Molina Healthcare, Inc. (NYSE: MOH):
Molina Healthcare, Inc. (NYSE: MOH) today reported its financial results for the fourth quarter and year ended December 31, 2017, and provided its preliminary guidance for fiscal year 2018.
“Our fourth quarter results are emblematic of the significant transition Molina is undertaking,” said Joe Zubretsky, president and CEO. “The disappointment of contract losses and related goodwill charges, continued restructuring costs, and catch up adjustments to unacceptable Marketplace results are legacies of the past. Looking forward, the core business results showed improvement quarter over quarter, and we took steps to strengthen the quality of the balance sheet, all of which serve as a solid platform to achieve our margin recovery and sustainability plan we outlined for investors last month. Medical cost control, administrative cost discipline, and capital strength remain at the fore of our plan.”
Fourth Quarter 2017 and Full Year Highlights
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||||||
(Dollar amounts in millions, except per-share amounts) | |||||||||||||||||||
Premium revenue | $ | 4,689 | $ | 4,190 | $ | 18,854 | $ | 16,445 | |||||||||||
Operating (loss) income | $ | (269 | ) | $ | (6 | ) | $ | (555 | ) | $ | 306 | ||||||||
Net (loss) income | $ | (262 | ) | $ | (47 | ) | $ | (512 | ) | $ | 52 | ||||||||
Net (loss) income per diluted share | $ | (4.59 | ) | $ | (0.85 | ) | $ | (9.07 | ) | $ | 0.92 | ||||||||
Diluted weighted average shares outstanding | 57.1 | 55.6 | 56.5 | 56.3 | |||||||||||||||
Operating Statistics: | |||||||||||||||||||
Medical care ratio (1) | 90.7 | % | 91.7 | % | 90.6 | % | 89.8 | % | |||||||||||
G&A ratio (2) | 7.4 | % | 7.9 | % | 8.0 | % | 7.8 | % | |||||||||||
Premium tax ratio (1) | 2.2 | % | 2.9 | % | 2.3 | % | 2.8 | % | |||||||||||
Effective income tax (benefit) expense rate | (17.2 | )% | 54.5 | % | (16.4 | )% | 74.8 | % | |||||||||||
Net (loss) profit margin (2) | (5.3 | )% | (1.0 | )% | (2.6 | )% | 0.3 | % |
__________________ | ||
(1) | Medical care ratio represents medical care costs as a percentage of premium revenue; premium tax ratio represents premium tax expenses as a percentage of premium revenue plus premium tax revenue. | |
(2) | G&A ratio represents general and administrative expenses as a percentage of total revenue. Net (loss) profit margin represents net (loss) income as a percentage of total revenue. | |
Summary of Significant Items Affecting 2017 Financial Results
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||||||
(In millions, except per diluted share amounts) | |||||||||||||||||||
Amount |
Per Diluted |
Amount |
Per Diluted |
||||||||||||||||
Termination of CSR subsidy payments for the fourth quarter of 2017 | $ | 73 | $ | 0.81 | $ | 73 | $ | 0.82 | |||||||||||
Marketplace adjustments for CSR subsidies, risk adjustment and medical loss ratio (MLR) floor liabilities for January through September 2017 dates of service | 50 | 0.55 | N/A | N/A | |||||||||||||||
Marketplace adjustments related to risk adjustment, CSR subsidies, and other items for 2016 dates of service | — | — | 47 | 0.52 | |||||||||||||||
Change in Marketplace premium deficiency reserve for 2017 dates of service | (70 | ) | (0.77 | ) | (30 | ) | (0.33 | ) | |||||||||||
Impairment losses | 269 | 3.22 | 470 | 6.01 | |||||||||||||||
Restructuring and separation costs | 73 | 0.81 | 234 | 2.86 | |||||||||||||||
Loss on debt extinguishment | 14 | 0.24 | 14 | 0.24 | |||||||||||||||
Fee received for terminated Medicare acquisition | — | — | (75 | ) | (0.84 | ) | |||||||||||||
$ | 409 | $ | 4.86 | $ | 733 | $ | 9.28 |
__________________ | ||
(1) | Amounts shown are before considering revaluation of related deferred tax assets as a result of the Tax Cuts and Jobs Act of 2017, as applicable, and which is described further below. Except for certain items that are not deductible for tax purposes, per diluted share amounts are generally calculated at a statutory income tax rate of 37%, which is in excess of the effective tax rate recorded in our consolidated statements of operations. | |
Fourth Quarter 2017 Compared With Third Quarter 2017
Developments in our business during 2017 limit the value of comparisons to 2016 performance. The Company believes that the comparison of 2017 fourth quarter performance with 2017 third quarter performance provides the most meaningful context for fourth quarter results.
Loss before income tax benefit for the fourth quarter of 2017 was $316 million, compared with a loss before income tax benefit of $113 million for the third quarter of 2017. Net loss per diluted share was $4.59 for the fourth quarter of 2017 compared with net loss per diluted share of $1.70 reported for the third quarter of 2017.
Despite the loss reported for the quarter, the performance of core operations and overall administrative cost efficiency improved in the fourth quarter when compared with the third quarter of 2017.
Marketplace performance deteriorated due to normal seasonality and other matters discussed below. The Company has increased premium rates and reduced its Marketplace presence effective January 1, 2018 as part of its overall program to improve profitability.
Among the key developments affecting fourth quarter 2017 results were:
Income Tax (Benefit) Expense
The revaluation of deferred tax assets in connection with the Tax Cuts and Jobs Act of 2017 resulted in $54 million additional income tax expense in the fourth quarter and year ended December 31, 2017 ($0.94 per diluted share and $0.95 per diluted share, respectively). In addition, the effective tax benefit for 2017 is less than the statutory tax benefit due to the relatively large amount of reported expenses that are not deductible for tax purposes, primarily relating to goodwill impairment losses and separation costs.
2018 Preliminary Guidance
The Company has offered guidance on a preliminary basis because of the inherent uncertainty around achievement and the timing of its numerous profit improvement initiatives. While those initiatives extend across the various dimensions of managed care fundamentals, many are in the early stages of development and implementation.
Therefore, the Company’s guidance should be viewed as a preliminary estimate of what it expects to achieve until the profit improvement initiatives manifest themselves in the earnings stream. Once it has the benefit of first quarter earnings and further insight into the execution of the profit improvement initiatives, the Company will be able to provide a firmer view of 2018 guidance.
To provide for an appropriate amount of execution risk, the Company’s preliminary guidance has been developed with appropriately conservative views of:
The following table summarizes 2018 Preliminary Guidance (1):
Premium revenue | ~ $17.5B | ||||
Service revenue | ~ $525M | ||||
Premium tax revenue | ~ $410M | ||||
Health insurer fees reimbursed | ~ $295M | ||||
Investment income and other revenue | ~ $85M | ||||
Total revenue | ~ $18.8B | ||||
Medical care costs | ~ $15.6B | ||||
Medical care ratio (2) | ~ 89% | ||||
Cost of service revenue | ~ $480M | ||||
General and administrative expenses | ~ $1.4B | ||||
G&A ratio (3) | ~ 7.3% | ||||
Premium tax expenses | ~ $410M | ||||
Health insurer fees | ~ $310M | ||||
Depreciation and amortization | ~ $115M | ||||
Interest expense and other income | ~ $125M | ||||
Income before income taxes | $355M - $400M | ||||
Net income | $202M - $236M | ||||
EBITDA (4) | $632M - $676M | ||||
Effective tax rate | 41% - 43% | ||||
Net profit margin (3) | 1.1% - 1.3% | ||||
Diluted weighted average shares | ~ 67.3M | ||||
Net income per share | $3.00 - $3.50 | ||||
Adjusted net income per share (4) | $3.23 - $3.73 | ||||
End-of-year Marketplace membership | 303,000 | ||||
End-of-year Non-Marketplace membership | 3,738,000 |
__________________ | ||
(1) | All amounts are estimates; actual results may differ materially. See our risk factors as discussed in our 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 expense 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. | |
Conference Call
Management will host a conference call and webcast to discuss Molina Healthcare’s fourth quarter and year-end 2017 results at 8:30 a.m. Eastern time on Tuesday, February 13, 2018. The number to call for the interactive teleconference is (888) 317-6003 and entering confirmation number 5278774. A telephonic replay of the conference call will be available through Tuesday, February 20, 2018, by dialing (877) 344-7529 and entering confirmation number 10116226. A live audio broadcast of Molina Healthcare’s conference call will be available on our website, molinahealthcare.com. A 30-day online replay will be available approximately an hour following the conclusion of the live broadcast.
