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Watchlist
Account
Molina Healthcare
MOH
#2592
Rank
$6.98 B
Marketcap
๐บ๐ธ
United States
Country
$135.68
Share price
0.24%
Change (1 day)
-49.48%
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
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Price history
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Price history
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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 FY2013 Q2
Molina Healthcare - 10-Q quarterly report FY2013 Q2
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Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
(Mark One)
x
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended
June 30, 2013
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, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.
Large accelerated filer
x
Accelerated filer
¨
Non-accelerated filer
¨
(Do not check if a smaller reporting company)
Smaller reporting company
¨
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 outstanding as of July 19, 2013, was approximately 45,684,600.
Table of Contents
MOLINA HEALTHCARE, INC.
Index
Part I — Financial Information
Item 1. Financial Statements
Consolidated Balance Sheets as of June 30, 2013 (unaudited) and December 31, 2012
1
Consolidated Statements of Operations for the three months and six months ended June 30, 2013 and 2012 (unaudited)
2
Consolidated Statements of Comprehensive Income (Loss) for the three months and six months ended June 30, 2013 and 2012 (unaudited)
3
Consolidated Statements of Cash Flows for the six months ended June 30, 2013 and 2012 (unaudited)
4
Notes to Consolidated Financial Statements (unaudited)
6
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
33
Item 3. Quantitative and Qualitative Disclosures About Market Risk
59
Item 4. Controls and Procedures
60
Part II — Other Information
Item 1. Legal Proceedings
60
Item 1A. Risk Factors
60
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
60
Item 6. Exhibits
61
Signatures
63
Table of Contents
PART I — FINANCIAL INFORMATION
Item 1.
Financial Statements.
MOLINA HEALTHCARE, INC.
CONSOLIDATED BALANCE SHEETS
June 30,
2013
December 31,
2012
(Amounts in thousands,
except per-share data)
(Unaudited)
ASSETS
Current assets:
Cash and cash equivalents
$
742,670
$
795,770
Investments
718,544
342,845
Receivables
213,776
149,682
Deferred income taxes
21,995
32,443
Prepaid expenses and other current assets
47,817
28,386
Total current assets
1,744,802
1,349,126
Property, equipment, and capitalized software, net
249,298
221,443
Deferred contract costs
51,319
58,313
Intangible assets, net
68,987
77,711
Goodwill and indefinite-lived intangible assets
153,152
151,088
Derivative asset
207,123
—
Restricted investments
56,935
44,101
Auction rate securities
12,527
13,419
Other assets
35,773
19,621
$
2,579,916
$
1,934,822
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Medical claims and benefits payable
$
465,487
$
494,530
Accounts payable and accrued liabilities
180,227
184,034
Deferred revenue
45,949
141,798
Income taxes payable
15,496
6,520
Current maturities of long-term debt
—
1,155
Total current liabilities
707,159
828,037
Convertible senior notes
585,825
175,468
Lease financing obligations
175,666
—
Other long-term debt
—
86,316
Derivative liabilities
207,017
1,307
Deferred income taxes
3,919
37,900
Other long-term liabilities
23,943
23,480
Total liabilities
1,703,529
1,152,508
Stockholders’ equity:
Common stock, $0.001 par value; 150,000 shares authorized; outstanding: 45,683 shares at June 30, 2013 and 46,762 shares at December 31, 2012
46
47
Preferred stock, $0.001 par value; 20,000 shares authorized, no shares issued and outstanding
—
—
Additional paid-in capital
324,360
285,524
Accumulated other comprehensive loss
(2,705
)
(457
)
Treasury stock, at cost; 111 shares at December 31, 2012
—
(3,000
)
Retained earnings
554,686
500,200
Total stockholders’ equity
876,387
782,314
$
2,579,916
$
1,934,822
See accompanying notes.
1
Table of Contents
MOLINA HEALTHCARE, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
Three Months Ended
Six Months Ended
June 30,
June 30,
2013
2012
2013
2012
(Amounts in thousands, except
net income (loss) per share)
(Unaudited)
Revenue:
Premium revenue
$
1,548,612
$
1,432,403
$
3,083,045
$
2,701,196
Service revenue
49,672
41,724
99,428
83,929
Investment income
1,628
1,059
3,144
2,738
Rental and other income
5,922
3,977
10,616
8,236
Total revenue
1,605,834
1,479,163
3,196,233
2,796,099
Expenses:
Medical care costs
1,294,706
1,317,597
2,582,621
2,395,464
Cost of service revenue
39,305
30,613
79,075
61,107
General and administrative expenses
161,479
125,819
302,757
241,048
Premium tax expenses
46,883
38,354
83,883
80,540
Depreciation and amortization
17,015
16,210
33,578
31,058
Total expenses
1,559,388
1,528,593
3,081,914
2,809,217
Operating income (loss)
46,446
(49,430
)
114,319
(13,118
)
Other expenses:
Interest expense
11,667
3,808
24,704
8,106
Other expense
3,502
1,086
3,371
1,086
Total other expenses
15,169
4,894
28,075
9,192
Income (loss) from continuing operations before income tax expense
31,277
(54,324
)
86,244
(22,310
)
Income tax expense (benefit)
15,481
(21,267
)
39,926
(9,147
)
Income (loss) from continuing operations
15,796
(33,057
)
46,318
(13,163
)
Income (loss) from discontinued operations, net of tax benefit of $9,968, $4,502, $10,143, and $5,589, respectively
8,775
(4,249
)
8,168
(6,054
)
Net income (loss)
$
24,571
$
(37,306
)
$
54,486
$
(19,217
)
Basic income (loss) per share
Income (loss) from continuing operations
$
0.35
$
(0.71
)
$
1.01
$
(0.29
)
Income (loss) from discontinued operations
0.19
(0.09
)
0.18
(0.13
)
Basic net income (loss) per share
$
0.54
$
(0.80
)
$
1.19
$
(0.42
)
Diluted income (loss) per share
Income (loss) from continuing operations
$
0.34
$
(0.71
)
$
1.00
$
(0.29
)
Income (loss) from discontinued operations
0.19
(0.09
)
0.17
(0.13
)
Diluted net income (loss) per share
$
0.53
$
(0.80
)
$
1.17
$
(0.42
)
Weighted average shares outstanding:
Basic
45,446
46,355
45,712
46,176
Diluted
46,507
46,355
46,506
46,176
See accompanying notes.
2
Table of Contents
MOLINA HEALTHCARE, INC.
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Three Months Ended
Six Months Ended
June 30,
June 30,
2013
2012
2013
2012
(Amounts in thousands)
(Unaudited)
Net income (loss)
$
24,571
$
(37,306
)
$
54,486
$
(19,217
)
Other comprehensive (loss) income:
Gross unrealized investment (loss) gain
(4,045
)
523
(3,626
)
1,001
Effect of income taxes
(1,537
)
199
(1,378
)
381
Other comprehensive (loss) income, net of tax
(2,508
)
324
(2,248
)
620
Comprehensive income (loss)
$
22,063
$
(36,982
)
$
52,238
$
(18,597
)
See accompanying notes.
3
Table of Contents
MOLINA HEALTHCARE, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
Six Months Ended
June 30,
2013
2012
(Amounts in thousands)
(Unaudited)
Operating activities:
Net income (loss)
$
54,486
$
(19,217
)
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities:
Depreciation and amortization
43,907
38,010
Deferred income taxes
(22,155
)
(1,264
)
Stock-based compensation
12,150
9,812
Gain on sale of subsidiary
—
(1,747
)
Amortization of convertible senior notes
9,688
2,915
Change in fair value of derivatives
3,384
1,086
Amortization of premium/discount on investments
4,298
3,615
Amortization of deferred financing costs
2,366
515
Tax deficiency from employee stock compensation
(38
)
(50
)
Changes in operating assets and liabilities:
Receivables
(64,094
)
6,891
Prepaid expenses and other current assets
(22,856
)
(10,352
)
Medical claims and benefits payable
(29,043
)
123,062
Accounts payable and accrued liabilities
(16,968
)
(22,982
)
Deferred revenue
(95,849
)
125,426
Income taxes
8,976
(19,737
)
Net cash (used in) provided by operating activities
(111,748
)
235,983
Investing activities:
Purchases of equipment
(35,229
)
(33,301
)
Purchases of investments
(532,151
)
(144,348
)
Sales and maturities of investments
149,420
136,772
Proceeds from sale of subsidiary, net of cash surrendered
—
9,162
Change in deferred contract costs
6,994
(23,055
)
Increase in restricted investments
(12,834
)
(2,154
)
Change in other non-current assets and liabilities
(8,012
)
(4,383
)
Net cash used in investing activities
(431,812
)
(61,307
)
Financing activities:
Proceeds from issuance of 1.125% Notes, net of deferred issuance costs
537,973
—
Proceeds from sale-leaseback transactions
158,694
—
Purchase of 1.125% Notes call option
(149,331
)
—
Proceeds from issuance of warrants
75,074
—
Treasury stock purchases
(50,000
)
—
Repayment of amounts borrowed under credit facility
(40,000
)
(10,000
)
Amount borrowed under credit facility
—
60,000
Principal payments on term loan
(47,471
)
(573
)
Settlement of interest rate swap
(875
)
—
Proceeds from employee stock plans
4,852
5,485
Excess tax benefits from employee stock compensation
1,544
3,677
Net cash provided by financing activities
490,460
58,589
Net (decrease) increase in cash and cash equivalents
(53,100
)
233,265
Cash and cash equivalents at beginning of period
795,770
493,827
Cash and cash equivalents at end of period
$
742,670
$
727,092
4
Table of Contents
MOLINA HEALTHCARE, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
(continued)
Six Months Ended
June 30,
2013
2012
(Amounts in thousands)
(Unaudited)
Supplemental cash flow information:
Cash paid during the period for:
Income taxes
$
41,407
$
1,074
Interest
$
21,933
$
4,719
Schedule of non-cash investing and financing activities:
Retirement of treasury stock
$
53,000
$
—
Common stock used for stock-based compensation
$
5,669
$
9,390
Details of change in fair value of derivatives:
Gain on 1.125% Call Option
$
57,792
$
—
Loss on embedded cash conversion option
(57,686
)
—
Loss on 1.125% Warrants
(3,923
)
—
Gain (loss) on interest rate swap
433
(1,086
)
Change in fair value of derivatives
$
(3,384
)
$
(1,086
)
Details of sale of subsidiary:
Decrease in carrying value of assets
$
—
$
30,942
Decrease in carrying value of liabilities
—
(23,527
)
Gain on sale
—
1,747
Proceeds from sale of subsidiary, net of cash surrendered
$
—
$
9,162
See accompanying notes.
5
Table of Contents
MOLINA HEALTHCARE, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
June 30, 2013
1. Basis of Presentation
Organization and Operations
Molina Healthcare, Inc. provides quality and cost-effective Medicaid-related solutions to meet the health care needs of low-income families and individuals and to assist state agencies in their administration of the Medicaid program. We report our financial performance based on
two
reportable segments: Health Plans and Molina Medicaid Solutions.
Our Health Plans segment comprises health plans in California, Florida, Michigan, New Mexico, Ohio, Texas, Utah, Washington, and Wisconsin, and includes our direct delivery business. As of
June 30, 2013
, these health plans served approximately
1.8 million
members eligible for Medicaid, Medicare, and other government-sponsored health care programs for low-income families and individuals. The health plans are operated by our respective wholly owned subsidiaries in those states, each of which is licensed as a health maintenance organization, or HMO. Our direct delivery business consists of primary care community clinics in California, Florida, New Mexico, and Washington.
Our health plans’ state Medicaid contracts generally have terms of
three
to
four
years with annual adjustments to premium rates. These contracts are renewable at the discretion of the state. In general, either the state Medicaid agency or the health plan may terminate the state contract with or without cause.
Most of these contracts contain renewal options that are exercisable by the state. Our health plan subsidiaries have generally been successful in retaining their contracts. Our state contracts are generally at greatest risk of loss when a state issues a new request for proposals, or RFP, subject 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 be subject to non-renewal. For instance, on February 17, 2012, the Division of Purchasing of the Missouri Office of Administration notified us that our Missouri health plan, Alliance for Community Health, L.L.C., was not awarded a contract under the Missouri HealthNet Managed Care Request for Proposal; therefore, the Missouri health plan's prior contract with the state expired without renewal on June 30, 2012 subject to certain transition obligations. On April 5, 2013, the Missouri health plan assigned its affiliate, Molina Healthcare of Illinois, Inc., substantially all of its assets and liabilities. Additionally, the Missouri health plan surrendered its certificate of authority as a health maintenance organization.
The Missouri health plan's revenues amounted to
$0.2 million
and
$113.8 million
for the six months ended June 30, 2013 and 2012, respectively.
Until the second quarter of 2013, we reported the results of the Missouri health plan in continuing operations because of our continuing significant involvement in the payment of medical claims incurred on or prior to June 30, 2012, for that entity. On May 13, 2013, we abandoned our equity interests in the Missouri health plan to an unrelated entity, and assigned the Missouri health plan's surviving rights, duties and obligations (which we believe to be insignificant) to Molina Healthcare of Illinois, Inc. Effective June 30, 2013, the transition obligations associated with the Missouri health plan's contract with the state terminated. As a result of these activities, we commenced reporting the Missouri health plan as a discontinued operation as of June 30, 2013. In connection with the abandonment of our equity interests in the Missouri health plan to an unrelated entity, we recognized a
$9.5 million
tax benefit for the tax deduction associated with the basis of such equity interests, which is included in discontinued operations in our consolidated statement of operations. Additionally, we recognized a pretax loss of
$0.5 million
for the write off of the Missouri health plan's remaining assets in the second quarter of 2013.
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, or ABD); and regions or service areas. For example, our Texas health plan added significant membership effective March 1, 2012, in service areas we had not previously served (the Hidalgo and El Paso service areas); and among populations we had not previously served within existing service areas, such as the Temporary Assistance for Needy Families, or TANF, population in the Dallas service area. Additionally, the health benefits provided to our TANF and ABD members in Texas under our contracts with the state were expanded to include inpatient facility and pharmacy services effective March 1, 2012.
On July 3, 2013, we announced that our New Mexico health plan has entered into a definitive agreement to assume Lovelace Community Health Plan's contract for the New Mexico Medicaid Salud! Program. Lovelace Community Health Plan currently participates in the New Mexico Medicaid Salud! State Coverage Insurance Program and arranges for healthcare services for approximately
84,000
New Mexicans. Our New Mexico health plan serves over
92,000
Medicaid members across the state. Subject to satisfaction of customary closing conditions, we anticipate completing the transaction on August 1, 2013; the total payment to Lovelace Community Health Plan will be based on the membership transferred as of that date.
6
Table of Contents
Our Molina Medicaid Solutions segment provides business processing and information technology development and administrative services to Medicaid agencies in Idaho, Louisiana, Maine, New Jersey, and West Virginia, and drug rebate administration services in Florida.
On June 9, 2011, Molina Medicaid Solutions received notice from the state of Louisiana that the state intended to award the contract for a replacement Medicaid Management Information System (MMIS) to a different vendor, CNSI. However, in March 2013, the state of Louisiana cancelled its contract award to CNSI. CNSI is currently challenging the contract cancellation. The state has informed us that we will continue to perform under our current contract until a successor is named. At such time as a new RFP may be issued, we intend to respond to the state's RFP. For the
six months ended June 30, 2013,
our revenue under the Louisiana MMIS contract was approximately
$20.2 million
, or
20.3%
of total service revenue. So long as our Louisiana MMIS contract continues, we expect to recognize approximately
$40 million
of service revenue annually under this contract.
Consolidation and Interim Financial Information
The consolidated financial statements include the accounts of Molina Healthcare, Inc., its subsidiaries and variable interest entities in which Molina Healthcare, Inc. is considered to be the primary beneficiary. Such variable interest entities 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 current interim period are not necessarily indicative of the results for the entire year ending December 31, 2013.
