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Watchlist
Account
Molina Healthcare
MOH
#2613
Rank
$6.87 B
Marketcap
๐บ๐ธ
United States
Country
$133.51
Share price
-1.36%
Change (1 day)
-50.29%
Change (1 year)
โ๏ธ Healthcare
๐ฆ Insurance
Categories
Molina Healthcare
is a managed care company that provides health insurance to individuals through government programs such as Medicaid and Medicare.
Market cap
Revenue
Earnings
Price history
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Price history
P/E ratio
P/S ratio
P/B ratio
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Fails to deliver
Cost to borrow
Total assets
Total liabilities
Total debt
Cash on Hand
Net Assets
Annual Reports (10-K)
Molina Healthcare
Quarterly Reports (10-Q)
Financial Year FY2018 Q3
Molina Healthcare - 10-Q quarterly report FY2018 Q3
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Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
ý
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended
September 30, 2018
OR
¨
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from to
Commission file number: 001-31719
MOLINA HEALTHCARE, INC.
(Exact name of registrant as specified in its charter)
Delaware
13-4204626
(State or other jurisdiction of incorporation or organization)
(I.R.S. Employer Identification No.)
200 Oceangate, Suite 100
Long Beach, California
90802
(Address of principal executive offices)
(Zip Code)
(562) 435-3666
(Registrant’s telephone number, including area code)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes
ý
No
¨
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes
ý
No
¨
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filer
ý
Accelerated filer
¨
Non-accelerated filer
¨
(Do not check if a smaller reporting company)
Smaller reporting company
¨
Emerging growth company
¨
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section13(a) of the Exchange Act.
¨
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).
Yes
¨
No
ý
The number of shares of the issuer’s Common Stock, $0.001 par value, outstanding as of
October 26, 2018
, was approximately
62,389,000
.
Table of Contents
MOLINA HEALTHCARE, INC. FORM 10-Q
FOR THE QUARTERLY PERIOD ENDED
September 30, 2018
TABLE OF CONTENTS
ITEM NUMBER
Page
PART I - Financial Information
1.
Financial Statements
3
2.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
39
3.
Quantitative and Qualitative Disclosures About Market Risk
55
4.
Controls and Procedures
59
Part II
- Other Information
1.
Legal Proceedings
60
1A.
Risk Factors
60
2.
Unregistered Sales of Equity Securities and Use of Proceeds
60
3.
Defaults Upon Senior Securities
Not Applicable.
4.
Mine Safety Disclosures
Not Applicable.
5.
Other Information
Not Applicable.
6.
Exhibits
61
Signatures
62
Table of Contents
CONSOLIDATED STATEMENTS OF OPERATIONS
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions, except per-share data)
(Unaudited)
Revenue:
Premium revenue
$
4,337
$
4,777
$
13,174
$
14,165
Service revenue
130
130
391
390
Premium tax revenue
110
106
320
331
Health insurer fees reimbursed
83
—
248
—
Investment income and other revenue
37
18
93
48
Total revenue
4,697
5,031
14,226
14,934
Operating expenses:
Medical care costs
3,790
4,220
11,362
12,822
Cost of service revenue
111
123
349
369
General and administrative expenses
311
383
998
1,227
Premium tax expenses
110
106
320
331
Health insurer fees
87
—
261
—
Depreciation and amortization
25
33
76
109
Restructuring and separation costs
5
118
38
161
Impairment losses
—
129
—
201
Total operating expenses
4,439
5,112
13,404
15,220
Gain on sale of subsidiary
37
—
37
—
Operating income (loss)
295
(81
)
859
(286
)
Other expenses, net:
Interest expense
26
32
91
85
Other expenses (income), net
10
—
25
(75
)
Total other expenses, net
36
32
116
10
Income (loss) before income tax expense (benefit)
259
(113
)
743
(296
)
Income tax expense (benefit)
62
(16
)
237
(46
)
Net income (loss)
$
197
$
(97
)
$
506
$
(250
)
Net income (loss) per share:
Basic
$
3.22
$
(1.70
)
$
8.32
$
(4.44
)
Diluted
$
2.90
$
(1.70
)
$
7.60
$
(4.44
)
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions)
(Unaudited)
Net income (loss)
$
197
$
(97
)
$
506
$
(250
)
Other comprehensive income (loss):
Unrealized investment gain (loss)
1
1
(5
)
2
Less: effect of income taxes
—
1
(1
)
1
Other comprehensive income (loss), net of tax
1
—
(4
)
1
Comprehensive income (loss)
$
198
$
(97
)
$
502
$
(249
)
See accompanying notes.
Molina Healthcare, Inc. September 30, 2018 Form 10-Q |
3
Table of Contents
CONSOLIDATED BALANCE SHEETS
September 30,
2018
December 31,
2017
(In millions,
except per-share data)
(Unaudited)
ASSETS
Current assets:
Cash and cash equivalents
$
2,814
$
3,186
Investments
1,812
2,524
Restricted investments
—
169
Receivables
1,346
871
Prepaid expenses and other current assets
486
239
Derivative asset
843
522
Total current assets
7,301
7,511
Property, equipment, and capitalized software, net
264
342
Goodwill and intangible assets, net
195
255
Restricted investments
118
119
Deferred income taxes
143
103
Other assets
30
141
$
8,051
$
8,471
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Medical claims and benefits payable
$
2,042
$
2,192
Amounts due government agencies
1,030
1,542
Accounts payable and accrued liabilities
824
366
Deferred revenue
178
282
Current portion of long-term debt
296
653
Derivative liability
843
522
Total current liabilities
5,213
5,557
Long-term debt
1,019
1,318
Lease financing obligations
198
198
Other long-term liabilities
60
61
Total liabilities
6,490
7,134
Stockholders’ equity:
Common stock, $0.001 par value, 150 shares authorized; outstanding: 62 shares at September 30, 2018 and 60 shares at December 31, 2017
—
—
Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding
—
—
Additional paid-in capital
760
1,044
Accumulated other comprehensive loss
(10
)
(5
)
Retained earnings
811
298
Total stockholders’ equity
1,561
1,337
$
8,051
$
8,471
See accompanying notes.
Molina Healthcare, Inc. September 30, 2018 Form 10-Q |
4
Table of Contents
CONSOLIDATED STATEMENT OF STOCKHOLDERS’ EQUITY
Common Stock
Additional
Paid-in
Capital
Accumulated
Other
Comprehensive
Loss
Retained
Earnings
Total
Outstanding
Amount
(In millions)
(Unaudited)
Balance at January 1, 2018
60
$
—
$
1,044
$
(5
)
$
298
$
1,337
Net income
—
—
—
—
107
107
Adoption of Topic 606
—
—
—
—
6
6
Adoption of ASU 2018-02
—
—
—
(1
)
1
—
Exchange of 1.625% Notes
2
—
108
—
—
108
Other comprehensive loss, net
—
—
—
(6
)
—
(6
)
Share-based compensation
—
—
1
—
—
1
Balance at March 31, 2018
62
—
1,153
(12
)
412
1,553
Net income
—
—
—
—
202
202
Partial termination of 1.125% Warrants
—
—
(113
)
—
—
(113
)
Other comprehensive income, net
—
—
—
1
—
1
Share-based compensation
—
—
15
—
—
15
Balance at June 30, 2018
62
—
1,055
(11
)
614
1,658
Net income
—
—
—
—
197
197
Partial termination of 1.125% Warrants
—
—
(306
)
—
—
(306
)
Conversion of 1.625% Notes
—
—
4
—
—
4
Other comprehensive income, net
—
—
—
1
—
1
Share-based compensation
—
7
—
—
7
Balance at September 30, 2018
62
$
—
$
760
$
(10
)
$
811
$
1,561
Common Stock
Additional
Paid-in
Capital
Accumulated
Other
Comprehensive
Loss
Retained
Earnings
Total
Outstanding
Amount
(In millions)
(Unaudited)
Balance at January 1, 2017
57
$
—
$
841
$
(2
)
$
810
$
1,649
Net income
—
—
—
—
77
77
Other comprehensive income, net
—
—
—
1
—
1
Balance at March 31, 2017
57
—
841
(1
)
887
1,727
Net loss
—
—
—
—
(230
)
(230
)
Share-based compensation
—
—
24
—
—
24
Balance at June 30, 2017
57
—
865
(1
)
657
1,521
Net loss
—
—
—
—
(97
)
(97
)
Share-based compensation
—
—
5
—
—
5
Balance at September 30, 2017
57
$
—
$
870
$
(1
)
$
560
$
1,429
See accompanying notes.
Molina Healthcare, Inc. September 30, 2018 Form 10-Q |
5
Table of Contents
CONSOLIDATED STATEMENTS OF CASH FLOWS
Nine Months Ended September 30,
2018
2017
(In millions)
(Unaudited)
Operating activities:
Net income (loss)
$
506
$
(250
)
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities:
Depreciation and amortization
104
139
Deferred income taxes
(32
)
(68
)
Share-based compensation
20
38
Non-cash restructuring costs
17
49
Amortization of convertible senior notes and lease financing obligations
18
24
Gain on sale of subsidiary
(37
)
—
Loss on debt extinguishment
25
—
Impairment losses
—
201
Other, net
6
13
Changes in operating assets and liabilities:
Receivables
(507
)
(28
)
Prepaid expenses and other current assets
(117
)
(53
)
Medical claims and benefits payable
(144
)
549
Amounts due government agencies
(511
)
122
Accounts payable and accrued liabilities
398
90
Deferred revenue
(55
)
153
Income taxes
118
(22
)
Net cash (used in) provided by operating activities
(191
)
957
Investing activities:
Purchases of investments
(1,202
)
(1,894
)
Proceeds from sales and maturities of investments
2,070
1,536
Purchases of property, equipment and capitalized software
(24
)
(85
)
Other, net
(23
)
(33
)
Net cash provided by (used in) investing activities
821
(476
)
Financing activities:
Repayment of credit facility
(300
)
—
Repayment of principal amount of 1.125% Notes
(236
)
—
Cash paid for partial settlement of 1.125% Conversion Option
(477
)
—
Cash received for partial termination of 1.125% Call Option
477
—
Cash paid for partial termination of 1.125% Warrants
(419
)
—
Repayment of principal amount of 1.625% Notes
(64
)
—
Proceeds from senior notes offerings, net of issuance costs
—
325
Proceeds from borrowings under credit facility
—
300
Other, net
7
7
Net cash (used in) provided by financing activities
(1,012
)
632
Net (decrease) increase in cash, cash equivalents, and restricted cash and cash equivalents
(382
)
1,113
Cash, cash equivalents, and restricted cash and cash equivalents at beginning of period
3,290
2,912
Cash, cash equivalents, and restricted cash and cash equivalents at end of period
$
2,908
$
4,025
Molina Healthcare, Inc. September 30, 2018 Form 10-Q |
6
Table of Contents
CONSOLIDATED STATEMENTS OF CASH FLOWS
(continued)
Nine Months Ended September 30,
2018
2017
(In millions)
(Unaudited)
Supplemental cash flow information:
Schedule of non-cash investing and financing activities:
Common stock used for share-based compensation
$
(6
)
$
(21
)
Details of sale of subsidiary:
Decrease in carrying amount of assets
$
(243
)
$
—
Decrease in carrying amount of liabilities
59
—
Transaction costs
(12
)
—
Receivable from buyer - recorded in prepaid expenses and other current assets
233
—
Gain on sale of subsidiary
$
37
$
—
Details of change in fair value of derivatives, net:
Gain on 1.125% Call Option
$
321
$
158
Loss on 1.125% Conversion Option
(321
)
(158
)
Change in fair value of derivatives, net
$
—
$
—
1.625% Notes exchange transaction:
Common stock issued in exchange for 1.625% Notes
$
131
$
—
Component of 1.625% Notes allocated to additional paid-in capital, net of income taxes
(23
)
—
Net increase to additional paid-in capital
$
108
$
—
See accompanying notes.
Molina Healthcare, Inc. September 30, 2018 Form 10-Q |
7
Table of Contents
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
September 30, 2018
1
.
Organization and Basis of Presentation
Organization and Operations
Molina Healthcare, Inc. provides quality managed health care to people receiving government assistance. We offer cost-effective Medicaid-related solutions to meet the health care needs of low-income families and individuals, and to assist government agencies in their administration of the Medicaid program.
We have
three
reportable segments, consisting of our Health Plans segment, which constitutes the vast majority of our operations; our Molina Medicaid Solutions segment; and our Other segment.
The Health Plans segment consists of health plans operating in
13
states and the Commonwealth of Puerto Rico. As of
September 30, 2018
, these health plans served approximately
4.0 million
members eligible for Medicaid, Medicare, and other government-sponsored health care programs for low-income families and individuals. This membership includes Affordable Care Act Marketplace (Marketplace) members, most of whom receive government premium subsidies.
The health plans are operated by our respective wholly owned subsidiaries in those states, each of which is licensed as a health maintenance organization (HMO).
Our health plans’ state Medicaid contracts generally have terms of
three
to
five
years. These contracts typically contain renewal options exercisable by the state Medicaid agency, and allow either the state or the health plan to terminate the contract with or without cause. Such contracts are subject to risk of loss in states that issue requests for proposal (RFP) open to competitive bidding by other health plans. If one of our health plans is not a successful responsive bidder to a state RFP, its contract may not be renewed.
In addition to contract renewal, our state Medicaid contracts may be periodically amended to include or exclude certain health benefits (such as pharmacy services, behavioral health services, or long-term care services); populations such as the aged, blind or disabled (ABD); and regions or service areas.
The Molina Medicaid Solutions segment provides support to state government agencies’ administration of their Medicaid programs, including business processing, information technology development and administrative services.
The Other segment includes primarily our behavioral health and social services provider subsidiary (Pathways), and corporate amounts not allocated to other reportable segments.
Recent Developments – Health Plans Segment
New Mexico Health Plan.
In our Annual Report on Form 10-K for 2017, we reported that we were notified by the New Mexico Medicaid agency that we had not been selected for a tentative award of a 2019 Medicaid contract. A hearing was held on our judicial protest on October 17, 2018, with a decision expected in the fourth quarter of 2018. Regardless of the court’s decision on our protest, we would have further rights of appeal. We are continuing to manage the business in run-off until such time as a different outcome is determined.
As of
September 30, 2018
,
we served approximately
206,000
Medicaid members in New Mexico, which represented premium revenue o
f
$891 million
for the
nine months ended September 30, 2018
.
Puerto Rico Health Plan
.
In July 2018, our Puerto Rico health plan was selected by the Puerto Rico Health Insurance Administration to be one of the organizations to administer the Commonwealth’s new Medicaid Managed Care contract. We expect to serve approximately
290,000
members under the new contract. The base contract runs for a period of three years with an optional one-year extension. As of September 30, 2018, we served approximately
320,000
Medicaid members in the East and Southwest regions of Puerto Rico, which represented premium revenue of
$549 million
for the
nine months ended September 30, 2018
.
Florida Health Plan.
In June 2018, our Florida health plan was awarded comprehensive Medicaid Managed Care contracts by the Florida Agency for Health Care Administration (AHCA) in Regions 8 and 11 of the Florida Statewide Medicaid Managed Care Invitation to Negotiate. As of September 30, 2018, we served approximately
96,000
Medicaid members in those regions, which represented premium revenue of approximately
$346 million
for the
nine months ended September 30, 2018
. Services under the new contract are expected to begin on January 1, 2019. We will be serving both the Medicaid and long-term care populations in the two regions.
Washington Health Plan.
In May 2018, our Washington health plan was selected by the Washington State Health Care Authority (HCA) to enter into a managed care contract for the eight remaining regions of the state’s Apple Health Integrated Managed Care program, in addition to the two regions previously awarded to us. We were
Molina Healthcare, Inc. September 30, 2018 Form 10-Q |
8
Table of Contents
selected by HCA for the following regions: Greater Columbia, King, North Sound, Pierce, and Spokane beginning January 1, 2019; and Salish, Thurston-Mason, and Great Rivers beginning January 1, 2020. As of September 30, 2018, we served approximately
738,000
Medicaid members in Washington, which represented premium revenue of
$1,558 million
for the
nine months ended September 30, 2018
.
Recent Developments – Molina Medicaid Solutions Segment
We closed on the sale of Molina Medicaid Solutions (MMS) to DXC Technology Company on September 30, 2018. The net cash selling price for the equity interests of MMS was
$233 million
, which we received on October 1, 2018. As a result of this transaction, we recognized a pretax gain, net of transaction costs, of
$37 million
. Refer to Note
11
, “
Segments
,” for further information.
Subsequent Event – Other Segment
On October 19, 2018, we sold our Pathways subsidiary to Pyramid Health Holdings, LLC for a nominal purchase price. We expect to record a loss on sale of subsidiary amounting to approximately
$40 million
, net of income tax benefits.
Presentation and Reclassification
We have reclassified certain amounts in the 2017 consolidated statement of cash flows to conform to the 2018 presentation, relating to the presentation of restricted cash and cash equivalents. The reclassification is a result of our adoption of Accounting Standards Update (ASU) 2016-18,
Restricted Cash
effective January 1, 2018. See Note
2
, “
Significant Accounting Policies
,” for further information, including the amount reclassified.
We have combined certain line items in the accompanying consolidated balance sheets. For all periods presented, we have combined the presentation of:
•
Income taxes refundable with “Prepaid expenses and other current assets;”
•
Income taxes payable with “Accounts payable and accrued liabilities;”
•
Goodwill, and intangible assets, net to a single line; and
•
Deferred contract costs with “Other assets.”
Consolidation and Interim Financial Information
The consolidated financial statements include the accounts of Molina Healthcare, Inc., its subsidiaries, and variable interest entities (VIEs) in which Molina Healthcare, Inc. is considered to be the primary beneficiary. Such VIEs are insignificant to our consolidated financial position and results of operations. In the opinion of management, all adjustments considered necessary for a fair presentation of the results as of the date and for the interim periods presented have been included; such adjustments consist of normal recurring adjustments. All significant intercompany balances and transactions have been eliminated. The consolidated results of operations for the
nine months ended September 30, 2018
are not necessarily indicative of the results for the entire year ending
December 31, 2018
.
The unaudited consolidated interim financial statements have been prepared under the assumption that users of the interim financial data have either read or have access to our audited consolidated financial statements for the fiscal year ended
December 31, 2017
. Accordingly, certain disclosures that would substantially duplicate the disclosures contained in our
December 31, 2017
audited consolidated financial statements have been omitted. These unaudited consolidated interim financial statements should be read in conjunction with our audited consolidated financial statements for the fiscal year ended
December 31, 2017
.
2
.
Significant Accounting Policies
Cash and Cash Equivalents
Cash and cash equivalents consist of cash and short-term, highly liquid investments that are both readily convertible into known amounts of cash and have a maturity of three months or less on the date of purchase. The following table provides a reconciliation of cash, cash equivalents, and restricted cash and cash equivalents reported within the accompanying consolidated balance sheets that sum to the total of the same such amounts presented in the accompanying consolidated statements of cash flows. The restricted cash and cash equivalents presented below are included in non-current “Restricted investments” in the accompanying consolidated balance sheets.
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Nine Months Ended September 30,
2018
2017
(In millions)
Cash and cash equivalents
$
2,814
$
3,934
Restricted cash and cash equivalents
94
91
Total cash, cash equivalents, and restricted cash and cash equivalents presented in the statements of cash flows
$
2,908
$
4,025
Revenue Recognition
We adopted ASU 2014-09,
Revenue from Contracts with Customers (Topic 606)
effective January 1, 2018, using the modified retrospective approach. The insurance contracts of our Health Plans segment, which segment constitutes the vast majority of our operations, are excluded from the scope of Topic 606 because the recognition of revenue under these contracts is dictated by other accounting standards governing insurance contracts. The cumulative effect of initially applying the guidance, relating entirely to our Molina Medicaid Solutions segment contracts, resulted in an immaterial impact to beginning retained earnings, as presented in the accompanying consolidated statement of stockholders’ equity. Topic 606 was only applied to service contracts that were not completed as of December 31, 2017. Refer to “Other segment” below for further information.
