 | 23.87 | 8.5 | 248 | 24.72 | 8.5 | ||||||||||||||||||||||
Direct delivery | 18 | 1.39 | 0.5 | 27 | 2.78 | 1.0 | ||||||||||||||||||||||
Other | 123 | 9.68 | 3.4 | 159 | 15.80 | 5.4 | ||||||||||||||||||||||
$ | 3,594 | $ | 282.54 | 100.0 | % | $ | 2,929 | $ | 291.65 | 100.0 | % | |||||||||||||||||
Six Months Ended June 30, | ||||||||||||||||||||||||||||
2016 | 2015 | |||||||||||||||||||||||||||
Amount | PMPM |
% of
Total |
Amount | PMPM |
% of
Total |
|||||||||||||||||||||||
Fee for service | $ | 5,357 | $ | 213.77 | 74.6 | % | $ | 4,051 | $ | 217.05 | 72.8 | % | ||||||||||||||||
Pharmacy | 1,054 | 42.05 | 14.7 | 743 | 39.81 | 13.4 | ||||||||||||||||||||||
Capitation | 599 | 23.87 | 8.3 | 465 | 24.90 | 8.3 | ||||||||||||||||||||||
Direct delivery | 34 | 1.36 | 0.5 | 54 | 2.93 | 1.0 | ||||||||||||||||||||||
Other | 138 | 5.52 | 1.9 | 252 | 13.49 | 4.5 | ||||||||||||||||||||||
$ | 7,182 | $ | 286.57 | 100.0 | % | $ | 5,565 | $ | 298.18 | 100.0 | % | |||||||||||||||||
The following table provides the details of our medical claims and benefits payable as of the dates indicated:
June 30, | December 31, | ||||||||
2016 | 2015 | ||||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,292 | $ | 1,191 | |||||
Pharmacy payable | 103 | 88 | |||||||
Capitation payable | 37 | 140 | |||||||
Other (1) | 334 | 266 | |||||||
$ | 1,766 | $ | 1,685 | ||||||
(1) “Other” medical claims and benefits payable include amounts payable to certain providers for which we act as an intermediary on behalf of various state agencies without assuming financial risk. Such receipts and payments do not impact our consolidated statements of income. As of June 30, 2016 and December 31, 2015, we had recorded non-risk provider payables of approximately $191 million and $167 million, respectively. |
UNAUDITED CHANGE IN MEDICAL
CLAIMS AND BENEFITS PAYABLE
(Dollars in millions, except
per-member amounts)
Our claims liability includes a provision for adverse claims deviation based on historical experience and other factors including, but not limited to, variations in claims payment patterns, changes in utilization and cost trends, known outbreaks of disease, and large claims. Our reserving methodology is consistently applied across all periods presented. The amounts displayed for “Components of medical care costs related to: Prior period” represent the amount by which our original estimate of claims and benefits payable at the beginning of the period were more than the actual amount of the liability based on information (principally the payment of claims) developed since that liability was first reported. The following table presents the components of the change in medical claims and benefits payable for the periods indicated:
Year Ended | |||||||||||||||
Six Months Ended June 30, | December 31, | ||||||||||||||
2016 | 2015 | 2015 | |||||||||||||
Medical claims and benefits payable, beginning balance | $ | 1,685 | $ | 1,201 | $ | 1,201 | |||||||||
Components of medical care costs related to: | |||||||||||||||
Current period | 7,371 | 5,703 | 11,935 | ||||||||||||
Prior period | (189 | ) | (138 | ) | (141 | ) | |||||||||
Total medical care costs | 7,182 | 5,565 | 11,794 | ||||||||||||
Change in non-risk provider payables | 24 | 14 | 48 | ||||||||||||
Payments for medical care costs related to: | |||||||||||||||
Current period | 5,885 | 4,449 | 10,448 | ||||||||||||
Prior period | 1,240 | 839 | 910 | ||||||||||||
Total paid | 7,125 | 5,288 | 11,358 | ||||||||||||
Medical claims and benefits payable, ending balance | $ | 1,766 | $ | 1,492 | $ | 1,685 | |||||||||
Benefit from prior period as a percentage of: | |||||||||||||||
Balance at beginning of period | 11.3 | % | 11.5 | % | 11.8 | % | |||||||||
Premium revenue, trailing twelve months | 1.3 | % | 1.2 | % | 1.1 | % | |||||||||
Medical care costs, trailing twelve months | 1.4 | % | 1.4 | % | 1.2 | % | |||||||||
Fee-For-Service Claims Data: | |||||||||||||||
Days in claims payable, fee for service | 48 | 49 | 48 | ||||||||||||
Number of members at end of period | 4,233,000 | 3,352,000 | 3,533,000 | ||||||||||||
Number of claims in inventory at end of period | 530,900 | 463,200 | 380,800 | ||||||||||||
Billed charges of claims in inventory at end of period | $ | 1,279 | $ | 905 | $ | 816 | |||||||||
Claims in inventory per member at end of period | 0.13 | 0.14 | 0.11 | ||||||||||||
Billed charges of claims in inventory per member at end of period | $ | 302.06 | $ | 269.93 | $ | 230.91 | |||||||||
Number of claims received during the period | 26,279,000 | 18,679,000 | 40,173,300 | ||||||||||||
Billed charges of claims received during the period | $ | 31,649 | $ | 21,505 | $ | 46,211 |
View source version on businesswire.com: http://www.businesswire.com/news/home/20160727006389/en/
Source:
Molina Healthcare, Inc.
Investor Relations:
Juan José
Orellana, 562-435-3666, ext. 111143