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, 2012. Accordingly, certain disclosures that would substantially duplicate the disclosures contained in the December 31, 2012 audited consolidated financial statements have been omitted. These unaudited consolidated interim financial statements should be read in conjunction with our December 31, 2012 audited consolidated financial statements.
Reclassifications
We have reclassified certain amounts in the 2012 consolidated balance sheet, and statements of operations and cash flows to conform to the 2013 presentation.
2. Significant Accounting Policies
Revenue Recognition
Premium Revenue – 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.
Certain components of premium revenue are subject to accounting estimates. The components of premium revenue subject to estimation fall into
two
categories:
(1) Contractual provisions that may limit revenue based upon the costs incurred or the profits realized under a specific contract:
These are contractual provisions that require the health plan to return premiums to the extent that certain thresholds are not met. In some instances premiums are returned when medical costs fall below a certain percentage of gross premiums; or when administrative costs or profits exceed a certain percentage of gross premiums. In other instances, premiums are partially determined by the acuity of care provided to members (risk adjustment). To the extent that our expenses and profits change
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from the amounts previously reported (due to changes in estimates), our revenue earned for those periods will also change. In all of these instances, our revenue is only subject to estimate due to the fact that the thresholds themselves contain elements (expense or profit) that are subject to estimate. While we have adequate experience and data to make sound estimates of our expenses or profits, changes to those estimates may be necessary, which in turn would lead to changes in our estimates of revenue. In general, a change in estimate relating to expense or profit would offset any related change in estimate to premium, resulting in no or small impact to net income. The following contractual provisions fall into this category:
California Health Plan Medical Cost Floors (Minimums):
A portion of certain premiums received by our California health plan may be returned to the state if certain minimum amounts are not spent on defined medical care costs. We recorded a liability under the terms of these contract provisions of approximately
$0.7 million
and
$0.3 million
at
June 30, 2013
, and
December 31, 2012
, respectively.
Florida Health Plan Medical Cost Floor (Minimum):
A portion of premiums received by our Florida health plan may be returned to the state if certain minimum amounts are not spent on defined behavioral health care costs (in all counties except Broward). A similar minimum expenditure is required for total health care costs in Broward county only. At both
June 30, 2013
, and
December 31, 2012
, we had not recorded any liability under the terms of these contract provisions.
New Mexico Health Plan Medical Cost Floors (Minimums) and Administrative Cost and Profit Ceilings (Maximums):
Our contract with the state of New Mexico directs that a portion of premiums received may be returned to the state if certain minimum amounts are not spent on defined medical care costs, or if administrative costs or profit, as defined in the contract, exceed certain amounts. At both
June 30, 2013
, and
December 31, 2012
, we had not recorded any liability under the terms of these contract provisions.
Ohio Health Plan Medical Cost Floors (Minimums):
Sanctions may be levied by the state if certain minimum amounts are not spent on defined medical care costs. These sanctions include the requirements to file a corrective action plan as well as an enrollment freeze.
Texas Health Plan Profit Sharing:
Under our contract with the state of Texas, there is a profit-sharing agreement under which we pay a rebate to the state of Texas if our Texas health plan generates pretax income, as defined in the contract, above a certain specified percentage, as determined in accordance with a tiered rebate schedule. We are limited in the amount of administrative costs that we may deduct in calculating the rebate, if any. As a result of profits in excess of the amount we are allowed to fully retain, we had accrued an aggregate liability of approximately
$3.9 million
and
$3.2 million
pursuant to our profit-sharing agreement with the state of Texas at
June 30, 2013
, and
December 31, 2012
, respectively.
Washington Health Plan Medical Cost Floors (Minimums):
A portion of certain premiums received by our Washington health plan may be returned to the state if certain minimum amounts are not spent on defined medical care costs. At
June 30, 2013
, and
December 31, 2012
, we had not recorded any liability under the terms of this contract provision.
Medicare Revenue Risk Adjustment:
Based on member encounter data that we submit to the Centers for Medicare and Medicaid Services, or CMS, our Medicare premiums are subject to retroactive adjustment for both member risk scores and member pharmacy cost experience for up to two years after the original year of service. This adjustment takes into account the acuity of each member’s medical needs relative to what was anticipated when premiums were originally set for that member. In the event that a member requires less acute medical care than was anticipated by the original premium amount, CMS may recover premium from us. In the event that a member requires more acute medical care than was anticipated by the original premium amount, CMS may pay us additional retroactive premium. A similar retroactive reconciliation is undertaken by CMS for our Medicare members’ pharmacy utilization. We estimate the amount of Medicare revenue that will ultimately be realized for the periods presented based on our knowledge of our members’ heath care utilization patterns and CMS practices. Based on our knowledge of member health care utilization patterns and expenses we have recorded a net receivable of approximately
$7.1 million
and
$0.3 million
as of
June 30, 2013
and
December 31, 2012
, respectively for anticipated Medicare risk adjustment premiums.
(2) Quality incentives that allow us to recognize incremental revenue if certain quality standards are met:
These are contract provisions that allow us to earn additional premium revenue in certain states if we achieve certain quality-of-care or administrative measures. We estimate the amount of revenue that will ultimately be realized for the periods presented based on our experience and expertise in meeting the quality and administrative measures as well as our ongoing and current monitoring of our progress in meeting those measures. The amount of the revenue that we will realize under these contractual provisions is determinable based upon that experience. The following contractual provisions fall into this category:
New Mexico Health Plan Quality Incentive Premiums:
Under our contract with the state of New Mexico, incremental revenue of up to
0.75%
of our total premium is earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care and administrative measures dictated by the state.
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Ohio Health Plan Quality Incentive Premiums:
Under our contract with the state of Ohio, incremental revenue of up to
1%
of our total premium is earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care measures dictated by the state.
Texas Health Plan Quality Incentive Premiums:
Effective March 1, 2012, under our contract with the state of Texas, incremental revenue of up to
5%
of our total premium may be earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care measures established by the state.
Wisconsin Health Plan Quality Incentive Premiums:
Under our contract with the state of Wisconsin, incremental revenue of up to
3.25%
of total premium is earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care measures dictated by the state.
The following table quantifies the quality incentive premium revenue recognized for the periods presented, including the amounts earned in the period presented and prior periods. Although the reasonably possible effects of a change in estimate related to quality incentive premium revenue as of
June 30, 2013
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
June 30, 2013
.
Three Months Ended June 30, 2013
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
588
$
535
$
49
$
584
$
86,527
Ohio
2,964
1,087
553
1,640
292,706
Texas
15,675
15,675
2,752
18,427
324,600
Wisconsin
1,269
—
495
495
37,740
$
20,496
$
17,297
$
3,849
$
21,146
$
741,573
Three Months Ended June 30, 2012
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
561
$
482
$
630
$
1,112
$
82,706
Ohio
2,720
2,720
—
2,720
297,069
Texas
18,252
14,284
—
14,284
359,486
Wisconsin
449
—
246
246
18,788
$
21,982
$
17,486
$
876
$
18,362
$
758,049
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Six Months Ended June 30, 2013
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
1,173
$
867
$
157
$
1,024
$
172,325
Ohio
5,969
2,139
553
2,692
584,224
Texas
31,939
29,187
8,747
37,934
659,896
Wisconsin
2,030
—
1,104
1,104
64,864
$
41,111
$
32,193
$
10,561
$
42,754
$
1,481,309
Six Months Ended June 30, 2012
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
1,116
$
818
$
658
$
1,476
$
163,932
Ohio
5,398
5,398
966
6,364
590,594
Texas
24,002
20,034
—
20,034
557,722
Wisconsin
865
—
246
246
35,930
$
31,381
$
26,250
$
1,870
$
28,120
$
1,348,178
Service Revenue and Cost of Service Revenue — Molina Medicaid Solutions Segment
The payments received by our Molina Medicaid Solutions segment under its state contracts are based on the performance of multiple services. The first of these is the design, development and implementation (DDI) of a Medicaid Management Information System (MMIS). An additional service, following completion of DDI, is the operation of the MMIS under a business process outsourcing (BPO) arrangement. While providing BPO services (which include claims payment and eligibility processing), we also provide the state with other services including both hosting and support and maintenance. Our Molina Medicaid Solutions contracts may extend over a number of years, particularly in circumstances where we are delivering extensive and complex DDI services, such as the initial design, development and implementation of a complete MMIS. For example, the terms of our most recently implemented Molina Medicaid Solutions contracts (in Idaho and Maine) were each seven years in total, consisting of two years allocated for the delivery of DDI services, followed by five years for the performance of BPO services. We receive progress payments from the state during the performance of DDI services based upon the attainment of predetermined milestones. We receive a flat monthly payment for BPO services under our Idaho and Maine contracts. The terms of our other Molina Medicaid Solutions contracts – which primarily involve the delivery of BPO services with only minimal DDI activity (consisting of system enhancements) – are shorter in duration than our Idaho and Maine contracts.
We have evaluated our Molina Medicaid Solutions contracts to determine if such arrangements include a software element. Based on this evaluation, we have concluded that these arrangements do not include a software element. As such, we have concluded that our Molina Medicaid Solutions contracts are multiple-element service arrangements.
Additionally, we evaluate each required deliverable under our multiple-element service arrangements to determine whether it qualifies as a separate unit of accounting. Such evaluation is generally based on whether the deliverable has standalone value to the customer. The arrangement’s consideration that is fixed or determinable is then allocated to each separate unit of accounting based on the relative selling price of each deliverable. In general, the consideration allocated to each unit of accounting is recognized as the related goods or services are delivered, limited to the consideration that is not contingent.
We have concluded that the various service elements in our Molina Medicaid Solutions contracts represent a single unit of accounting due to the fact that DDI, which is the only service performed in advance of the other services (all other services are performed over an identical period), does not have standalone value because our DDI services are not sold separately by any vendor and the customer could not resell our DDI services. Further, we have no objective and reliable evidence of fair value for any of the individual elements in these contracts, and at no point in the contract will we have objective and reliable
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evidence of fair value for the undelivered elements in the contracts. We lack objective and reliable evidence of the fair value of the individual elements of our Molina Medicaid Solutions contracts for the following reasons:
•
Each contract calls for the provision of its own specific set of services. While all contracts support the system of record for state MMIS, the actual services we provide vary significantly between contracts; and
•
The nature of the MMIS installed varies significantly between our older contracts (proprietary mainframe systems) and our new contracts (commercial off-the-shelf technology solutions).
Because we have determined the services provided under our Molina Medicaid Solutions contracts represent a single unit of accounting and because we are unable to determine a pattern of performance of services during the contract period, we recognize all revenue (both the DDI and BPO elements) associated with such contracts on a straight-line basis over the period during which BPO, hosting, and support and maintenance services are delivered. As noted above, the period of performance of BPO services under our Idaho and Maine contracts is five years. Therefore, absent any contingencies as discussed in the following paragraph, we would recognize all revenue associated with those contracts over a period of five years. In cases where there is no DDI element associated with our contracts, BPO revenue is recognized on a monthly basis as specified in the applicable contract or contract extension.
Provisions specific to each contract may, however, lead us to modify this general principle. In those circumstances, the right of the state to refuse acceptance of services, as well as the related obligation to compensate us, may require us to delay recognition of all or part of our revenue until that contingency (the right of the state to refuse acceptance) has been removed. In those circumstances we defer recognition of any contingent revenue (whether DDI, BPO services, hosting, and support and maintenance services) until the contingency has been removed. These types of contingency features are present in our Maine and Idaho contracts. In those states, we deferred recognition of revenue until the contingencies were removed.
Costs associated with our Molina Medicaid Solutions contracts include software-related costs and other costs. With respect to software related costs, we apply the guidance for internal-use software and capitalize external direct costs of materials and services consumed in developing or obtaining the software, and payroll and payroll-related costs associated with employees who are directly associated with and who devote time to the computer software project. With respect to all other direct costs, such costs are expensed as incurred, unless corresponding revenue is being deferred. If revenue is being deferred, direct costs relating to delivered service elements are deferred as well and are recognized on a straight-line basis over the period of revenue recognition, in a manner consistent with our recognition of revenue that has been deferred. Such direct costs can include:
•
Transaction processing costs
;
•
Employee costs incurred in performing transaction services
;
•
Vendor costs incurred in performing transaction services
;
•
Costs incurred in performing required monitoring of and reporting on contract performance
;
•
Costs incurred in maintaining and processing member and provider eligibility
; and
•
Costs incurred in communicating with members and providers
.
The recoverability of deferred contract costs associated with a particular contract is analyzed on a periodic basis using the undiscounted estimated cash flows of the whole contract over its remaining contract term. If such undiscounted cash flows are insufficient to recover the long-lived assets and deferred contract costs, the deferred contract costs are written down by the amount of the cash flow deficiency. If a cash flow deficiency remains after reducing the balance of the deferred contract costs to zero, any remaining long-lived assets are evaluated for impairment. Any such impairment recognized would equal the amount by which the carrying value of the long-lived assets exceeds the fair value of those assets
.
Income Taxes
The provision for income taxes is determined using an estimated annual effective tax rate, which is generally greater than the U.S. federal statutory rate primarily because of state taxes and non-deductible compensation under a provision of the Affordable Care Act that limits deductions claimed by health insurers on compensation earned after December 31, 2009 that is paid after December 31, 2012. 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 factors such as the mix of pretax earnings in the various tax jurisdictions in which we operate, valuation allowances against deferred tax assets, the recognition or derecognition 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
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between the financial reporting basis and the tax basis of our assets and liabilities, along with net operating loss and tax credit carryovers.
The total amount of unrecognized tax benefits was
$10.6 million
as of
June 30, 2013
and
December 31, 2012
. Approximately
$8.4 million
of the unrecognized tax benefits recorded at
June 30, 2013
and
December 31, 2012
, relate to a tax position claimed on a state refund claim that will not result in a cash payment for income taxes if our claim is denied. The total amount of unrecognized tax benefits that, if recognized, would affect the effective tax rate was
$7.4 million
as of
June 30, 2013
and
December 31, 2012
. We expect that during the next 12 months it is reasonably possible that unrecognized tax benefit liabilities may decrease by as much as
$8.6 million
due to the expiration of statute of limitations and the resolution to the state refund claim described above.
Our continuing practice is to recognize interest and/or penalties related to unrecognized tax benefits in income tax expense. As of
June 30, 2013
, and
December 31, 2012
, we had accrued
$75,000
and
$56,000
, respectively, for the payment of interest and penalties.
Recent Accounting Pronouncements
Reclassifications Out of Accumulated Other Comprehensive Income
. In February 2013, the Financial Accounting Standards Board (FASB) issued guidance for the reporting of amounts reclassified out of accumulated other comprehensive income. The new guidance requires entities to report the effect of significant reclassifications out of accumulated other comprehensive income on the respective line items in net income if the amount being reclassified is required under U.S. generally accepted accounting principles (GAAP) to be reclassified in its entirety to net income. The new guidance does not change the current requirements for reporting net income or other comprehensive income in financial statements and is effective prospectively for reporting periods beginning after December 15, 2012. The adoption of this new guidance in 2013 did not impact our financial position, results of operations or cash flows.
Balance Sheet Offsetting
. In December 2011, the FASB issued guidance for new disclosure requirements related to the nature of an entity’s rights of set-off and related arrangements associated with its financial instruments and derivative instruments. The new guidance is effective for annual reporting periods, and interim periods within those years, beginning on or after January 1, 2013. The adoption of this new guidance in 2013 did not impact our financial position, results of operations or cash flows.
Federal Premium-Based Assessment.
In July 2011, the FASB issued guidance related to accounting for the fees to be paid by health insurers to the federal government under the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act (ACA). The ACA imposes an annual fee on health insurers for each calendar year beginning on or after January 1, 2014. The fee will be imposed beginning in 2014 based on a company's share of the industry's net premiums written during the preceding calendar year.