Health Plans segment
Premium revenue is fixed in advance of the periods covered and, except as described below, is not generally subject to significant accounting estimates. Premium revenues are recognized in the month that members are entitled to receive health care services, and premiums collected in advance are deferred. Certain components of premium revenue are subject to accounting estimates and fall into two broad categories discussed in further detail below: 1) “Contractual Provisions That May Adjust or Limit Revenue or Profit;” and 2) “Quality Incentives.” Liabilities recorded for such provisions are included in “Amounts due government agencies” in the accompanying consolidated balance sheets.
1)
Contractual Provisions That May Adjust or Limit Revenue or Profit:
Medicaid
•
Medical Cost Floors (Minimums), and Medical Cost Corridors:
Pursuant to certain contract provisions, a portion of our premium revenue may be returned if certain minimum amounts are not spent on defined medical care costs. In the aggregate, we recorded a liability under the terms of such contract provisions of
$198 million
and
$135 million
at
September 30, 2018
and
December 31, 2017
, respectively. Approximately
$144 million
and
$96 million
of this liability accrued at
September 30, 2018
and
December 31, 2017
, respectively, relates to our participation in Medicaid Expansion programs. Refer to Note
12
, “
Commitments and Contingencies
,” for further information regarding the California Medicaid Expansion program.
•
Retroactive Premium Adjustments:
State Medicaid programs periodically adjust premium rates on a retroactive basis. In these cases, we must adjust our premium revenue in the period in which we learn of the adjustment, rather than in the months of service to which the retroactive adjustment applies.
Medicare
•
Minimum MLR:
The Affordable Care Act (ACA) has established a minimum annual medical loss ratio (Minimum MLR) of 85% for Medicare. The medical loss ratio represents medical costs as a percentage of premium revenue. Federal regulations define what constitutes medical costs and premium revenue. If the Minimum MLR is not met, we may be required to pay rebates to the federal government. We recognize estimated rebates under the Minimum MLR as an adjustment to premium revenue in our consolidated statements of operations. The payable for the Medicare Minimum MLR was not significant at September 30, 2018 and December 31, 2017.
Marketplace
•
Risk adjustment:
Under this program, our health plans’ composite risk scores are compared with the overall average risk score for the relevant state and market pool. Generally, our health plans will make a risk adjustment payment into the pool if their composite risk scores are below the average risk score, and will receive a risk adjustment payment from the pool if their composite risk scores are above the average risk score. We estimate our ultimate premium based on insurance policy year-to-date experience, and recognize estimated premiums relating to the risk adjustment program as an adjustment to premium
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revenue in our consolidated statements of operations. As of
September 30, 2018
, and December 31, 2017, the Marketplace risk adjustment payable amounted to
$390 million
and
$912 million
, respectively.
•
Minimum MLR:
The ACA has established a Minimum MLR of
80%
for the Marketplace. If the Minimum MLR is not met, we may be required to pay rebates to our Marketplace policyholders. The Marketplace risk adjustment program is taken into consideration when computing the Minimum MLR. We recognize estimated rebates under the Minimum MLR as an adjustment to premium revenue in our consolidated statements of operations. The payable for the Marketplace Minimum MLR was not significant at September 30, 2018 and December 31, 2017.
2)
Quality Incentives:
At many of our health plans, revenue ranging from approximately
1%
to
3%
of certain health plan premiums is earned only if certain performance measures are met.
The following table quantifies the quality incentive premium revenue recognized for the periods presented, including the amounts earned in the periods presented and prior periods. Although the reasonably possible effects of a change in estimate related to quality incentive premium revenue as of
September 30, 2018
are not known, we have no reason to believe that the adjustments to prior years noted below are not indicative of the potential future changes in our estimates as of
September 30, 2018
.
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(Dollars in millions)
Maximum available quality incentive premium - current period
$
48
$
36
$
135
$
113
Quality incentive premium revenue recognized in current period:
Earned current period
$
39
$
24
$
97
$
72
Earned prior periods
9
3
32
9
Total
$
48
$
27
$
129
81
Quality incentive premium revenue recognized as a percentage of total premium revenue
1.1
%
0.6
%
1.0
%
0.6
%
Other segment
Our Pathways subsidiary’s revenue is all variable, and generally invoiced after services are rendered; customer payment follows invoicing. We concluded that there is no change to revenue recognition under Topic 606 for Pathways, and therefore no impact to retained earnings effective January 1, 2018. As discussed in Note
1
, “
Organization and Basis of Presentation
,” we sold Pathways on October 19, 2018.
Medical Care Costs - Marketplace Cost Share Reduction (CSR) Update
In the nine months ended September 30, 2018, we recognized a benefit of approximately
$81 million
in reduced medical expense related to 2017 dates of service, including
$5 million
in the third quarter of 2018, as a result of the federal government’s confirmation that the reconciliation of 2017 Marketplace CSR subsidies would be performed on an annual basis. In the fourth quarter of 2017, we had assumed a nine-month reconciliation of this item pending confirmation of the time period to which the 2017 reconciliation would be applied.
Concentrations of Credit Risk
Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash and cash equivalents, investments, receivables, and restricted investments. Our investments and a portion of our cash equivalents are managed by professional portfolio managers operating under documented investment guidelines. Our portfolio managers must obtain our prior approval before selling investments where the loss position of those investments exceeds certain levels. Our investments consist primarily of investment-grade debt securities with a maximum maturity of
10
years and an average duration of
three
years or less. Restricted investments are invested principally in certificates of deposit and U.S. treasury securities. Concentration of credit risk with respect to accounts receivable is generally limited because our payors consist principally of the governments of each state in which our health plan subsidiaries operate.
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Income Taxes
The provision for income taxes is determined using an estimated annual effective tax rate, which generally differs from the U.S. federal statutory rate primarily because of state taxes, nondeductible expenses such as the Health Insurer Fee (HIF), certain compensation, and other general and administrative expenses. The effective tax rate was not impacted by HIF in 2017 given the 2017 HIF moratorium.
The effective tax rate may be subject to fluctuations during the year as new information is obtained. Such information may affect the assumptions used to estimate the annual effective tax rate, including projected pretax earnings, the mix of pretax earnings in the various tax jurisdictions in which we operate, valuation allowances against deferred tax assets, the recognition or the reversal of the recognition of tax benefits related to uncertain tax positions, and changes in or the interpretation of tax laws in jurisdictions where we conduct business. We recognize deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of our assets and liabilities, along with net operating loss and tax credit carryovers.
The Tax Cuts and Jobs Act (TCJA) was enacted on December 22, 2017. The TCJA, in part, reduced the U.S. federal statutory corporate income tax rate from 35% to 21% effective January 1, 2018. Accounting guidance allows filers a measurement period of one year from the enactment date to finalize the provisional valuation of deferred tax assets and liabilities. During the third quarter of 2018, we recognized approximately
$4 million
in adjustments to our provisional valuation of our deferred tax assets and liabilities recorded at December 31, 2017, and included these adjustments as a component of income tax expense from continuing operations, which decreased our effective tax rate by 150 basis points in the quarter. At
September 30, 2018
, we had not completed our accounting for the tax effects resulting from enactment of TCJA with respect to valuation of our deferred tax assets and liabilities. We will continue to refine our calculations as additional analysis is completed. In addition, our estimates may also be affected by expected future guidance on the tax law from the Internal Revenue Service and U.S. Treasury.
Recent Accounting Pronouncements Adopted
Revenue Recognition (Topic 606).
See discussion above, in “Revenue Recognition.”
Comprehensive Income.
In February 2018, the Financial Accounting Standards Board (FASB) issued ASU 2018-02,
Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income
, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from the TCJA. ASU 2018-02 is effective beginning January 1, 2019; we early adopted this ASU effective January 1, 2018. The effect of applying the guidance resulted in an immaterial impact to beginning retained earnings, as presented in the accompanying consolidated statement of stockholders’ equity.
Restricted Cash.
In November 2016, the FASB issued ASU 2016-18,
Restricted Cash,
which requires us to include in our consolidated statements of cash flows the changes in the balances of cash, cash equivalents, restricted cash and restricted cash equivalents. We adopted ASU 2016-18 on January 1, 2018. We have applied the guidance retrospectively to all periods presented. Such retrospective adoption resulted in a
$91 million
reclassification of restricted cash and cash equivalents from “Investing activities,” to the beginning and ending balances of cash and cash equivalents in our consolidated statements of cash flows for the
nine months ended September 30, 2017
. There was no impact to our consolidated statements of operations, balance sheets, or stockholders’ equity. The reconciliation of cash and cash equivalents to cash, cash equivalents, and restricted cash and cash equivalents is presented at the beginning of this note.
Recent Accounting Pronouncements Not Yet Adopted
Software Licenses.
In August 2018, the FASB issued ASU 2018-15,
Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract,
which aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. ASU 2018-15 is effective beginning January 1, 2020, and can be applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption; early adoption is permitted. We are evaluating the effect of this guidance.
Callable Debt Securities.
In March 2017, the FASB issued ASU 2017-08,
Premium Amortization on Purchased Callable Debt Securities
, which shortens the amortization period for certain callable debt securities held at a premium. Specifically, the amendments require the premium to be amortized to the earliest call date. ASU 2017-08 is effective beginning January 1, 2019, and must be adopted as a cumulative effect adjustment to retained earnings; early adoption is permitted. We are evaluating the effect of this guidance.
Credit Losses.
In June 2016, the FASB issued ASU 2016-13,
Measurement of Credit Losses on Financial Instruments
. Rather than generally recognizing credit losses when it is probable that the loss has been incurred, the
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revised guidance requires companies to recognize an allowance for credit losses for the difference between the amortized cost basis of a financial instrument and the amount of amortized cost that the company expects to collect over the instrument’s contractual life. ASU 2016-13 is effective beginning January 1, 2020, and must be adopted as a cumulative effect adjustment to retained earnings; early adoption is permitted. We are evaluating the effect of this guidance.
Leases.
In February 2016, the FASB issued ASU 2016-02,
Leases (Topic 842),
as modified by:
•
ASU 2017-03,
Transition and Open Effective Date Information;
•
ASU 2018-01,
Leases (Topic 842): Land Easement Practical Expedient for Transition to Topic 842;
•
ASU 2018-10,
Codification Improvements to Topic 842, Leases; and
•
ASU 2018-11,
Leases (Topic 842): Targeted Improvements.
Under Topic 842, an entity will be required to recognize assets and liabilities for the rights and obligations created by leases on the entity’s balance sheet for both financing and operating leases. Topic 842 also requires new disclosures that depict the amount, timing, and uncertainty of cash flows pertaining to an entity’s leases. We will adopt Topic 842 effective January 1, 2019, using the modified retrospective method. Under this method, we will recognize the cumulative effect of initially applying the standard as an adjustment to the opening balance of retained earnings on January 1, 2019. In addition, we have elected the transition option provided under ASU 2018-11, which allows entities to continue to apply the legacy guidance in Topic 840,
Leases
, including its disclosure requirements, in the comparative periods presented in the year of adoption.
Under Topic 842, we will record right-of-use assets and liabilities relating primarily to our long-term office operating leases. We have substantially completed the configuration of our lease database management system for the adoption of Topic 842. We do not currently expect the adoption of this guidance to have a material effect on our consolidated results of operations, financial condition or cash flows.
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3
.
Net Income (Loss) per Share
The following table sets forth the calculation of basic and diluted net income (loss) per share:
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions, except net income per share)
Numerator:
Net income (loss)
$
197
$
(97
)
$
506
$
(250
)
Denominator:
Shares outstanding at the beginning of the period
61.3
56.5
59.3
55.8
Weighted-average number of shares issued:
Exchange of 1.625% Notes
(1)
—
—
1.3
—
Stock-based compensation
—
—
0.2
0.4
Denominator for basic net income per share
61.3
56.5
60.8
56.2
Effect of dilutive securities:
1.125% Warrants
(1)
5.6
—
5.0
—
1.625% Notes
(1)
0.6
—
0.5
—
Stock-based compensation
0.4
—
0.3
—
Denominator for diluted net income per share
67.9
56.5
66.6
56.2
Net income (loss) per share:
(2)
Basic
$
3.22
$
(1.70
)
$
8.32
$
(4.44
)
Diluted
$
2.90
$
(1.70
)
$
7.60
$
(4.44
)
Potentially dilutive common shares excluded from calculations:
1.125% Warrants
(1)
—
2.3
—
1.3
1.625% Notes
(1)
—
0.6
—
0.3
Stock-based compensation
—
0.2
—
0.3
______________________________
(1)
For more information and definitions regarding the
1.625%
Notes, refer to Note
7
, “
Debt
.” For more information and definitions regarding the
1.125%
Warrants, refer to Note
9
, “
Stockholders' Equity
.” The dilutive effect of all potentially dilutive common shares is calculated using the treasury stock method. Certain potentially dilutive common shares issuable are not included in the computation of diluted net income (loss) per share because to do so would be anti-dilutive.
(2)
Source data for calculations in thousands.
4
.
Fair Value Measurements
We consider the carrying amounts of cash, cash equivalents and other current assets and current liabilities (not including derivatives and the current portion of long-term debt) to approximate their fair values because of the relatively short period of time between the origination of these instruments and their expected realization or payment. For our financial instruments measured at fair value on a recurring basis, we prioritize the inputs used in measuring fair value according to the three-tier fair value hierarchy. For a description of the methods and assumptions that we use to a) estimate the fair value; and b) determine the classification according to the fair value hierarchy for each financial instrument, see Note 4, “Fair Value Measurements,” in our
2017
Annual Report on Form 10-K.
Derivative financial instruments include the
1.125%
Call Option derivative asset and the
1.125%
Conversion Option derivative liability (see Note
8
“
Derivatives
,” for definitions and further information). These derivatives are not actively traded and are valued based on an option pricing model that uses observable and unobservable market data for inputs. Significant market data inputs used to determine fair value as of
September 30, 2018
, included the price of our common stock, the time to maturity of the derivative instruments, the risk-free interest rate, and the implied volatility of our common stock. The 1.125% Call Option derivative asset and the 1.125% Conversion Option
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derivative liability were designed such that changes in their fair values would offset, with minimal impact to the consolidated statements of operations. Therefore, the sensitivity of changes in the unobservable inputs to the option pricing model for such derivative instruments is mitigated.
The net changes in fair value of Level 3 financial instruments were insignificant to our results of operations for the
nine months ended September 30, 2018
.
Our financial instruments measured at fair value on a recurring basis at
September 30, 2018
, were as follows:
Total
Quoted Market Prices (Level 1)
Significant Other Observable Inputs (Level 2)
Significant Unobservable Inputs (Level 3)
(In millions)
Corporate debt securities
$
1,191
$
—
$
1,191
$
—
U.S. treasury notes
221
221
—
—
Government-sponsored enterprise securities (GSEs)
170
170
—
—
Municipal securities
119
—
119
—
Asset-backed securities
92
—
92
—
Certificate of deposit
15
—
15
—
Other
4
—
4
—
Subtotal - current investments
1,812
391
1,421
—
1.125% Call Option derivative asset
843
—
—
843
Total assets
$
2,655
$
391
$
1,421
$
843
1.125% Conversion Option derivative liability
$
843
$
—
$
—
$
843
Total liabilities
$
843
$
—
$
—
$
843
Our financial instruments measured at fair value on a recurring basis at
December 31, 2017
, were as follows:
Total
Quoted Market Prices (Level 1)
Significant Other Observable Inputs (Level 2)
Significant Unobservable Inputs (Level 3)
(In millions)
Corporate debt securities
$
1,588
$
—
$
1,588
$
—
U.S. treasury notes
388
388
—
—
GSEs
253
253
—
—
Municipal securities
141
—
141
—
Asset-backed securities
117
—
117
—
Certificates of deposit
37
—
37
—
Subtotal - current investments
2,524
641
1,883
—
Corporate debt securities
101
—
101
—
U.S. treasury notes
68
68
—
—
Subtotal - current restricted investments
169
68
101
—
1.125% Call Option derivative asset
522
—
—
522
Total assets
$
3,215
$
709
$
1,984
$
522
1.125% Conversion Option derivative liability
$
522
$
—
$
—
$
522
Total liabilities
$
522
$
—
$
—
$
522
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Fair Value Measurements – Disclosure Only
The carrying amounts and estimated fair values of our senior notes are classified as Level 2 financial instruments. Fair value for these securities is determined using a market approach based on quoted market prices for similar securities in active markets or quoted prices for identical securities in inactive markets.
September 30, 2018
December 31, 2017
Carrying
Amount
Fair Value
Carrying
Amount
Fair Value
(In millions)
5.375% Notes
$
693
$
711
$
692
$
730
1.125% Notes
(1)
295
1,142
496
1,052
4.875% Notes
326
325
325
329
1.625% Notes
(2)
—
—
157
220
Credit Facility
(2)
—
—
300
300
$
1,314
$
2,178
$
1,970
$
2,631
______________________
(1)
The fair value of the 1.125% Conversion Option (the embedded cash conversion option), which is included in the fair value amounts presented above, amounted to
$843 million
and
$522 million
as of
September 30, 2018
, and
December 31, 2017
, respectively. See further discussion at Note
7
, “
Debt
,” and Note
8
, “
Derivatives
.”
(2)
For more information on debt repayments in the nine months ended September 30, 2018, refer to Note
7
, “
Debt
.”
5
.
Investments
Available-for-Sale Investments
We consider all of our investments classified as current assets to be available-for-sale. The following tables summarize our investments as of the dates indicated:
September 30, 2018
Amortized
Gross
Unrealized
Estimated
Fair
Cost
Gains
Losses
Value
(In millions)
Corporate debt securities
$
1,197
$
1
$
7
$
1,191
U.S. treasury notes
222
—
1
221
GSEs
172
—
2
170
Municipal securities
121
—
2
119
Asset backed securities
93
—
1
92
Certificates of deposit
15
—
—
15
Other
4
—
—
4
$
1,824
$
1
$
13
$
1,812
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December 31, 2017
Amortized
Gross
Unrealized
Estimated
Fair
Cost
Gains
Losses
Value
(In millions)
Corporate debt securities
$
1,591
$
1
$
4
$
1,588
U.S. treasury notes
389
—
1
388
GSEs
255
—
2
253
Municipal securities
142
—
1
141
Asset-backed securities
117
—
—
117
Certificates of deposit
37
—
—
37
Subtotal - current investments
2,531
1
8
2,524
Corporate debt securities
101
—
—
101
U.S. treasury notes
68
—
—
68
Subtotal - current restricted investments
169
—
—
169
$
2,700
$
1
$
8
$
2,693
The contractual maturities of our available-for-sale investments as of
September 30, 2018
are summarized below:
Amortized Cost
Estimated
Fair Value
(In millions)
Due in one year or less
$
1,025
$
1,023
Due after one year through five years
799
789
$
1,824
$
1,812
As discussed further in Note
7
, “
Debt
,” the
4.875%
Notes’ indenture required us to hold a portion of the net proceeds from their issuance in a segregated account to be used to settle the conversion of the 1.625% Notes. Prior to September 30, 2018, this account was reported as a current asset, entitled “Restricted investments,” in the accompanying consolidated balance sheets. Because this account was used to settle the conversion of the
1.625%
Notes in the third quarter of 2018, current restricted investments, as of September 30, 2018, was reduced to zero.