About Molina Healthcare
Molina Healthcare, Inc., a FORTUNE 500 company, provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through our health plans operating in 13 states across the nation and in the Commonwealth of Puerto Rico, Molina serves approximately 4.5 million members. For more information about Molina Healthcare, please visit our website at molinahealthcare.com.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995: This earnings release contains “forward-looking statements” regarding our 2018 preliminary guidance, as well as 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:
and numerous other risk factors, including those discussed in our periodic reports and filings with the Securities and Exchange Commission. These reports can be accessed under the investor relations tab of our website or on the SEC’s website at sec.gov. Given these risks and uncertainties, we can give no assurances that our forward-looking statements will prove to be accurate, or that any other results or events projected or contemplated by our forward-looking statements will in fact occur, and we caution investors not to place undue reliance on these statements. All forward-looking statements in this release represent our judgment as of February 12, 2018, and we disclaim any obligation to update any forward-looking statements to conform the statement to actual results or changes in our expectations.
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED STATEMENTS OF OPERATIONS |
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Three Months Ended December 31, | Year Ended December 31, | |||||||||||||||||||
2017 | 2016 | 2017 | 2016 | |||||||||||||||||
(Dollar amounts in millions, except per-share amounts) | ||||||||||||||||||||
Revenue: | ||||||||||||||||||||
Premium revenue (1) | $ | 4,689 | $ | 4,190 | $ | 18,854 | $ | 16,445 | ||||||||||||
Service revenue | 131 | 131 | 521 | 539 | ||||||||||||||||
Premium tax revenue | 107 | 123 | 438 | 468 | ||||||||||||||||
Health insurer fees reimbursed (1) | — | 81 | — | 292 | ||||||||||||||||
Investment income and other revenue | 22 | 9 | 70 | 38 | ||||||||||||||||
Total revenue | 4,949 | 4,534 | 19,883 | 17,782 | ||||||||||||||||
Operating expenses: | ||||||||||||||||||||
Medical care costs | 4,251 | 3,844 | 17,073 | 14,774 | ||||||||||||||||
Cost of service revenue | 123 | 123 | 492 | 485 | ||||||||||||||||
General and administrative expenses | 367 | 359 | 1,594 | 1,393 | ||||||||||||||||
Premium tax expenses | 107 | 123 | 438 | 468 | ||||||||||||||||
Health insurer fees | — | 54 | — | 217 | ||||||||||||||||
Depreciation and amortization | 28 | 37 | 137 | 139 | ||||||||||||||||
Impairment losses | 269 | — | 470 | — | ||||||||||||||||
Restructuring and separation costs | 73 | — | 234 | — | ||||||||||||||||
Total operating expenses | 5,218 | 4,540 | 20,438 | 17,476 | ||||||||||||||||
Operating (loss) income | (269 | ) | (6 | ) | (555 | ) | 306 | |||||||||||||
Other expenses, net: | ||||||||||||||||||||
Interest expense | 33 | 25 | 118 | 101 | ||||||||||||||||
Other expense (income), net | 14 | — | (61 | ) | — | |||||||||||||||
Total other expenses, net | 47 | 25 | 57 | 101 | ||||||||||||||||
(Loss) income before income tax (benefit) expense |
(316 | ) | (31 | ) | (612 | ) | 205 | |||||||||||||
Income tax (benefit) expense | (54 | ) | 16 | (100 | ) | 153 | ||||||||||||||
Net (loss) income | $ | (262 | ) | $ | (47 | ) | $ | (512 | ) | $ | 52 | |||||||||
Net (loss) income per diluted share | $ | (4.59 | ) | $ | (0.85 | ) | $ | (9.07 | ) | $ | 0.92 | |||||||||
Diluted weighted average shares outstanding | 57.1 | 55.6 | 56.5 | 56.3 | ||||||||||||||||
Operating Statistics: | ||||||||||||||||||||
Medical care ratio | 90.7 | % | 91.7 | % | 90.6 | % | 89.8 | % | ||||||||||||
G&A ratio | 7.4 | % | 7.9 | % | 8.0 | % | 7.8 | % | ||||||||||||
Premium tax ratio | 2.2 | % | 2.9 | % | 2.3 | % | 2.8 | % | ||||||||||||
Effective income tax (benefit) expense rate | (17.2 | )% | 54.5 | % | (16.4 | )% | 74.8 | % | ||||||||||||
Net (loss) profit margin | (5.3 | )% | (1.0 | )% | (2.6 | )% | 0.3 | % |
__________________ | ||
(1) | The Centers for Medicare and Medicaid Services (CMS) incorporates the Health Insurer Fee in our Medicare and Marketplace premium rates. We have therefore reclassified such amounts to premium revenue, from health insurer fees reimbursed, for all applicable periods presented. | |
MOLINA HEALTHCARE, INC. UNAUDITED CONSOLIDATED BALANCE SHEETS |
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December 31, | ||||||||||
2017 | 2016 | |||||||||
(In millions, except per-share data) |
||||||||||
ASSETS | ||||||||||
Current assets: | ||||||||||
Cash and cash equivalents | $ | 3,186 | $ | 2,819 | ||||||
Investments | 2,524 | 1,758 | ||||||||
Restricted investments | 169 | — | ||||||||
Receivables | 871 | 974 | ||||||||
Income taxes refundable | 54 | 39 | ||||||||
Prepaid expenses and other current assets | 185 | 131 | ||||||||
Derivative asset | 522 | 267 | ||||||||
Total current assets | 7,511 | 5,988 | ||||||||
Property, equipment, and capitalized software, net | 342 | 454 | ||||||||
Deferred contract costs | 101 | 86 | ||||||||
Intangible assets, net | 69 | 140 | ||||||||
Goodwill | 186 | 620 | ||||||||
Restricted investments | 119 | 110 | ||||||||
Deferred income taxes | 103 | 10 | ||||||||
Other assets | 40 | 41 | ||||||||
$ | 8,471 | $ | 7,449 | |||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||||
Current liabilities: | ||||||||||
Medical claims and benefits payable | $ | 2,192 | $ | 1,929 | ||||||
Amounts due government agencies | 1,542 | 1,202 | ||||||||
Accounts payable and accrued liabilities | 366 | 385 | ||||||||
Deferred revenue | 282 | 315 | ||||||||
Current portion of long-term debt | 653 | 472 | ||||||||
Derivative liability | 522 | 267 | ||||||||