The new guidance specifies that the liability for the fee should be estimated and recorded in full once the entity provides qualifying health insurance in the applicable calendar year in which the fee is payable with a corresponding deferred cost that is amortized to expense using a straight-line method of allocation unless another method better allocates the fee over the calendar year that it is payable. The new guidance is effective for annual reporting periods beginning after December 31, 2013, when the fee initially becomes effective. As enacted, this federal premium-based assessment is non-deductible for income tax purposes, and is anticipated to be significant. It is yet undetermined how this premium-based assessment will be factored into the calculation of our premium rates, if at all. Accordingly, adoption of this guidance and the enactment of this assessment as currently written will have a material impact on our financial position, results of operations, or cash flows in future periods. We are currently evaluating the impact of the fee to our financial position, results of operations and cash flows.
Other recent accounting pronouncements issued by the FASB (including its Emerging Issues Task Force), the American Institute of Certified Public Accountants (AICPA), and the Securities and Exchange Commission (SEC) did not have, or are not believed by management to have, a material impact on our present or future consolidated financial statements.
3. Net Income per Share
The following table sets forth the calculation of the denominators used to compute basic and diluted net income per share:
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Three Months Ended June 30,
Six Months Ended June 30,
2013
2012
2013
2012
(In thousands)
Shares outstanding at the beginning of the period
45,415
46,347
46,762
45,815
Weighted-average number of shares repurchased
—
—
(1,248
)
—
Weighted-average number of shares issued
31
8
198
361
Denominator for basic net income per share
45,446
46,355
45,712
46,176
Dilutive effect of employee stock options and stock grants (1)
378
—
488
—
Dilutive effect of convertible senior notes
683
—
306
—
Denominator for diluted net income per share (2)
46,507
46,355
46,506
46,176
(1)
Unvested restricted shares are included in the calculation of diluted income per share when their grant date fair values are below the average fair value of the common shares for each of the periods presented. Options to purchase common shares are included in the calculation of diluted income per share when their exercise prices are below the average fair value of the common shares for each of the periods presented. For the three and six months ended
June 30, 2013
there were no anti-dilutive weighted restricted shares. For the three and six months ended
June 30, 2013
there were approximately
60,000
and
42,800
anti-dilutive weighted options, respectively. Potentially dilutive unvested restricted shares and stock options were not included in the computation of diluted loss per share for the three and six months ended
June 30, 2012
, because to do so would have been anti-dilutive.
(2)
Potentially dilutive shares issuable pursuant to our 1.125% Warrants (defined in Note 10, "Long-Term Debt") were not included in the computation of diluted income per share for the three and six month period ended
June 30, 2013
, because to do so would have been anti-dilutive. Potentially dilutive shares issuable pursuant to our 3.75% Notes (defined in Note 10, "Long-Term Debt") were not included in the computation of diluted loss per share for the three and six month period ended
June 30, 2012
, because to do so would have been anti-dilutive.
4. Stock-Based Compensation
At
June 30, 2013
, we had employee equity incentives outstanding under two plans: (1) the 2011 Equity Incentive Plan; and (2) the 2002 Equity Incentive Plan (from which equity incentives are no longer awarded).
In March 2013, our named executive officers were granted restricted stock awards with performance conditions as follows: our chief executive officer was awarded
186,858
shares, our chief financial officer was awarded
93,429
shares, our chief operating officer was awarded
62,286
shares, our chief accounting officer was awarded
28,029
shares, and our general counsel was awarded
21,800
shares. These awards were apportioned into four equal increments, and will vest in accordance with the following four measures: (i) 1/4th will vest in equal 1/3rd increments over three years on March 1, 2014, March 1, 2015, and March 1, 2016; (ii) 1/4th will vest upon our achievement of three-year Total Stockholder Return as determined by Institutional Shareholder Services Inc. (ISS) calculations for the three-year period ending December 31, 2013 equal to or greater than the 50th percentile within our ISS peer group; (iii) 1/4th shall vest upon our achievement of total revenue in any of the 2013, 2014, or 2015 fiscal years equal to or greater than
$12 billion
; and (iv) 1/4th shall vest upon our achievement of the three-year earnings before interest, taxes, depreciation and amortization (EBITDA) margin percentage for the three-year period ending December 31, 2013 equal to or greater than
2.5%
. In the event the vesting conditions are not achieved, the awards shall lapse. As of
June 30, 2013
, such performance goals have not yet been met, but we do expect the awards to vest in full.
Charged to general and administrative expenses, total stock-based compensation expense was as follows for the three month and six month periods ended
June 30, 2013
and
2012
:
Three Months Ended June 30,
Six Months Ended June 30,
2013
2012
2013
2012
(In thousands)
Restricted stock and performance awards
$
7,111
$
4,452
$
10,959
$
8,850
Employee stock purchase plan and stock options
618
694
1,191
962
$
7,729
$
5,146
$
12,150
$
9,812
As of
June 30, 2013
, there was
$35.2 million
of total unrecognized compensation expense related to unvested restricted share awards, which we expect to recognize over a remaining weighted-average period of
1.9
years. Also as of
June 30, 2013
,
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there was
$0.7 million
of total unrecognized compensation expense related to unvested stock options, which we expect to recognize over a weighted-average period of
2.5
years.
Restricted stock activity for the
six months ended June 30, 2013
is summarized below:
Shares
Weighted
Average
Grant Date
Fair Value
Unvested balance as of December 31, 2012
986,577
$
23.74
Granted
1,038,880
31.53
Vested
(495,221
)
23.64
Forfeited
(21,751
)
26.63
Unvested balance as of June 30, 2013
1,508,485
29.10
The total fair value of restricted stock and stock unit awards, including those with performance conditions, granted during the
six months ended June 30, 2013
and
2012
was
$33.1 million
and
$22.4 million
, respectively. The total fair value of restricted stock and stock unit awards vested during the
six months ended June 30, 2013
and
2012
was
$16.2 million
and
$23.6 million
, respectively.
Stock option activity for the
six months ended June 30, 2013
is summarized below:
Options
Weighted
Average
Exercise
Price
Aggregate
Intrinsic
Value
Weighted
Average
Remaining
Contractual
term
(In thousands)
(Years)
Outstanding as of December 31, 2012
414,061
$
22.39
Granted
45,000
33.02
Exercised
(54,500
)
17.93
Forfeited
(300
)
17.63
Outstanding as of June 30, 2013
404,261
24.18
$
5,255
3.8
Stock options exercisable and expected to vest as of June 30, 2013
404,261
24.18
$
5,255
3.8
Exercisable as of June 30, 2013
349,261
22.74
$
5,045
2.9
The weighted-average grant date fair value per share of stock options awarded to the new members of our board of directors during the
six months ended June 30, 2013
was
$14.67
. The weighted-average grant date fair value per share of the stock option awarded to the director appointed during
2012
was
$13.97
. To determine the fair values of these stock options we applied risk-free interest rates of
1.1%
to
1.4%
, expected volatilities of
41.3%
to
43.0%
, dividend yields of
0%
, and expected lives of
6
years to
7
years.
5. Fair Value Measurements
Our consolidated balance sheets include the following financial instruments: cash and cash equivalents, investments, receivables, a derivative asset, trade accounts payable, medical claims and benefits payable, long-term debt, a derivative liability, and other liabilities. We consider the carrying amounts of cash and cash equivalents, receivables, other current assets and current liabilities 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 a three-tier fair value hierarchy as follows:
•
Level 1 — Observable inputs such as quoted prices in active markets:
Our Level 1 financial instruments recorded at fair value consist of investments including government-sponsored enterprise securities (GSEs) and U.S. treasury notes that are classified as current investments in the accompanying consolidated balance sheets. These financial instruments are actively traded and therefore the fair value for these securities is based on quoted market prices on one or more securities exchanges.
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•
Level 2 — Inputs other than quoted prices in active markets that are either directly or indirectly observable:
Our Level 2 financial instruments recorded at fair value consist of investments including corporate debt securities, municipal securities, and certificates of deposit that are classified as current investments in the accompanying consolidated balance sheets. Our investments classified as Level 2 are traded frequently though not necessarily daily. Fair value for these investments is determined using a market approach based on quoted prices for similar securities in active markets or quoted prices for identical securities in inactive markets.
•
Level 3 — Unobservable inputs in which little or no market data exists, therefore requiring an entity to develop its own assumptions:
Our Level 3 financial instruments recorded at fair value include non-current auction rate securities that are designated as available-for-sale, and are reported at fair value of
$12.5 million
(par value of
$13.4 million
) as of
June 30, 2013
. To estimate the fair value of these securities we use valuation data from our primary pricing source, a third party who provides a marketplace for illiquid assets with over 10,000 participants including global financial institutions, hedge funds, private equity funds, mutual funds, corporations and other institutional investors. This valuation data is based on a range of prices that represent indicative bids from potential buyers. To validate the reasonableness of the data, we compare these valuations to data from two other third-party pricing sources, which also provide a range of prices representing indicative bids from potential buyers. We have concluded that these estimates, given the lack of market available pricing, provide a reasonable basis for determining the fair value of the auction rate securities as of
June 30, 2013
.
Additionally, Level 3 financial instruments include derivative financial instruments comprising the
1.125%
Call Option asset, and the embedded cash conversion option liability. 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 June 30, 2013 included our common stock price, time to maturity of the derivative instruments, the risk-free interest rate, and the implied volatility of our common stock. As described further in Note
10
, “
Long-Term Debt
,” and Note
11
, “
Derivative Financial Instruments
,” the 1.125% Call Option asset and the embedded cash conversion option 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 instruments is mitigated.
Our financial instruments measured at fair value on a recurring basis at
June 30, 2013
, were as follows:
Total
Level 1
Level 2
Level 3
(In thousands)
Corporate debt securities
$
463,723
$
—
$
463,723
$
—
GSEs
84,101
84,101
—
—
Municipal securities
105,936
—
105,936
—
U.S. treasury notes
26,495
26,495
—
—
Certificates of deposit
38,289
—
38,289
—
Auction rate securities
12,527
—
—
12,527
1.125% Call Option derivative asset
207,123
—
—
207,123
Total assets measured at fair value on a recurring basis
$
938,194
$
110,596
$
607,948
$
219,650
Embedded cash conversion option derivative liability
$
207,017
$
—
$
—
$
207,017
15
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Our financial instruments measured at fair value on a recurring basis at
December 31, 2012
, were as follows:
Total
Level 1
Level 2
Level 3
(In thousands)
Corporate debt securities
$
191,008
$
—
$
191,008
$
—
GSEs
29,525
29,525
—
—
Municipal securities
75,848
—
75,848
—
U.S. treasury notes
35,740
35,740
—
—
Certificates of deposit
10,724
—
10,724
—
Auction rate securities
13,419
—
—
13,419
Total assets measured at fair value on a recurring basis
$
356,264
$
65,265
$
277,580
$
13,419
Interest rate swap derivative liability
$
1,307
$
—
$
1,307
$
—
The following tables present activity relating to our assets (liabilities) measured at fair value on a recurring basis using significant unobservable inputs (Level 3):
Changes in Level 3 Instruments for the Six Months Ended June 30, 2013
Total
Auction Rate Securities
Derivatives, Net
(In thousands)
Balance at December 31, 2012
$
13,419
$
13,419
$
—
Net unrealized gains included in other comprehensive income
358
358
—
Net unrealized gains (losses) included in other expense
(3,817
)
—
(3,817
)
Issuances
(75,074
)
—
(75,074
)
Settlements and derivative redesignation
77,747
(1,250
)
78,997
Balance at June 30, 2013
$
12,633
$
12,527
$
106
The amount of total unrealized gains for the period included in other comprehensive income attributable to the change in accumulated other comprehensive losses relating to assets still held at June 30, 2013
$
290
$
290
$
—
Changes in Level 3 Instruments for the Year Ended December 31, 2012
Total
Auction Rate Securities
Derivatives, Net
(In thousands)
Balance at December 31, 2011
$
16,134
$
16,134
$
—
Net unrealized gains included in other comprehensive income
1,635
1,635
—
Settlements
(4,350
)
(4,350
)
—
Balance at December 31, 2012
$
13,419
$
13,419
$
—
The amount of total unrealized gains for the period included in other comprehensive income attributable to the change in accumulated other comprehensive losses relating to assets still held at December 31, 2012
$
1,059
$
1,059
$
—
Fair Value Measurements – Disclosure Only
The carrying amounts and estimated fair values of our long-term debt, as well as the applicable fair value hierarchy tiers, are contained in the tables below. Our convertible senior notes are classified as Level 2 financial instruments. Fair value for these securities is determined using a market approach based on quoted prices for similar securities in active markets or quoted prices for identical securities in inactive markets. As described in greater detail Note
10
, "Long-Term Debt," we recorded lease financing obligations in connection with sale-leaseback transactions executed in the first half of 2013. The lease financing obligations are classified as Level 3 financial instruments because certain inputs used to determine their fair value are unobservable. At
June 30, 2013
, the carrying amount of the lease financing obligations approximate their fair value because of the short period of time between the origination of the obligations in 2013, and
June 30, 2013
. The credit facility was repaid and terminated effective
February 15, 2013
, and the term loan was repaid on June 13, 2013.
16
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June 30, 2013
Carrying
Value
Total
Fair Value
Level 1
Level 2
Level 3
(In thousands)
1.125% Notes
$
407,215
$
608,416
$
—
$
608,416
$
—
3.75% Notes
178,610
242,466
—
242,466
—
Lease financing obligations
175,666
175,666
—
—
175,666
$
761,491
$
1,026,548
$
—
$
850,882
$
175,666
December 31, 2012
Carrying
Total
Value
Fair Value
Level 1
Level 2
Level 3
(In thousands)
3.75% Notes
$
175,468
$
208,460
$
—
$
208,460
$
—
Term loan
47,471
47,471
—
—
47,471
Credit facility
40,000
40,000
—
—
40,000
$
262,939
$
295,931
$
—
$
208,460
$
87,471
6. Investments
The following tables summarize our investments as of the dates indicated:
June 30, 2013
Amortized
Gross
Unrealized
Estimated
Fair
Cost
Gains
Losses
Value
(In thousands)
Corporate debt securities
$
465,943
$
215
$
2,436
$
463,722
GSEs
84,310
9
218
84,101
Municipal securities
106,933
103
1,100
105,936
U.S. treasury notes
26,557
11
72
26,496
Certificates of deposit
38,291
3
5
38,289
Subtotal - current investments
722,034
341
3,831
718,544
Auction rate securities
13,400
—
873
12,527
$
735,434
$
341
$
4,704
$
731,071
December 31, 2012
Amortized
Gross
Unrealized
Estimated
Fair
Cost
Gains
Losses
Value
(In thousands)
Corporate debt securities
$
190,545
$
528
$
65
$
191,008
GSEs
29,481
45
1
29,525
Municipal securities
75,909
185
246
75,848
U.S. treasury notes
35,700
42
2
35,740
Certificates of deposit
10,715
9
—
10,724
Subtotal - current investments
342,350
809
314
342,845
Auction rate securities
14,650
—
1,231
13,419
$
357,000
$
809
$
1,545
$
356,264
17
The contractual maturities of our investments as of
June 30, 2013
are summarized below:
Cost
Estimated
Fair Value
(In thousands)
Due in one year or less
$
348,784
$
348,700
Due one year through five years
373,250
369,844
Due after ten years
13,400
12,527
$
735,434
$
731,071
Gross realized gains and gross realized losses from sales of available-for-sale securities are calculated under the specific identification method and are included in investment income. Net realized investment gains for the
three months ended June 30, 2013
, and
2012
were
$48,000
and
$174,000
, respectively. Net realized investment gains for the
six months ended June 30, 2013
, and
2012
were
$142,000
and
$238,000
, respectively.