Gross realized gains and losses from sales of available-for-sale securities are calculated under the specific identification method and are included in investment income. Gross realized investment gains and losses for the three and
nine months ended September 30, 2018
and
2017
were insignificant.
We have determined that unrealized losses at
September 30, 2018
and
December 31, 2017
, are temporary in nature, because the change in market value for these securities has resulted from fluctuating interest rates, rather than a deterioration of the creditworthiness of the issuers. So long as we maintain the intent and ability to hold these securities to maturity, we are unlikely to experience losses. In the event that we dispose of these securities before maturity, we expect that realized losses, if any, will be insignificant.
The following table segregates those available-for-sale investments that have been in a continuous loss position for less than 12 months, and those that have been in a continuous loss position for 12 months or more as of
September 30, 2018
:
In a Continuous Loss Position
for Less than 12 Months
In a Continuous Loss Position
for 12 Months or More
Estimated
Fair
Value
Unrealized
Losses
Total
Number of
Positions
Estimated
Fair
Value
Unrealized
Losses
Total
Number of
Positions
(Dollars in millions)
Corporate debt securities
$
727
$
4
460
$
186
$
3
127
U.S. Treasury notes
—
—
—
94
1
31
GSEs
—
—
—
127
2
68
Municipal securities
63
1
63
55
1
57
Asset backed securities
72
1
41
—
—
—
$
862
$
6
564
$
462
$
7
283
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The following table segregates those available-for-sale investments that have been in a continuous loss position for less than 12 months, and those that have been in a continuous loss position for 12 months or more as of
December 31, 2017
:
In a Continuous Loss Position
for Less than 12 Months
In a Continuous Loss Position
for 12 Months or More
Estimated
Fair
Value
Unrealized
Losses
Total
Number of
Positions
Estimated
Fair
Value
Unrealized
Losses
Total
Number of
Positions
(Dollars in millions)
Corporate debt securities
$
1,297
$
3
561
$
94
$
1
69
U.S. Treasury Notes
470
1
89
—
—
—
GSEs
173
1
69
95
1
47
Municipal securities
—
—
—
38
1
48
$
1,940
$
5
719
$
227
$
3
164
Held-to-Maturity Investments
Pursuant to the regulations governing our Health Plans segment subsidiaries, we maintain statutory deposits and deposits required by government authorities primarily in certificates of deposit and U.S. treasury securities. We also maintain restricted investments as protection against the insolvency of certain capitated providers. The use of these funds is limited as required by regulations in the various states in which we operate, or as needed in the event of insolvency of capitated providers. Therefore, such investments are reported as non-current “Restricted investments” in the accompanying consolidated balance sheets. We have the ability to hold these restricted investments until maturity, and as a result, we would not expect the value of these investments to decline significantly due to a sudden change in market interest rates.
Our held-to-maturity restricted investments are carried at amortized cost, which approximates fair value. Held-to-maturity restricted investments as of
September 30, 2018
, are summarized below:
Amortized
Cost
Estimated
Fair Value
(In millions)
Due in one year or less
$
111
$
111
Due after one year through five years
7
7
$
118
$
118
6
.
Medical Claims and Benefits Payable
The following table provides the details of our medical claims and benefits payable (including amounts payable for the provision of long-term services and supports, or LTSS) as of the dates indicated:
September 30,
2018
December 31,
2017
(In millions)
Fee-for-service claims incurred but not paid (IBNP)
$
1,609
$
1,717
Pharmacy payable
121
112
Capitation payable
48
67
Other
264
296
$
2,042
$
2,192
“Other” medical claims and benefits payable includes amounts payable to certain providers for which we act as an intermediary on behalf of various government agencies without assuming financial risk. Such receipts and payments do not impact our consolidated statements of operations. Non-risk provider payables amounted to
$158 million
and
$122 million
as of
September 30, 2018
and
December 31, 2017
, respectively.
The following table presents the components of the change in our medical claims and benefits payable for the periods indicated. The amounts presented for “Components of medical care costs related to: Prior periods” represent the amounts by which our original estimate of medical claims and benefits payable at the beginning of the
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period were (more) less than the actual amount of the liability based on information (principally the payment of claims) developed since that liability was first reported.
Nine Months Ended September 30,
2018
2017
(In millions)
Medical claims and benefits payable, beginning balance
$
2,192
$
1,929
Components of medical care costs related to:
Current period
11,589
12,813
Prior periods
(227
)
9
Total medical care costs
11,362
12,822
Change in non-risk provider payables
60
172
Payments for medical care costs related to:
Current period
9,866
10,944
Prior periods
1,706
1,501
Total paid
11,572
12,445
Medical claims and benefits payable, ending balance
$
2,042
$
2,478
The differences between our original estimates and the amounts ultimately paid out for the most part relate to IBNP. Assuming that our initial estimate of IBNP is accurate, we believe that amounts ultimately paid would generally be between
8%
and
10%
less than the IBNP liability recorded at the end of the period as a result of the inclusion in that liability of the provision for adverse claims deviation and the accrued cost of settling those claims. Because we establish the provision for adverse claims deviation and the accrued cost of settling claims on a consistent basis every quarter, the lower cost recognized in a subsequent period if such a provision proved unnecessary would be offset by the establishment of a similar provision during that same period.
Because the amount of our initial liability is an estimate, we will always experience variability in that estimate as new information becomes available with the passage of time. Therefore, there can be no assurance that amounts ultimately paid out will fall within the range of
8%
to
10%
lower than the liability that was initially recorded.
Further, because our initial estimate of IBNP is derived from many factors, some of which are qualitative in nature rather than quantitative, we are seldom able to assign specific values to the reasons for a change in estimate—we will only be able to identify specific factors if they represent a significant departure from expectations. As a result, we do not expect to be able to fully quantify the impact of individual factors on changes in estimates.
We believe that the most significant uncertainties surrounding our IBNP estimates at
September 30, 2018
are as follows:
•
Across all of our health plans, the inventory of unpaid claims increased significantly during the first half of 2017, then decreased in the last half of 2017 and into 2018. Changes in claims inventories impact the timing between date of service and the date of claim payment, increasing the volatility of our liability estimates.
•
In June 2018, our Puerto Rico health plan implemented state prescribed claim billing requirements to ensure more accurate claims submissions. The billing requirements were more stringent and caused a significant number of claim denials. Although we expect providers to ultimately submit updated claims with the required information, the impact of the new billing requirements creates more uncertainty in our liability estimates.
•
At our Florida health plan, a new clinical service system was implemented in the first quarter of 2018. This system impacted the reporting of inpatient authorizations used in our development of claims liabilities, which makes our liability estimates subject to more than the usual amount of uncertainty.
•
We recently implemented a new process for increased quality review of claims payments in 11 of our health plans. While we do not anticipate this new process will impact the percentage of claims paid within the timely turnaround requirements, we believe it will have a minor impact on the timing of some paid claims. For this reason, our liability estimates in these 11 health plans are subject to more than the usual amount of uncertainty.
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We recognized favorable prior period claims development in the amount of
$227 million
for the
nine months ended
September 30, 2018
. This amount represents our estimate as of
September 30, 2018
, of the extent to which our initial estimate of medical claims and benefits payable at December 31, 2017, was more than the amount that will ultimately be paid out in satisfaction of that liability. We believe these differences were due primarily to the following factors:
•
The impact of the provision for adverse claims deviation and the accrued cost of settling claims as discussed above. Because we re-establish the provision for adverse claims deviation and the accrued cost of settling claims on a consistent basis every quarter, the impact of this item to medical care costs in the nine months ended September 30, 2018, results was minimal.
•
Across all of our health plans, the inventory of unpaid claims increased significantly during the first half of 2017, then decreased in the last half of 2017. In hindsight, the impact of the changes in claims processing timing reduced our liabilities more than we had anticipated.
•
December 2017 data from The Centers for Disease Control and Prevention indicated widespread influenza activity in several states in which we operate health plans. The additional liabilities established in consideration of increased claims related to a more severe influenza season turned out to be higher than our actual experience.
•
In establishing our liability at December 31, 2017, we anticipated an increase in the utilization of medical services by Marketplace members concerned about the future of their healthcare coverage as a result of uncertainties related to high premium increases and issuer exits. This induced demand did not materialize to the degree we expected.
7
.
Debt
As of
September 30, 2018
, contractual maturities of debt were as follows. All amounts represent the principal amounts of the debt instruments outstanding.
Total
2019
2020
2021
2022
2023
Thereafter
(In millions)
5.375% Notes
$
700
$
—
$
—
$
—
$
700
$
—
$
—
4.875% Notes
330
—
—
—
—
—
330
1.125% Notes
314
—
314
—
—
—
—
$
1,344
$
—
$
314
$
—
$
700
$
—
$
330
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All of our debt is held at the parent, which is reported in the Other segment. The following table summarizes our outstanding debt obligations and their classification in the accompanying consolidated balance sheets:
September 30,
2018
December 31,
2017
(In millions)
Current portion of long-term debt:
1.125% Notes, net of unamortized discount of $18 at September 30, 2018, and $51 at December 31, 2017
$
296
$
499
1.625% Notes, net of unamortized discount of $3 at December 31, 2017
—
157
Lease financing obligations
1
1
Debt issuance costs
(1
)
(4
)
296
653
Non-current portion of long-term debt:
5.375% Notes
700
700
4.875% Notes
330
330
Credit Facility
—
300
Debt issuance costs
(11
)
(12
)
1,019
1,318
Lease financing obligations
198
198
$
1,513
$
2,169
Interest cost recognized relating to our convertible senior notes for the periods presented was as follows:
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions)
Contractual interest at coupon rate
$
1
$
3
$
5
$
9
Amortization of the discount
5
8
18
24
$
6
$
11
$
23
$
33
Credit Facility
In January 2017, we
entered into an amended unsecured
$500 million
revolving credit facility (the Credit Facility). The Credit Facility has a term of
five years
and all amounts outstanding will be due and payable on January 31, 2022. In May 2018, we repaid the
$300 million
outstanding borrowings under the Credit Facility. As of
September 30, 2018
, no amounts were outstanding under the Credit Facility, and outstanding letters of credit amounting to
$6 million
reduced our borrowing capacity under the Credit Facility to
$494 million
.
Borrowings under our Credit Facility bear interest based, at our election, on a base rate or an adjusted London Interbank Offered Rate (LIBOR), plus in each case the applicable margin. In addition to interest payable on the principal amount of indebtedness outstanding from time to time under the Credit Facility, we are required to pay a quarterly commitment fee. Certain of our wholly owned subsidiaries guarantee our obligations under the Credit Facility. The Credit Facility contains customary non-financial and financial covenants, including a net leverage ratio and an interest coverage ratio. As of
September 30, 2018
, we were in compliance with all financial and non-financial covenants under the Credit Facility and other long-term debt.
Bridge Credit Agreement
In January 2018, we entered into a bridge credit agreement with several banks, which was subsequently terminated in August 2018.
5.375% Notes due 2022
We have
$700 million
aggregate principal amount of senior notes (the
5.375%
Notes) outstanding as of
September 30, 2018
, which are due November 15, 2022, unless earlier redeemed. Interest on the 5.375% Notes is payable semiannually in arrears on May 15 and November 15. Certain of our wholly owned subsidiaries guarantee our obligations under the 5.375% Notes; such guarantees mirror those of the Credit Facility. See Note
13
,
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“
Supplemental Condensed Consolidating Financial Information
,” for more information on the guarantors. The 5.375% Notes contain customary non-financial covenants and change in control provisions.
4.875% Notes due 2025
We have
$330 million
aggregate principal amount of senior notes (the
4.875%
Notes) outstanding as of
September 30, 2018
, which are due June 15, 2025, unless earlier redeemed. Interest on the 4.875% Notes is payable semiannually in arrears on June 15 and December 15. Certain of our wholly owned subsidiaries guarantee our obligations under the 4.875% Notes; such guarantees mirror those of the Credit Facility. The 4.875% Notes contain customary non-financial covenants and change of control provisions.
1.125% Cash Convertible Senior Notes due 2020
In the second and third quarters of 2018, we entered into privately negotiated note purchase agreements with certain holders of our outstanding 1.125% cash convertible senior notes due January 15, 2020 (the 1.125% Notes).
In the third quarter of 2018, we repaid
$140 million
aggregate principal amount of the 1.125% Notes, plus accrued interest, for a total cash payment of
$483 million
. The
$343 million
difference between the principal amount extinguished and our cash payment primarily represents the settlement of the 1.125% Notes’ embedded cash conversion option feature at fair value (which is a derivative liability we refer to as the 1.125% Conversion Option).
In the second quarter of 2018, we repaid
$96 million
aggregate principal amount of the 1.125% Notes
, plus accrued interest, for a total cash payment of
$228 million
. As noted above, the
$132 million
difference between the principal amount extinguished and our cash payment primarily represents the settlement of the embedded cash conversion option feature at fair value.
In the nine months ended September 30, 2018, we have recorded a loss on debt extinguishment of
$15 million
for the 1.125% Notes purchases, including
$10 million
in the third quarter of 2018, primarily relating to the acceleration of the debt discount. This loss is reported in “Other expenses (income), net” in the accompanying consolidated statements of operations. No common shares were issued in connection with these transactions.
In connection with the 1.125% Notes purchases, we also entered into privately negotiated termination agreements with each of the counterparties in the second and third quarters of 2018, to partially terminate the Call Spread Overlay, defined and further discussed in Notes
8
, “
Derivatives
,” and
9
, “
Stockholders' Equity
.” The net cash proceeds from the Call Spread Overlay partial termination transactions partially offset the cash paid to settle the 1.125% Notes.
Following the transactions described above, we have
$314 million
aggregate principal amount of the
1.125%
Notes outstanding at
September 30, 2018
. Interest is payable semiannually in arrears on January 15 and July 15. The 1.125% Notes are convertible only into cash, and not into shares of our common stock or any other securities. The initial conversion rate for the 1.125% Notes is
24.5277
shares of our common stock per $1,000 principal amount, or approximately
$40.77
per share of our common stock. Upon conversion, in lieu of receiving shares of our common stock, a holder will receive an amount in cash, per $1,000 principal amount of 1.125% Notes, equal to the settlement amount, determined in the manner set forth in the indenture. We may not redeem the 1.125% Notes prior to the maturity date. The 1.125% Notes
are convertible by the holders within one year of the current balance sheet date until they mature; therefore, they are reported in current portion of long-term debt.
Concurrent with the issuance of the 1.125% Notes, the 1.125% Conversion Option was separated from the 1.125% Notes and accounted for separately as a derivative liability, with changes in fair value reported in our consolidated statements of operations until the 1.125% Conversion Option fully settles or expires. This initial liability simultaneously reduced the carrying value of the 1.125% Notes’ principal amount (effectively an original issuance discount), which is amortized to the principal amount through the recognition of non-cash interest expense over the expected life of the debt. The effective interest rate approximating what we would have incurred had nonconvertible debt with otherwise similar terms been issued is approximately
6%
. As of
September 30, 2018
, the 1.125% Notes had a remaining amortization period of
1.3
years, and their ‘if-converted’ value exceeded their principal amount by approximately
$626 million
and
$406 million
as of
September 30, 2018
and
December 31, 2017
, respectively.
1.625% Convertible Senior Notes due 2044
Conversion.
On July 11, 2018, we announced notice of our election to redeem the remaining
$64 million
aggregate principal amount of the 1.625% convertible senior notes due 2044 (the 1.625% Notes) on August 20, 2018 (the Redemption Date), pursuant to the terms of the indenture.
Also pursuant to the indenture, the 1.625% Notes were convertible until August 17, 2018, at a conversion rate of
17.2157
shares of our common stock per $1,000 principal amount equal to the settlement amount (as defined in the related indenture), or approximately $
58.09
per share of our common stock.
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Through August 17, 2018, we received conversion notices from substantially all of the remaining holders of the 1.625% Notes outstanding. Under the conversions, we paid cash for the remaining
$64 million
aggregate principal amount and delivered
0.6 million
shares of our common stock to the converting holders on the settlement dates in September 2018.
Exchange.
In March 2018, we entered into separate, privately negotiated, synthetic exchange agreements with certain holders of our outstanding 1.625% Notes, under which we exchanged
$97 million
aggregate principal amount and accrued interest for
1.8 million
shares of our common stock. We recorded a loss on debt extinguishment, including transaction fees, of
$10 million
, primarily relating to the inducement premium paid to the bondholders, which is recorded in “Other expenses (income), net” in the accompanying consolidated statements of operations. We did not receive any proceeds from the transaction.
Cross-Default Provisions
The
indentures governing the 4.875% Notes, the 5.375% Notes and the 1.125% Notes contain cross-default provisions that are triggered upon default by us or any of our subsidiaries on any indebtedness in excess of the amount specified in the applicable indenture.
8
.
Derivatives
The following table summarizes the fair values and the presentation of our derivative financial instruments (defined and discussed individually below) in the accompanying consolidated balance sheets:
Balance Sheet Location
September 30,
2018
December 31,
2017
(In millions)
Derivative asset:
1.125% Call Option
Current assets: Derivative asset
$
843
$
522
Derivative liability:
1.125% Conversion Option
Current liabilities: Derivative liability
$
843
$
522
Our derivative financial instruments do not qualify for hedge treatment; therefore, the change in fair value of these instruments is recognized immediately in our consolidated statements of operations, and reported in “Other expenses (income), net.” Gains and losses for our derivative financial instruments are presented individually in the accompanying consolidated statements of cash flows, “Supplemental cash flow information.”
1.125% Notes Call Spread Overlay.
Concurrent with the issuance of the 1.125% Notes in 2013, we entered into privately negotiated hedge transactions (collectively, the
1.125%
Call Option) and warrant transactions (collectively, the 1.125% Warrants), with certain of the initial purchasers of the 1.125% Notes (the Counterparties). We refer to these transactions collectively as the Call Spread Overlay. Under the Call Spread Overlay, the cost of the 1.125% Call Option we purchased to cover the cash outlay upon conversion of the 1.125% Notes was reduced by proceeds from the sale of the 1.125% Warrants. Assuming full performance by the Counterparties (and 1.125% Warrants strike prices in excess of the conversion price of the 1.125% Notes), these transactions are intended to offset cash payments in excess of the principal amount of the 1.125% Notes due upon any conversion of such notes.
In the second and third quarters of 2018, in connection with the 1.125% Notes purchases (described in Note
7
, “
Debt
”),
we entered into privately negotiated termination agreements with each of the Counterparties to partially terminate the Call Spread Overlay, in notional amounts corresponding to the aggregate principal amount of the 1.125% Notes purchased.
In the third quarter of 2018, this resulted in our receipt of
$343 million
for the settlement of the 1.125% Call Option (which is a derivative asset), and the payment of
$306 million
for the partial termination of the 1.125% Warrants, for an aggregate net cash receipt of
$37 million
from the Counterparties.
In the second quarter of 2018, this resulted in our receipt of
$134 million
for the settlement of the 1.125% Call Option, and the payment of
$113 million
for the partial termination of the 1.125% Warrants, for an aggregate net cash receipt of
$21 million
from the Counterparties.
1.125% Call Option.
The
1.125%
Call Option, which is indexed to our common stock, is a derivative asset that requires mark-to-market accounting treatment due to cash settlement features until the 1.125% Call Option settles or expires. For further discussion of the inputs used to determine the fair value of the 1.125% Call Option, refer to Note
4
, “
Fair Value Measurements
.”
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1.125% Conversion Option.