Total current liabilities | 5,557 | 4,570 | ||||||||
Long-term debt | 1,318 | 975 | ||||||||
Lease financing obligations | 198 | 198 | ||||||||
Deferred income taxes | — | 15 | ||||||||
Other long-term liabilities | 61 | 42 | ||||||||
Total liabilities | 7,134 | 5,800 | ||||||||
Stockholders’ equity: | ||||||||||
Common stock, $0.001 par value; 150 shares authorized; outstanding: 60 at December 31, 2017 and 57 shares at December 31, 2016 | — | — | ||||||||
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding | — | — | ||||||||
Additional paid-in capital | 1,044 | 841 | ||||||||
Accumulated other comprehensive loss | (5 | ) | (2 | ) | ||||||
Retained earnings | 298 | 810 | ||||||||
Total stockholders’ equity | 1,337 | 1,649 | ||||||||
$ | 8,471 | $ | 7,449 | |||||||
MOLINA HEALTHCARE, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS |
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Three Months Ended December 31, | Year Ended December 31, | |||||||||||||||||||
2017 | 2016 | 2017 | 2016 | |||||||||||||||||
(In millions) | ||||||||||||||||||||
Operating activities: | ||||||||||||||||||||
Net (loss) income | $ | (262 | ) | $ | (47 | ) | $ | (512 | ) | $ | 52 | |||||||||
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities: | ||||||||||||||||||||
Depreciation and amortization | 39 | 47 | 178 | 182 | ||||||||||||||||
Impairment losses | 269 | — | 470 | — | ||||||||||||||||
Deferred income taxes | (26 | ) | 2 | (94 | ) | 22 | ||||||||||||||
Share-based compensation, including accelerated share-based compensation | 8 | 2 | 46 | 26 | ||||||||||||||||
Non-cash restructuring charges | 11 | — | 60 | — | ||||||||||||||||
Amortization of convertible senior notes and lease financing obligations | 8 | 8 | 32 | 31 | ||||||||||||||||
Loss on debt extinguishment | 14 | — | 14 | — | ||||||||||||||||
Other, net | 8 | 2 | 21 | 16 | ||||||||||||||||
Changes in operating assets and liabilities: | ||||||||||||||||||||
Receivables | 131 | 79 | 103 | (348 | ) | |||||||||||||||
Prepaid expenses and other assets | (3 | ) | 47 | (56 | ) | (69 | ) | |||||||||||||
Medical claims and benefits payable | (286 | ) | 58 | 263 | 226 | |||||||||||||||
Amounts due government agencies | 219 | (30 | ) | 341 | 473 | |||||||||||||||
Accounts payable and accrued liabilities | (102 | ) | (5 | ) | (12 | ) | (4 | ) | ||||||||||||
Deferred revenue | (187 | ) | (65 | ) | (34 | ) | 92 | |||||||||||||
Income taxes | 6 | (58 | ) | (16 | ) | (26 | ) | |||||||||||||
Net cash (used in) provided by operating activities | (153 | ) | 40 | 804 | 673 | |||||||||||||||
Investing activities: | ||||||||||||||||||||
Purchases of investments | (822 | ) | (485 | ) | (2,718 | ) | (1,929 | ) | ||||||||||||
Proceeds from sales and maturities of investments | 233 | 454 | 1,771 | 1,966 | ||||||||||||||||
Purchases of property, equipment, and capitalized software | (1 | ) | (33 | ) | (86 | ) | (176 | ) | ||||||||||||
(Increase) decrease in restricted investments held-to-maturity | (2 | ) | — | (12 | ) | 4 | ||||||||||||||
Net cash paid in business combinations | — | — | — | (48 | ) | |||||||||||||||
Other, net | (7 | ) | (7 | ) | (28 | ) | (19 | ) | ||||||||||||
Net cash used in investing activities | (599 | ) | (71 | ) | (1,073 | ) | (202 | ) | ||||||||||||
Financing activities: | ||||||||||||||||||||
Proceeds from senior notes offering, net of issuance costs | — | — | 325 | — | ||||||||||||||||
Proceeds from borrowings under credit facility | — | — | 300 | — | ||||||||||||||||
Proceeds from employee stock plans | 8 | 8 | 19 | 18 | ||||||||||||||||
Cash paid for financing transaction fees | (7 | ) | — | (7 | ) | — | ||||||||||||||
Other, net | 3 | — | (1 | ) | 1 | |||||||||||||||
Net cash provided by financing activities | 4 | 8 | 636 | 19 | ||||||||||||||||
Net (decrease) increase in cash and cash equivalents | (748 | ) | (23 | ) | 367 | 490 | ||||||||||||||
Cash and cash equivalents at beginning of period | 3,934 | 2,842 | 2,819 | 2,329 | ||||||||||||||||
Cash and cash equivalents at end of period | $ | 3,186 | $ | 2,819 | $ | 3,186 | $ | 2,819 | ||||||||||||
MOLINA HEALTHCARE, INC. UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP |
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As of December 31, | |||||||||
2017 | 2016 | 2015 | |||||||
Ending Membership by Program: | |||||||||
Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) | 2,457,000 | 2,536,000 | 2,312,000 | ||||||
Marketplace | 815,000 | 526,000 | 205,000 | ||||||
Medicaid Expansion | 668,000 | 673,000 | 557,000 | ||||||
Aged, Blind or Disabled (ABD) | 412,000 | 396,000 | 366,000 | ||||||
Medicare-Medicaid Plan (MMP) - Integrated | 57,000 | 51,000 | 51,000 | ||||||
Medicare Special Needs Plans | 44,000 | 45,000 | 42,000 | ||||||
4,453,000 | 4,227,000 | 3,533,000 | |||||||
Ending Membership by Health Plan: | |||||||||
California | 746,000 | 683,000 | 620,000 | ||||||
Florida | 625,000 | 553,000 | 440,000 | ||||||
Illinois | 165,000 | 195,000 | 98,000 | ||||||
Michigan | 398,000 | 391,000 | 328,000 | ||||||
New Mexico | 253,000 | 254,000 | 231,000 | ||||||
New York | 32,000 | 35,000 | — | ||||||
Ohio | 327,000 | 332,000 | 327,000 | ||||||
Puerto Rico | 314,000 | 330,000 | 348,000 | ||||||
South Carolina | 116,000 | 109,000 | 99,000 | ||||||
Texas | 430,000 | 337,000 | 260,000 | ||||||
Utah | 152,000 | 146,000 | 102,000 | ||||||
Washington | 777,000 | 736,000 | 582,000 | ||||||
Wisconsin | 118,000 | 126,000 | 98,000 | ||||||
4,453,000 | 4,227,000 | 3,533,000 | |||||||
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
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Three Months Ended December 31, 2017 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
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Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