We monitor our investments for other-than-temporary impairment. For investments other than our auction rate securities, discussed below, we have determined that unrealized gains and losses at
June 30, 2013
, and
December 31, 2012
, 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 credit worthiness of the issuers. So long as we hold these securities to maturity, we are unlikely to experience gains or losses. In the event that we dispose of these securities before maturity, we expect that realized gains or losses, if any, will be immaterial.
The following tables segregate 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 loss position for 12 months or more as of
June 30, 2013
.
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
Securities
Estimated
Fair
Value
Unrealized
Losses
Total
Number of
Securities
(Dollars in thousands)
Corporate debt securities
$
349,918
$
2,436
158
$
—
$
—
—
Municipal securities
82,592
1,100
100
—
—
—
GSEs
70,453
218
27
—
—
—
U.S. treasury notes
20,720
72
17
—
—
—
Certificates of deposit
4,743
5
19
—
—
—
Auction rate securities
—
—
—
12,527
873
18
$
528,426
$
3,831
321
$
12,527
$
873
18
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 loss position for 12 months or more as of
December 31, 2012
.
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
Securities
Estimated
Fair
Value
Unrealized
Losses
Total
Number of
Securities
(Dollars in thousands)
Corporate debt securities
$
44,457
$
65
23
$
—
$
—
—
Municipal securities
35,223
246
43
—
—
—
GSEs
5,004
1
1
—
—
—
U.S. treasury notes
4,511
2
5
—
—
—
Auction rate securities
—
—
—
13,419
1,231
21
$
89,195
$
314
72
$
13,419
$
1,231
21
Auction Rate Securities
Due to events in the credit markets, the auction rate securities held by us experienced failed auctions beginning in the first quarter of 2008, and such auctions have not resumed. Therefore, quoted prices in active markets have not been available since
early 2008. Our investments in auction rate securities are collateralized by student loan portfolios guaranteed by the U.S. government, and the range of maturities for such securities is from
18
years to
34
years. Considering the relative insignificance of these securities when compared with our liquid assets and other sources of liquidity, we have no current intention of selling these securities nor do we expect to be required to sell these securities before a recovery in their cost basis. For this reason, and because the decline in the fair value of the auction securities was not due to the credit quality of the issuers, we do not consider the auction rate securities to be other-than-temporarily impaired at
June 30, 2013
. At the time of the first failed auctions during first quarter 2008, we held a total of
$82.1 million
in auction rate securities at par value; since that time, we have settled
$68.7 million
of these instruments at par value.
For the
six months ended June 30, 2013
, and
2012
, we recorded pretax unrealized gains of
$0.4 million
and
$1.0 million
, respectively, to accumulated other comprehensive income for the changes in their fair value. Any future fluctuation in fair value related to these instruments that we deem to be temporary, including any recoveries of previous write-downs, would be recorded to accumulated other comprehensive income. If we determine that any future valuation adjustment was other-than-temporary, we would record a charge to earnings as appropriate.
7. Receivables
Receivables consist primarily of amounts due from the various states in which we operate. Accounts receivable were as follows:
June 30,
2013
December 31,
2012
(In thousands)
Health Plans segment:
California
$
94,479
$
28,553
Florida
1,277
953
Michigan
11,087
12,873
New Mexico
11,720
9,059
Ohio
37,103
40,980
Texas
4,647
7,459
Utah
4,507
3,359
Washington
15,292
17,587
Wisconsin
16,332
4,098
Other
852
2,177
Total Health Plans segment
197,296
127,098
Molina Medicaid Solutions segment
16,480
22,584
$
213,776
$
149,682
8. Restricted Investments
Pursuant to the regulations governing our Health Plans segment subsidiaries, we maintain statutory deposits and deposits required by state authorities in certificates of deposit and U.S. treasury securities. We also maintain restricted investments as protection against the insolvency of certain capitated providers. Additionally, in connection with the Molina Medicaid Solutions segment contracts with the states of Maine and Idaho, we maintain restricted investments as collateral for letters of credit. The
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following table presents the balances of restricted investments:
June 30,
2013
December 31,
2012
(In thousands)
California
$
373
$
373
Florida
8,492
5,738
Michigan
1,014
1,014
New Mexico
15,917
15,915
Ohio
9,081
9,082
Texas
3,500
3,503
Utah
3,314
3,126
Washington
151
151
Other
4,792
5,199
Total Health Plans segment
46,634
44,101
Molina Medicaid Solutions segment
10,301
—
$
56,935
$
44,101
The contractual maturities of our held-to-maturity restricted investments as of
June 30, 2013
are summarized below.
Amortized
Cost
Estimated
Fair Value
(In thousands)
Due in one year or less
$
52,694
$
52,697
Due one year through five years
4,241
4,238
$
56,935
$
56,935
9. Medical Claims and Benefits Payable
The following table presents the components of the change in our medical claims and benefits payable for the periods indicated. The amounts displayed for “Components of medical care costs related to: Prior periods” represent the amount by which our original estimate of claims and benefits payable at the beginning of the period were (more) or less than the actual amount of the liability based on information (principally the payment of claims) developed since that liability was first reported. The following table shows the components of the change in medical claims and benefits payable from continuing and discontinued operations as of the periods indicated:
20
Table of Contents
Six Months Ended
Three Months Ended
Year Ended
June 30, 2013
June 30, 2013
Dec. 31, 2012
(Dollars in thousands)
Balances at beginning of period
$
494,530
$
491,145
$
402,476
Components of medical care costs related to:
Current period
2,647,083
1,345,592
5,136,055
Prior periods
(62,757
)
(50,020
)
(39,295
)
Total medical care costs
2,584,326
1,295,572
5,096,760
Payments for medical care costs related to:
Current period
2,206,474
940,186
4,649,363
Prior periods
406,895
381,044
355,343
Total paid
2,613,369
1,321,230
5,004,706
Balances at end of period
$
465,487
$
465,487
$
494,530
Benefit from prior period as a percentage of:
Balance at beginning of period
12.7
%
10.2
%
9.8
%
Premium revenue, trailing twelve months
1.0
%
0.8
%
0.7
%
Medical care costs, trailing twelve months
1.2
%
1.0
%
0.8
%
Assuming that our initial estimate of claims incurred but not paid (IBNP) is accurate, we believe that amounts ultimately paid out would generally be between 8% and 10% less than the liability recorded at the end of the period as a result of the inclusion in that liability of the allowance for adverse claims development and the accrued cost of settling those claims. Because the amount of our initial liability is merely an estimate (and therefore not perfectly accurate), 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.
Furthermore, 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 only know when the circumstances for any one or more factors are out of the ordinary.
As indicated above, the amounts ultimately paid out on our liabilities in fiscal years
2013
and
2012
were less than what we had expected when we had established our reserves. For example, for the year ended December 31, 2012, the amounts ultimately paid out were less than the amount of the reserves we had established as of December 31, 2011 by
9.8%
. While many related factors working in conjunction with one another determine the accuracy of our estimates, we are seldom able to quantify the impact that any single factor has on a change in estimate. In addition, given the variability inherent in the reserving process, 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 recognized favorable prior period claims development in the amount of
$62.8 million
for the
six months ended June 30, 2013
. This amount represents our estimate, as of
June 30, 2013
, of the extent to which our initial estimate of medical claims and benefits payable at
December 31, 2012
was more than the amount that will ultimately be paid out in satisfaction of that liability. We believe the overestimation of our claims liability at
December 31, 2012
was due primarily to the following factors:
•
At our Texas health plan, STAR+PLUS (the state’s program for ABD members) membership declined during mid– to late– 2012. This caused a reduction in costs per member that we did not fully recognize in our December 31, 2012 reserve estimates.
•
At our Washington health plan, prior to July 2012, certain high-cost newborns that were approved for supplemental security income (SSI) coverage by the state were retroactively dis-enrolled from our Healthy Options (TANF) coverage, and the health plan was reimbursed for the claims paid on behalf of these members. Starting July 1, 2012, these newborns, as well as other high-cost disabled members, are now covered by the health plan under the Healthy Options Blind and Disabled (HOBD) program. At the end of 2012, we had limited claims history with which to estimate the claims liability of the HOBD members, and as a result the liability for these high-cost members was overstated.
•
For our New Mexico health plan, we overestimated the impact of certain high-dollar outstanding claim payments as of December 31, 2012.
21
Table of Contents
We recognized favorable prior period claims development in the amount of
$50.0 million
for the
three months ended June 30, 2013
. This amount represents our estimate as of
June 30, 2013
, of the extent to which our initial estimate of medical claims and benefits payable at March 31, 2013 was more than the amount that will ultimately be paid out in satisfaction of that liability. We believe the overestimation of our claims liability at March 31, 2013 was due primarily to the following factors:
•
At our Washington health plan, we had limited claims history with which to estimate the incurred claims for members enrolled in the HOBD program. Because claims on this group of members were being paid at a rate faster than expected, the reserves for unpaid claims were overstated.
•
At our Ohio and New Mexico health plans, we overestimated the impact of several potential high-dollar claims on critically ill members.
We recognized favorable prior period claims development in the amount of
$36.4 million
and
$39.3 million
for the
six months ended June 30, 2012
, and the year ended
December 31, 2012
, respectively. This was primarily caused by the overestimation of our liability claims and medical benefits at
December 31, 2011
, as a result of the following factors:
•
At our Washington health plan, we underestimated the amount of recoveries we would collect for certain high-cost newborn claims, resulting in an overestimation of reserves at year end.
•
At our Texas health plan, we overestimated the cost of new members in STAR+PLUS, in the Dallas region.
•
The overestimation of our liability for medical claims and benefits payable was partially offset by an underestimation of that liability at our Missouri health plan, as a result of the costs associated with an unusually large number of premature infants during the fourth quarter of 2011.
In estimating our claims liability at
June 30, 2013
, we adjusted our base calculation to take account of the following factors which we believe are reasonably likely to change our final claims liability amount:
•
In our Texas health plan, we have noted an unusually large number of claims with incurred dates older than 10 months. This has caused some distortion in the claims lag pattern that we use to estimate the incurred claims.
•
Our Wisconsin health plan is experiencing significant membership increases, and approximately doubled in size during the first four months of 2013. This new membership is transitioning to our health plan from a terminated health plan. We enrolled approximately
50,000
new members in February, March and April 2013.
We have computed a separate reserve analysis for these members and have noted that paid claims thus far are less than what we would expect for newly transitioned members. It has been our experience that when members move to new health plans, there is a delay in the submission of claims for payment. Therefore, we have increased the reserves for this membership, in anticipation of higher claims costs eventually being reported for these members.
•
In our Michigan health plan, there were a large number of claim recoveries recorded in June 2013 due to overpayments that resulted from a system configuration issue. These recoveries impacted the completion factors used to estimate incurred claims. While we have attempted to remove this distortion from the claims data to develop a more accurate reserve estimate, this type of correction in claims data adds a degree of uncertainty for the Michigan reserves as of June 30, 2013.
The use of a consistent methodology in estimating our liability for claims and medical benefits payable minimizes the degree to which the under- or overestimation of that liability at the close of one period may affect consolidated results of operations in subsequent periods. In particular, the use of a consistent methodology should result in the replenishment of reserves during any given period in a manner that generally offsets the benefit of favorable prior period development in that period. Facts and circumstances unique to the estimation process at any single date, however, may still lead to a material impact on consolidated results of operations in subsequent periods. Any absence of adverse claims development (as well as the expensing through general and administrative expense of the costs to settle claims held at the start of the period) will lead to the recognition of a benefit from prior period claims development in the period subsequent to the date of the original estimate. In
2012
, and for the
six months ended June 30, 2013
, the absence of adverse development of the liability for claims and medical benefits payable at the close of the previous period resulted in the recognition of substantial favorable prior period development. In both years, however, the recognition of a benefit from prior period claims development did not have a material impact on our consolidated results of operations because the replenishment of reserves in the respective periods generally offset the benefit from the prior period.
10. Long-Term Debt
As of
June 30, 2013
, maturities of long-term debt for the years ending December 31 are as follows (in thousands):
22
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Total
2013
2014
2015
2016
2017
Thereafter
1.125% Notes
$
550,000
$
—
$
—
$
—
$
—
$
—
$
550,000
3.75% Notes
187,000
—
187,000
—
—
—
—
$
737,000
$
—
$
187,000
$
—
$
—
$
—
$
550,000
1.125% Cash Convertible Senior Notes due 2020
On
February 15, 2013
, we settled the issuance of
$550.0 million
aggregate principal amount of 1.125% Cash Convertible Senior Notes due 2020 (the 1.125% Notes). This transaction included the initial issuance of
$450.0 million
on
February 11, 2013
, plus the exercise of the full amount of the
$100.0 million
over-allotment option on
February 13, 2013
. The aggregate net proceeds of the 1.125% Notes were
$458.9 million
, after payment of the net cost of the Call Spread Overlay described below and in Note
11
, “
Derivative Financial Instruments
,” and transaction costs. Additionally, we used
$50.0 million
of the net proceeds to purchase shares of our common stock (see Note
12
, “
Stockholders' Equity
”), and
$40.0 million
to repay the principal owed under our Credit Facility.
Interest on the 1.125% Notes is payable semiannually in arrears on
January 15
and
July 15
of each year, at a rate of
1.125%
per annum commencing on
July 15, 2013
. The 1.125% Notes will mature on
January 15, 2020
unless repurchased or converted in accordance with their terms prior to such date.
The 1.125% Notes are convertible only into cash, and not into shares of our common stock or any other securities. Holders may convert their 1.125% Notes solely into cash at their option at any time prior to the close of business on the business day immediately preceding
July 15, 2019
only under the following circumstances: (1) during any calendar quarter commencing after the calendar quarter ending on
June 30, 2013
(and only during such calendar quarter), if the last reported sale price of the common stock for at least
20
trading days (whether or not consecutive) during a period of
30
consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to
130%
of the conversion price on each applicable trading day; (2) during the five business day period immediately after any five consecutive trading day period in which the trading price per
$1,000
principal amount of 1.125% Notes for each trading day of the measurement period was less than
98%
of the product of the last reported sale price of our common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events. On or after
July 15, 2019
until the close of business on the second scheduled trading day immediately preceding the maturity date, holders may convert their 1.125% Notes solely into cash at any time, regardless of the foregoing circumstances. 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.
The initial conversion rate will be
24.5277
shares of our common stock per
$1,000
principal amount of 1.125% Notes (equivalent to an initial conversion price of approximately
$40.77
per share of common stock). The conversion rate will be subject to adjustment in some events but will not be adjusted for any accrued and unpaid interest. In addition, following certain corporate events that occur prior to the maturity date, we will pay a cash make-whole premium by increasing the conversion rate for a holder who elects to convert its 1.125% Notes in connection with such a corporate event in certain circumstances. We may not redeem the 1.125% Notes prior to the maturity date, and no sinking fund is provided for the 1.125% Notes.
If we undergo a fundamental change (as defined in the indenture to the 1.125% Notes), holders may require us to repurchase for cash all or part of their 1.125% Notes at a repurchase price equal to
100%
of the principal amount of the 1.125% Notes to be repurchased, plus accrued and unpaid interest to, but excluding, the fundamental change repurchase date. The indenture provides for customary events of default, including cross acceleration to certain other indebtedness of ours, and our significant subsidiaries.
The 1.125% Notes are senior unsecured obligations, and rank senior in right of payment to any of our indebtedness that is expressly subordinated in right of payment to the 1.125% Notes; equal in right of payment to any of our unsecured indebtedness that is not so subordinated; effectively junior in right of payment to any of our secured indebtedness to the extent of the value of the assets securing such indebtedness; and structurally junior to all indebtedness and other liabilities (including trade payables) of our subsidiaries.
The 1.125% Notes contain an embedded cash conversion option. We have determined that the embedded cash conversion option is a derivative financial instrument, required to be 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 embedded cash conversion option transaction settles or expires. The initial fair value liability of the embedded cash conversion option was
$149.3 million
, which simultaneously reduced the carrying value of the 1.125% Notes (effectively an original issuance
23
Table of Contents
discount). For further discussion of the derivative financial instruments relating to the 1.125% Notes, refer to Note
11
, “
Derivative Financial Instruments
.”