The embedded cash conversion option within the
1.125%
Notes is accounted for separately as a derivative liability, with changes in fair value reported in our consolidated statements of operations until the cash conversion option settles or expires. For further discussion of the inputs used to determine the fair value of the
1.125%
Conversion Option, refer to Note
4
, “
Fair Value Measurements
.”
As of
September 30, 2018
, the 1.125% Call Option and the 1.125% Conversion Option were classified as a current asset and current liability, respectively, because the 1.125% Notes may be converted within twelve months of
September 30, 2018
, as described in Note
7
, “
Debt
.”
9
.
Stockholders' Equity
1.625% Notes
Conversion
. As described in Note
7
, “
Debt
,” we issued
0.6 million
shares of our common stock in connection with the conversion of the 1.625% Notes in the third quarter of 2018.
Exchange
. As described in Note
7
, “
Debt
,” we issued
1.8 million
shares of our common stock in connection with the exchange of the 1.625% Notes in March 2018.
1.125% Warrants
In connection with the Call Spread Overlay transaction described in Note
8
, “
Derivatives
,” in 2013, we issued
13.5
million warrants with a strike price of
$53.8475
per share. Under certain circumstances, beginning in April 2020, if the price of our common stock exceeds the strike price of the
1.125%
Warrants, we will be obligated to issue shares of our common stock subject to a share delivery cap. The 1.125% Warrants could separately have a dilutive effect to the extent that the market value per share of our common stock exceeds the applicable strike price of the 1.125% Warrants. Refer to Note
3
, “
Net Income (Loss) per Share
,” for dilution information for the periods presented. We will not receive any additional proceeds if the 1.125% Warrants are exercised. Following the transactions described below,
7.7 million
of the 1.125% Warrants remain outstanding.
As described in Note
8
, “
Derivatives
,” in the second and third quarters of 2018, we entered into privately negotiated termination agreements with each of the Counterparties to partially terminate the Call Spread Overlay, in notional amounts corresponding to the aggregate principal amount of the 1.125% Notes purchased. In the third quarter of 2018, we paid
$306 million
to the Counterparties for the termination of
3.4 million
of the 1.125% Warrants outstanding, which resulted in a reduction of additional paid-in-capital for the same amount.
In the second quarter of 2018, we paid
$113 million
to the Counterparties for the termination of
2.4 million
of the 1.125% Warrants outstanding, which resulted in a reduction of additional paid-in capital for the same amount.
Share-Based Compensation
In connection with our equity incentive plans and employee stock purchase plan, approximately
281,000
shares of common stock vested or were purchased, net of shares used to settle employees’ income tax obligations, during the
nine months ended September 30, 2018
.
Share-based compensation is generally recorded to “General and administrative expenses” in the accompanying consolidated statements of operations. Total share-based compensation expense for the three and nine months ended September 30, 2018, amounted to
$7 million
and
$20 million
, respectively. Total share-based compensation expense for the three months ended September 30, 2017, amounted to
$3 million
. Total share-based compensation expense for the nine months ended September 30, 2017, amounted to
$38 million
, of which
$23 million
was recorded to “Restructuring and separation costs” in the accompanying consolidated statements of operations.
As of
September 30, 2018
, there was
$41 million
of total unrecognized compensation expense related to unvested restricted stock awards (RSAs), performance stock awards (PSAs), and performance stock units (PSUs), which we expect to recognize over a remaining weighted-average period of
2.8 years
,
0.4 years
and
2.3 years
, respectively. This unrecognized compensation cost assumes an estimated forfeiture rate of
12.1%
for non-executive employees as of
September 30, 2018
.
Also as of
September 30, 2018
, there was
$11 million
of total unrecognized compensation expense related to unvested stock options, which we expect to recognize over a weighted-average period of
2.0 years
. No stock options were granted or exercised in the
nine months ended September 30, 2018
.
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Activity for RSAs, PSAs and PSUs, for the
nine months ended September 30, 2018
, is summarized below:
Restricted Stock Awards
Performance Stock Awards
Performance Stock Units
Total
Weighted
Average
Grant Date
Fair Value
Unvested balance, December 31, 2017
401,804
84,762
91,828
578,394
$
58.35
Granted
353,618
—
212,926
566,544
73.85
Vested
(188,954
)
(32,929
)
—
(221,883
)
57.87
Forfeited
(152,243
)
(48,701
)
(104,527
)
(305,471
)
63.67
Unvested balance, September 30, 2018
414,225
3,132
200,227
617,584
70.11
The aggregate fair values of RSAs, PSAs and PSUs granted and vested are presented in the following table:
Nine Months Ended September 30,
2018
2017
(In millions)
Granted:
Restricted stock awards
$
26
$
19
Performance stock units
16
16
$
42
$
35
Vested:
Restricted stock awards
$
14
$
21
Performance stock awards
3
15
Performance stock units
—
9
$
17
$
45
10
.
Restructuring and Separation Costs
Restructuring and separation costs are reported by the same name in the accompanying consolidated statements of operations.
IT Restructuring
Following the 2017 Restructuring Plan noted below, our
new executive team has focused on a margin recovery plan that includes identification and implementation of various profit improvement initiatives. To that end, we have begun to implement a plan to restructure our information technology department (the IT Restructuring) in the third quarter of 2018.
Expected Costs
In addition to
$3 million
incurred in the third quarter of 2018, we expect to incur approximately
$6 million
for the IT Restructuring in the fourth quarter of 2018. We expect such costs to consist primarily of one-time termination benefits and other costs in the Other segment. We will update the total estimated costs for the IT Restructuring in our 2018 Annual Report on Form 10-K.
Costs Incurred
We have incurred expenses under the IT Restructuring as follows:
Three and Nine Months Ended September 30, 2018
One-Time Termination Benefits
Other Restructuring Costs
Total
Consulting Fees
Contract Termination Costs
(In millions)
Other
$
2
$
1
$
—
$
3
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Reconciliation of Liability
For those restructuring and separation costs that require cash settlement (one-time termination benefits and consulting fees), the following table presents a roll-forward of the accrued liability, which is reported in “Accounts payable and accrued liabilities” in the accompanying consolidated balance sheets.
One-Time Termination Benefits
Other Restructuring Costs
Total
Accrued as of December 31, 2017
$
—
$
—
$
—
Charges
2
1
3
Cash payments
—
—
—
Accrued as of September 30, 2018
$
2
$
1
$
3
2017 Restructuring Plan
Following a management-initiated, broad operational assessment in early 2017, our board of directors approved, and we committed to, a comprehensive restructuring and profitability improvement plan in June 2017 (the 2017 Restructuring Plan). Key activities under this plan to date have included:
•
Streamlining of our organizational structure to eliminate redundant layers of management, consolidate regional support services, and other staff reductions to improve efficiency and the speed and quality of decision making;
•
Re-design of core operating processes such as provider payment, utilization management, quality monitoring and improvement, and information technology, to achieve more effective and cost-efficient outcomes;
•
Remediation of high-cost provider contracts and enhancement of high quality, cost-effective networks;
•
Restructuring, including selective exits, of direct delivery operations; and
•
Partnering with the lowest-cost, most effective vendors.
Costs Incurred
In our 2017 Annual Report on Form 10-K, we reported that we had incurred substantially all of the costs associated with the 2017 Restructuring Plan in 2017, amounting to
$234 million
. In the nine months ended September 30, 2018, we incurred an additional
$35 million
in such costs, primarily as a result of our further evaluation and write-off of a utilization and care management project terminated because of its inconsistency with the goals of the 2017 Restructuring Plan. We also recorded nominal amounts for one-time termination benefits, true-ups of certain lease contract termination costs, and consulting fees recorded in 2017. As of
September 30, 2018
, we had incurred
$269 million
in total costs under the 2017 Restructuring Plan. We expect to complete all activities under the 2017 Restructuring Plan in 2018, with the exception of the cash settlement of lease termination liabilities. We expect to continue to settle those liabilities through 2025, unless the leases are terminated sooner.
The following tables present the major types of such costs by segment. Current and long-lived assets include current and non-current capitalized project costs, and capitalized software determined to be unrecoverable.
Three Months Ended September 30, 2018
One-Time Termination Benefits
Other Restructuring Costs
Total
Write-offs of Current and Long-lived Assets
Consulting Fees
Contract Termination Costs
(In millions)
Health Plans
$
—
$
—
$
—
$
2
$
2
$
—
$
—
$
—
$
2
$
2
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Nine Months Ended September 30, 2018
One-Time Termination Benefits
Other Restructuring Costs
Total
Write-offs of Current and Long-lived Assets
Consulting Fees
Contract Termination Costs
(In millions)
Health Plans
$
—
$
(1
)
$
—
$
10
$
9
Other
5
20
1
—
26
$
5
$
19
$
1
$
10
$
35
Three Months Ended September 30, 2017
Separation Costs - Former Executives
One-Time Termination Benefits
Other Restructuring Costs
Total
Write-offs of Current and Long-lived Assets
Consulting Fees
Contract Termination Costs
(In millions)
Health Plans
$
—
$
27
$
6
$
—
$
—
$
33
Molina Medicaid Solutions
—
—
8
—
—
8
Other
—
23
35
16
3
77
$
—
$
50
$
49
$
16
$
3
$
118
Nine Months Ended September 30, 2017
Separation Costs - Former Executives
One-Time Termination Benefits
Other Restructuring Costs
Total
Write-offs of Current and Long-lived Assets
Consulting Fees
Contract Termination Costs
(In millions)
Health Plans
$
—
$
27
$
6
$
—
$
—
$
33
Molina Medicaid Solutions
—
—
8
—
—
8
Other
35
23
35
24
3
120
$
35
$
50
$
49
$
24
$
3
$
161
As of
September 30, 2018
, we had incurred cumulative restructuring costs under the 2017 Restructuring Plan as follows:
Separation Costs - Former Executives
One-Time Termination Benefits
Other Restructuring Costs
Total
Write-offs of Current and Long-lived Assets
Consulting Fees
Contract Termination Costs
(In millions)
Health Plans
$
—
$
33
$
15
$
—
$
34
$
82
Molina Medicaid Solutions
—
—
8
—
—
8
Other
36
39
57
45
2
179
$
36
$
72
$
80
$
45
$
36
$
269
Reconciliation of Liability
For those restructuring and separation costs that require cash settlement (primarily separation costs, one-time termination benefits, consulting fees and contract termination costs), the following table presents a roll-forward of the accrued liability, which is reported in “Accounts payable and accrued liabilities” in the accompanying
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consolidated balance sheets. The adjustments are due to true-ups of costs recorded in 2017.
Separation Costs - Former Executives
One-Time Termination Benefits
Other Restructuring Costs
Total
(In millions)
Accrued as of December 31, 2017
$
2
$
11
$
35
$
48
Adjustments
—
(1
)
10
9
Charges
—
6
2
8
Cash payments
(2
)
(15
)
(15
)
(32
)
Accrued as of September 30, 2018
$
—
$
1
$
32
$
33
11
.
Segments
We have
three
reportable segments, consisting of our Health Plans segment, which constitutes the vast majority of our operations; our Molina Medicaid Solutions segment; and our Other segment.
Our reportable segments are consistent with how we currently manage the business and view the markets we serve. Refer to Note
1
, “
Organization and Basis of Presentation
,” for a discussion of our recent divestiture of Pathways.
Recent Developments – Molina Medicaid Solutions Segment
We closed on the sale of MMS to DXC Technology Company on September 30, 2018. The net cash selling price for the equity interests of MMS was
$233 million
, which we received on October 1, 2018. As a result of this transaction, we recognized a pretax gain, net of transaction costs, of
$37 million
.
Description of Earnings Measures for Reportable Segments
Margin is the appropriate earnings measure for our reportable segments, based on how our chief operating decision maker currently reviews results, assesses performance, and allocates resources.
Margin for our Health Plans segment is referred to as “Medical margin,” and for our Molina Medicaid Solutions and Other segments, as “Service margin.” Medical margin represents the amount earned by the Health Plans segment after medical care costs are deducted from premium revenue. The medical care ratio represents medical care costs as a percentage of premium revenue, and is one of the key metrics used to assess the performance of the Health Plans segment. Therefore, the underlying medical margin is the most important measure of earnings reviewed by the chief operating decision maker. The service margin is equal to service revenue minus cost of service revenue.
The following table presents total revenue by segment. Inter-segment revenue was insignificant for all periods presented.
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions)
Total revenue:
Health Plans
$
4,565
$
4,899
$
13,826
$
14,538
Molina Medicaid Solutions
53
47
152
140
Other
79
85
248
256
Consolidated
$
4,697
$
5,031
$
14,226
$
14,934
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The following table reconciles margin by segment to consolidated income (loss) before income taxes:
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions)
Margin:
Health Plans
$
547
$
557
$
1,812
$
1,343
Molina Medicaid Solutions
14
5
26
13
Other
5
2
16
8
Total margin
566
564
1,854
1,364
Add: other operating revenues
(1)
230
124
661
379
Add: gain on sale of subsidiary
37
—
37
—
Less: other operating expenses
(2)
(538
)
(769
)
(1,693
)
(2,029
)
Operating income (loss)
295
(81
)
859
(286
)
Other expenses, net
36
32
116
10
Income (loss) before income taxes
$
259
$
(113
)
$
743
$
(296
)
______________________
(1)
Other operating revenues include premium tax revenue, health insurer fees reimbursed, and investment income and other revenue.
(2)
Other operating expenses include general and administrative expenses, premium tax expenses, health insurer fees, depreciation and amortization, restructuring and separation costs, and impairment losses.
12
.
Commitments and Contingencies
California Medicaid Expansion Risk Corridor
In October 2018, we entered into contract amendments with the California Department of Health Care Services that retroactively reinstated the Medicaid Expansion risk corridor requirement for the state fiscal year ended June 2017. This risk corridor mandates a minimum medical loss ratio (MLR) of 85% and a maximum MLR of 95%. The estimated impact of such requirement resulted in a reduction to 2016 and 2017 premium revenue totaling approximately
$57 million
, which we recognized in the quarter ended September 30, 2018.
Regulatory Capital Requirements and Dividend Restrictions
Our health plans are subject to state laws and regulations that, among other things, require the maintenance of minimum levels of statutory capital, as defined by each state. Regulators in some states may also attempt to enforce capital requirements that require the retention of net worth in excess of amounts formally required by statute or regulation. Such statutes, regulations, and informal capital requirements also restrict the timing, payment, and amount of dividends and other distributions that may be paid to us as the sole stockholder. To the extent our subsidiaries must comply with these regulations, they may not have the financial flexibility to transfer funds to us. Based on current statutes and regulations, the net assets in these subsidiaries (after intercompany eliminations) which may not be transferable to us in the form of loans, advances, or cash dividends was approximately
$2,041 million
at
September 30, 2018
, and
$1,691 million
at
December 31, 2017
.
Because of the statutory restrictions that inhibit the ability of our health plans to transfer net assets to us, the amount of retained earnings readily available to pay dividends to our stockholders is generally limited to cash, cash equivalents and investments held by the parent company—Molina Healthcare, Inc.
As of
September 30, 2018
, our health plans had aggregate statutory capital and surplus of approximately
$2,125 million
compared with the estimated required minimum aggregate statutory capital and surplus of approximately
$1,138 million
. All of our health plans were in compliance with the minimum capital requirements at
September 30, 2018
.
We have the ability, and have committed to provide, additional capital to each of our health plans as necessary to ensure compliance with statutory capital and surplus requirements.
Legal Proceedings
The health care industry is subject to numerous laws and regulations of federal, state, and local governments. Penalties associated with violations of these laws and regulations include significant fines, exclusion from participating in publicly funded programs, and the repayment of previously collected revenues.
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In the ordinary course of business we are involved in legal actions, some of which seek monetary damages, including claims for punitive damages, which are not covered by insurance. We have accrued liabilities for certain matters for which we deem the loss to be both probable and reasonably estimable, but the outcome of legal actions is inherently uncertain and our estimates of such losses could change as a result of further developments of these matters. For certain pending matters, accruals have not been established because such matters have not progressed sufficiently through discovery or factual development to enable us to reasonably estimate a range of possible loss. An adverse determination in one or more of these pending matters could have a material adverse effect on our consolidated financial position, results of operations, or cash flows.
Steamfitters Local 449 Pension Plan v. Molina Healthcare, Inc., et al.
On October 5, 2018, the Steamfitters Local 449 Pension Plan filed its first amended class action securities complaint in the Central District Court of California against the Company and its former executive officers, J. Mario Molina, John C. Molina, Terry P. Bayer, and Rick Hopfer, Case 2:18-cv-03579. The amended complaint purports to seek recovery on behalf of all persons or entities who purchased Molina common stock between October 31, 2014, and August 2, 2017, for alleged violations under Sections 10(b) and 20(a) of the Securities Exchange Act of 1934, as amended, and Rule 10b-5 promulgated thereunder. The plaintiff alleges the defendants misled investors regarding the scalability of the Company’s administrative infrastructure during the identified class period. The Company believes it has meritorious defenses to the alleged claims and intends to defend the matter vigorously.
States’ Budgets
Nearly all of our premium revenues come from the joint federal and state funding of the Medicaid and Children’s Health Insurance Program (CHIP) programs. The states and Commonwealth in which we operate our health plans regularly face significant budgetary pressures.
13
.
Supplemental Condensed Consolidating Financial Information
As discussed in Note
7
, “
Debt
,” we have outstanding
$700 million
aggregate principal amount of
5.375%
Notes due November 15, 2022, unless earlier redeemed. At
September 30, 2018
, the
5.375%
Notes were fully and unconditionally guaranteed by certain of our wholly owned subsidiaries on a joint and several basis, with exceptions considered customary for such guarantees.
For all periods presented, the following condensed consolidating financial statements present Molina Healthcare, Inc. (as “Parent Guarantor”), the subsidiary guarantors (as “Other Guarantors”), the subsidiary non-guarantors (as “Non-Guarantors”) and “Eliminations”, according to the guarantor structure as assessed as of and for the nine months ended
September 30, 2018
.
In connection with the divestiture of MMS described in Note
11
, “
Segments
,” MMS was released as an “Other Guarantor” effective September 30, 2018, and is reported in “Non-Guarantors” for all periods presented.
In connection with the sale of all of the membership interests of our wholly owned subsidiary Pathways Health and Community Support LLC (Pathways) described in
Note
1
, “
Organization and Basis of Presentation
,” Pathways was released as an “Other Guarantor” effective October 19, 2018, leaving our wholly owned subsidiary Molina Pathways, LLC as the sole subsidiary guarantor as of that date.