TANF and CHIP | 7.4 | $ | 1,369 | $ | 183.95 | $ | 1,250 | $ | 168.00 | 91.3 | % | $ | 119 | |||||||||||||||
Medicaid Expansion | 2.0 | 774 | 386.22 | 629 | 313.89 | 81.3 | 145 | |||||||||||||||||||||
ABD | 1.3 | 1,366 | 1,100.22 | 1,229 | 989.56 | 89.9 | 137 | |||||||||||||||||||||
Total Medicaid | 10.7 | 3,509 | 328.28 | 3,108 | 290.76 | 88.6 | 401 | |||||||||||||||||||||
MMP | 0.2 | 363 | 2,142.07 | 341 | 2,006.07 | 93.7 | 22 | |||||||||||||||||||||
Medicare | 0.1 | 152 | 1,155.15 | 124 | 948.16 | 82.1 | 28 | |||||||||||||||||||||
Total Medicare | 0.3 | 515 | 1,710.94 | 465 | 1,543.93 | 90.2 | 50 | |||||||||||||||||||||
Excluding Marketplace | 11.0 | 4,024 | 366.18 | 3,573 | 325.12 | 88.8 | 451 | |||||||||||||||||||||
Marketplace | 2.4 | 665 | 268.39 | 678 | 273.92 | 102.1 | (13 | ) | ||||||||||||||||||||
13.4 | $ | 4,689 | $ | 348.20 | $ | 4,251 | $ | 315.70 | 90.7 | % | $ | 438 | ||||||||||||||||
Three Months Ended December 31, 2016 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
TANF and CHIP | 7.7 | $ | 1,404 | $ | 183.96 | $ | 1,304 | $ | 170.83 | 92.9 | % | $ | 100 | |||||||||||||||
Medicaid Expansion | 2.0 | 768 | 383.19 | 625 | 311.57 | 81.3 | 143 | |||||||||||||||||||||
ABD | 1.2 | 1,200 | 1,003.09 | 1,104 | 921.69 | 91.9 | 96 | |||||||||||||||||||||
Total Medicaid | 10.9 | 3,372 | 311.31 | 3,033 | 279.82 | 89.9 | 339 | |||||||||||||||||||||
MMP | 0.1 | 319 | 2,076.73 | 274 | 1,785.00 | 86.0 | 45 | |||||||||||||||||||||
Medicare | 0.1 | 150 | 1,114.69 | 130 | 966.81 | 86.7 | 20 | |||||||||||||||||||||
Total Medicare | 0.2 | 469 | 1,626.50 | 404 | 1,402.09 | 86.2 | 65 | |||||||||||||||||||||
Excluding Marketplace | 11.1 | 3,841 | 345.40 | 3,437 | 308.91 | 89.4 | 404 | |||||||||||||||||||||
Marketplace | 1.6 | 349 | 221.05 | 407 | 258.71 | 117.0 | (58 | ) | ||||||||||||||||||||
12.7 | $ | 4,190 | $ | 329.96 | $ | 3,844 | $ | 302.68 | 91.7 | % | $ | 346 |
__________________ | ||
(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) |
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Year Ended December 31, 2017 | |||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
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Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
TANF and CHIP | 30.2 | $ | 5,554 | $ | 183.75 | $ | 5,111 | $ | 169.09 | 92.0 | % | $ | 443 | ||||||||||||||
Medicaid Expansion | 8.1 | 3,150 | 388.42 | 2,674 | 329.73 | 84.9 | 476 | ||||||||||||||||||||
ABD | 4.9 | 5,135 | 1,050.41 | 4,863 | 994.80 | 94.7 | 272 | ||||||||||||||||||||
Total Medicaid | 43.2 | 13,839 | 320.16 | 12,648 | 292.61 | 91.4 | 1,191 | ||||||||||||||||||||
MMP | 0.7 | 1,446 | 2,177.72 | 1,317 | 1,982.36 | 91.0 | 129 | ||||||||||||||||||||
Medicare | 0.5 | 601 | 1,143.63 | 493 | 939.67 | 82.2 | 108 | ||||||||||||||||||||
Total Medicare | 1.2 | 2,047 | 1,722.47 | 1,810 | 1,523.15 | 88.4 | 237 | ||||||||||||||||||||
Excluding Marketplace | 44.4 | 15,886 | 357.68 | 14,458 | 325.53 | 91.0 | 1,428 | ||||||||||||||||||||
Marketplace | 10.8 | 2,968 | 274.47 | 2,615 | 241.84 | 88.1 | 353 | ||||||||||||||||||||
55.2 | $ | 18,854 | $ | 341.39 | $ | 17,073 | $ | 309.14 | 90.6 | % | $ | 1,781 | |||||||||||||||
Year Ended December 31, 2016 | |||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||
TANF and CHIP | 30.2 | $ | 5,403 | $ | 179.21 | $ | 4,950 | $ | 164.18 | 91.6 | % | $ | 453 | ||||||||||||||
Medicaid Expansion | 7.8 | 2,952 | 378.58 | 2,475 | 317.37 | 83.8 | 477 | ||||||||||||||||||||
ABD | 4.7 | 4,666 | 991.24 | 4,277 | 908.39 | 91.6 | 389 | ||||||||||||||||||||
Total Medicaid | 42.7 | 13,021 | 305.28 | 11,702 | 274.33 | 89.9 | 1,319 | ||||||||||||||||||||
MMP | 0.6 | 1,321 | 2,160.94 | 1,141 | 1,866.93 | 86.4 | 180 | ||||||||||||||||||||
Medicare | 0.5 | 558 | 1,063.44 | 515 | 981.36 | 92.3 | 43 | ||||||||||||||||||||
Total Medicare | 1.1 | 1,879 | 1,653.73 | 1,656 | 1,457.67 | 88.1 | 223 | ||||||||||||||||||||
Excluding Marketplace | 43.8 | 14,900 | 340.28 | 13,358 | 305.03 | 89.6 | 1,542 | ||||||||||||||||||||
Marketplace | 6.7 | 1,545 | 231.38 | 1,416 | 212.17 | 91.7 | 129 | ||||||||||||||||||||
50.5 | $ | 16,445 | $ | 325.87 | $ | 14,774 | $ | 292.75 | 89.8 | % | $ | 1,671 |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—NON-MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
||||||||||||||||||||||||||||
Three Months Ended December 31, 2017 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 1.8 | $ | 621 | $ | 335.46 | $ | 531 | $ | 286.70 | 85.5 | % | $ | 90 | |||||||||||||||
Florida | 1.1 | 390 | 358.34 | 349 | 320.47 | 89.4 | 41 | |||||||||||||||||||||
Illinois | 0.5 | 146 | 294.68 | 146 | 295.25 | 100.2 | — | |||||||||||||||||||||
Michigan | 1.1 | 383 | 339.23 | 325 | 287.60 | 84.8 | 58 | |||||||||||||||||||||
New Mexico | 0.7 | 325 | 465.52 | 279 | 400.84 | 86.1 | 46 | |||||||||||||||||||||
New York (3) | 0.1 | 46 | 465.75 | 42 | 432.25 | 92.8 | 4 | |||||||||||||||||||||
Ohio | 1.0 | 532 | 555.50 | 460 | 480.48 | 86.5 | 72 | |||||||||||||||||||||
Puerto Rico | 0.9 | 179 | 187.49 | 178 | 187.68 | 100.1 | 1 | |||||||||||||||||||||
South Carolina | 0.4 | 116 | 337.14 | 111 | 320.47 | 95.1 | 5 | |||||||||||||||||||||
Texas | 0.7 | 558 | 796.86 | 510 | 728.72 | 91.4 | 48 | |||||||||||||||||||||
Utah | 0.3 | 88 | 319.80 | 71 | 259.95 | 81.3 | 17 | |||||||||||||||||||||
Washington | 2.2 | 610 | 275.76 | 540 | 243.70 | 88.4 | 70 | |||||||||||||||||||||
Wisconsin | 0.2 | 30 | 162.36 | 27 | 139.38 | 85.9 | 3 | |||||||||||||||||||||
Other (4) | — | — | — | 4 | — | — | (4 | ) | ||||||||||||||||||||
11.0 | $ | 4,024 | $ | 366.18 | $ | 3,573 | $ | 325.12 | 88.8 | % | $ | 451 | ||||||||||||||||
Three Months Ended December 31, 2016 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 1.9 | $ | 639 | $ | 342.41 | $ | 489 | $ | 261.60 | 76.4 | % | $ | 150 | |||||||||||||||
Florida | 1.1 | 374 | 348.59 | 335 | 312.59 | 89.7 | 39 | |||||||||||||||||||||