As noted above, the reduced carrying value on the 1.125% Notes resulted in a debt discount that is amortized to the 1.125% Notes' principal amount through the recognition of interest expense over the expected life of the debt. This has resulted in our recognition of interest expense on the 1.125% Notes at an effective rate approximating what we would have incurred had nonconvertible debt with otherwise similar terms been issued. The effective interest rate of the 1.125% Notes is
5.9%
, which is imputed based on the amortization of the fair value of the embedded cash conversion option over the remaining term of the 1.125% Notes. As of
June 30, 2013
, we expect the 1.125% Notes to be outstanding until their
January 15, 2020
maturity date, for a remaining amortization period of
6.5
years. The 1.125% Notes' if-converted value did not exceed their principal amount as of
June 30, 2013
.
Also in connection with the settlement of the 1.125% Notes, we paid approximately
$16.9 million
in transaction costs. Such costs have been allocated to the 1.125% Notes, the 1.125% Call Option (defined below) and the 1.125% Warrants (defined below) according to their relative fair values. The amount allocated to the 1.125% Notes, or
$12.0 million
, was capitalized and will be amortized over the term of the 1.125% Notes. The aggregate amount allocated to the 1.125% Call Option and 1.125% Warrants, or
$4.9 million
, was recorded to interest expense in the quarter ended March 31, 2013.
1.125% Notes Call Spread Overlay
Concurrent with the issuance of the 1.125% Notes, 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). These transactions represent a Call Spread Overlay, whereby 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 the sales price 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 due upon any conversion of the 1.125% Notes. We used
$149.3 million
of the proceeds from the settlement of the 1.125% Notes to pay for the 1.125% Call Option, and simultaneously received
$75.1 million
for the sale of the 1.125% Warrants, for a net cash outlay of
$74.2 million
for the Call Spread Overlay. The 1.125% Call Option is a derivative financial instrument. Until April 22, 2013, the 1.125% Warrants were classified as derivative financial instruments; refer to Note
11
, “
Derivative Financial Instruments
” for further discussion.
Aside from the initial payment of a premium to the Counterparties of
$149.3 million
for the 1.125% Call Option, we will not be required to make any cash payments to the Counterparties under the 1.125% Call Option, and will be entitled to receive from the Counterparties an amount of cash, generally equal to the amount by which the market price per share of common stock exceeds the strike price of the 1.125% Call Options during the relevant valuation period. The strike price under the 1.125% Call Option is initially equal to the conversion price of the 1.125% Notes. Additionally, if the market value per share of our common stock exceeds the strike price of the 1.125% Warrants on any trading day during the
160
trading day measurement period under the 1.125% Warrants, we will be obligated to issue to the Counterparties a number of shares equal in value to the product of the amount by which such market value exceeds such strike price and 1/160th of the aggregate number of shares of our common stock underlying the 1.125% Warrants, subject to a share delivery cap. We will not receive any additional proceeds if the 1.125% Warrants are exercised. Pursuant to the 1.125% Warrants, we issued
13,490,236
warrants with a strike price of
$53.8475
per share. The number of warrants and the strike price are subject to adjustment under certain circumstances.
3.75% Convertible Senior Notes due 2014
We had
$187.0 million
of
3.75%
Convertible Senior Notes due 2014 (the 3.75% Notes) outstanding as of
June 30, 2013
and
December 31, 2012
, respectively. The 3.75% Notes rank equally in right of payment with our existing and future senior indebtedness. The 3.75% Notes are convertible into cash and, under certain circumstances, shares of our common stock. The initial conversion rate is
31.9601
shares of our common stock per one thousand dollar principal amount of the 3.75% Notes. This represents an initial conversion price of approximately
$31.29
per share of our common stock. In addition, if certain corporate transactions that constitute a change of control occur prior to maturity, we will increase the conversion rate in certain circumstances.
Because the 3.75% Notes have cash settlement features, we have allocated the proceeds from their issuance between a liability component and an equity component. The reduced carrying value on the 3.75% Notes resulted in a debt discount that is amortized back to the 3.75% Notes' principal amount through the recognition of non-cash interest expense over the expected life of the debt. This has resulted in our recognition of interest expense on the 3.75% Notes at an effective rate approximating what we would have incurred had nonconvertible debt with otherwise similar terms had been issued. The effective interest rate
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Table of Contents
of the 3.75% Notes is
7.5%
, principally based on the
seven
-year U.S. Treasury note rate as of the October 2007 issuance date, plus an appropriate credit spread. As of
June 30, 2013
, we expect the 3.75% Notes to be outstanding until their
October 1, 2014
maturity date, for a remaining amortization period of
15 months
. As of
June 30, 2013
, the 3.75% Notes’ if-converted value exceeded their principal amount by approximately
$46 million
. The 3.75% Notes' if-converted value did not exceed their principal amount as of
December 31, 2012
. At
June 30, 2013
, the equity component of the 3.75% Notes, net of the impact of deferred taxes, was
$24.0 million
.
The principal amounts, unamortized discount and net carrying amounts of the 1.125% Notes and 3.75% Notes were as follows:
Principal Balance
Unamortized Discount
Net Carrying Amount
(In thousands)
June 30, 2013:
1.125% Notes
$
550,000
$
142,785
$
407,215
3.75% Notes
187,000
8,390
178,610
$
737,000
$
151,175
$
585,825
December 31, 2012:
3.75% Notes
$
187,000
$
11,532
$
175,468
Three Months Ended June 30,
Six Months Ended June 30,
2013
2012
2013
2012
(In thousands)
Interest cost recognized for the period relating to the:
Contractual interest coupon rate
$
3,300
$
1,753
$
5,827
$
3,506
Amortization of the discount
5,965
1,472
9,688
2,915
Total interest cost recognized
$
9,265
$
3,225
$
15,515
$
6,421
Lease Financing Obligations
On June 12, 2013 we entered into a sale-leaseback transaction for the sale and contemporaneous leaseback of
two
properties, including the Molina Center located in Long Beach, California, and the building that houses our Ohio health plan located in Columbus, Ohio. We sold the two properties for
$158.6 million
in the aggregate. Due to our continuing involvement with these leased properties, the sale did not qualify for sale-leaseback accounting treatment and we remain the "accounting owner" of the properties. The carrying values of these properties, including the related intangible assets, amounted to
$78.8 million
in the aggregate as of June 30, 2013. These assets continue to be included in our consolidated balance sheets, and also continue to be depreciated and amortized over their remaining useful lives. The sales price of
$158.6 million
was recorded as a lease financing obligation, which is amortized over the 25-year lease term such that there will be no gain or loss recorded if the lease is not extended at the end of its term. Payments under the lease adjust the lease financing obligation, and the imputed interest is recorded to interest expense in our consolidated statements of operations. Transaction costs associated with this transaction, amounting to
$3.5 million
, have been deferred and will be amortized over the initial lease term. Future minimum rental income on noncancelable leases from third party tenants of these properties, as reported in our December 31, 2012 Form 10-K, is now considered to be sublease rental income, and continues to be reported in rental income in our consolidated statements of operations. The future minimum rental income previously reported as of December 31, 2012 is consistent with our expected sublease rental income as of June 30, 2013. For information regarding the future minimum lease obligation, refer to Note
14
, “Commitments and Contingencies.”
As described and defined in further detail in Note
15
, "Related Party Transactions," we entered into a lease for office space in February 2013 consisting of two office buildings then under construction. We have concluded that we are the accounting owner of the construction projects because of our continuing involvement in those projects. Therefore, we have recorded
$17.0 million
to property, equipment and capitalized software, net, in the accompanying consolidated balance sheet as of
June 30, 2013
, which represents the total cost, including imputed interest, incurred by the Landlord thus far in the construction projects. As of
June 30, 2013
, the aggregate amounts recorded to property, equipment and capitalized software, net, for both Building A and B are also recorded as a corresponding lease financing obligation of
$17.0 million
. Payments under the lease adjust the lease financing obligation, and the imputed interest is recorded to interest expense in our consolidated statements of operations. In addition to the capitalization of the costs incurred by the Landlord, we impute and record rent expense relating to the ground leases for the property sites. Such rent expense is computed based on the fair value of the land
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and our incremental borrowing rate, and was immaterial for the
six months ended June 30, 2013
. For information regarding the future minimum lease obligation, refer to Note
14
, “Commitments and Contingencies.”
Term Loan
In December 2011, our wholly owned subsidiary, Molina Center LLC, entered into a term loan agreement with various lenders and East West Bank to borrow
$48.6 million
to finance a portion of the purchase price for the Molina Center, located in Long Beach, California. On June 13, 2013, we repaid the principal balance outstanding under the term loan on that date with proceeds we received in the sale-leaseback transaction described above.
Credit Facility
On February 15, 2013, we used approximately
$40.0 million
of the net proceeds from the offering of the 1.125% Notes to repay all of the outstanding indebtedness under our
$170 million
revolving Credit Facility, with various lenders and U.S. Bank National Association, as Line of Credit Issuer, Swing Line Lender, and Administrative Agent. As of December 31, 2012, there was
$40.0 million
outstanding under the Credit Facility.
We terminated the Credit Facility in connection with the closing of the offering and sale of the 1.125% Notes. Two letters of credit in the aggregate principal amount of
$10.3 million
that reduced the amount available for borrowing under the Credit Facility as of December 31, 2012, were transferred to direct issue letters of credit with another financial institution. Such direct issue letters of credit are collateralized by restricted investments.
11. Derivative Financial Instruments
The following table summarizes the fair values and the presentation of our derivative financial instruments (defined and discussed individually below) in the consolidated balance sheets:
Balance Sheet Location
June 30, 2013
(In thousands)
Derivative asset:
1.125% Call Option
Non-current assets: Derivative asset
$
207,123
Derivative liability:
Embedded cash conversion option
Non-current liabilities: Derivative liability
$
207,017
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, in other expense. The following table summarizes the gains (losses) recorded in the periods presented:
Three Months Ended June 30,
Six Months Ended June 30,
2013
2012
2013
2012
(In thousands)
Derivative gains (losses):
1.125% Call Option
$
59,738
$
—
$
57,792
$
—
Embedded cash conversion option
(59,708
)
—
(57,686
)
—
1.125% Warrants
(3,923
)
—
(3,923
)
—
Interest rate swap
390
(1,086
)
433
(1,086
)
$
(3,503
)
$
(1,086
)
$
(3,384
)
$
(1,086
)
1.125% Notes Call Spread Overlay
As described in Note 10, "Long-Term Debt," we entered into a Call Spread Overlay, whereby the cost of the 1.125% Call Option we purchased to cover the cash outlay upon conversion of the debentures was reduced by the sales price 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 due upon any conversion of the 1.125% Notes.
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Table of Contents
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 the cash settlement features until the 1.125% Call Option settles or expires. The 1.125% Call Option is measured and reported at fair value on a recurring basis, within Level 3 of the fair value hierarchy. For further discussion of the inputs used to determine the fair value of the 1.125% Call Option, refer to Note
5
, “
Fair Value Measurements
.”
Until April 22, 2013, the 1.125% Warrants were recorded as a derivative liability that required mark-to-market accounting treatment due to certain terms in the 1.125% Warrants that prevented such instruments being considered to be indexed in our common stock. Effective April 22, 2013, we entered into amended and restated warrant confirmations with the Counterparties to clarify these terms, such that 1.125% Warrants are no longer considered to be derivative instruments, and have been recorded to additional paid-in capital. For the six months ended June 30, 2013, we recorded a loss of
$3.9 million
for the change in fair value of the 1.125% Warrants from February 15, 2013 to April 22, 2013.
Embedded Cash Conversion Option
The embedded cash conversion option within the 1.125% Notes is required to be 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 cash conversion option settles or expires. The initial fair value liability of the embedded cash conversion option was
$149.3 million
, which simultaneously reduced the carrying value of the 1.125% Notes (effectively an original issuance discount). The embedded cash conversion option is measured and reported at fair value on a recurring basis, within Level 3 of the fair value hierarchy. For further discussion of the inputs used to determine the fair value of the embedded cash conversion option, refer to Note
5
, “
Fair Value Measurements
.”
Interest Rate Swap
In May 2012, we entered into a
$42.5 million
notional amount interest rate swap agreement, with an effective date of
March 1, 2013
. On June 14, 2013, we settled the interest rate swap for
$0.9 million
.
12
. Stockholders’ Equity
Stockholders' equity increased
$94.1 million
during the six months ended June 30, 2013. The increase was primarily due to the
$79.0 million
reclassification of the 1.125% Warrants to additional paid-in capital, net income of
$54.5 million
, and
$11.3 million
related to employee stock transactions, partially offset by
$50.0 million
in repurchases of our common stock, as described in further detail below.
Common Shares Authorized.
On May 1, 2013, our stockholders approved an amendment to our certificate of incorporation to increase the number of authorized shares of our common stock from
80,000,000
to
150,000,000
.
1.125% Warrants.
As described in Note 11, "Derivative Financial Instruments," we reclassified the 1.125% Warrants to additional paid-in capital during the second quarter of 2013, resulting in a
$79.0 million
increase to stockholders' equity. If the market value per share of our common stock exceeds the strike price of the 1.125% Warrants on any trading day during the 160 trading day measurement period under the 1.125% Warrants, we will be obligated to issue to the Counterparties a number of shares equal in value to the product of the amount by which such market value exceeds such strike price and 1/160th of the aggregate number of shares of our common stock underlying the 1.125% Warrants, subject to a share delivery cap. We will not receive any additional proceeds if the 1.125% Warrants are exercised. Pursuant to the 1.125% Warrants, we issued
13,490,236
warrants with strike price of
$53.8475
per share. The number of warrants and the strike price are subject to adjustment under certain circumstances. The 1.125% Warrants could separately have a dilutive effect to the extent that the market value per share of our common stock (as measured under the terms of the warrant transactions) exceeds the applicable strike price of the 1.125% Warrants.
Securities Repurchases and Repurchase Program.
In connection with the issuance and settlement of the 1.125% Notes, we used a portion of the net proceeds from the offering to repurchase
$50 million
of our common stock in negotiated transactions with institutional investors in the offering, concurrently with the pricing of the offering. On
February 12, 2013
, we repurchased a total of
1,624,959
shares at
$30.77
per share, which was our closing stock price on that date.
Effective as of
February 13, 2013
, our board of directors authorized the repurchase of
$75 million
in aggregate of either our common stock or the 3.75% Notes, in addition to the
$50 million
repurchase discussed above. The repurchase program extends through
December 31, 2014
.
Shelf Registration Statement.
In May 2012, we filed an automatic shelf registration statement on Form S-3 with the SEC covering the issuance of an indeterminate number of our securities, including common stock, warrants, or debt securities. We may publicly offer securities from time to time at prices and terms to be determined at the time of the offering.
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Table of Contents
Stock Plans.
In connection with the plans described in Note
4
, “
Stock-Based Compensation
,” we issued approximately
546,000
shares of common stock, net of shares used to settle employees’ income tax obligations, for the
six months ended June 30, 2013
.
13. Segment Reporting
We report our financial performance based on
two
reportable segments: Health Plans and Molina Medicaid Solutions. Our reportable segments are consistent with how we manage the business and view the markets we serve. Our Health Plans segment consists of our state health plans and also includes our direct delivery business. Our state health plans represent operating segments that have been aggregated for reporting purposes because they share similar economic characteristics.
Our Molina Medicaid Solutions segment provides design, development, implementation; business process outsourcing solutions; hosting services; and information technology support services to state Medicaid agencies.
We rely on an internal management reporting process that provides segment information to the operating income level for purposes of making financial decisions and allocating resources. The accounting policies of the segments are the same as those described in Note 2, “Significant Accounting Policies.” The cost of services shared between the Health Plans and Molina Medicaid Solutions segments is charged to the Health Plans segment.