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CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
Three Months Ended September 30, 2018
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Revenue:
Total revenue
$
273
$
—
$
4,695
$
(271
)
$
4,697
Expenses:
Medical care costs
(11
)
—
3,801
—
3,790
Cost of service revenue
—
—
111
—
111
General and administrative expenses
243
1
338
(271
)
311
Premium tax expenses
—
—
110
—
110
Health insurer fees
—
—
87
—
87
Depreciation and amortization
17
—
8
—
25
Restructuring and separation costs
3
—
2
—
5
Total operating expenses
252
1
4,457
(271
)
4,439
Gain on sale of subsidiary
37
—
—
—
37
Operating income (loss)
58
(1
)
238
—
295
Interest expense
26
—
—
—
26
Other expenses, net
10
—
—
—
10
Income (loss) before income taxes
22
(1
)
238
—
259
Income tax (benefit) expense
(6
)
—
68
—
62
Net income (loss) before equity in net earnings (losses) of subsidiaries
28
(1
)
170
—
197
Equity in net earnings (losses) of subsidiaries
169
(2
)
—
(167
)
—
Net income (loss)
$
197
$
(3
)
$
170
$
(167
)
$
197
CONDENSED CONSOLIDATING STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Three Months Ended September 30, 2018
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Net income (loss)
$
197
$
(3
)
$
170
$
(167
)
$
197
Other comprehensive gain, net of tax
1
—
1
(1
)
1
Comprehensive income (loss)
$
198
$
(3
)
$
171
$
(168
)
$
198
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CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
Three Months Ended September 30, 2017
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Revenue:
Total revenue
$
380
$
(1
)
$
5,031
$
(379
)
$
5,031
Expenses:
Medical care costs
3
—
4,217
—
4,220
Cost of service revenue
—
—
123
—
123
General and administrative expenses
244
—
518
(379
)
383
Premium tax expenses
—
—
106
—
106
Depreciation and amortization
23
—
10
—
33
Restructuring and separation costs
77
—
41
—
118
Impairment losses
—
—
129
—
129
Total operating expenses
347
—
5,144
(379
)
5,112
Operating income (loss)
33
(1
)
(113
)
—
(81
)
Interest expense
32
—
—
—
32
Income (loss) before income taxes
1
(1
)
(113
)
—
(113
)
Income tax expense (benefit)
9
(1
)
(24
)
—
(16
)
Net loss before equity in net (losses) earnings of subsidiaries
(8
)
—
(89
)
—
(97
)
Equity in net (losses) earnings of subsidiaries
(89
)
(86
)
8
167
—
Net loss
$
(97
)
$
(86
)
$
(81
)
$
167
$
(97
)
CONDENSED CONSOLIDATING STATEMENTS OF COMPREHENSIVE LOSS
Three Months Ended September 30, 2017
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Net loss
$
(97
)
$
(86
)
$
(81
)
$
167
$
(97
)
Other comprehensive income, net of tax
—
—
—
—
—
Comprehensive loss
$
(97
)
$
(86
)
$
(81
)
$
167
$
(97
)
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CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
Nine Months Ended September 30, 2018
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Revenue:
Total revenue
$
867
$
2
$
14,220
$
(863
)
$
14,226
Expenses:
Medical care costs
(4
)
—
11,366
—
11,362
Cost of service revenue
—
—
349
—
349
General and administrative expenses
762
3
1,096
(863
)
998
Premium tax expenses
—
—
320
—
320
Health insurer fees
—
—
261
—
261
Depreciation and amortization
53
—
23
—
76
Restructuring and separation costs
28
—
10
—
38
Total operating expenses
839
3
13,425
(863
)
13,404
Gain on sale of subsidiary
37
—
—
—
37
Operating income (loss)
65
(1
)
795
—
859
Interest expense
90
—
1
—
91
Other expenses, net
25
—
—
—
25
(Loss) income before income taxes
(50
)
(1
)
794
—
743
Income tax expense
4
—
233
—
237
Net (loss) income before equity in net earnings (losses) of subsidiaries
(54
)
(1
)
561
—
506
Equity in net earnings (losses) of subsidiaries
560
(6
)
—
(554
)
—
Net income (loss)
$
506
$
(7
)
$
561
$
(554
)
$
506
CONDENSED CONSOLIDATING STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Nine Months Ended September 30, 2018
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Net income (loss)
$
506
$
(7
)
$
561
$
(554
)
$
506
Other comprehensive loss, net of tax
(4
)
—
(4
)
4
(4
)
Comprehensive income (loss)
$
502
$
(7
)
$
557
$
(550
)
$
502
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CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
Nine Months Ended September 30, 2017
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Revenue:
Total revenue
$
1,010
$
1
$
14,937
$
(1,014
)
$
14,934
Expenses:
Medical care costs
10
—
12,812
—
12,822
Cost of service revenue
—
—
369
—
369
General and administrative expenses
799
2
1,440
(1,014
)
1,227
Premium tax expenses
—
—
331
—
331
Depreciation and amortization
75
—
34
—
109
Restructuring and separation costs
120
—
41
—
161
Impairment losses
—
—
201
—
201
Total operating expenses
1,004
2
15,228
(1,014
)
15,220
Operating income (loss)
6
(1
)
(291
)
—
(286
)
Interest expense
85
—
—
—
85
Other income, net
(75
)
—
—
—
(75
)
Loss before income taxes
(4
)
(1
)
(291
)
—
(296
)
Income tax expense (benefit)
26
(1
)
(71
)
—
(46
)
Net loss before equity in net (losses) earnings of subsidiaries
(30
)
—
(220
)
—
(250
)
Equity in net (losses) earnings of subsidiaries
(220
)
(152
)
8
364
—
Net loss
$
(250
)
$
(152
)
$
(212
)
$
364
$
(250
)
CONDENSED CONSOLIDATING STATEMENTS OF COMPREHENSIVE LOSS
Nine Months Ended September 30, 2017
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Net loss
$
(250
)
$
(152
)
$
(212
)
$
364
$
(250
)
Other comprehensive income, net of tax
1
—
1
(1
)
1
Comprehensive loss
$
(249
)
$
(152
)
$
(211
)
$
363
$
(249
)
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CONDENSED CONSOLIDATING BALANCE SHEETS
September 30, 2018
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
ASSETS
Current assets:
Cash and cash equivalents
$
399
$
2
$
2,413
$
—
$
2,814
Investments
106
—
1,706
—
1,812
Receivables
2
—
1,344
—
1,346
Due from (to) affiliates
63
(4
)
(59
)
—
—
Prepaid expenses and other current assets
293
—
193
—
486
Derivative asset
843
—
—
—
843
Total current assets
1,706
(2
)
5,597
—
7,301
Property, equipment, and capitalized software, net
187
—
77
—
264
Goodwill and intangible assets, net
14
—
181
—
195
Restricted investments
—
—
118
—
118
Investment in subsidiaries, net
2,578
74
—
(2,652
)
—
Deferred income taxes
48
—
95
—
143
Other assets
40
—
6
(16
)
30
$
4,573
$
72
$
6,074
$
(2,668
)
$
8,051
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Medical claims and benefits payable
$
4
$
—
$
2,038
$
—
$
2,042
Amounts due government agencies
—
—
1,030
—
1,030
Accounts payable and accrued liabilities
635
—
189
—
824
Deferred revenue
—
—
178
—
178
Current portion of long-term debt
296
—
—
—
296
Derivative liability
843
—
—
—
843
Total current liabilities
1,778
—
3,435
—
5,213
Long-term debt and lease financing obligations
1,217
—
16
(16
)
1,217
Other long-term liabilities
17
—
43
—
60
Total liabilities
3,012
—
3,494
(16
)
6,490
Total stockholders’ equity
1,561
72
2,580
(2,652
)
1,561
$
4,573
$
72
$
6,074
$
(2,668
)
$
8,051
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CONDENSED CONSOLIDATING BALANCE SHEETS
December 31, 2017
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
ASSETS
Current assets:
Cash and cash equivalents
$
504
$
—
$
2,682
$
—
$
3,186
Investments
192
—
2,332
—
2,524
Restricted investments
169
—
—
—
169
Receivables
2
—
869
—
871
Due from (to) affiliates
148
(5
)
(143
)
—
—
Prepaid expenses and other current assets
103
16
136
(16
)
239
Derivative asset
522
—
—
—
522
Total current assets
1,640
11
5,876
(16
)
7,511
Property, equipment, and capitalized software, net
223
—
119
—
342
Goodwill and intangible assets, net
15
—
240
—
255
Restricted investments
—
—
119
—
119
Investment in subsidiaries, net
2,306
82
—
(2,388
)
—
Deferred income taxes
17
—
101
(15
)
103
Other assets
32
—
110
(1
)
141
$
4,233
$
93
$
6,565
$
(2,420
)
$
8,471
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Medical claims and benefits payable
$
3
$
—
$
2,189
$
—
$
2,192
Amounts due government agencies
—
—
1,542
—
1,542
Accounts payable and accrued liabilities
178
14
174
—
366
Deferred revenue
—
—
282
—
282
Current portion of long-term debt
653
—
16
(16
)
653
Derivative liability
522
—
—
—
522
Total current liabilities
1,356
14
4,203
(16
)
5,557
Long-term debt and lease financing obligations
1,516
—
—
—
1,516
Deferred income taxes
—
—
15
(15
)
—
Other long-term liabilities
24
1
37
(1
)
61
Total liabilities
2,896
15
4,255
(32
)
7,134
Total stockholders’ equity
1,337
78
2,310
(2,388
)
1,337
$
4,233
$
93
$
6,565
$
(2,420
)
$
8,471
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CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWS
Nine Months Ended September 30, 2018
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Operating activities:
Net cash provided by (used in) operating activities
$
451
$
1
$
(643
)
$
—
$
(191
)
Investing activities:
Purchases of investments
(136
)
—
(1,066
)
—
(1,202
)
Proceeds from sales and maturities of investments
383
—
1,687
—
2,070
Purchases of property, equipment and capitalized software
(16
)
—
(8
)
—
(24
)
Capital contributions to subsidiaries
(122
)
—
122
—
—
Dividends from subsidiaries
268
—
(268
)
—
—
Change in amounts due to/from affiliates
70
1
(71
)
—
—
Other, net
—
—
(23
)
—
(23
)
Net cash provided by investing activities
447
1
373
—
821
Financing activities:
Repayment of credit facility
(300
)
—
—
—
(300
)
Repayment of principal amount of 1.125% Notes
(236
)
—
—
—
(236
)
Cash paid for partial settlement of 1.125% Conversion Option
(477
)
—
—
—
(477
)
Cash received for partial termination of 1.125% Call Option
477
—
—
—
477
Cash paid for partial termination of 1.125% Warrants
(419
)
—
—
—
(419
)
Repayment of principal amount of 1.625% Notes
(64
)
—
—
—
(64
)
Other, net
7
—
—
—
7
Net cash used in financing activities
(1,012
)
—
—
—
(1,012
)
Net (decrease) increase in cash, cash equivalents, and restricted cash and cash equivalents
(114
)
2
(270
)
—
(382
)
Cash, cash equivalents, and restricted cash and cash equivalents at beginning of period
513
—
2,777
—
3,290
Cash, cash equivalents, and restricted cash and cash equivalents at end of period
$
399
$
2
$
2,507
$
—
$
2,908
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Nine Months Ended September 30, 2017
Parent Guarantor
Other Guarantors
Non-Guarantors
Eliminations
Consolidated
(In millions)
Operating activities:
Net cash provided by operating activities
$
215
$
—
$
742
$
—
$
957
Investing activities:
Purchases of investments
(331
)
—
(1,563
)
—
(1,894
)
Proceeds from sales and maturities of investments
148
—
1,388
—
1,536
Purchases of property, equipment and capitalized software
(67
)
—
(18
)
—
(85
)
Capital contributions to subsidiaries
(363
)
2
361
—
—
Dividends from subsidiaries
136
—
(136
)
—
—
Change in amounts due to/from affiliates
(100
)
—
100
—
—
Other, net
—
—
(33
)
—
(33
)
Net cash (used in) provided by investing activities
(577
)
2
99
—
(476
)
Financing activities:
Proceeds from senior notes offerings, net of issuance costs
325
—
—
—
325
Proceeds from borrowings under credit facility
300
—
—
—
300
Other, net
7
—
—
—
7
Net cash provided by financing activities
632
—
—
—
632
Net increase in cash, cash equivalents, and restricted cash and cash equivalents
270
2
841
—
1,113
Cash, cash equivalents, and restricted cash and cash equivalents at beginning of period
86
—
2,826
—
2,912
Cash, cash equivalents, and restricted cash and cash equivalents at end of period
$
356
$
2
$
3,667
$
—
$
4,025
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MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS (MD&A)
FORWARD-LOOKING STATEMENTS
This quarterly report on Form 10-Q contains forward-looking statements regarding our business, financial condition, and results of operations within the meaning of Section 27A of the Securities Act of 1933, or Securities Act, and Section 21E of the Securities Exchange Act of 1934, or Securities Exchange Act. We intend such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995, and we are including this statement for purposes of complying with these safe harbor provisions. All statements included in this quarterly report, other than statements of historical fact, may be deemed to be forward-looking statements for purposes of the Securities Act and the Securities Exchange Act. Without limiting the foregoing, we use the words “anticipate(s),” “believe(s),” “estimate(s),” “expect(s),” “intend(s),” “may,” “plan(s),” “project(s),” “will,” “would,” “could,” “should” and similar expressions to identify forward-looking statements, although not all forward-looking statements contain these identifying words. We cannot guarantee that we will actually achieve the plans, intentions, or expectations disclosed in our forward-looking statements and, accordingly, you should not place undue reliance on our forward-looking statements. We caution you that we do not undertake any obligation to update forward-looking statements made by us. Forward-looking statements involve known and unknown risks and uncertainties that may cause our actual results in future periods to differ materially from those projected, estimated, or expected. Those known risks and uncertainties include, but are not limited to, the following:
•
the success of the Company’s profit improvement and maintenance initiatives, including the timing and amounts of the benefits realized, and administrative and medical cost savings achieved;
•
the numerous political and market-based uncertainties associated with the Affordable Care Act (the “ACA”) or “Obamacare;”
•
the market dynamics surrounding the ACA Marketplaces, including but not limited to uncertainties associated with risk adjustment requirements, the potential for disproportionate enrollment of higher acuity members, the discontinuation of premium tax credits, and the adequacy of agreed rates;
•
subsequent adjustments to reported premium revenue based upon subsequent developments or new information, including changes to estimated amounts payable or receivable related to Marketplace risk adjustment;
•
effective management of the Company’s medical costs;
•
the Company’s ability to predict with a reasonable degree of accuracy utilization rates, including utilization rates associated with seasonal flu patterns or other newly emergent diseases;
•
significant budget pressures on state governments and their potential inability to maintain current rates, to implement expected rate increases, or to maintain existing benefit packages or membership eligibility thresholds or criteria;
•
the full reimbursement of the ACA health insurer fee, or HIF;
•
the success of the Company’s efforts to retain existing or awarded government contracts, including the success of any protest filings or defenses;
•
the Company’s ability to manage its operations, including maintaining and creating adequate internal systems and controls relating to authorizations, approvals, provider payments, and the overall success of its care management initiatives;
•
the Company’s ability to consummate and realize benefits from divestitures and acquisitions, including the recently consummated MMS and Pathways divestitures;
•
the Company’s receipt of adequate premium rates to support increasing pharmacy costs, including costs associated with specialty drugs and costs resulting from formulary changes that allow the option of higher-priced non-generic drugs;
•
the Company’s ability to operate profitably in an environment where the trend in premium rate increases lags behind the trend in increasing medical costs;
•
the interpretation and implementation of federal or state medical cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit sharing arrangements, and risk adjustment provisions and requirements;
•
the Company’s estimates of amounts owed for such cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit-sharing arrangements, and risk adjustment provisions;
•
the Medicaid expansion medical cost corridors in California, New Mexico, and Washington, and any other retroactive adjustment to revenue where methodologies and procedures are subject to interpretation or dependent upon information about the health status of participants other than Molina members;
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•
the interpretation and implementation of at-risk premium rules and state contract performance requirements regarding the achievement of certain quality measures, and the Company’s ability to recognize revenue amounts associated therewith;
•
cyber-attacks or other privacy or data security incidents resulting in an inadvertent unauthorized disclosure of protected health information;
•
the success of the Company’s health plan in Puerto Rico, including the resolution of the debt crisis and the effect of the PROMESA law, and the impact of any future significant weather events;
•
the success and renewal of the Company’s duals demonstration programs in California, Illinois, Michigan, Ohio, South Carolina, and Texas;
•
the accurate estimation of incurred but not reported or paid medical costs across the Company’s health plans;
•
efforts by states to recoup previously paid and recognized premium amounts;
•
complications, member confusion, or enrollment backlogs related to the annual renewal of Medicaid coverage;
•
government audits and reviews, or potential investigations, and any fine, sanction, enrollment freeze, monitoring program, or premium recovery that may result therefrom;
•
changes with respect to the Company’s provider contracts and the loss of providers;
•
approval by state regulators of dividends and distributions by the Company’s health plan subsidiaries;
•
changes in funding under the Company’s contracts as a result of regulatory changes, programmatic adjustments, or other reforms;
•
high dollar claims related to catastrophic illness;
•
the favorable resolution of litigation, arbitration, or administrative proceedings, including litigation involving the ACA to which we ourselves are not a direct party;
•
the relatively small number of states in which we operate health plans, including the greater scale and revenues of the Company’s California, Ohio, Texas, and Washington health plans;
•
the availability of adequate financing on acceptable terms to fund and capitalize the Company’s expansion and growth, repay the Company’s outstanding indebtedness at maturity and meet its liquidity needs, including the interest expense and other costs associated with such financing;
•
the Company’s failure to comply with the financial or other covenants in its credit agreement or the indentures governing its outstanding notes;
•
the sufficiency of the Company’s funds on hand to pay the amounts due upon conversion or maturity of its outstanding notes;
•
the failure of a state in which we operate to renew its federal Medicaid waiver;
•
changes generally affecting the managed care or Medicaid management information systems industries;
•
increases in government surcharges, taxes, and assessments, including but not limited to the deductibility of certain compensation costs;
•
newly emergent viruses or widespread epidemics, public catastrophes or terrorist attacks, and associated public alarm;
•
the unexpected loss of the leadership of one or more of our senior executives;
and
•
increasing competition and consolidation in the Medicaid industry
;
Readers should refer to the section entitled “Risk Factors” in our Annual Report on Form 10-K for the year ended
December 31, 2017
for a discussion of certain risk factors that could materially affect our business, financial condition, cash flows, or results of operations. Given these risks and uncertainties, we can give no assurance that any results or events projected or contemplated by our forward-looking statements will in fact occur.
This Quarterly Report on Form 10-Q and the following discussion of our financial condition and results of operations should be read in conjunction with the accompanying consolidated financial statements and the notes to those statements appearing elsewhere in this report, and the audited financial statements and Management’s Discussion and Analysis appearing in our Annual Report on Form 10-K for the year ended
December 31, 2017
.
ABOUT MOLINA HEALTHCARE
OUR MISSION IS TO PROVIDE QUALITY HEALTHCARE TO PEOPLE RECEIVING GOVERNMENT ASSISTANCE.
Molina Healthcare, Inc. provides quality managed health care to people receiving government assistance. We offer cost-effective Medicaid-related solutions to meet the health care needs of low-income families and individuals, and to assist government agencies in their administration of the Medicaid program.
We have
three
reportable segments,
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consisting of our Health Plans segment, which constitutes the vast majority of our operations; our Molina Medicaid Solutions segment; and our Other segment.
OVERVIEW - FINANCIAL SUMMARY
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions, except per-share amounts)
Revenue:
Premium revenue
$
4,337
$
4,777
$
13,174
$
14,165
Premium tax revenue
110
106
320
331
Health insurer fees reimbursed
83
—
248
—
Investment income and other revenue
37
18
93
48
Operating expenses:
Medical care costs
3,790
4,220
11,362
12,822
General and administrative expenses
311
383
998
1,227
Premium tax expenses
110
106
320
331
Health insurer fees
87
—
261
—
Gain on sale of subsidiary
37
—
37
—
Operating income (loss)
295
(81
)
859
(286
)
Interest expense
26
32
91
85
Other expenses (income), net
10
—
25
(75
)
Income tax expense (benefit)
62
(16
)
237
(46
)
Net income (loss)
197
(97
)
506
(250
)
Operating Statistics:
Ending total membership
4.0
4.5
4.0
4.5
MCR
(1)
87.4
%
88.3
%
86.2
%
90.5
%
G&A ratio
(2)
6.6
%
7.6
%
7.0
%
8.2
%
Premium tax ratio
(1)
2.5
%
2.2
%
2.4
%
2.3
%
Effective income tax rate
24.0
%
14.6
%
31.9
%
15.5
%
Net profit (loss) margin
(2)
4.2
%
(1.9
)%
3.6
%
(1.7
)%
Net income (loss) per diluted share
$
2.90
$
(1.70
)
$
7.60
$
(4.44
)
________________________
(1)
MCR 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)
Net profit margin represents net income as a percentage of total revenue. G&A ratio represents general and administrative expenses as a percentage of total revenue.