Illinois | 0.5 | 136 | 234.17 | 154 | 265.84 | 113.5 | (18 | ) | ||||||||||||||||||||
Michigan | 1.1 | 376 | 323.24 | 326 | 279.55 | 86.5 | 50 | |||||||||||||||||||||
New Mexico | 0.7 | 270 | 380.36 | 289 | 406.50 | 106.9 | (19 | ) | ||||||||||||||||||||
New York (3) | 0.1 | 50 | 460.08 | 49 | 451.09 | 98.0 | 1 | |||||||||||||||||||||
Ohio | 1.0 | 479 | 489.73 | 432 | 442.31 | 90.3 | 47 | |||||||||||||||||||||
Puerto Rico | 1.0 | 191 | 193.54 | 178 | 179.02 | 92.5 | 13 | |||||||||||||||||||||
South Carolina | 0.4 | 105 | 318.31 | 88 | 267.65 | 84.1 | 17 | |||||||||||||||||||||
Texas | 0.7 | 528 | 738.53 | 460 | 643.05 | 87.1 | 68 | |||||||||||||||||||||
Utah | 0.2 | 87 | 302.48 | 75 | 263.94 | 87.3 | 12 | |||||||||||||||||||||
Washington | 2.1 | 568 | 268.88 | 505 | 238.99 | 88.9 | 63 | |||||||||||||||||||||
Wisconsin | 0.3 | 34 | 166.56 | 28 | 131.60 | 79.0 | 6 | |||||||||||||||||||||
Other (4) | — | 4 | — | 29 | — | — | (25 | ) | ||||||||||||||||||||
11.1 | $ | 3,841 | $ | 345.40 | $ | 3,437 | $ | 308.91 | 89.4 | % | $ | 404 |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | The New York health plan was acquired on August 1, 2016. | |
(4) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—NON-MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
||||||||||||||||||||||||||||
Year Ended December 31, 2017 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 7.4 | $ | 2,392 | $ | 321.46 | $ | 2,117 | $ | 284.53 | 88.5 | % | $ | 275 | |||||||||||||||
Florida | 4.3 | 1,522 | 350.15 | 1,461 | 335.97 | 96.0 | 61 | |||||||||||||||||||||
Illinois | 2.1 | 593 | 286.69 | 638 | 308.41 | 107.6 | (45 | ) | ||||||||||||||||||||
Michigan | 4.6 | 1,545 | 334.22 | 1,360 | 294.15 | 88.0 | 185 | |||||||||||||||||||||
New Mexico | 2.9 | 1,258 | 439.95 | 1,166 | 407.94 | 92.7 | 92 | |||||||||||||||||||||
New York (3) | 0.4 | 181 | 449.85 | 170 | 424.17 | 94.3 | 11 | |||||||||||||||||||||
Ohio | 3.9 | 2,130 | 544.98 | 1,894 | 484.66 | 88.9 | 236 | |||||||||||||||||||||
Puerto Rico | 3.8 | 732 | 190.13 | 691 | 179.65 | 94.5 | 41 | |||||||||||||||||||||
South Carolina | 1.4 | 445 | 328.41 | 412 | 304.04 | 92.6 | 33 | |||||||||||||||||||||
Texas | 2.8 | 2,150 | 769.82 | 1,978 | 708.20 | 92.0 | 172 | |||||||||||||||||||||
Utah | 1.1 | 355 | 316.44 | 290 | 258.96 | 81.8 | 65 | |||||||||||||||||||||
Washington | 8.9 | 2,445 | 275.64 | 2,143 | 241.55 | 87.6 | 302 | |||||||||||||||||||||
Wisconsin | 0.8 | 131 | 168.64 | 107 | 136.84 | 81.1 | 24 | |||||||||||||||||||||
Other (4) | — | 7 | — | 31 | — | — | (24 | ) | ||||||||||||||||||||
44.4 | $ | 15,886 | $ | 357.68 | $ | 14,458 | $ | 325.53 | 91.0 | % | $ | 1,428 | ||||||||||||||||
Year Ended December 31, 2016 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 7.4 | $ | 2,247 | $ | 304.83 | $ | 1,900 | $ | 257.72 | 84.5 | % | $ | 347 | |||||||||||||||
Florida | 4.1 | 1,348 | 329.58 | 1,227 | 299.94 | 91.0 | 121 | |||||||||||||||||||||
Illinois | 2.3 | 603 | 258.72 | 568 | 243.71 | 94.2 | 35 | |||||||||||||||||||||
Michigan | 4.7 | 1,517 | 324.18 | 1,339 | 286.00 | 88.2 | 178 | |||||||||||||||||||||
New Mexico | 2.8 | 1,245 | 440.63 | 1,162 | 411.30 | 93.3 | 83 | |||||||||||||||||||||
New York (3) | 0.2 | 82 | 446.72 | 79 | 431.73 | 96.6 | 3 | |||||||||||||||||||||
Ohio | 3.9 | 1,927 | 490.71 | 1,718 | 437.56 | 89.2 | 209 | |||||||||||||||||||||
Puerto Rico | 4.0 | 726 | 180.65 | 694 | 172.57 | 95.5 | 32 | |||||||||||||||||||||
South Carolina | 1.3 | 378 | 296.58 | 320 | 250.97 | 84.6 | 58 | |||||||||||||||||||||
Texas | 2.9 | 2,182 | 744.65 | 1,926 | 657.38 | 88.3 | 256 | |||||||||||||||||||||
Utah | 1.1 | 344 | 297.68 | 296 | 256.31 | 86.1 | 48 | |||||||||||||||||||||
Washington | 8.1 | 2,146 | 263.50 | 1,936 | 237.66 | 90.2 | 210 | |||||||||||||||||||||
Wisconsin | 1.0 | 142 | 165.95 | 106 | 123.44 | 74.4 | 36 | |||||||||||||||||||||
Other (4) | — | 13 | — | 87 | — | — | (74 | ) | ||||||||||||||||||||
43.8 | $ | 14,900 | $ | 340.28 | $ | 13,358 | $ | 305.03 | 89.6 | % | $ | 1,542 |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | The New York health plan was acquired on August 1, 2016. | |
(4) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||
Three Months Ended December 31, 2017 | |||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||
California | 0.5 | $ | 68 | $ | 163.41 | $ | 75 | $ | 181.70 | 111.2 | % | $ | (7 | ) | |||||||||||||||
Florida | 0.8 | 225 | 283.63 | 251 | 316.67 | 111.6 | (26 | ) | |||||||||||||||||||||
Michigan | 0.1 | 10 | 153.52 | 11 | 166.49 | 108.5 | (1 | ) | |||||||||||||||||||||
New Mexico | 0.1 | 28 | 387.65 | 22 | 291.42 | 75.2 | 6 | ||||||||||||||||||||||
Ohio | — | 18 | 355.81 | 17 | 317.65 | 89.3 | 1 | ||||||||||||||||||||||
Texas | 0.5 | 146 | 242.38 | 166 | 276.16 | 113.9 | (20 | ) | |||||||||||||||||||||
Utah | 0.2 | 45 | 238.32 | 43 | 227.77 | 95.6 | 2 | ||||||||||||||||||||||
Washington | 0.1 | 40 | 321.91 | 28 | 233.26 | 72.5 | 12 | ||||||||||||||||||||||
Wisconsin | 0.1 | 85 | 505.67 | 67 | 401.16 | 79.3 | 18 | ||||||||||||||||||||||
Other (3) | — | — | — | (2 | ) | — | — | 2 | |||||||||||||||||||||
2.4 | $ | 665 | $ | 268.39 | $ | 678 | $ | 273.92 | 102.1 | % | $ | (13 | ) | ||||||||||||||||
Three Months Ended December 31, 2016 | |||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||
California | 0.2 | $ | 26 | $ | 127.99 | $ | 55 | $ | 282.83 | 221.0 | % | $ | (29 | ) | |||||||||||||||
Florida | 0.6 | 108 | 183.99 | 129 | 219.31 | 119.2 | (21 | ) | |||||||||||||||||||||
Michigan | — | 3 | 285.50 | 1 | 204.16 | 71.6 | 2 | ||||||||||||||||||||||
New Mexico | — | 18 | 353.63 | 15 | 294.95 | 83.3 | 3 | ||||||||||||||||||||||
Ohio | — | 11 | 420.48 | 9 | 325.28 | 77.2 | 2 | ||||||||||||||||||||||
Texas | 0.3 | 76 | 245.20 | 51 | 164.54 | 67.1 | 25 | ||||||||||||||||||||||