Three Months Ended June 30,
Six Months Ended June 30,
2013
2012
2013
2012
(In thousands)
Revenue from continuing operations:
Health Plans:
Premium revenue
$
1,548,612
$
1,432,403
$
3,083,045
$
2,701,196
Investment income
1,628
1,059
3,144
2,738
Rental and other income
5,922
3,977
10,616
8,236
Molina Medicaid Solutions:
Service revenue
49,672
41,724
99,428
83,929
$
1,605,834
$
1,479,163
$
3,196,233
$
2,796,099
Depreciation and amortization reported in the consolidated statements of cash flows:
Health Plans
$
15,685
$
15,104
$
30,922
$
28,847
Molina Medicaid Solutions
6,423
4,567
12,985
9,163
$
22,108
$
19,671
$
43,907
$
38,010
Operating income (loss) from continuing operations:
Health Plans
$
40,151
$
(56,072
)
$
101,671
$
(28,169
)
Molina Medicaid Solutions
6,295
6,642
12,648
15,051
Total operating income (loss) from continuing operations
46,446
(49,430
)
114,319
(13,118
)
Interest expense
(11,667
)
(3,808
)
(24,704
)
(8,106
)
Other expense
(3,502
)
(1,086
)
(3,371
)
(1,086
)
Income (loss) from continuing operations before
income taxes
$
31,277
$
(54,324
)
$
86,244
$
(22,310
)
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June 30,
2013
December 31,
2012
(In thousands)
Goodwill and intangible assets, net:
Health Plans
$
137,071
$
139,710
Molina Medicaid Solutions
85,068
89,089
$
222,139
$
228,799
Total assets:
Health Plans
$
2,376,308
$
1,702,212
Molina Medicaid Solutions
203,608
232,610
$
2,579,916
$
1,934,822
14. Commitments and Contingencies
Sale-Leaseback Transactions
As described in Note 10, "Long-Term Debt," we entered into sale-leaseback transactions that have been classified as lease financing obligations. For the sale-leaseback transaction entered into in June 2013, the initial lease term is
25 years
, with
five
five-year renewal options. For the sale-leaseback transaction relating to the construction project completed in June 2013, the initial lease term is
11.5 years
, with
two
five-year renewal options. We expect minimum lease payments under these leases, for the six months ended December 31, 2013, to be
$6.6 million
. Future minimum lease payments due under these leases beginning January 1, 2014 are as follows:
(In thousands)
2014
$
14,395
2015
18,277
2016
18,877
2017
19,496
2018
20,137
Thereafter
385,813
Total minimum lease payments
$
476,995
Legal Proceedings
The health care and business process outsourcing industries are subject to numerous laws and regulations of federal, state, and local governments. Compliance with these laws and regulations can be subject to government review and interpretation, as well as regulatory actions unknown and unasserted at this time. Penalties associated with violations of these laws and regulations include significant fines and penalties, exclusion from participating in publicly funded programs, and the repayment of previously billed and collected revenues.
We are involved in legal actions in the ordinary course of business, 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 estimable. Although we believe that our estimates of such losses are reasonable, these estimates could change as a result of further developments of these matters. The outcome of legal actions is inherently uncertain and such pending matters for which accruals have not been established have not progressed sufficiently through discovery and/or development of important factual information and legal issues to enable us to estimate a range of possible loss, if any. While it is not possible to accurately predict or determine the eventual outcomes of these items, 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.
Provider Claims
Many of our medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations have led certain medical providers to pursue us for additional compensation. The claims made by providers in such circumstances often involve issues of contract compliance,
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Table of Contents
interpretation, payment methodology, and intent. These claims often extend to services provided by the providers over a number of years.
Various providers have contacted us seeking additional compensation for claims that we believe to have been settled. These matters, when finally concluded and determined, will not, in our opinion, have a material adverse effect on our business, consolidated financial position, results of operations, or cash flows.
Regulatory Capital and Dividend Restrictions
Our health plans, which are operated by our respective wholly owned subsidiaries in those states, 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. Such state laws and regulations 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. 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
$607.5 million
at
June 30, 2013
, and
$549.7 million
at
December 31, 2012
.
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
$527.8 million
and
$46.9 million
as of
June 30, 2013
, and
December 31, 2012
, respectively.
The National Association of Insurance Commissioners, or NAIC, adopted rules effective December 31, 1998, which, if implemented by the states, set minimum capitalization requirements for insurance companies, HMOs, and other entities bearing risk for health care coverage. The requirements take the form of risk-based capital (RBC) rules. Michigan, New Mexico, Ohio, Texas, Utah, Washington, and Wisconsin have adopted these rules, which may vary from state to state. California and Florida have not adopted NAIC risk-based capital requirements for HMOs and have not formally given notice of their intention to do so. Such requirements, if adopted by California and Florida, may increase the minimum capital required for those states.
As of
June 30, 2013
, our health plans had aggregate statutory capital and surplus of approximately
$627.7 million
compared with the required minimum aggregate statutory capital and surplus of approximately
$363.2 million
.
All of our health plans were in compliance with the minimum capital requirements at
June 30, 2013
. We have the ability and commitment to provide additional capital to each of our health plans when necessary to ensure that statutory capital and surplus continue to meet regulatory requirements.
As described in Note 2, "Significant Accounting Policies," the ACA imposes an annual fee on health insurers for each calendar year beginning on or after January 1, 2014. The fee will be imposed beginning in 2014 based on a company's share of the industry's net premiums written during the preceding calendar year. If the fee assessment is enacted as written, our minimum capitalization requirements will increase significantly on January 1, 2014; we are currently evaluating the impact of the fee assessment to our financial position, results of operations and cash flows.
15. Related Party Transactions
Leased Office Buildings
On
February 27, 2013
, we entered into a lease (the Lease) with 6
th
& Pine Development, LLC (the Landlord) for office space located in Long Beach, California. The Lease consists of two office buildings, one of which is under construction. The building which comprises approximately
90,000
square feet of office and storage space (Building A) was completed in June 2013; immediately following its completion, we occupied Building A and commenced lease payments. The second building (Building B) is expected to comprise approximately
120,000
square feet of office space.
The term of the Lease with respect to Building A commenced on
June 6, 2013
, and the term of the Lease with respect to Building B is expected to commence on
November 1, 2014
. The initial term of the Lease with respect to both buildings expires on
December 31, 2024
, subject to two options to extend the term for a period of five years each. Initial annual rent for Building A is approximately
$2.6 million
, and initial annual rent for Building B is expected to be approximately
$4.0 million
. Rent will increase
3.75%
per year through the initial term. Rent during the extension terms will be the greater of then-current rent or fair market rent.
The principal members of the Landlord are John C. Molina, our chief financial officer and a director of the Company, and his wife. In addition, in connection with the development of the buildings being leased, the Landlord has pledged shares of common stock in the Company he holds as trustee. Dr. J. Mario Molina, our chief executive officer and chairman of the board of directors, holds a partial interest in such shares as trust beneficiary.
Medical Services
30
Table of Contents
We have an equity investment in a medical service provider that provides certain vision services to our members; we account for this investment under the equity method of accounting. For the
three months ended June 30, 2013
and
2012
, we paid
$8.7 million
and
$7.0 million
, respectively, for medical service fees to this provider. For the
six months ended June 30, 2013
and
2012
, we paid
$16.4 million
, and
$13.6 million
, respectively, for medical service fees to this provider.
16. Variable Interest Entities
Joseph M. Molina M.D., Professional Corporations
The
Joseph M. Molina, M.D. Professional Corporations (JMMPC) were created in 2012 to further advance our direct delivery business. JMMPC's sole shareholder is Dr. J. Mario Molina, our Chairman of the Board, President and Chief Executive Officer. Dr. Molina is paid no salary and receives no dividends in connection with his work for, or ownership of, JMMPC. JMMPC provides outpatient professional medical services to the general public for routine non-life threatening, outpatient health care needs. Substantially all of the individuals served by JMMPC are members of our health plans. JMMPC does not have agreements to provide professional medical services with any other entities.
Our wholly owned subsidiary, American Family Care, Inc. (AFC), has entered into services agreements with JMMPC to provide clinic facilities, clinic administrative support staff, patient scheduling services and medical supplies to JMMPC. The services agreements were designed such that JMMPC will not operate at a loss, ensuring the availability of quality care and access for our health plan members. The services agreements provide that the administrative fees charged to JMMPC by AFC are reviewed annually to assure the achievement of this goal.
Our California, Florida, New Mexico and Washington health plans have entered into primary care capitation agreements with JMMPC. These agreements also direct our health plans to fund JMMPC's operating deficits, or receive JMMPC's operating surpluses, based on a monthly reconciliation. Because the AFC services agreements described above mitigate the likelihood of significant operating deficits or surpluses, such monthly reconciliation amounts are insignificant.
We have determined that JMMPC is a variable interest entity, or VIE, and that we are its primary beneficiary. We have reached this conclusion under the power and benefits criterion model according to GAAP. Specifically, we have the power to direct the activities that most significantly affect JMMPC's economic performance, and the obligation to absorb losses or right to receive benefits that are potentially significant to the VIE, under the agreements described above. Because we are its primary beneficiary, we have consolidated JMMPC. JMMPC's assets may be used to settle only JMMPC's obligations, and JMMPC's creditors have no recourse to the general credit of Molina Healthcare, Inc. As of
June 30, 2013
, JMMPC had total assets of $
1.4 million
, comprising primarily cash and equivalents, and total liabilities of
$1.1 million
, comprising primarily accrued payroll and employee benefits.
Our maximum exposure to loss as a result of our involvement with JMMPC is equal to the amounts needed to fund JMMPC's ongoing payroll and employee benefits. We believe that such loss exposure will be immaterial to our consolidated operating results and cash flows for the foreseeable future. We provided an initial cash infusion of
$0.3 million
to JMMPC in the first quarter of 2012 to fund its start-up operations.
New Markets Tax Credit
During the fourth quarter of 2011, our New Mexico data center subsidiary entered into a financing transaction with Wells Fargo Community Investment Holdings, LLC, or Wells Fargo, its wholly owned subsidiary New Mexico Healthcare Data Center Investment Fund, LLC, or Investment Fund, and certain of Wells Fargo's affiliated Community Development Entities, or CDEs, in connection with our participation in the federal government's New Markets Tax Credit Program, or NMTC. The NMTC was established by Congress in 2000 to facilitate new or increased investments in businesses and real estate projects in low-income communities. The NMTC attracts investment capital to low-income communities by permitting investors to receive a tax credit against their federal income tax return in exchange for equity investments in specialized financial institutions, called CDEs, which provide financing to qualified active businesses operating in low-income communities. The credit amounts to
39%
of the original investment amount and is claimed over a period of
seven
years (five percent for each of the first
three
years, and six percent for each of the remaining
four
years). The investment in the CDE cannot be redeemed before the end of the seven-year period.
In the fourth quarter of 2011, as a result of a series of simultaneous financing transactions, Wells Fargo contributed capital of
$5.9 million
to the Investment Fund, and Molina Healthcare, Inc. loaned the principal amount of
$15.5 million
to the Investment Fund. The Investment Fund then contributed the proceeds to certain CDEs, which, in turn, loaned the proceeds of
$20.9 million
to our New Mexico data center subsidiary. Wells Fargo will be entitled to claim the NMTC while we effectively received net loan proceeds equal to Wells Fargo's contribution to the Investment Fund, or approximately
$5.9 million
.
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Additionally, financing costs incurred in structuring the arrangement amounting to
$1.2 million
were deferred and will be recognized as expense over the term of the loans. This transaction also includes a put/call feature that becomes enforceable at the end of the seven-year compliance period. Wells Fargo may exercise its put option or we can exercise the call, both of which will serve to transfer the debt obligation to us. Incremental costs to maintain the structure during the compliance period will be recognized as incurred.
We have determined that the financing arrangement with Investment Fund and CDEs is a VIE, and that we are the primary beneficiary of the VIE. We reached this conclusion based on the following:
•
The ongoing activities of the VIE-collecting and remitting interest and fees and NMTC compliance-were all considered in the initial design and are not expected to significantly affect economic performance throughout the life of the VIE;
•
Contractual arrangements obligate us to comply with NMTC rules and regulations and provide various other guarantees to Investment Fund and CDEs;
•
Wells Fargo lacks a material interest in the underling economics of the project; and
•
We are obligated to absorb losses of the VIE.
Because we are the primary beneficiary of the VIE, we have included it in our consolidated financial statements. Wells Fargo's contribution of
$5.9 million
is included in cash at December 31, 2012 and the offsetting Wells Fargo's interest in the financing arrangement is included in other liabilities in the accompanying consolidated balance sheets.
As described above, this transaction also includes a put/call provision whereby we may be obligated or entitled to repurchase Wells Fargo's interest in the Investment Fund. The value attributed to the put/call is nominal. The NMTC is subject to 100% recapture for a period of seven years as provided in the Internal Revenue Code and applicable U.S. Treasury regulations. We are required to be in compliance with various regulations and contractual provisions that apply to the NMTC arrangement. Non-compliance with applicable requirements could result in Wells Fargo's projected tax benefits not being realized and, therefore, require us to indemnify Wells Fargo for any loss or recapture of NMTCs related to the financing until such time as the recapture provisions have expired under the applicable statute of limitations. We do not anticipate any credit recaptures will be required in connection with this arrangement.
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Item 2.
Management's Discussion and Analysis of Financial Condition and Results of Operations.
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, other than statements of historical facts, included in this quarterly report 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. There are a number of important factors that could cause actual results or events to differ materially from the forward-looking statements that we make. You should read these factors and the other cautionary statements as being applicable to all related forward-looking statements wherever they appear in this quarterly report. 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, expected, or contemplated as a result of, but not limited to, risk factors related to the following:
•
uncertainties associated with the implementation of the Affordable Care Act, including the impact of the health insurance industry excise tax, the expansion of Medicaid eligibility in participating states to previously uninsured populations unfamiliar with managed care, the implementation of state insurance exchanges currently expected to become operational by October 1, 2013, the effect of various implementing regulations, and uncertainties regarding the impact of other federal or state health care and insurance reform measures, including the duals demonstration programs in California, Ohio, Michigan, and Texas;
•
the success of our medical cost containment initiatives in Texas, and other risks associated with the expansion of our Texas health plan's service areas in 2012;
•
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;
•
management of our medical costs, including seasonal flu patterns and rates of utilization that are consistent with our expectations and our accruals for incurred but not reported medical costs;
•
the success of our efforts to retain existing government contracts and to obtain new government contracts in connection with state requests for proposals (RFPs) in both existing and new states, and our ability to increase our revenues consistent with our expectations;
•
accurate estimation of incurred but not reported medical costs across our health plans;
•
risks associated with the continued growth in new Medicaid and Medicare enrollees, and the development of actuarially sound rates with respect to such new enrollees, including duals;
•
retroactive adjustments to premium revenue or accounting estimates which require adjustment based upon subsequent developments, including Medicaid pharmaceutical rebates;
•
continuation and renewal of the government contracts of both our health plans and Molina Medicaid Solutions and the terms under which such contracts are renewed;
•
government audits and reviews, and any enrollment freeze or monitoring program that may result therefrom;
•
changes with respect to our provider contracts and the loss of providers;
•
the establishment of a federal or state medical cost expenditure floor as a percentage of the premiums we receive, and the interpretation and implementation of medical cost expenditure floors, administrative cost and profit ceilings, and profit sharing arrangements;
•
interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures;
•
approval by state regulators of dividends and distributions by our health plan subsidiaries;
•
changes in funding under our contracts as a result of regulatory changes, programmatic adjustments, or other reforms;
•
high dollar claims related to catastrophic illness;
•
the favorable resolution of litigation, arbitration, or administrative proceedings, including our pending litigation against the state of California related to rates paid to our California plan in earlier years that were not actuarially sound;
•
restrictions and covenants in any future credit facility;
•
the relatively small number of states in which we operate health plans;
•
the availability of adequate financing to fund and capitalize our expansion and growth activities and to meet our liquidity needs, including the interest expense and other costs associated with such financing;
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Table of Contents
•
a state's failure to renew its federal Medicaid waiver;
•
inadvertent unauthorized disclosure of protected health information;
•
changes generally affecting the managed care or Medicaid management information systems industries;
•
increases in government surcharges, taxes, and assessments;
•
changes in general economic conditions, including unemployment rates; and
•
increasing consolidation in the Medicaid industry.