CONSOLIDATED RESULTS
See tables below, under “Summary of Significant Items,” for details relating to significant non-run rate items, such as impairment losses, restructuring costs and material out of period adjustments to premiums or medical care costs.
NET INCOME AND OPERATING INCOME
Net income for the
third quarter of 2018
amounted to
$197 million
, or
$2.90
per diluted share, compared with a net loss of
$97 million
, or
$1.70
per diluted share for the
third quarter of 2017
. Operating income for the third quarter of 2018 amounted to
$295 million
, compared with an operating loss of
$81 million
in the third quarter of 2017. The
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year-over-year improvement is mainly driven by a decline in the medical care ratio (MCR). Additionally, results for the third quarter of 2017 reflect
$247 million
in impairment and restructuring charges, or $3.16 per diluted share.
Net income for the
nine months ended September 30, 2018
was
$506 million
, or
$7.60
per diluted share, compared with a net loss of
$250 million
, or
$4.44
per diluted share for the
nine months ended September 30, 2017
. Operating income for the
nine months ended September 30, 2018
amounted to
$859 million
, compared with an operating loss of
$286 million
for the
nine months ended September 30, 2017
. The year-over-year improvement is mainly driven by a decline in the MCR. Additionally, results for the nine months ended September 30, 2017 reflect $362 million in impairment and restructuring charges, or $4.69 per diluted share.
PREMIUM REVENUE
Premium revenue decreased
$440 million
in the
third quarter of 2018
, when compared with the
third quarter of 2017
. Member months declined
11%
, partially offset by a per-member per-month (PMPM) revenue increase of
2%
. Lower premium revenue was driven by a decrease in Marketplace membership, partially offset by Marketplace premium rate increases. In addition, we recognized a
$57 million
reduction in revenues for a retroactive California Medicaid Expansion risk corridor for the state’s 2017 fiscal year
in the
third quarter of 2018
.
Premium revenue decreased
$991 million
in the
nine months ended September 30, 2018
, when compared with the
nine months ended September 30, 2017
. Member months declined
13%
, partially offset by a revenue PMPM increase of
6%
, primarily relating to Marketplace membership as noted above.
PREMIUM TAX REVENUE AND EXPENSES
The premium tax ratio (premium tax expense as a percentage of premium revenue plus premium tax revenue) was
2.5%
for the
third quarter of 2018
compared with
2.2%
for the
third quarter of 2017
; and
2.4%
compared with
2.3%
for the
nine months ended September 30, 2018
and 2017, respectively. At our California health plan, the premium tax rate is based on the prior state fiscal year enrollment. Because the California health plan’s enrollment and premium revenue have declined in 2018, premium taxes recognized in 2018 have driven a higher premium tax ratio in 2018.
INVESTMENT INCOME AND OTHER REVENUE
Investment income and other revenue increased to
$37 million
for the
third quarter of 2018
, compared with
$18 million
for the
third quarter of 2017
, and increased to
$93 million
for the
nine months ended September 30, 2018
, compared with
$48 million
for the
nine months ended September 30, 2017
. The current quarter and year-to-date increases were a result of two factors. First, investment income improved due to annualized portfolio yields, and, for the
nine months ended September 30, 2018
, we had higher average invested assets. In addition, other revenue increased in the
third quarter
and
nine months ended September 30, 2018
, due to administrative services fees earned in our Washington health plan following that state’s decision to transition the management of Medicaid pharmacy benefits to an administrative services-based arrangement in 2018.
MEDICAL CARE RATIO (MCR)
Overall, the MCR decreased to
87.4%
in the
third quarter of 2018
, from
88.3%
in the
third quarter of 2017
. Excluding the retroactive California Medicaid Expansion risk corridor adjustment and a small benefit from the 2017 Marketplace cost sharing reduction (CSR), the MCR would have been
86.4%
in the third quarter of 2018.
Excluding the change in Marketplace premium deficiency reserve for 2017 dates of service, the MCR for the third quarter of 2017 would have been
89.0%
. The improvement was mainly due to a decrease in the Medicaid and Marketplace MCRs, partially offset by an increase in the Medicare MCR.
Overall, the MCR improved to
86.2%
for the
nine months ended September 30, 2018
, from
90.5%
in the
nine months ended September 30, 2017
. Excluding adjustments for the retroactive California Medicaid Expansion risk corridor, and the combined benefit of the 2017 Marketplace risk adjustment and CSR reimbursement, the MCR for the
nine months ended September 30, 2018
would have been
86.9%
. Excluding the change in Marketplace premium deficiency reserve for 2017 dates of service, the MCR for the
nine months ended September 30, 2017
would have been
90.2%
. The improvement was due to a decrease in the MCRs across our Medicaid, Medicare and Marketplace plans.
GENERAL AND ADMINISTRATIVE (G&A) EXPENSES
The general and administrative (G&A) expense ratio decreased to
6.6%
for the
third quarter of 2018
, from
7.6%
for the
third quarter of 2017
, and decreased to
7.0%
for the
nine months ended September 30, 2018
, from
8.2%
for the
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nine months ended September 30, 2017
. This year-over-year improvement was primarily the result of continued G&A cost containment.
HEALTH INSURER FEES (HIF)
Health insurer fees amounted to
$87 million
and
$261 million
, and health insurer fees reimbursed amounted to
$83 million
and
$248 million
, in the
third quarter of 2018
and the
nine months ended September 30, 2018
, respectively.
There were no HIF expensed or reimbursed in 2017 due to the HIF moratorium under the Consolidated Appropriations Act of 2016.
GAIN ON SALE OF SUBSIDIARY
We closed on the sale of Molina Medicaid Solutions (MMS) to DXC Technology Company on September 30, 2018. The net cash selling price for the equity interests of MMS was
$233 million
, which we received on October 1, 2018. As a result of this transaction, we recognized a pretax gain, net of transaction costs, of
$37 million
, or
$0.42
per diluted share in the third quarter of 2018.
INTEREST EXPENSE
Interest expense was
$26 million
for the
third quarter of 2018
, compared with
$32 million
for the
third quarter of 2017
. Interest expense was
$91 million
for the
nine months ended September 30, 2018
, compared with
$85 million
for the
nine months ended September 30, 2017
. As further described below in “Liquidity,” year to date we have reduced the principal amount of outstanding debt by
$697 million
.
Interest expense includes non-cash interest expense relating primarily to the amortization of the discount on convertible senior notes, which amounted to
$5 million
and
$8 million
in the
third quarter of 2018
and
2017
, respectively and
$18 million
and
$24 million
in the
nine months ended September 30, 2018
and 2017, respectively. See further discussion in Notes to Consolidated Financial Statements, Note
7
, “
Debt
.”
OTHER EXPENSES (INCOME), NET
In the three and
nine months ended September 30, 2018
, we recorded other expenses of
$10 million
and
$25 million
, respectively, due to the loss on debt extinguishment resulting from our 1.125% Notes repayments and the 1.625% Notes exchange. These transactions are described further in Notes to Consolidated Financial Statements, Note
7
, “
Debt
.” In early 2017, we received a
$75 million
fee in connection with a terminated Medicare acquisition.
INCOME TAXES
The provision for income taxes was recorded at an effective rate of
24.0%
for the
third quarter of 2018
, compared with a benefit of
14.6%
for the
third quarter of 2017
, and
31.9%
for the
nine months ended September 30, 2018
, compared with a benefit of
15.5%
for the
nine months ended September 30, 2017
. The effective tax rate for 2018 differs from 2017 as a result of the reduction in the federal statutory rate from 35% to 21% under the TCJA and higher non-deductible expenses in 2018, primarily related to the non-deductible HIF, as a percentage of pre-tax income (loss). The HIF was not applicable in 2017 due to the 2017 HIF moratorium.
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SUMMARY OF SIGNIFICANT ITEMS
The tables below summarize the impact of certain items significant to our financial performance in the periods presented. The individual items presented below increase (decrease) income (loss) before income tax expense (benefit).
Three Months Ended September 30, 2018
Nine Months Ended September 30, 2018
Amount
Per Diluted Share
(1)
Amount
Per Diluted Share
(1)
Retroactive California Medicaid Expansion risk corridor for the state fiscal year ended June 30, 2017
$
(57
)
$
(0.65
)
$
(57
)
$
(0.67
)
Marketplace risk adjustment, for 2017 dates of service
—
—
56
0.66
Marketplace CSR subsidies, for 2017 dates of service
5
0.06
81
0.95
Gain on sale of subsidiary
37
0.42
37
0.43
Restructuring costs
(2)
(5
)
(0.06
)
(38
)
(0.45
)
Loss on debt extinguishment
(10
)
(0.12
)
(25
)
(0.33
)
$
(30
)
$
(0.35
)
$
54
$
0.59
Three Months Ended September 30, 2017
Nine Months Ended September 30, 2017
Amount
Per Diluted Share
(1)
Amount
Per Diluted Share
(1)
Restructuring costs
(2)
$
(118
)
$
(1.39
)
$
(161
)
$
(1.92
)
Impairment losses
(3)
(129
)
(1.77
)
(201
)
(2.77
)
Change in Marketplace premium deficiency reserve for 2017 service dates
30
0.33
(40
)
(0.45
)
Termination fee received for terminated Medicare acquisition
—
—
75
0.84
$
(217
)
$
(2.83
)
$
(327
)
$
(4.30
)
__________________
(1)
Except for certain items that are not deductible for tax purposes, per diluted share amounts are generally calculated at the statutory income tax rates of 22% for 2018, and 37% for 2017.
(2)
For more information, refer to Notes to Consolidated Financial Statements, Note
10
, “
Restructuring and Separation Costs
.”
(3)
In the nine months ended September 30, 2017, we recorded non-cash impairment losses for goodwill and intangibles, primarily relating to our Pathways subsidiary.
REPORTABLE SEGMENTS
HOW WE ASSESS PERFORMANCE
We derive our revenues primarily from health insurance premiums, and our primary customers are state Medicaid agencies and the federal government.
One of the key metrics used to assess the performance of our most significant segment, the Health Plans segment, is the MCR, which represents medical care costs as a percentage of premium revenue. Therefore, the underlying margin, or the amount earned by the Health Plans segment after medical costs are deducted from premium revenue, is the most important measure of earnings reviewed by management.
Margin for our Health Plans segment is referred to as “Medical margin,” and for our Molina Medicaid Solutions and Other segments, as “Service margin.” The service margin is equal to service revenue minus cost of service revenue. Management’s discussion and analysis of the changes in the individual components of medical margin and service margin follows.
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SEGMENT SUMMARY
Three Months Ended September 30,
Nine Months Ended September 30,
2018
2017
2018
2017
(In millions)
Health Plans segment medical margin
(1)
$
547
$
557
$
1,812
$
1,343
Molina Medicaid Solutions segment service margin
(2)
14
5
26
13
Other segment service margin
(2)
5
2
16
8
Total margin
$
566
$
564
$
1,854
$
1,364
Health Plans segment medical care ratio
87.4
%
88.3
%
86.2
%
90.5
%
_______________________
(1)
Represents premium revenue minus medical care costs.
(2)
Represents service revenue minus cost of service revenue.
HEALTH PLANS
The Health Plans segment consists of health plans operating in
13
states and the Commonwealth of Puerto Rico. As of
September 30, 2018
, these health plans served approximately
4.0 million
members eligible for Medicaid, Medicare, and other government-sponsored health care programs for low-income families and individuals. This membership includes Marketplace members, most of whom receive government premium subsidies.
RECENT DEVELOPMENTS
Renewal of Medicaid Contracts
Year to date in 2018, we renewed Medicaid contracts in Washington, Florida and Puerto Rico as follows:
•
In May 2018, our Washington health plan was selected by the Washington State Health Care Authority (HCA) to enter into a managed care contract for the eight remaining regions of the state’s Apple Health Integrated Managed Care program, in addition to the two regions previously awarded to us. We were selected by HCA for the following regions: Greater Columbia, King, North Sound, Pierce, and Spokane beginning January 1, 2019; and Salish, Thurston-Mason, and Great Rivers beginning January 1, 2020. As of September 30, 2018, we served approximately
738,000
Medicaid members in Washington, which represented premium revenue of
$1,558 million
for the
nine months ended September 30, 2018
.
•
In June 2018, our Florida health plan was awarded comprehensive Medicaid Managed Care contracts by the Florida Agency for Health Care Administration (AHCA) in Regions 8 and 11 of the Florida Statewide Medicaid Managed Care Invitation to Negotiate. As of September 30, 2018, we served approximately
96,000
Medicaid members in those regions, which represented premium revenue of approximately
$346 million
for the
nine months ended September 30, 2018
. Services under the new contract are expected to begin on January 1, 2019. We will be serving both the Medicaid and long-term care populations in the two regions.
•
In July 2018, our Puerto Rico health plan was selected by the Puerto Rico Health Insurance Administration to be one of the organizations to administer the Commonwealth’s new Medicaid Managed Care contract. We expect to serve approximately
290,000
members under the new contract. The base contract runs for a period of three years with an optional one-year extension. As of September 30, 2018, we served approximately
320,000
Medicaid members in the East and Southwest regions of Puerto Rico, which represented premium revenue of
$549 million
for the
nine months ended September 30, 2018
.
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TRENDS AND UNCERTAINTIES
Upcoming Contract Reprocurements
The following table illustrates Health Plans segment Medicaid contracts scheduled for re-procurement in the near term. While we have been notified of the Medicaid regulators’ intention to re-procure the contracts, the anticipated award dates and effective dates are management’s current best estimates; such dates are subject to change. Premium revenue is stated in millions.
Premium Revenue
Membership as of
Nine Months Ended
Anticipated
State Health Plan
Medicaid Program(s)
September 30, 2018
September 30, 2018
Award Date
Effective Date
Texas
ABD, MMP
99,000
$
1,460
Q2 2019
6/1/2020
Texas
TANF, CHIP
124,000
236
Q3 2019
9/1/2020
New Mexico Health Plan Update.
In our Annual Report on Form 10-K for 2017, we reported that we were notified by the New Mexico Medicaid agency that we had not been selected for a tentative award of a 2019 Medicaid contract. A hearing was held on our judicial protest on October 17, 2018, with a decision expected in the fourth quarter of 2018. Regardless of the court’s decision on our protest, we would have further rights of appeal. We are continuing to manage the business in run-off until such time as a different outcome is determined.
As of
September 30, 2018
,
we served approximately
206,000
Medicaid members in New Mexico, which represented premium revenue o
f $891 million for the
nine months ended September 30, 2018
.
Medicare-Medicaid Plans (MMP) Update.
The current authority for three of our MMP programs, in California, Illinois and Ohio, ends December 31, 2019. In July 2018, the Ohio Medicaid agency submitted a request to Centers for Medicare and Medicaid Services (CMS) for a three-year extension of its duals demonstration program, through December 31, 2022. We estimate annualized premium revenues of approximately $690 million in 2018 under our Ohio MMP program.
In June 2018, the California Medicaid agency submitted a request to CMS for a one-year extension of its duals demonstration program, through December 31, 2020. We estimate annualized premium revenues of approximately $180 million in 2018 under our California MMP program.
As of October 31, 2018, the Illinois Medicaid agency had not yet submitted an extension request to CMS for its duals demonstration program. We estimate annualized premium revenues of approximately $80 million in 2018 under our Illinois MMP program.
Pressures on Medicaid Funding
Currently, there are a number of different legislative proposals being considered, some of which would involve significantly reduced federal spending on the Medicaid program and constitute a fundamental change in the federal role in health care. These proposals include elements such as the following:
•
Ending the entitlement nature of Medicaid by capping future increases in federal health spending for these programs, and shifting more of the risk for health costs in the future to states and consumers;
•
Reversing the ACA’s expansion of Medicaid that enables states to cover low-income childless adults;
•
Changing Medicaid to a state block grant program, including potentially capping spending on a per-enrollee basis (a “per capita cap”);
•
Requiring Medicaid beneficiaries to work;
•
Limiting the amount of lifetime benefits for Medicaid beneficiaries; and
•
Numerous other potential changes and reforms.
ACA and the Marketplace
The future of the Affordable Care Act (ACA) and its underlying programs, including the Marketplace, are subject to substantial uncertainty. While we continue to monitor the current political and programmatic developments pertaining to the Marketplace, in 2018 we have taken various actions to improve our Marketplace operating performance. The action with the greatest impact to year-to-date results, effective January 1, 2018, was the significant increase to premium rates (averaging 58%).
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We have entered into contracts to participate in nine Marketplace states, including the Utah and Wisconsin Marketplaces, effective January 2019.
MEMBERSHIP
The following tables set forth our Health Plans membership as of the dates indicated:
September 30,
2018
December 31,
2017
September 30,
2017
Ending Membership by Program:
Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP)
2,436,000
2,457,000
2,451,000
Medicaid Expansion
664,000
668,000
662,000
Aged, Blind or Disabled (ABD)
415,000
412,000
411,000
Total Medicaid
3,515,000
3,537,000
3,524,000
Medicare-Medicaid Plan (MMP) – Integrated
(1)
55,000
57,000
58,000
Medicare Special Needs Plans (Medicare)
45,000
44,000
44,000
Total Medicare
100,000
101,000
102,000
Total Medicaid and Medicare
3,615,000
3,638,000
3,626,000
Marketplace
384,000
815,000
877,000
3,999,000
4,453,000
4,503,000
Ending Membership by Health Plan:
California
623,000
746,000
751,000
Florida
395,000
625,000
641,000
Illinois
223,000
165,000
163,000
Michigan
394,000
398,000
399,000
New Mexico
234,000
253,000
256,000
Ohio
315,000
327,000
343,000
Puerto Rico
320,000
314,000
306,000
South Carolina
117,000
116,000
113,000
Texas
436,000
430,000
444,000
Washington
770,000
777,000
770,000
Other
(2)
172,000
302,000
317,000
3,999,000
4,453,000
4,503,000
_________________________
(1)
MMP members receive both Medicaid and Medicare coverage from Molina Healthcare.
(2)
“Other” includes the Idaho, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results.
Premiums by Program
The amount of the premiums paid to our health plans vary substantially between states and among various government programs. The following table sets forth the ranges of premiums paid to our state health plans by program on a PMPM basis, for the
nine months ended September 30, 2018
. The “Consolidated” column represents the weighted-average amounts for our total membership by program.