Utah | 0.3 | 27 | 181.65 | 36 | 232.38 | 127.9 | (9 | ) | |||||||||||||||||||||
Washington | 0.1 | 18 | 239.89 | 31 | 424.83 | 177.0 | (13 | ) | |||||||||||||||||||||
Wisconsin | 0.1 | 62 | 366.22 | 82 | 479.24 | 130.9 | (20 | ) | |||||||||||||||||||||
Other (3) | — | — | — | (2 | ) | — | — | 2 | |||||||||||||||||||||
1.6 | $ | 349 | $ | 221.05 | $ | 407 | $ | 258.71 | 117.0 | % | $ | (58 | ) |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—MARKETPLACE (In millions, except percentages and per-member per-month amounts) |
|||||||||||||||||||||||||||||
Year Ended December 31, 2017 | |||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||
California | 1.7 | $ | 309 | $ | 185.88 | $ | 231 | $ | 138.61 | 74.6 | % | $ | 78 | ||||||||||||||||
Florida | 3.6 | 1,046 | 293.35 | 1,009 | 283.17 | 96.5 | 37 | ||||||||||||||||||||||
Michigan | 0.3 | 51 | 180.26 | 38 | 135.64 | 75.2 | 13 | ||||||||||||||||||||||
New Mexico | 0.3 | 110 | 349.50 | 84 | 264.14 | 75.6 | 26 | ||||||||||||||||||||||
Ohio | 0.2 | 86 | 363.24 | 81 | 340.44 | 93.7 | 5 | ||||||||||||||||||||||
Texas | 2.6 | 663 | 250.08 | 517 | 195.20 | 78.1 | 146 | ||||||||||||||||||||||
Utah | 0.9 | 180 | 215.93 | 178 | 213.33 | 98.8 | 2 | ||||||||||||||||||||||
Washington | 0.5 | 163 | 317.39 | 156 | 304.74 | 96.0 | 7 | ||||||||||||||||||||||
Wisconsin | 0.7 | 360 | 477.53 | 327 | 433.98 | 90.9 | 33 | ||||||||||||||||||||||
Other (3) | — | — | — | (6 | ) | — | — | 6 | |||||||||||||||||||||
10.8 | $ | 2,968 | $ | 274.47 | $ | 2,615 | $ | 241.84 | 88.1 | % | $ | 353 | |||||||||||||||||
Year Ended December 31, 2016 | |||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
|||||||||||||||||||||||||
Total | PMPM | Total | PMPM | ||||||||||||||||||||||||||
California | 0.8 | $ | 131 | $ | 166.01 | $ | 129 | $ | 164.35 | 99.0 | % | $ | 2 | ||||||||||||||||
Florida | 2.6 | 590 | 228.65 | 538 | 208.53 | 91.2 | 52 | ||||||||||||||||||||||
Michigan | — | 10 | 232.88 | 6 | 154.32 | 66.3 | 4 | ||||||||||||||||||||||
New Mexico | 0.2 | 60 | 287.37 | 47 | 223.85 | 77.9 | 13 | ||||||||||||||||||||||
Ohio | 0.1 | 40 | 348.06 | 29 | 254.78 | 73.2 | 11 | ||||||||||||||||||||||
Texas | 1.4 | 279 | 208.48 | 184 | 137.13 | 65.8 | 95 | ||||||||||||||||||||||
Utah | 0.7 | 103 | 166.21 | 127 | 204.14 | 122.8 | (24 | ) | |||||||||||||||||||||
Washington | 0.3 | 76 | 272.48 | 79 | 284.87 | 104.5 | (3 | ) | |||||||||||||||||||||
Wisconsin | 0.6 | 256 | 363.54 | 282 | 399.51 | 109.9 | (26 | ) | |||||||||||||||||||||
Other (3) | — | — | — | (5 | ) | — | — | 5 | |||||||||||||||||||||
6.7 | $ | 1,545 | $ | 231.38 | $ | 1,416 | $ | 212.17 | 91.7 | % | $ | 129 |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—TOTAL (In millions, except percentages and per-member per-month amounts) |
||||||||||||||||||||||||||||
Three Months Ended December 31, 2017 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 2.3 | $ | 689 | $ | 303.98 | $ | 606 | $ | 267.49 | 88.0 | % | $ | 83 | |||||||||||||||
Florida | 1.9 | 615 | 326.80 | 600 | 318.86 | 97.6 | 15 | |||||||||||||||||||||
Illinois | 0.5 | 146 | 294.68 | 146 | 295.25 | 100.2 | — | |||||||||||||||||||||
Michigan | 1.2 | 393 | 329.50 | 336 | 281.26 | 85.4 | 57 | |||||||||||||||||||||
New Mexico | 0.8 | 353 | 458.22 | 301 | 390.58 | 85.2 | 52 | |||||||||||||||||||||
New York (3) | 0.1 | 46 | 465.75 | 42 | 432.25 | 92.8 | 4 | |||||||||||||||||||||
Ohio | 1.0 | 550 | 545.09 | 477 | 471.99 | 86.6 | 73 | |||||||||||||||||||||
Puerto Rico | 0.9 | 179 | 187.49 | 178 | 187.68 | 100.1 | 1 | |||||||||||||||||||||
South Carolina | 0.4 | 116 | 337.14 | 111 | 320.47 | 95.1 | 5 | |||||||||||||||||||||
Texas | 1.2 | 704 | 541.55 | 676 | 520.34 | 96.1 | 28 | |||||||||||||||||||||
Utah | 0.5 | 133 | 286.70 | 114 | 246.88 | 86.1 | 19 | |||||||||||||||||||||
Washington | 2.3 | 650 | 278.21 | 568 | 243.15 | 87.4 | 82 | |||||||||||||||||||||
Wisconsin | 0.3 | 115 | 324.48 | 94 | 263.00 | 81.1 | 21 | |||||||||||||||||||||
Other (4) | — | — | — | 2 | — | — | (2 | ) | ||||||||||||||||||||
13.4 | $ | 4,689 | $ | 348.20 | $ | 4,251 | $ | 315.70 | 90.7 | % | $ | 438 | ||||||||||||||||
Three Months Ended December 31, 2016 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 2.1 | $ | 665 | $ | 321.74 | $ | 544 | $ | 263.64 | 81.9 | % | $ | 121 | |||||||||||||||
Florida | 1.7 | 482 | 290.53 | 464 | 279.69 | 96.3 | 18 | |||||||||||||||||||||
Illinois | 0.5 | 136 | 234.17 | 154 | 265.84 | 113.5 | (18 | ) | ||||||||||||||||||||
Michigan | 1.1 | 379 | 322.91 | 327 | 278.89 | 86.4 | 52 | |||||||||||||||||||||
New Mexico | 0.7 | 288 | 378.63 | 304 | 399.29 | 105.5 | (16 | ) | ||||||||||||||||||||
New York (3) | 0.1 | 50 | 460.08 | 49 | 451.09 | 98.0 | 1 | |||||||||||||||||||||
Ohio | 1.0 | 490 | 487.83 | 441 | 439.09 | 90.0 | 49 | |||||||||||||||||||||
Puerto Rico | 1.0 | 191 | 193.54 | 178 | 179.02 | 92.5 | 13 | |||||||||||||||||||||
South Carolina | 0.4 | 105 | 318.31 | 88 | 267.65 | 84.1 | 17 | |||||||||||||||||||||
Texas | 1.0 | 604 | 590.59 | 511 | 499.56 | 84.6 | 93 | |||||||||||||||||||||
Utah | 0.5 | 114 | 260.05 | 111 | 252.85 | 97.2 | 3 | |||||||||||||||||||||
Washington | 2.2 | 586 | 267.92 | 536 | 245.11 | 91.5 | 50 | |||||||||||||||||||||
Wisconsin | 0.4 | 96 | 256.93 | 110 | 288.94 | 112.5 | (14 | ) | ||||||||||||||||||||
Other (4) | — | 4 | — | 27 | — | — | (23 | ) | ||||||||||||||||||||
12.7 | $ | 4,190 | $ | 329.96 | $ | 3,844 | $ | 302.68 | 91.7 | % | $ | 346 |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | The New York health plan was acquired on August 1, 2016. | |
(4) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—TOTAL (In millions, except percentages and per-member per-month amounts) |
||||||||||||||||||||||||||||
Year Ended December 31, 2017 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 9.1 | $ | 2,701 | $ | 296.68 | $ | 2,348 | $ | 257.86 | 86.9 | % | $ | 353 | |||||||||||||||