Investors should refer to Part I, Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2012, 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 document 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, 2012.
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Overview
Molina Healthcare, Inc. provides quality and cost-effective Medicaid-related solutions to meet the health care needs of low-income families and individuals and to assist state agencies in their administration of the Medicaid program. We report our financial performance based on
two
reportable segments: Health Plans and Molina Medicaid Solutions.
Our Health Plans segment comprises health plans in California, Florida, Michigan, New Mexico, Ohio, Texas, Utah, Washington, and Wisconsin, and includes our direct delivery business. As of
June 30, 2013
, these health plans served approximately
1.8 million
members eligible for Medicaid, Medicare, and other government-sponsored health care programs for low-income families and individuals. The health plans are operated by our respective wholly owned subsidiaries in those states, each of which is licensed as a health maintenance organization, or HMO. Our direct delivery business consists of primary care community clinics in California, Florida, New Mexico, and Washington.
Our health plans’ state Medicaid contracts generally have terms of
three
to
four
years with annual adjustments to premium rates. These contracts are renewable at the discretion of the state. In general, either the state Medicaid agency or the health plan may terminate the state contract with or without cause.
Most of these contracts contain renewal options that are exercisable by the state. Our health plan subsidiaries have generally been successful in retaining their contracts. Our state contracts are generally at greatest risk of loss when a state issues a new request for proposals, or RFP, subject 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 be subject to non-renewal. For instance, on February 17, 2012, the Division of Purchasing of the Missouri Office of Administration notified us that our Missouri health plan, Alliance for Community Health, L.L.C., was not awarded a contract under the Missouri HealthNet Managed Care Request for Proposal; therefore, the Missouri health plan's prior contract with the state expired without renewal on June 30, 2012 subject to certain transition obligations. On April 5, 2013, the Missouri health plan assigned its affiliate, Molina Healthcare of Illinois, Inc., substantially all of its assets and liabilities. Additionally, the Missouri health plan surrendered its certificate of authority as a health maintenance organization.
The Missouri health plan's revenues amounted to
$0.2 million
and
$113.8 million
for the six months ended June 30, 2013 and 2012, respectively.
Until the second quarter of 2013, we reported the results of the Missouri health plan in continuing operations because of our continuing significant involvement in the payment of medical claims incurred on or prior to June 30, 2012, for that entity. On May 13, 2013, we abandoned our equity interests in the Missouri health plan to an unrelated entity, and assigned the Missouri health plan's surviving rights, duties and obligations (which we believe to be insignificant) to Molina Healthcare of Illinois, Inc. Effective June 30, 2013, the transition obligations associated with the Missouri health plan's contract with the state terminated. As a result of these activities, we commenced reporting the Missouri health plan as a discontinued operation as of June 30, 2013. In connection with the abandonment of our equity interests in the Missouri health plan to an unrelated entity, we recognized a
$9.5 million
tax benefit for the tax deduction associated with the basis of such equity interests, which is included in discontinued operations in our consolidated statement of operations. Additionally, we recognized a pretax loss of
$0.5 million
for the write off of the Missouri health plan's remaining assets in the second quarter of 2013.
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, or ABD); and regions or service areas. For example, our Texas health plan added significant membership effective March 1, 2012, in service areas we had not previously served (the Hidalgo and El Paso service areas); and among populations we had not previously served within existing service areas, such as the Temporary Assistance for Needy Families, or TANF, population in the Dallas service area. Additionally, the health benefits provided to our TANF and ABD members in Texas under our contracts with the state were expanded to include inpatient facility and pharmacy services effective March 1, 2012.
On July 3, 2013, we announced that our New Mexico health plan has entered into a definitive agreement to assume Lovelace Community Health Plan's contract for the New Mexico Medicaid Salud! Program. Lovelace Community Health Plan currently participates in the New Mexico Medicaid Salud! State Coverage Insurance Program and arranges for healthcare services for approximately 84,000 New Mexicans. Our New Mexico health plan serves over 92,000 Medicaid members across the state. Subject to satisfaction of customary closing conditions, we anticipate completing the transaction on August 1, 2013; the total payment to Lovelace Community Health Plan will be based on the membership transferred as of that date.
On February 14, 2013, we announced that the Florida Agency for Health Care Administration awarded our Florida health plan contracts in three regions under the Statewide Medicaid Managed Care Long-Term Care program. As a result of the awards, we will now enter into a comprehensive pre-contracting assessment, with the program currently scheduled to commence on December 1, 2013. Under the program, we will provide long-term care benefits, including institutional and home and community-based services.
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On February 11, 2013, we announced that our New Mexico health plan was selected by the New Mexico Human Services Department, or HSD, to participate in the new Centennial Care program. In addition to continuing to provide physical and acute health care services, under the new program our New Mexico health plan will expand its services to provide behavioral health and long-term care services. The selection of our New Mexico health plan was made by HSD pursuant to its request for proposals issued in August 2012. The operational start date for the program is currently scheduled for January 2014.
Our Molina Medicaid Solutions segment provides business processing and information technology development and administrative services to Medicaid agencies in Idaho, Louisiana, Maine, New Jersey, and West Virginia, and drug rebate administration services in Florida.
On June 9, 2011, Molina Medicaid Solutions received notice from the state of Louisiana that the state intended to award the contract for a replacement Medicaid Management Information System (MMIS) to a different vendor, CNSI. However, in March 2013, the state of Louisiana cancelled its contract award to CNSI. CNSI is currently challenging the contract cancellation. The state has informed us that we will continue to perform under our current contract until a successor is named. At such time as a new RFP may be issued, we intend to respond to the state's RFP. For the
six months ended June 30, 2013,
our revenue under the Louisiana MMIS contract was approximately
$20.2 million, or 20.3%
of total service revenue. So long as our Louisiana MMIS contract continues, we expect to recognize approximately
$40 million
of service revenue annually under this contract.
Composition of Revenue and Membership
Health Plans Segment
Our Health Plans segment derives its revenue, in the form of premiums, chiefly from Medicaid contracts with the states in which our health plans operate. Premium revenue is fixed in advance of the periods covered and, except as described in “Critical Accounting Policies” below, is not generally subject to significant accounting estimates. For the
six months ended
June 30, 2013
, we received approximately 96% of our premium revenue as a fixed amount per member per month, or PMPM, pursuant to our Medicaid contracts with state agencies, our Medicare contracts with the Centers for Medicare and Medicaid Services, or CMS, and our contracts with other managed care organizations for which we operate as a subcontractor. These premium revenues are recognized in the month that members are entitled to receive health care services. The state Medicaid programs and the federal Medicare program periodically adjust premium rates.
For the
six months ended
June 30, 2013
, we recognized approximately 4% of our premium revenue in the form of “birth income” — a one-time payment for the delivery of a child — from the Medicaid programs in all of our state health plans except New Mexico. Such payments are recognized as revenue in the month the birth occurs.
The amount of the premiums paid to us may vary substantially between states and among various government programs. PMPM premiums for the Children’s Health Insurance Program, or CHIP, members are generally among our lowest, with rates as low as approximately $80 PMPM in Michigan. Premium revenues for Medicaid members are generally higher. Among the TANF Medicaid population — the Medicaid group that includes mostly mothers and children — PMPM premiums range between approximately $100 in California to $260 in Ohio. Among our ABD membership, PMPM premiums range from approximately $400 in Utah to $1,400 in Ohio. Contributing to the variability in Medicaid rates among the states is the practice of some states to exclude certain benefits from the managed care contract (most often pharmacy, inpatient, behavioral health and catastrophic case benefits) and retain responsibility for those benefits at the state level. Medicare membership generates the highest PMPM premiums in the aggregate, at approximately $1,100 PMPM.
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The following table sets forth the approximate total number of members by state health plan as of the dates indicated:
June 30,
2013
March 31,
2013
December 31,
2012
June 30,
2012
Total Ending Membership by Health Plan:
California
355,000
332,000
336,000
350,000
Florida
81,000
75,000
73,000
70,000
Michigan
215,000
217,000
220,000
220,000
New Mexico
92,000
91,000
91,000
89,000
Ohio
240,000
242,000
244,000
260,000
Texas
266,000
274,000
282,000
301,000
Utah
87,000
87,000
87,000
86,000
Washington
413,000
416,000
418,000
356,000
Wisconsin
98,000
86,000
46,000
42,000
Total
1,847,000
1,820,000
1,797,000
1,774,000
Total Ending Membership for our Medicare Advantage Plans:
California
8,100
7,700
7,700
7,000
Florida
600
600
900
900
Michigan
9,500
9,200
9,700
8,900
New Mexico
900
900
900
900
Ohio
400
300
300
200
Texas
2,300
1,900
1,500
800
Utah
7,800
7,600
8,200
8,300
Washington
6,600
6,100
6,500
5,700
Total
36,200
34,300
35,700
32,700
Total Ending Membership for our Aged, Blind or Disabled Population:
California
45,400
44,600
44,700
41,100
Florida
11,200
10,400
10,300
10,400
Michigan
45,000
44,000
41,900
40,000
New Mexico
6,000
5,800
5,700
5,600
Ohio
28,000
28,200
28,200
29,600
Texas
92,000
94,200
95,900
111,000
Utah
9,400
9,200
9,000
8,800
Washington
31,700
31,300
30,000
4,400
Wisconsin
1,600
1,600
1,700
1,700
Total
270,300
269,300
267,400
252,600
Molina Medicaid Solutions Segment
The payments received by our Molina Medicaid Solutions segment under its state contracts are based on the performance of multiple services. The first of these is the design, development and implementation, or DDI, of a Medicaid Management Information System, or MMIS. An additional service, following completion of DDI, is the operation of the MMIS under a business process outsourcing, or BPO arrangement. While providing BPO services (which include claims payment and eligibility processing) we also provide the state with other services including both hosting and support and maintenance. Because we have determined the services provided under our Molina Medicaid Solutions contracts represent a single unit of accounting, we recognize revenue associated with such contracts on a straight-line basis over the period during which BPO, hosting, and support and maintenance services are delivered.
Composition of Expenses
Health Plans Segment
Operating expenses for the Health Plans segment include expenses related to the provision of medical care services, G&A expenses, and premium tax expenses. Our results of operations are impacted by our ability to effectively manage expenses related to medical care services and to accurately estimate medical costs incurred. Expenses related to medical care services are captured in the following four categories:
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•
Fee-for-service
— Expenses paid for specific encounters or episodes of care according to a fee schedule or other basis established by the state or by contract with the provider.
•
Capitation
— Expenses for PMPM payments to the provider without regard to the frequency, extent, or nature of the medical services actually furnished.
•
Pharmacy
— Expenses for all drug, injectible, and immunization costs paid through our pharmacy benefit manager.
•
Other
— Expenses for medically related administrative costs of approximately $68.4 million, and $62.6 million, for the
six months ended
June 30, 2013
and
2012
, respectively, as well as certain provider incentive costs, reinsurance, costs to operate our medical clinics, and other medical expenses.
Our medical care costs include amounts that have been paid by us through the reporting date as well as estimated liabilities for medical care costs incurred but not paid by us as of the reporting date. See “Critical Accounting Policies” below for a comprehensive discussion of how we estimate such liabilities.
Molina Medicaid Solutions Segment
Cost of service revenue consists primarily of the costs incurred to provide business process outsourcing and technology outsourcing services under our MMIS contracts. General and administrative costs consist primarily of indirect administrative costs and business development costs.
In some circumstances we may defer recognition of incremental direct costs (such as direct labor, hardware, and software) associated with a contract if revenue recognition is also deferred. Such deferred contract costs are amortized on a straight-line basis over the remaining original contract term, consistent with the revenue recognition period.
Second Quarter Financial Performance Summary, Continuing Operations
The following table and narrative briefly summarize our financial and operating performance for continuing operations for the three and
six months ended June 30, 2013
and
2012
. All ratios, with the exception of the medical care ratio and the premium tax ratio, are shown as a percentage of total revenue. The medical care ratio is computed as a percentage of premium revenue, net of premium tax and the premium tax ratio is computed as a percentage of premium revenue because there are direct relationships between premium revenue earned, and the cost of health care and premium taxes.
Three Months Ended June 30,
Six Months Ended June 30,
2013
2012
2013
2012
(Dollar amounts in thousands, except per share data)
Net income (loss) per diluted share
$
0.34
$
(0.71
)
$
1.00
$
(0.29
)
Premium revenue
$
1,548,612
$
1,432,403
$
3,083,045
$
2,701,196
Service revenue
$
49,672
$
41,724
$
99,428
$
83,929
Operating income (loss)
$
46,446
$
(49,430
)
$
114,319
$
(13,118
)
Net income (loss)
$
15,796
$
(33,057
)
$
46,318
$
(13,163
)
Total ending membership
1,847,000
1,774,000
1,847,000
1,774,000
Premium revenue
96.4
%
96.8
%
96.5
%
96.6
%
Service revenue
3.1
%
2.8
%
3.1
%
3.0
%
Investment income
0.1
%
0.1
%
0.1
%
0.1
%
Rental and other income
0.4
%
0.3
%
0.3
%
0.3
%
Total revenue
100.0
%
100.0
%
100.0
%
100.0
%
Medical care ratio
86.2
%
94.5
%
86.1
%
91.4
%
General and administrative expense ratio
10.1
%
8.5
%
9.5
%
8.6
%
Premium tax ratio
3.0
%
2.7
%
2.7
%
3.0
%
Operating income (loss)
2.9
%
(3.3
)%
3.6
%
(0.5
)%
Net income (loss)
1.0
%
(2.2
)%
1.4
%
(0.5
)%
Effective tax rate
49.5
%
(39.1
)%
46.3
%
(41.0
)%
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Reconciliation of Non-GAAP to GAAP Financial Measures
We have included presentations of earnings before interest, taxes, depreciation and amortization (EBITDA) below. EBITDA is a non-GAAP financial measure and is reconciled to net income, which we believe to be the most comparable GAAP measure (GAAP stands for U.S. generally accepted accounting principles).
EBITDA is not prepared in conformity with GAAP because it excludes depreciation and amortization, as well as interest expense and income tax expense. This non-GAAP financial measure should not be considered as an alternative to the GAAP measures of net income, operating income, operating margin, or cash provided by operating activities; nor should EBITDA be considered in isolation from these GAAP measures of operating performance. Management uses EBITDA as a supplemental metric in evaluating our financial performance, in evaluating financing and business development decisions, and in forecasting and analyzing future periods. For these reasons, management believes that EBITDA is a useful supplemental measure to investors in evaluating our performance and the performance of other companies in our industry.
Three months ended June 30,
Six months ended June 30,
2013
2012
2013
2012
(In thousands)
Net income (loss)
$
24,571
$
(37,306
)
$
54,486
$
(19,217
)
Add back:
Depreciation and amortization reported in the consolidated statements of cash flows
22,108
19,671
43,907
38,010
Interest expense
11,667
3,808
24,704
8,106
Income tax expense (benefit)
5,513
(25,769
)
29,783
(14,736
)
EBITDA
$
63,859
$
(39,596
)
$
152,880
$
12,163
Second Quarter 2013 Overview
For the
second quarter
of
2013
, net income rose to
$24.6 million
, or
$0.53
per diluted share, compared with a net loss of
$37.3 million
, or
$0.80
per diluted share, for the
second quarter
of
2012
. Net income per diluted share from continuing operations was
$0.34
for the second quarter of 2013, versus a net loss of $0.71 per diluted share from continuing operations for the second quarter of 2012.