PMPM Premiums
Low
High
Consolidated
TANF and CHIP
$
120.00
$
340.00
$
190.00
Medicaid Expansion
300.00
510.00
360.00
ABD
520.00
1,530.00
1,030.00
MMP – Integrated
1,360.00
3,190.00
2,170.00
Medicare
600.00
1,270.00
1,170.00
Marketplace
250.00
650.00
380.00
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FINANCIAL PERFORMANCE BY PROGRAM
The following tables summarize member months, premium revenue, medical care costs, MCR and medical margin by program for the periods indicated (PMPM amounts are in whole dollars; member months and other dollar amounts are in millions):
Three Months Ended September 30, 2018
Member
Months
(1)
Premium Revenue
Medical Care Costs
MCR
(2)
Medical Margin
Total
PMPM
Total
PMPM
TANF and CHIP
7.4
$
1,379
$
187.03
$
1,228
$
166.41
89.0
%
$
151
Medicaid Expansion
2.0
671
333.11
640
317.62
95.3
31
ABD
1.2
1,322
1,054.92
1,186
946.38
89.7
136
Total Medicaid
10.6
3,372
316.86
3,054
286.86
90.5
318
MMP
0.2
353
2,159.72
323
1,981.45
91.7
30
Medicare
0.1
156
1,157.71
121
895.25
77.3
35
Total Medicare
0.3
509
1,706.95
444
1,490.63
87.3
65
Total Medicaid and Medicare
10.9
3,881
354.70
3,498
319.63
90.1
383
Marketplace
1.2
456
394.02
292
252.61
64.1
164
12.1
$
4,337
$
358.46
$
3,790
$
313.23
87.4
%
$
547
Three Months Ended September 30, 2017
Member
Months
(1)
Premium Revenue
Medical Care Costs
MCR
(2)
Medical Margin
Total
PMPM
Total
PMPM
TANF and CHIP
7.5
$
1,392
$
185.95
$
1,242
$
165.76
89.1
%
$
150
Medicaid Expansion
2.0
773
385.58
667
332.99
86.4
106
ABD
1.2
1,288
1,038.85
1,259
1,016.06
97.8
29
Total Medicaid
10.7
3,453
321.77
3,168
295.23
91.8
285
MMP
0.2
378
2,263.07
336
2,013.67
89.0
42
Medicare
0.1
163
1,231.61
126
951.01
77.2
37
Total Medicare
0.3
541
1,806.26
462
1,543.05
85.4
79
Total Medicaid and Medicare
11.0
3,994
362.04
3,630
329.08
90.9
364
Marketplace
2.7
783
301.72
590
227.22
75.3
193
13.7
$
4,777
$
350.55
$
4,220
$
309.68
88.3
%
$
557
Nine Months Ended September 30, 2018
Member
Months
(1)
Premium Revenue
Medical Care Costs
MCR
(2)
Medical Margin
Total
PMPM
Total
PMPM
TANF and CHIP
22.3
$
4,145
$
186.12
$
3,705
$
166.35
89.4
%
$
440
Medicaid Expansion
6.1
2,184
359.37
1,957
322.01
89.6
227
ABD
3.7
3,864
1,034.25
3,550
950.11
91.9
314
Total Medicaid
32.1
10,193
317.70
9,212
287.10
90.4
981
MMP
0.5
1,077
2,173.90
941
1,899.26
87.4
136
Medicare
0.4
470
1,171.59
385
959.54
81.9
85
Total Medicare
0.9
1,547
1,725.71
1,326
1,479.06
85.7
221
Total Medicaid and Medicare
33.0
11,740
355.96
10,538
319.50
89.8
1,202
Marketplace
3.8
1,434
379.91
824
218.44
57.5
610
36.8
$
13,174
$
358.42
$
11,362
$
309.12
86.2
%
$
1,812
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Nine Months Ended September 30, 2017
Member
Months
(1)
Premium Revenue
Medical Care Costs
MCR
(2)
Medical Margin
Total
PMPM
Total
PMPM
TANF and CHIP
22.8
$
4,185
$
183.69
$
3,861
$
169.44
92.2
%
$
324
Medicaid Expansion
6.1
2,376
389.14
2,045
334.93
86.1
331
ABD
3.6
3,769
1,033.45
3,634
996.58
96.4
135
Total Medicaid
32.5
10,330
317.49
9,540
293.21
92.4
790
MMP
0.5
1,083
2,189.96
976
1,974.22
90.1
107
Medicare
0.4
449
1,142.68
369
939.21
82.2
80
Total Medicare
0.9
1,532
1,726.39
1,345
1,516.09
87.8
187
Total Medicaid and Medicare
33.4
11,862
354.88
10,885
325.66
91.8
977
Marketplace
8.4
2,303
276.27
1,937
232.31
84.1
366
41.8
$
14,165
$
339.19
$
12,822
$
307.03
90.5
%
$
1,343
_______________________
(1)
A member month is defined as the aggregate of each month’s ending membership for the period presented.
(2)
“MCR” represents medical costs as a percentage of premium revenue.
Medicaid
The Medicaid MCR decreased to
90.5%
in the
third quarter of 2018
, from
91.8%
in the
third quarter of 2017
, and decreased to
90.4%
for the
nine months ended September 30, 2018
, from
92.4%
for the
nine months ended September 30, 2017
.
Excluding recognition of the
$57 million
retroactive California Medicaid Expansion risk corridor adjustment, the Medicaid MCR would have been
89.0%
in the third quarter of 2018, and
89.9%
for the
nine months ended September 30, 2018
. The decreases were mainly due to improved performance for ABD and TANF and CHIP, partially offset by a decline in performance for Medicaid Expansion.
TANF and CHIP
. The MCR for TANF and CHIP improved to
89.0%
in the
third quarter of 2018
, from
89.1%
in the
third quarter of 2017
; and improved to
89.4%
for the
nine months ended September 30, 2018
, from
92.2%
for the
nine months ended September 30, 2017
. The year over year improvement was primarily due to improved performance at our Illinois, California and Texas health plans, partially offset by a decline in performance at our New Mexico health plan.
Medicaid Expansion.
The MCR for Medicaid Expansion was
95.3%
in the
third quarter of 2018
, up from
86.4%
in the
third quarter of 2017
, and was
89.6%
for the
nine months ended September 30, 2018
, up from
86.1%
for the
nine months ended September 30, 2017
.
Excluding recognition of the
$57 million
retroactive California Medicaid Expansion risk corridor adjustment, the Medicaid Expansion MCR would have been
87.9%
in the
third quarter of 2018
, and
87.3%
for the
nine months ended September 30, 2018
. These increases were primarily due to the premium reduction we received in California in July 2017. Medicaid Expansion has generally performed well because rate adequacy has trended favorably, and membership is concentrated in our higher performing health plans, particularly California, Michigan, and Washington.
ABD
. The MCR for ABD improved to
89.7%
in the
third quarter of 2018
, compared with
97.8%
in the
third quarter of 2017
; and improved to
91.9%
for the
nine months ended September 30, 2018
, from
96.4%
for the
nine months ended September 30, 2017
. The year-over-year improvement can be attributed to a number of actions, including our management of high acuity members.
Medicare and MMP
The overall MCR for the combined Medicare programs increased to
87.3%
in the
third quarter of 2018
, from
85.4%
in the
third quarter of 2017
, but improved to
85.7%
for the
nine months ended September 30, 2018
, from
87.8%
for the
nine months ended September 30, 2017
. The MCR increase in the third quarter of 2018 is mainly due to certain premium transfers between the MMP and Medicaid programs that had no impact on consolidated results, and higher inpatient costs in our MMP program. The improvement for the nine months ended September 30, 2018 was partly driven by the recognition of additional MMP at‑risk revenue for dates of service in 2016 and 2017, resulting from ultimate settlements with CMS that were higher than the original estimates recognized in those periods. The Medicare business also benefited from favorable medical care trends and improved medical management of inpatient utilization for this population. Accurate and complete risk score documentation and effective management of chronic and high acuity conditions are critical to the successful management of this program.
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Marketplace
Lower Marketplace premium revenue was driven by a decrease in membership of over
50%
, partially offset by premium rate increases. As previously disclosed, we increased premium rates and reduced our Marketplace presence effective January 1, 2018, as part of our overall program to improve profitability.
The MCR for the Marketplace program decreased to
64.1%
in the
third quarter of 2018
, from
75.3%
in the
third quarter of 2017
; and improved to
57.5%
in the
nine months ended September 30, 2018
, from
84.1%
for the
nine months ended September 30, 2017
. Excluding the benefit of the 2017 Marketplace cost sharing reduction (CSR) reimbursement recognized in 2018, the MCR for the
third quarter of 2018
would have been
65.3%
. Excluding the combined benefit of the 2017 Marketplace risk adjustment and CSR reimbursement recognized in 2018, the MCR for the
nine months ended September 30, 2018
would have been
65.7%
. Excluding the changes in Marketplace premium deficiency reserves for 2017 dates of service, the MCR for the third quarter of 2017 would have been
79.1%
, and
82.4%
for the
nine months ended September 30, 2017
. The year over year improvement is mainly due to the overall program to improve profitability, as discussed above.
FINANCIAL PERFORMANCE BY STATE
The following tables summarize member months, premium revenue, medical care costs, MCR, and medical margin by state health plan for the periods indicated (PMPM amounts are in whole dollars; member months and other dollar amounts are in millions):
Health Plans Segment Financial Data — Medicaid and Medicare
Three Months Ended September 30, 2018
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
1.7
$
435
$
249.00
$
446
$
255.22
102.5
%
$
(11
)
Florida
1.0
388
363.16
362
339.33
93.4
26
Illinois
0.7
207
312.72
182
274.98
87.9
25
Michigan
1.1
397
350.05
321
282.49
80.7
76
New Mexico
0.6
304
471.66
275
426.69
90.5
29
Ohio
0.9
584
624.84
532
568.93
91.1
52
Puerto Rico
1.0
179
189.65
162
171.96
90.7
17
South Carolina
0.4
124
354.53
112
318.56
89.9
12
Texas
0.7
577
848.47
525
772.14
91.0
52
Washington
2.3
511
226.77
444
197.04
86.9
67
Other
(1)
0.5
175
334.29
137
261.49
78.2
38
10.9
$
3,881
$
354.70
$
3,498
$
319.63
90.1
%
$
383
Three Months Ended September 30, 2017
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
1.9
$
601
$
322.97
$
563
$
302.67
93.7
%
$
38
Florida
1.0
388
355.59
390
356.83
100.3
(2
)
Illinois
0.5
137
287.69
138
289.36
100.6
(1
)
Michigan
1.2
390
337.17
345
298.83
88.6
45
New Mexico
0.7
304
429.07
277
390.91
91.1
27
Ohio
0.9
549
560.06
483
492.61
88.0
66
Puerto Rico
1.0
191
202.59
159
168.25
83.1
32
South Carolina
0.3
113
332.48
101
297.74
89.6
12
Texas
0.7
541
778.50
506
728.19
93.5
35
Washington
2.3
612
276.73
522
236.11
85.3
90
Other
(1)
0.5
168
294.99
146
256.99
87.1
22
11.0
$
3,994
$
362.04
$
3,630
$
329.08
90.9
%
$
364
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Nine Months Ended September 30, 2018
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
5.3
$
1,446
$
270.63
$
1,299
$
243.14
89.8
%
$
147
Florida
3.2
1,147
356.15
1,069
331.93
93.2
78
Illinois
1.8
551
308.45
474
265.47
86.1
77
Michigan
3.4
1,161
343.08
983
290.26
84.6
178
New Mexico
2.0
936
469.19
875
438.70
93.5
61
Ohio
2.8
1,670
590.71
1,474
521.26
88.2
196
Puerto Rico
2.9
549
190.34
501
173.83
91.3
48
South Carolina
1.1
369
350.94
323
306.76
87.4
46
Texas
2.1
1,715
831.21
1,554
753.31
90.6
161
Washington
6.8
1,666
245.40
1,544
227.41
92.7
122
Other
(1)
1.6
530
323.84
442
269.98
83.4
88
33.0
$
11,740
$
355.96
$
10,538
$
319.50
89.8
%
$
1,202
Nine Months Ended September 30, 2017
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
5.6
$
1,771
$
316.83
$
1,586
$
283.82
89.6
%
$
185
Florida
3.2
1,132
347.41
1,112
341.15
98.2
20
Illinois
1.6
447
284.18
492
312.54
110.0
(45
)
Michigan
3.5
1,162
332.60
1,035
296.28
89.1
127
New Mexico
2.2
933
431.70
887
410.24
95.0
46
Ohio
2.9
1,598
541.56
1,434
486.02
89.7
164
Puerto Rico
2.9
553
190.99
513
177.01
92.7
40
South Carolina
1.0
329
325.43
301
298.43
91.7
28
Texas
2.1
1,592
760.76
1,468
701.32
92.2
124
Washington
6.7
1,835
275.60
1,603
240.83
87.4
232
Other
(1)
1.7
510
292.93
454
261.01
89.1
56
33.4
$
11,862
$
354.88
$
10,885
$
325.66
91.8
%
$
977
______________________
(1)
“Other” includes the Idaho, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results.
Health Plans Segment Financial Data — Marketplace
Three Months Ended September 30, 2018
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
0.2
$
49
$
309.04
$
37
$
235.63
76.2
%
$
12
Florida
0.2
66
548.60
45
362.39
66.1
21
Michigan
—
12
233.51
7
145.13
62.1
5
New Mexico
0.1
28
419.20
18
249.33
59.5
10
Ohio
0.1
27
485.08
18
336.86
69.4
9
Texas
0.6
228
357.54
134
209.80
58.7
94
Washington
—
44
656.70
34
518.75
79.0
10
Other
(1)
—
2
NM
(1
)
NM
NM
3
1.2
$
456
$
394.02
$
292
$
252.61
64.1
%
$
164
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Three Months Ended September 30, 2017
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
0.3
$
88
$
208.19
$
63
$
147.87
71.0
%
$
25
Florida
0.9
260
313.36
235
283.13
90.4
25
Michigan
—
14
212.08
10
150.24
70.8
4
New Mexico
0.1
29
383.58
20
269.28
70.2
9
Ohio
0.1
23
386.09
20
364.31
94.4
3
Texas
0.7
183
291.14
109
172.70
59.3
74
Washington
0.1
42
327.40
33
256.52
78.3
9
Other
(1)
0.5
144
375.83
100
259.15
69.0
44
2.7
$
783
$
301.72
$
590
$
227.22
75.3
%
$
193
Nine Months Ended September 30, 2018
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
0.6
$
171
$
326.82
$
89
$
169.98
52.0
%
$
82
Florida
0.5
211
491.13
67
155.24
31.6
144
Michigan
0.1
40
248.24
23
145.38
58.6
17
New Mexico
0.2
93
426.07
55
247.57
58.1
38
Ohio
0.2
84
466.75
58
324.91
69.6
26
Texas
2.0
679
330.92
440
214.65
64.9
239
Washington
0.2
139
654.78
105
497.00
75.9
34
Other
(1)
—
17
NM
(13
)
NM
NM
30
3.8
$
1,434
$
379.91
$
824
$
218.44
57.5
%
$
610
Nine Months Ended September 30, 2017
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
1.2
$
241
$
193.33
$
156
$
124.32
64.3
%
$
85
Florida
2.8
821
296.14
758
273.55
92.4
63
Michigan
0.2
41
187.96
27
126.76
67.4
14
New Mexico
0.2
82
338.18
62
256.05
75.7
20
Ohio
0.2
68
365.35
64
346.93
95.0
4
Texas
2.1
517
252.32
351
171.57
68.0
166
Washington
0.4
123
315.95
128
327.51
103.7
(5
)
Other
(1)
1.3
410
333.05
391
316.86
95.1
19
8.4
$
2,303
$
276.27
$
1,937
$
232.31
84.1
%
$
366
_________________________
(1)
“Other” includes the Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results. We terminated Marketplace operations at these plans effective January 1, 2018, so the ratios for 2018 periods are not meaningful (NM).
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Health Plans Segment Financial Data — Total
Three Months Ended September 30, 2018
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
1.9
$
484
$
253.96
$
483
$
253.60
99.9
%
$
1
Florida
1.2
454
382.20
407
341.70
89.4
47
Illinois
0.7
207
312.72
182
274.98
87.9
25
Michigan
1.1
409
345.28
328
276.88
80.2
81
New Mexico
0.7
332
466.63
293
409.68
87.8
39
Ohio
1.0
611
616.95
550
555.83
90.1
61
Puerto Rico
1.0
179
189.65
162
171.96
90.7
17
South Carolina
0.4
124
354.53
112
318.56
89.9
12
Texas
1.3
805
611.01
659
500.14
81.9
146
Washington
2.3
555
239.25
478
206.38
86.3
77
Other
(1)
0.5
177
336.18
136
260.19
77.4
41
12.1
$
4,337
$
358.46
$
3,790
$
313.23
87.4
%
$
547
Three Months Ended September 30, 2017
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
2.2
$
689
$
301.64
$
626
$
273.90
90.8
%
$
63
Florida
1.9
648
337.40
625
325.09
96.4
23
Illinois
0.5
137
287.69
138
289.36
100.6
(1
)
Michigan
1.2
404
330.27
355
290.63
88.0
49
New Mexico
0.8
333
424.61
297
378.98
89.3
36
Ohio
1.0
572
550.75
503
485.61
88.2
69
Puerto Rico
1.0
191
202.59
159
168.25
83.1
32
South Carolina
0.3
113
332.48
101
297.74
89.6
12
Texas
1.4
724
546.57
615
463.83
84.9
109
Washington
2.4
654
279.52
555
237.23
84.9
99
Other
(1)
1.0
312
327.47
246
257.86
78.7
66
13.7
$
4,777
$
350.55
$
4,220
$
309.68
88.3
%
$
557
Nine Months Ended September 30, 2018
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
5.9
$
1,617
$
275.64
$
1,388
$
236.61
85.8
%
$
229
Florida
3.7
1,358
372.07
1,136
311.09
83.6
222
Illinois
1.8
551
308.45
474
265.47
86.1
77
Michigan
3.5
1,201
338.83
1,006
283.77
83.7
195
New Mexico
2.2
1,029
464.92
930
419.78
90.3
99
Ohio
3.0
1,754
583.29
1,532
509.52
87.4
222
Puerto Rico
2.9
549
190.34
501
173.83
91.3
48
South Carolina
1.1
369
350.94
323
306.76
87.4
46
Texas
4.1
2,394
581.74
1,994
484.70
83.3
400
Washington
7.0
1,805
257.82
1,649
235.59
91.4
156
Other
(1)
1.6
547
334.26
429
262.27
78.5
118
36.8
$
13,174
$
358.42
$
11,362
$
309.12
86.2
%
$
1,812
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Nine Months Ended September 30, 2017
Member
Months
Premium Revenue
Medical Care Costs
MCR
Medical Margin
Total
PMPM
Total
PMPM
California
6.8
$
2,012
$
294.26
$
1,742
$
254.67
86.5
%
$
270
Florida
6.0
1,953
323.86
1,870
310.09
95.7
83
Illinois
1.6
447
284.18
492
312.54
110.0
(45
)
Michigan
3.7
1,203
324.12
1,062
286.35
88.3
141
New Mexico
2.4
1,015
422.25
949
394.66
93.5
66
Ohio
3.1
1,666
531.17
1,498
477.81
90.0
168
Puerto Rico
2.9
553
190.99
513
177.01
92.7
40
South Carolina
1.0
329
325.43
301
298.43
91.7
28
Texas
4.2
2,109
509.09
1,819
439.11
86.3
290
Washington
7.1
1,958
277.83
1,731
245.62
88.4
227
Other
(1)
3.0
920
309.56
845
284.16
91.8
75
41.8
$
14,165
$
339.19
$
12,822
$
307.03
90.5
%
$
1,343
__________________
(1)
“Other” includes the Idaho, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results.