Florida | 7.9 | 2,568 | 324.56 | 2,470 | 312.18 | 96.2 | 98 | |||||||||||||||||||||
Illinois | 2.1 | 593 | 286.69 | 638 | 308.41 | 107.6 | (45 | ) | ||||||||||||||||||||
Michigan | 4.9 | 1,596 | 325.43 | 1,398 | 285.11 | 87.6 | 198 | |||||||||||||||||||||
New Mexico | 3.2 | 1,368 | 430.97 | 1,250 | 393.67 | 91.3 | 118 | |||||||||||||||||||||
New York (3) | 0.4 | 181 | 449.85 | 170 | 424.17 | 94.3 | 11 | |||||||||||||||||||||
Ohio | 4.1 | 2,216 | 534.56 | 1,975 | 476.39 | 89.1 | 241 | |||||||||||||||||||||
Puerto Rico | 3.8 | 732 | 190.13 | 691 | 179.65 | 94.5 | 41 | |||||||||||||||||||||
South Carolina | 1.4 | 445 | 328.41 | 412 | 304.04 | 92.6 | 33 | |||||||||||||||||||||
Texas | 5.4 | 2,813 | 516.84 | 2,495 | 458.50 | 88.7 | 318 | |||||||||||||||||||||
Utah | 2.0 | 535 | 273.55 | 468 | 239.49 | 87.5 | 67 | |||||||||||||||||||||
Washington | 9.4 | 2,608 | 277.93 | 2,299 | 245.01 | 88.2 | 309 | |||||||||||||||||||||
Wisconsin | 1.5 | 491 | 320.71 | 434 | 283.14 | 88.3 | 57 | |||||||||||||||||||||
Other (4) | — | 7 | — | 25 | — | — | (18 | ) | ||||||||||||||||||||
55.2 | $ | 18,854 | $ | 341.39 | $ | 17,073 | $ | 309.14 | 90.6 | % | $ | 1,781 | ||||||||||||||||
Year Ended December 31, 2016 | ||||||||||||||||||||||||||||
Member |
Premium Revenue | Medical Care Costs | MCR (2) |
Medical |
||||||||||||||||||||||||
Total | PMPM | Total | PMPM | |||||||||||||||||||||||||
California | 8.2 | $ | 2,378 | $ | 291.41 | $ | 2,029 | $ | 248.70 | 85.3 | % | $ | 349 | |||||||||||||||
Florida | 6.7 | 1,938 | 290.56 | 1,765 | 264.60 | 91.1 | 173 | |||||||||||||||||||||
Illinois | 2.3 | 603 | 258.72 | 568 | 243.71 | 94.2 | 35 | |||||||||||||||||||||
Michigan | 4.7 | 1,527 | 323.36 | 1,345 | 284.82 | 88.1 | 182 | |||||||||||||||||||||
New Mexico | 3.0 | 1,305 | 430.15 | 1,209 | 398.49 | 92.6 | 96 | |||||||||||||||||||||
New York (3) | 0.2 | 82 | 446.72 | 79 | 431.73 | 96.6 | 3 | |||||||||||||||||||||
Ohio | 4.0 | 1,967 | 486.66 | 1,747 | 432.36 | 88.8 | 220 | |||||||||||||||||||||
Puerto Rico | 4.0 | 726 | 180.65 | 694 | 172.57 | 95.5 | 32 | |||||||||||||||||||||
South Carolina | 1.3 | 378 | 296.58 | 320 | 250.97 | 84.6 | 58 | |||||||||||||||||||||
Texas | 4.3 | 2,461 | 576.69 | 2,110 | 494.41 | 85.7 | 351 | |||||||||||||||||||||
Utah | 1.8 | 447 | 251.63 | 423 | 238.03 | 94.6 | 24 | |||||||||||||||||||||
Washington | 8.4 | 2,222 | 263.80 | 2,015 | 239.21 | 90.7 | 207 | |||||||||||||||||||||
Wisconsin | 1.6 | 398 | 255.30 | 388 | 248.28 | 97.2 | 10 | |||||||||||||||||||||
Other (4) | — | 13 | — | 82 | — | — | (69 | ) | ||||||||||||||||||||
50.5 | $ | 16,445 | $ | 325.87 | $ | 14,774 | $ | 292.75 | 89.8 | % | $ | 1,671 |
__________________ | ||
(1) | A member month is defined as the aggregate of each month’s ending membership for the period presented. | |
(2) | The MCR represents medical costs as a percentage of premium revenue. | |
(3) | The New York health plan was acquired on August 1, 2016. | |
(4) | “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs. | |
MOLINA HEALTHCARE, INC. UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA (In millions, except percentages and per-member per-month amounts) |
||||||||||||||||||||||||
The following tables provide the details of our medical care costs for the periods indicated: |
||||||||||||||||||||||||
Three Months Ended December 31, | ||||||||||||||||||||||||
2017 | 2016 | |||||||||||||||||||||||
Amount | PMPM |
% of |
Amount | PMPM |
% of |
|||||||||||||||||||
Fee for service | $ | 3,052 | $ | 226.66 | 71.8 | % | $ | 2,837 | $ | 223.43 | 73.8 | % | ||||||||||||
Pharmacy | 659 | 48.88 | 15.4 | 592 | 46.57 | 15.4 | ||||||||||||||||||
Capitation | 338 | 25.13 | 8.0 | 317 | 24.93 | 8.2 | ||||||||||||||||||
Direct delivery | 11 | 0.80 | 0.3 | 23 | 1.80 | 0.6 | ||||||||||||||||||
Other | 191 | 14.23 | 4.5 | 75 | 5.95 | 2.0 | ||||||||||||||||||
$ | 4,251 | $ | 315.70 | 100.0 | % | $ | 3,844 | $ | 302.68 | 100.0 | % | |||||||||||||
Year Ended December 31, | ||||||||||||||||||||||||
2017 | 2016 | |||||||||||||||||||||||
Amount | PMPM |
% of |
Amount | PMPM |
% of |
|||||||||||||||||||
Fee for service | $ | 12,682 | $ | 229.63 | 74.3 | % | $ | 10,993 | $ | 217.84 | 74.4 | % | ||||||||||||
Pharmacy | 2,563 | 46.40 | 15.0 | 2,213 | 43.84 | 15.0 | ||||||||||||||||||
Capitation | 1,360 | 24.63 | 8.0 | 1,218 | 24.13 | 8.2 | ||||||||||||||||||
Direct delivery | 73 | 1.33 | 0.4 | 78 | 1.55 | 0.5 | ||||||||||||||||||
Other | 395 | 7.15 | 2.3 | 272 | 5.39 | 1.9 | ||||||||||||||||||
$ | 17,073 | $ | 309.14 | 100.0 | % | $ | 14,774 | $ | 292.75 | 100.0 | % | |||||||||||||
The following table provides the details of our medical claims and benefits payable as of the dates indicated: |
||||||||
December 31, | ||||||||
2017 | 2016 | |||||||
Fee-for-service claims incurred but not paid (IBNP) | $ | 1,717 | $ | 1,352 | ||||
Pharmacy payable | 112 | 112 | ||||||
Capitation payable | 67 | 37 | ||||||
Other (1) | 296 | 428 | ||||||
$ | 2,192 | $ | 1,929 |
__________________ | ||
(1) | “Other” medical claims and benefits payable include amounts payable to certain providers for which we act as an intermediary on behalf of various state agencies without assuming financial risk. Such receipts and payments do not impact our consolidated statements of operations. As of December 31, 2017 and 2016, we had recorded non-risk provider payables of approximately $122 million and $225 million, respectively. | |
MOLINA HEALTHCARE, INC. |
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 was less (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 December 31, | |||||||||
2017 | 2016 | ||||||||
Medical claims and benefits payable, beginning balance | $ | 1,929 | $ | 1,685 | |||||
Components of medical care costs related to: | |||||||||
Current period | 17,037 | 14,966 | |||||||
Prior period | 36 | (192 | ) | ||||||