MEDICAL CARE COSTS BY TYPE
The following table provides the details of consolidated medical care costs by category for the periods indicated (dollars in millions except PMPM amounts):
Three Months Ended September 30,
2018
2017
Amount
PMPM
% of
Total
Amount
PMPM
% of
Total
Fee for service
$
2,865
$
236.74
75.6
%
$
3,196
$
234.51
75.8
%
Pharmacy
495
40.90
13.1
638
46.85
15.1
Capitation
297
24.52
7.8
342
25.07
8.1
Other
133
11.07
3.5
44
3.25
1.0
$
3,790
$
313.23
100.0
%
$
4,220
$
309.68
100.0
%
Nine Months Ended September 30,
2018
2017
Amount
PMPM
% of Total
Amount
PMPM
% of Total
Fee for service
$
8,471
$
230.46
74.6
%
$
9,630
$
230.58
75.1
%
Pharmacy
1,645
44.76
14.5
1,904
45.60
14.8
Capitation
891
24.23
7.8
1,022
24.47
8.0
Other
355
9.67
3.1
266
6.38
2.1
$
11,362
$
309.12
100.0
%
$
12,822
$
307.03
100.0
%
MOLINA MEDICAID SOLUTIONS
We closed on the sale of MMS to DXC Technology Company on September 30, 2018.
FINANCIAL OVERVIEW
The Molina Medicaid Solutions segment service margin for the
third quarter
of 2018 and 2017 and for the
nine months ended September 30, 2018
and 2017, was insignificant.
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OTHER
The Other segment includes primarily our Pathways behavioral health and social services provider, and corporate amounts not allocated to other reportable segments.
We sold our Pathways subsidiary on October 19, 2018. See further information in the Notes to Consolidated Financial Statements, Note
1
. “
Organization and Basis of Presentation
.”
FINANCIAL OVERVIEW
The Other segment service margin for the
third quarter
of 2018 and 2017 and for the
nine months ended September 30, 2018
and 2017, was insignificant.
LIQUIDITY AND FINANCIAL CONDITION
INTRODUCTION
We manage our cash, investments, and capital structure to meet the short- and long-term obligations of our business while maintaining liquidity and financial flexibility. We forecast, analyze, and monitor our cash flows to enable prudent investment management and financing within the confines of our financial strategy.
A majority of the assets held by our Health Plans segment regulated subsidiaries is in the form of cash, cash equivalents, and investments. After considering expected cash flows from operating activities, we generally invest cash of regulated subsidiaries that exceeds our expected short-term obligations in longer term, investment-grade, and marketable debt securities to improve our overall investment return. These investments are made pursuant to board-approved investment policies that conform to applicable state laws and regulations.
Our investments are classified as current assets, except for our held-to-maturity restricted investments, which are classified as non-current assets, and which are not included in the totals below. Our held-to-maturity restricted investments are invested principally in certificates of deposit and U.S. treasury securities.
MARKET RISK
Our earnings and financial position are exposed to financial market risk relating to changes in interest rates, and the resulting impact on investment income and interest expense.
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Substantially all of our investments and restricted investments are subject to interest rate risk and will decrease in value if market interest rates increase. Assuming a hypothetical and immediate 1% increase in market interest rates at
September 30, 2018
, the fair value of our fixed income investments would decrease by approximately $16 million. Declines in interest rates over time will reduce our investment income.
For further information on fair value measurements and our investment portfolio, please refer to Notes to Consolidated Financial Statements, Note
4
, “
Fair Value Measurements
,” and Note
5
, “
Investments
.”
Borrowings under our Credit Facility bear interest based, at our election, on a base rate or an adjusted London Interbank Offered Rate (LIBOR), plus in each case the applicable margin. As of
September 30, 2018
, no amounts were outstanding under the Credit Facility.
LIQUIDITY
A condensed schedule of cash flows to facilitate our discussion of liquidity follows:
Nine Months Ended September 30,
2018
2017
Change
(In millions)
Net cash (used in) provided by operating activities
$
(191
)
$
957
$
(1,148
)
Net cash provided by (used in) investing activities
821
(476
)
1,297
Net cash (used in) provided by financing activities
(1,012
)
632
(1,644
)
Net (decrease) increase in cash, cash equivalents, and restricted cash and cash equivalents
$
(382
)
$
1,113
$
(1,495
)
Operating Activities
We typically receive capitation payments monthly, in advance of payments for medical claims; however, state or federal payors may decide to adjust their payment schedules which could positively or negatively impact our reported cash flows from operating activities in any given period. State or federal payors may delay our premium payments, or they may prepay the following month’s premium payment.
Net cash used in operations for the
nine months ended September 30, 2018
, was
$191 million
, compared with
$957 million
of net cash provided for the
nine months ended September 30, 2017
. The year over year decline was mainly due to the following:
•
The timing effect of premium receipts and other revenues negatively impacted our cash flows from operating activities by
$687 million
on a year-over-year comparative basis. This impact was mainly related to the timing of premiums received at our California, Florida, Ohio, and Washington health plans.
•
The decline in medical claims and benefits payable, mainly resulting from reduced Marketplace membership in Florida, Utah, Washington and Wisconsin decreased cash flows from operations by
$693 million
.
•
Settlements with government agencies decreased our cash flows by
$633 million
on a year-over-year comparative basis, primarily due to payments in the
third quarter of 2018
, including risk transfer payments associated with our Marketplace health plans.
•
The declines discussed above were partially offset by favorable timing differences in the settlement of various operating expenses, including the health insurer fee (HIF).
The HIF payable of $348 million was paid on October 1, 2018, after receiving certain related state reimbursements.
These favorable timing differences benefited our cash flows by
$308 million
on a year-over-year comparative basis
.
Investing Activities
Net cash provided by investing activities was
$821 million
for the
nine months ended September 30, 2018
, compared with
$476 million
of net cash used in investing activities for the
nine months ended September 30, 2017
. The year over year improvement is primarily due to higher proceeds from sales and maturities of investments, net of purchases, for the
nine months ended September 30, 2018
, largely driven by cash flow needs associated with our financing activities, as described below.
Financing Activities
Net cash used in financing activities was
$1,012 million
for the
nine months ended September 30, 2018
, compared with
$632 million
of net cash provided by financing activities for the
nine months ended September 30, 2017
. The year over year decline was mainly due to the following:
•
$300 million
repayment of the Credit Facility in 2018;
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•
$236 million
partial principal repayment of the 1.125% Notes in 2018;
•
$477 million
cash paid for partial settlement of the 1.125% Conversion Option in 2018;
•
$419 million
cash paid for partial termination of the 1.125% Warrants in 2018;
•
$64 million
principal repayment of 1.625% Notes in 2018; and
•
$625 million
of proceeds from the sale of the 4.875% Notes and borrowings under the Credit Facility in 2017.
These uses of cash were partially offset by
$477 million
of cash received in the
nine months ended September 30, 2018
for a partial settlement of the 1.125% Call Option.
FINANCIAL CONDITION
We believe that our cash resources, our borrowing capacity available under our Credit Facility as discussed further below in “Future Sources and Uses of Liquidity—Future Sources,” and internally generated funds will be sufficient to support operations, regulatory requirements, debt repayment obligations and capital expenditures for at least the next 12 months.
On a consolidated basis, at
September 30, 2018
, our working capital was
$2,088 million
, compared with
$1,954 million
at
December 31, 2017
. At
September 30, 2018
, our cash and investments amounted to
$4,746 million
, compared with
$6,000 million
at
December 31, 2017
.
Because of the statutory restrictions that inhibit the ability of our health plans to transfer net assets to us, the amount of retained earnings readily available to pay dividends to our stockholders is generally limited to cash, cash equivalents and investments held by the parent company—Molina Healthcare, Inc.
Such cash, cash equivalents and investments amounted to
$505 million
as of
September 30, 2018
, or $390 million when adjusted for the timing of the HIF payment and the proceeds received from the sale of MMS, both of which occurred on October 1, 2018. Parent company cash, cash equivalents and investments amounted to
$696 million
as of
December 31, 2017
. The decrease is mainly attributed to reductions in the principal amount of outstanding debt, partially offset by net cash paid to the parent company by our subsidiaries.
In the
nine months ended September 30, 2018
, the regulated health plan subsidiaries paid $258 million in dividends to the parent, and our unregulated subsidiaries paid $10 million in dividends to the parent. In the
nine months ended September 30, 2018
, the parent company contributed capital of
$122 million
to our regulated health plan subsidiaries to satisfy statutory net worth requirements.
Debt Ratings
Our 5.375% Notes are rated “BB-” by Standard & Poor’s, and “B3” by Moody’s Investor Service, Inc. A downgrade in our ratings could adversely affect our borrowing capacity and increase our borrowing costs.
Financial Covenants
Our Credit Facility contains customary non-financial and financial covenants, including a net leverage ratio and an interest coverage ratio. Such ratios, presented below, are computed as defined by the terms of the Credit Facility.
Credit Facility Financial Covenants
Required Per Agreement
As of September 30, 2018
Net leverage ratio
<4.0x
1.2x
Interest coverage ratio
>3.5x
10.8x
In addition, the
indentures governing the 4.875% Notes, the 5.375% Notes and the 1.125% Notes contain cross-default provisions that are triggered upon default by us or any of our subsidiaries on any indebtedness in excess of the amount specified in the applicable indenture.
As of September 30, 2018
, we were in compliance with all covenants under the Credit Facility and the indentures governing our outstanding notes.
Capital Plan Progress
Year to date, we have reduced the principal amount of outstanding debt by
$697 million
.
In the third quarter of 2018, we repaid
$140 million
aggregate principal amount of our 1.125% Notes and entered into privately negotiated termination agreements to partially terminate the related 1.125% Call Option and 1.125% Warrants. In addition, we converted
the remaining
$64 million
aggregate principal amount of our 1.625% Notes for
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cash and
0.6 million
shares of our common stock. Additionally, we terminated our bridge credit agreement in the third quarter of 2018.
In the second quarter of 2018, we repaid
$300 million
outstanding under our Credit Facility. In addition, we repaid
$96 million
aggregate principal amount of our 1.125% Notes, and entered into privately negotiated termination agreements to partially terminate the related 1.125% Call Option and 1.125% Warrants.
In the first quarter of 2018, we exchanged
$97 million
aggregate principal amount and accrued interest of our 1.625% Notes for
1.8 million
shares of our common stock.
FUTURE SOURCES AND USES OF LIQUIDITY
Future Sources
Our Health Plans segment regulated subsidiaries generate significant cash flows from premium revenue, which we generally receive a short time before we pay for the related health care services. Such cash flows are our primary source of liquidity. Thus, any future decline in our profitability may have a negative impact on our liquidity.
Dividends from Subsidiaries.
When available and as permitted by applicable regulations, cash in excess of the capital needs of our regulated health plans is generally paid in the form of dividends to our unregulated parent company to be used for general corporate purposes. For more information on our regulatory capital requirements and dividend restrictions, refer to Notes to Consolidated Financial Statements, Note
12
, “
Commitments and Contingencies
—Regulatory Capital Requirements and Dividend Restrictions.”
Borrowing Capacity and Debt Financing.
We have available borrowing capacity of
$494 million
under our Credit Facility. See further discussion in the Notes to Consolidated Financial Statements, Note
7
, “
Debt
.”
Sale of MMS.
We closed on the sale of Molina Medicaid Solutions (MMS) to DXC Technology Company on September 30, 2018. The net cash selling price for the equity interests of MMS was
$233 million
, which we received on October 1, 2018.
Savings from Restructuring Plans.
Our
new executive team has focused on a margin recovery plan that includes identification and implementation of various profit improvement initiatives. To that end, we have begun to implement a plan to restructure our information technology department (the IT Restructuring) in the third quarter of 2018.
As we further implement the IT Restructuring in the fourth quarter of 2018, we will report estimates of anticipated future savings in our 2018 Annual Report on Form 10-K.
Under the restructuring plan we implemented in 2017 (the 2017 Restructuring Plan), we have achieved savings in our Health Plans and Other segments of approximately $230 million since the plan’s inception through September 30, 2018. These savings have reduced both “General and administrative expenses” and “Medical care costs” reported in our consolidated statements of operations.
Further details of our restructuring plans, including costs associated with such plans, are described in the Notes to Consolidated Financial Statements, Note
10
, “
Restructuring and Separation Costs
.”
Shelf Registration Statement.
We have a shelf registration statement on file with the Securities and Exchange Commission to register an unlimited amount of any combination of debt or equity securities in one or more offerings. Specific information regarding the terms and securities being offered and the use of proceeds will be provided at the time of an offering.
Future Uses
Regulatory Capital Requirements and Dividend Restrictions.
We have the ability, and have committed to provide, additional capital to each of our health plans as necessary to ensure compliance with statutory capital and surplus requirements.
1.125% Notes.
Refer to the Notes to Consolidated Financial Statements, Note
7
, “
Debt
,” for a detailed discussion of our convertible notes, including recent transactions. The principal amount of our 1.125% Notes is convertible into cash prior to its maturity date under certain circumstances, one of which relates to the closing price of our common stock over a specified period. We refer to this conversion trigger as the stock price trigger, which is $53.00 per share. The 1.125% Notes met this trigger in the quarter ended
September 30, 2018
, and are convertible to cash through at least December 31, 2018. In addition, they
are convertible by the holders within one year of the current balance sheet date until they mature; therefore, they are reported in current portion of long-term debt.
If conversion requests are received, the settlement of the notes must be paid in cash pursuant to the terms of the relevant indentures. We have sufficient available cash, combined with borrowing capacity available under our Credit Facility, to fund conversions should they occur.
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HIF
. The HIF payable of $348 million was paid on October 1, 2018.
CONTRACTUAL OBLIGATIONS
A summary of future obligations under our various contractual obligations and commitments as of
December 31, 2017
, was disclosed in our
2017
Annual Report on Form 10-K.
As of September 30, 2018, the principal amount of debt outstanding was
$1,344 million
, compared with
$2,041 million
reported at December 31, 2017. Refer to the Notes to Consolidated Financial Statements, Note
7
, “
Debt
,” for a description of debt repayments in 2018.
As of December 31, 2017, we reported operating lease obligations of $262 million. Of this total, approximately $49 million related to the Molina Medicaid Solutions and Pathways subsidiaries. As noted in the Notes to Consolidated Financial Statements, Note
1
, “
Organization and Basis of Presentation
,” these subsidiaries were recently sold; therefore, such lease obligations are no longer obligations of Molina Healthcare.
Other than these items, there were no significant changes to this previously filed information outside the ordinary course of business during the
nine months ended September 30, 2018
.
CRITICAL ACCOUNTING ESTIMATES
When we prepare our consolidated financial statements, we use estimates and assumptions that may affect reported amounts and disclosures; actual results could differ from these estimates. Our critical accounting estimates relate to:
•
Health Plans segment medical claims and benefits payable
. Refer to Notes to Consolidated Financial Statements, Note
6
, “
Medical Claims and Benefits Payable
,” for a table that presents the components of the change in medical claims and benefits payable, and for additional information regarding the factors used to determine our changes in estimates for all periods presented in the accompanying consolidated financial statements. Other than the discussion as noted above, there have been no significant changes during the
nine months ended September 30, 2018
, to our disclosure reported in “Critical Accounting Estimates” in our Annual Report on Form 10-K for the year ended
December 31, 2017
.
•
Health Plans segment contractual provisions that may adjust or limit revenue or profit
. For a discussion of this topic, including amounts recorded in our consolidated financial statements, refer to Notes to Consolidated Financial Statements, Note
2
, “
Significant Accounting Policies
.”
•
Health Plans segment quality incentives
. For a discussion of this topic, including amounts recorded in our consolidated financial statements, refer to Notes to Consolidated Financial Statements, Note
2
, “
Significant Accounting Policies
.”
•
Goodwill and intangible assets, net.
As result of the divestiture of MMS on September 30, 2018, the carrying amount of goodwill was reduced by $43 million; therefore, goodwill and intangible assets, net, represented approximately 2% of total assets and 12% of stockholders’ equity as of September 30, 2018, compared with 3% and 19%, respectively, at
December 31, 2017
. Other than the divestiture of MMS, there have been no significant changes during the
nine months ended September 30, 2018
, to our disclosure reported in “Critical Accounting Estimates” in our Annual Report on Form 10-K for the year ended
December 31, 2017
.
CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures.
Our management, with the participation of our chief executive officer and our chief financial officer, has concluded, based upon its evaluation as of the end of the period covered by this report, that the Company’s “disclosure controls and procedures” (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the “Exchange Act”)), are effective to ensure that information required to be disclosed in the reports that we file or submit under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in the SEC’s rules and forms.
Changes in Internal Control Over Financial Reporting.
There has been no change in our internal control over financial reporting during the fiscal quarter ended September 30, 2018 that has materially affected, or is reasonably likely to materially affect, our internal controls over financial reporting.
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Table of Contents
LEGAL PROCEEDINGS
For information regarding legal proceedings, see Notes to Consolidated Financial Statements, Note
12
, “
Commitments and Contingencies
.”
RISK FACTORS
Certain risks may have a material adverse effect on our business, financial condition, cash flows, results of operations, or stock price, and you should carefully consider them before making an investment decision with respect to our securities. In addition to the other information set forth in this report, you should carefully consider the risk factors discussed in “Risk Factors,” in our Annual Report on Form 10-K for the year ended
December 31, 2017
. The risk factors described in our
2017
Annual Report on Form 10-K are not the only risks that we face. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial may also materially adversely affect our business, financial condition, cash flows, results of operations, or stock price.
UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS
ISSUER PURCHASES OF EQUITY SECURITIES
Purchases of common stock made by us, or on our behalf during the quarter ended
September 30, 2018
, including shares withheld by us to satisfy our employees’ income tax obligations, are set forth below:
Total Number
of Shares
Purchased
(1)
Average Price
Paid per Share
Total Number of Shares
Purchased as Part of
Publicly
Announced
Plans or
Programs
Approximate
Dollar Value
of Shares Authorized to Be Purchased Under the Plans or Programs
July 1 - July 31
105
$
97.94
—
$
—
August 1 - August 31
243
$
134.01
—
$
—
September 1 - September 30
—
$
—
—
$
—
Total
348
$
123.13
—
_______________________
(1)
During the
three months ended September 30, 2018
, we withheld
348
shares of common stock under our 2011 Equity Incentive Plan to settle employee income tax obligations.
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Table of Contents
INDEX TO EXHIBITS
Exhibit No.
Title
Method of Filing
2.1
Membership Interest Purchase Agreement, dated as of October 19, 2018, by and among Pyramid Health Holdings, LLC, Molina Pathways, LLC, and Molina Healthcare, Inc.*
Filed herewith.
31.1
Section 302 Certification of Chief Executive Officer
Filed herewith.
31.2
Section 302 Certification of Chief Financial Officer
Filed herewith.
32.1
Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
Filed herewith.
32.2
Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
Filed herewith.
101.INS
XBRL Taxonomy Instance Document.
Filed herewith.
101.SCH
XBRL Taxonomy Extension Schema Document.
Filed herewith.
101.CAL
XBRL Taxonomy Extension Calculation Linkbase Document.
Filed herewith.
101.DEF
XBRL Taxonomy Extension Definition Linkbase Document.
Filed herewith.
101.LAB
XBRL Taxonomy Extension Label Linkbase Document.
Filed herewith.
101.PRE
XBRL Taxonomy Extension Presentation Linkbase Document
Filed herewith.
* Certain schedules and exhibits to this agreement have been omitted in accordance with Item 601(b)(2) of Regulation S-K. A copy of any omitted schedule and/or exhibit will be furnished to the Securities and Exchange Commission upon request.
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
MOLINA HEALTHCARE, INC.
(Registrant)
Dated:
November 1, 2018
/s/ JOSEPH M. ZUBRETSKY
Joseph M. Zubretsky
Chief Executive Officer
(Principal Executive Officer)
Dated:
November 1, 2018
/s/ THOMAS L. TRAN
Thomas L. Tran
Chief Financial Officer and Treasurer
(Principal Financial Officer)
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