Total medical care costs | 17,073 | 14,774 | |||||||
Change in non-risk provider payables | (106 | ) | 58 | ||||||
Payments for medical care costs related to: | |||||||||
Current period | 15,130 | 13,304 | |||||||
Prior period | 1,574 | 1,284 | |||||||
Total paid | 16,704 | 14,588 | |||||||
Medical claims and benefits payable, ending balance | $ | 2,192 | $ | 1,929 | |||||
Benefit from prior period as a percentage of: | |||||||||
Balance at beginning of period | (1.9 | )% | 11.4 | % | |||||
Premium revenue, trailing twelve months | (0.2 | )% | 1.2 | % | |||||
Medical care costs, trailing twelve months | (0.2 | )% | 1.3 | % | |||||
Days in claims payable, fee for service (1) | 54 | 47 |
__________________ | ||
(1) | Claims payable includes primarily IBNP. Additionally, it includes certain fee-for-service payables reported in “Other” medical claims and benefits payable amounting to $99 million and $94 million, as of December 31, 2017 and 2016, respectively. | |
MOLINA HEALTHCARE, INC. |
UNAUDITED NON-GAAP FINANCIAL MEASURES |
We use non-GAAP financial measures as supplemental metrics in evaluating our financial performance, making financing and business decisions, and forecasting and planning for future periods. For these reasons, management believes such measures are useful supplemental measures to investors in comparing our performance to the performance of other public companies in the health care industry. These non-GAAP financial measures should be considered as supplements to, and not as substitutes for or superior to, GAAP measures. See further information regarding non-GAAP measures below the tables (in millions, except per diluted share amounts).
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||||||||||||||||||
Net (loss) income | $(262 | ) | $(47 | ) | $(512 | ) | $52 | ||||||||||||||||||||||||||||||||
Adjustments: | |||||||||||||||||||||||||||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 36 | 43 | 165 | 161 | |||||||||||||||||||||||||||||||||||
Interest expense | 33 | 25 | 118 | 101 | |||||||||||||||||||||||||||||||||||
Income tax (benefit) expense | (54 | ) | 16 | (100 | ) | 153 | |||||||||||||||||||||||||||||||||
EBITDA | $(247 | ) | $37 | $(329 | ) | $467 | |||||||||||||||||||||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||||||||||||||||||||||||||
2017 | 2016 | 2017 |
2016 |
||||||||||||||||||||||||||||||||||||
Amount |
Per |
Amount |
Per |
Amount |
Per |
Amount |
Per |
||||||||||||||||||||||||||||||||
Net (loss) income | $ | (262 | ) | $ | (4.59 | ) | $ | (47 | ) | $ | (0.85 | ) | $ | (512 | ) | $ | (9.07 | ) |
$ |
52 |
$ | 0.92 | |||||||||||||||||
Adjustment: | |||||||||||||||||||||||||||||||||||||||
Amortization of intangible assets |
|
6 |
0.11 |
8 |
0.16 |
30 |
0.55 |
32 |
0.57 |
||||||||||||||||||||||||||||||
Income tax effect (1) |
(2 |
) |
(0.04 |
) |
(3 |
) |
(0.06 |
) |
(11 |
) |
(0.20 |
) |
(12 |
) |
(0.21 |
) | |||||||||||||||||||||||
Amortization of intangible assets, net of tax effect |
4 |
0.07 |
5 |
0.10 |
19 |
0.35 |
20 |
0.36 | |||||||||||||||||||||||||||||||
Adjusted net (loss) income | $ | (258 | ) | $ | (4.52 | ) | $ | (42 | ) | $ | (0.75 | ) | $ | (493 | ) | $ | (8.72 | ) |
$ |
72 |
$ | 1.28 |
__________________ | ||
(1) | Income tax effect of adjustment calculated at the blended federal and state statutory tax rate of 37%. | |
The following are descriptions of the adjustments made to GAAP measures used to calculate the non-GAAP measures used in this news release:
Earnings before interest, taxes, depreciation and amortization (EBITDA): Net (loss) income (GAAP) less depreciation, and amortization of intangible assets and capitalized software, interest expense and income tax (benefit) expense. We believe that EBITDA is helpful in assessing our ability to meet the cash demands of our operating units.
Adjusted net (loss) income: Net (loss) income (GAAP) less amortization of intangible assets, net of income tax effect calculated at the statutory tax rate of 37%. We believe that adjusted net (loss) income is helpful in assessing our financial performance exclusive of the non-cash impact of the amortization of purchased intangibles.
Adjusted net (loss) income per diluted share: Adjusted net (loss) income divided by weighted average common shares outstanding on a fully diluted basis.
MOLINA HEALTHCARE, INC. 2018 PRELIMINARY GUIDANCE |
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Reconciliation of Non-GAAP Financial Measures |
||||||||||||||||||||
Low End | High End | |||||||||||||||||||
Net income | $ | 202 | $ | 236 | ||||||||||||||||
Adjustments: | ||||||||||||||||||||
Depreciation, and amortization of intangible assets and capitalized software | 150 | 150 | ||||||||||||||||||
Interest expense | 125 | 125 | ||||||||||||||||||
Income tax expense | 155 | 165 | ||||||||||||||||||
EBITDA | $ | 632 | $ | 676 | ||||||||||||||||
Low End | High End | |||||||||||||||||||
Amount | Per share (2) | Amount | Per share (2) | |||||||||||||||||
Net income | $ | 202 | $ | 3.00 | $ | 236 | $ | 3.50 | ||||||||||||
Adjustments: | ||||||||||||||||||||
Amortization of intangible assets | 20 | 0.30 | 20 | 0.30 | ||||||||||||||||
Income tax effect (1) | (5 | ) | (0.07 | ) | (5 | ) | (0.07 | ) | ||||||||||||
Amortization of intangible assets, net of tax effect | 15 | 0.23 | 15 | 0.23 | ||||||||||||||||
Adjusted net income | $ | 217 | $ | 3.23 | $ | 251 | $ | 3.73 |
__________________ | ||
(1) | Income tax effect calculated at the statutory tax rate of 22.5%. | |
(2) | Computation assumes 67.3 million diluted weighted average shares outstanding. |
View source version on businesswire.com: http://www.businesswire.com/news/home/20180212006254/en/
Molina Healthcare, Inc.
Ryan Kubota, 562-435-3666, ext. 119057
Investor
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