Premium revenue for the second quarter of 2013 increased
8%
over the second quarter of 2012, primarily due to membership growth in Washington and Wisconsin and rate increases in Texas and Washington in the second half of 2012.
Our consolidated medical care ratio decreased to
86.2%
in the second quarter of 2013, from
94.5%
in the second quarter of 2012. The decline in the consolidated medical care ratio was the result of dramatically improved operating results in Texas combined with improved performance at most of our other health plans. Medical care ratios decreased in seven of our nine health plans; while medical margin (measured as the excess of premium revenue net of premium tax, over medical costs) increased in eight out of nine health plans.
General and administrative expenses increased to
10.1%
of revenue in the second quarter of 2013, from
8.5%
in the second quarter of 2012, primarily due to higher costs incurred as a result of our preparations for significant membership growth in 2014, and a litigation charge of $3.5 million related to the final settlement of a provider dispute.
Second quarter 2013 results include a one-time non-cash charge of
$3.9 million
related to warrants issued in conjunction with our convertible senior notes offering in February 2013. As originally issued, certain terms in the warrant agreements required that they be recorded as a derivative liability requiring mark-to-market accounting treatment. The warrants were reclassified to equity during the second quarter and there will be no further mark-to-market adjustments.
We previously reported that our Medicaid managed care contract with the state of Missouri expired without renewal on June 30, 2012. Effective June 30, 2013 the transition obligations associated with that contract terminated. Therefore, we have reclassified the results relating to the Missouri health plan to discontinued operations for all periods presented. These results are presented in a single line item, net of taxes, in the unaudited consolidated statements of operations. Additionally, we abandoned all of our equity interests in the Missouri health plan during the second quarter of 2013, resulting in the recognition of a tax benefit of approximately $9.5 million, which is also included in discontinued operations in the unaudited consolidated statements of operations.
Results of Operations, Continuing Operations
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Table of Contents
Three Months Ended June 30, 2013 Compared with the Three Months Ended June 30, 2012
Health Plans Segment
Premium Revenue
Premium revenue for the
second quarter
of
2013
increased
8%
over the
second quarter
of
2012
, primarily due to membership growth in Washington and Wisconsin, and rate increases in Texas and Washington in the second half of 2012. Medicare premium revenue was $131.5 million for the
second quarter
of
2013
compared with $120.8 million for the
second quarter
of
2012
.
Growth in our ABD membership in Washington and California led to higher premium revenue PMPM in 2013. ABD membership, as a percent of total membership, has increased approximately
3%
year over year. Premium revenue PMPM also increased in the
second quarter
of
2013
as a result of the inclusion of revenue for pharmacy benefits for the Utah health plan effective January 1, 2013.
Medical Care Costs
The following table provides the details of consolidated medical care costs for the periods indicated (dollars in thousands except PMPM amounts):
Three Months Ended June 30,
2013
2012
Amount
PMPM
% of
Total
Amount
PMPM
% of
Total
Fee for service
$
879,865
$
158.96
68.0
%
$
925,039
$
174.04
70.2
%
Pharmacy
222,992
40.29
17.2
212,944
40.06
16.2
Capitation
138,409
25.00
10.7
136,376
25.66
10.3
Other
53,440
9.66
4.1
43,238
8.14
3.3
Total
$
1,294,706
$
233.91
100.0
%
$
1,317,597
$
247.90
100.0
%
Medical care costs decreased in the
second quarter
of
2013
primarily due to significantly lower medical care costs at our Texas health plan. Our consolidated medical care ratio decreased to
86.2%
in the
second quarter
of
2013
, from
94.5%
in the
second quarter
of
2012
. Higher margins at the Texas health plan, along with stable inpatient utilization and lower pharmacy unit costs across the Company, were the primary causes of the lower medical care ratio in the
second quarter
of
2013
.
Individual Health Plan Analysis
The medical care ratio at the California health plan increased to
94.4%
in the
second quarter
of
2013
from
90.5%
in the
second quarter
of
2012
. The higher medical care ratio was primarily the result of higher Medicare inpatient fee-for-service costs.
The medical care ratio of the Florida health plan
decreased
to
84.0%
in the
second quarter
of
2013
, from
84.5%
in the
second quarter
of
2012
due to inpatient utilization reductions and lower pharmacy costs.
The medical care ratio of the Michigan health plan
decreased
to
84.7%
in the
second quarter
of
2013
, from
87.1%
in the
second quarter
of
2012
, primarily due to a reduction in inpatient costs.
The medical care ratio of the New Mexico health plan
decreased
to
80.8%
in the
second quarter
of
2013
, from
84.3%
in the
second quarter
of
2012
, primarily as a result of higher Medicaid premium rates PMPM effective January 1, 2013, and lower fee-for-service claims costs.
The medical care ratio of the Ohio health plan
decreased
to
79.8%
for the
second quarter
of
2013
, from
89.5%
for the
second quarter
of
2012
, due to reductions in inpatient, pharmacy and professional costs as well as a 4% premium rate increase effective January 1, 2013.
The medical care ratio of the Texas health plan was 86.5% in the second quarter of 2013 compared with 111.5% in the second quarter of 2012 (which included a premium deficiency reserve (PDR) of $10 million). We received a blended rate increase in Texas of approximately 4%, or $4.5 million per month, effective September 1, 2012; and implemented various medical cost containment initiatives in the second half of 2012.
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Table of Contents
The medical care ratio of the Utah health plan
decreased
to
79.6%
in the
second quarter
of
2013
, from
82.5%
in the
second quarter
of
2012
primarily due to a lower fee-for-service claim costs.
The medical care ratio of the Washington health plan
increased
to
88.0%
in the
second quarter
of
2013
, from
85.5%
in the
second quarter
of
2012
primarily due to the addition of ABD members effective July 1, 2012. The higher premium revenue PMPM associated with the ABD membership, however, offset the increased medical care ratio, so that the excess of premium revenue over medical care costs increased to
$36.0 million
for the
second quarter
of
2013
, compared with
$29.6 million
for the
second quarter
of
2012
.
The medical care ratio of the Wisconsin health plan decreased to
82.6%
in the
second quarter
of
2013
, from
121.1%
in the
second quarter
of
2012
. A $3.0 million PDR was recorded in the second quarter of 2012. Absent the PDR, the medical care ratio would have been 105.2% in the second quarter of 2012. The health plan has successfully implemented several cost saving initiatives including improvements in provider contracts, in-sourcing the management of behavioral health services and enhanced utilization management activities. The health plan received a 3% premium rate increase effective January 1, 2013. Additionally, the health plan gained approximately 50,000 members in February, March and April due to another health plan's recent exit from the market. We are closely monitoring the utilization patterns and loss reserves for these new members.
Operating Data
The following table summarizes member months, premium revenue, medical care costs, medical care ratio, and premium taxes by health plan for the periods indicated (PMPM amounts are in whole dollars; member months and other dollar amounts are in thousands):
Three Months Ended June 30, 2013
Member
Months (1)
Premium Revenue
Medical Care Costs
Premium Tax
Expense
MCR (2)
Medical Margin
Total
PMPM
Total
PMPM
California
1,055
$
191,059
$
181.19
$
170,777
$
161.96
$
10,132
94.4
%
$
10,150
Florida
238
61,838
260.61
51,915
218.80
1
84.0
9,922
Michigan
648
168,446
259.88
141,859
218.86
961
84.7
25,626
New Mexico
275
86,527
314.76
68,253
248.28
2,078
80.8
16,196
Ohio
722
292,706
405.05
215,664
298.44
22,599
79.8
54,443
Texas
805
324,600
403.06
275,959
342.66
5,645
86.5
42,996
Utah
261
77,511
296.69
61,677
236.08
—
79.6
15,834
Washington
1,238
305,000
246.30
263,512
212.80
5,467
88.0
36,021
Wisconsin
293
37,740
128.79
31,185
106.43
—
82.6
6,555
Other
(3)
—
3,185
—
13,905
—
—
—
(10,720
)
5,535
$
1,548,612
$
279.77
$
1,294,706
$
233.91
$
46,883
86.2
%
$
207,023
Three Months Ended June 30, 2012
Member
Months (1)
Premium Revenue
Medical Care Costs
Premium Tax
Expense
MCR (2)
Medical Margin
Total
PMPM
Total
PMPM
California
1,056
$
167,644
$
158.77
$
149,239
$
141.34
$
2,683
90.5
%
$
15,722
Florida
210
57,303
273.00
48,442
230.79
(21
)
84.5
8,882
Michigan
662
162,758
245.89
141,682
214.04
31
87.1
21,045
New Mexico
266
82,706
310.94
67,836
255.03
2,257
84.3
12,613
Ohio
762
297,069
389.85
245,284
321.89
23,011
89.5
28,774
Texas
907
359,486
396.63
393,237
433.87
6,670
111.5
(40,421
)
Utah
259
76,911
297.00
63,419
244.90
—
82.5
13,492
Washington
1,068
207,376
194.14
174,045
162.93
3,701
85.5
29,630
Wisconsin
125
18,788
150.12
22,758
181.84
—
121.1
(3,970
)
Other
(3)
—
2,362
—
11,655
—
22
—
(9,315
)
5,315
$
1,432,403
$
269.53
$
1,317,597
$
247.90
$
38,354
94.5
%
$
76,452
(1)
A member month is defined as the aggregate of each month’s ending membership for the period presented.
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Table of Contents
(2)
The MCR represents medical costs as a percentage of premium revenues, where premium revenue is reduced by premium tax expense.
(3)
“Other” medical care costs also include medically related administrative costs at the parent company.
Molina Medicaid Solutions Segment
Performance of the Molina Medicaid Solutions segment was as follows:
Three Months Ended June 30,
2013
2012
(In thousands)
Service revenue before amortization
$
50,400
$
41,877
Amortization recorded as reduction of service revenue
(728
)
(153
)
Service revenue
49,672
41,724
Cost of service revenue
39,305
30,613
General and administrative costs
2,790
3,187
Amortization of customer relationship intangibles recorded as amortization
1,282
1,282
Operating income
$
6,295
$
6,642
Operating income for our Molina Medicaid Solutions segment decreased
$0.3 million
for the
three months ended June 30, 2013
, compared with the same prior year period. The decrease in operating income was primarily the result of a change in the mix of transactions processed from fee-for-service claims to managed care encounters (processing fees are lower for encounters than for fee-for-service claims) and changes to state contract revenues implemented during 2012.
Results of Operations, Continuing Operations
Six Months Ended June 30, 2013 Compared with the Six Months Ended June 30, 2012
Health Plans Segment
Premium Revenue
Premium revenue for the
six months ended June 30, 2013
increased
14%
over the
six months ended June 30, 2012
, due to both higher enrollment and higher premium revenue PMPM. Medicare premium revenue was $249.9 million for the
six months ended June 30, 2013
compared with $230.5 million for the
six months ended June 30, 2012
.
Growth in our ABD membership in Washington and California led to higher premium revenue PMPM in 2013. ABD membership, as a percent of total membership, has increased approximately
3%
year over year. Premium revenue PMPM also increased in the
six months ended June 30, 2013
as a result of the inclusion of revenue for pharmacy benefits for the Utah health plan effective January 1, 2013, and as a result of the inclusion of revenue for inpatient facility and pharmacy benefits across all of the Texas health plan’s membership effective March 1, 2012.
Medical Care Costs
The following table provides the details of consolidated medical care costs for the periods indicated (dollars in thousands except PMPM amounts):
Six Months Ended June 30,
2013
2012
Amount
PMPM
% of
Total
Amount
PMPM
% of
Total
Fee for service
$
1,746,620
$
159.48
67.6
%
$
1,653,024
$
160.57
69.0
%
Pharmacy
454,830
41.53
17.6
386,181
37.51
16.1
Capitation
278,733
25.45
10.8
269,968
26.22
11.3
Other
102,438
9.35
4.0
86,291
8.38
3.6
Total
$
2,582,621
$
235.81
100.0
%
$
2,395,464
$
232.68
100.0
%
Our medical care ratio decreased in the six months ended June 30, 2013, when compared with the six months ended
June 30, 2012, primarily due to improved financial performance at our Texas health plan.
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Table of Contents
Operating Data
The following table summarizes member months, premium revenue, medical care costs, medical care ratio, and premium taxes by health plan for the periods indicated (PMPM amounts are in whole dollars; member months and other dollar amounts are in thousands):
Six Months Ended June 30, 2013
Member
Months (1)
Premium Revenue
Medical Care Costs
Premium Tax
Expense
MCR (2)
Medical Margin
Total
PMPM
Total
PMPM
California
2,056
$
378,939
$
184.33
$
330,540
$
160.79
$
10,224
89.6
%
$
38,175
Florida
461
120,005
260.39
101,319
219.84
4
84.4
18,682
Michigan
1,300
336,122
258.56
288,607
222.01
2,080
86.4
45,435
New Mexico
549
172,325
314.15
140,402
255.95
3,876
83.3
28,047
Ohio
1,448
584,224
403.39
443,118
305.96
45,309
82.2
95,797
Texas
1,637
659,896
403.02
542,408
331.27
11,490
83.7
105,998
Utah
520
152,467
293.16
126,706
243.63
—
83.1
25,761
Washington
2,488
608,719
244.67
524,909
210.98
10,900
87.8
72,910
Wisconsin
493
64,864
131.53
54,849
111.22
—
84.6
10,015
Other
(3)
—
5,484
—
29,763
—
—
—
(24,279
)
10,952
$
3,083,045
$
281.51
$
2,582,621
$
235.81
$
83,883
86.1
%
$
416,541
Six Months Ended June 30, 2012
Member
Months (1)
Premium Revenue
Medical Care Costs
Premium Tax
Expense
MCR (2)
Medical Margin
Total
PMPM
Total
PMPM
California
2,115
$
329,329
$
155.70
$
290,588
$
137.39
$
4,992
89.6
%
$
33,749
Florida
418
113,493
271.44
98,011
234.41
(14
)
86.3
15,496
Michigan
1,327
330,664
249.20
275,893
207.92
8,071
85.5
46,700
New Mexico
532
163,932
308.29
134,947
253.78
4,210
84.5
24,775
Ohio
1,508
590,594
391.77
481,985
319.72
45,864
88.5
62,745
Texas
1,499
557,722
372.11
573,326
382.53
9,867
104.6
(25,471
)
Utah
511
152,049
297.29
121,300
237.17
—
79.8
30,749
Washington
2,135
422,986
198.11
355,470
166.49
7,517
85.6
59,999
Wisconsin
250
35,930
143.54
39,644
158.31
—
110.3
(3,714
)
Other
(3)
—
4,497
—
24,300
—
33
—
(19,836
)
10,295
$
2,701,196
$
262.38
$
2,395,464
$
232.68
$
80,540
91.4
%
$
225,192
(1)
A member month is defined as the aggregate of each month’s ending membership for the period presented.
(2)
The MCR represents medical costs as a percentage of premium revenues, where premium revenue is reduced by premium tax expense.
(3)
“Other” medical care costs also include medically related administrative costs at the parent company.
Molina Medicaid Solutions Segment
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Table of Contents
Performance of the Molina Medicaid Solutions segment was as follows:
Six Months Ended June 30,
2013
2012
(In thousands)
Service revenue before amortization
$
100,885
$
84,235
Amortization recorded as reduction of service revenue
(1,457
)
(306
)
Service revenue
99,428
83,929
Cost of service revenue
79,075
61,107
General and administrative costs
5,141
5,207
Amortization of customer relationship intangibles recorded as amortization
2,564
2,564
Operating income
$
12,648
$
15,051
Operating income for our Molina Medicaid Solutions segment decreased
$2.4 million
for the
six months ended June 30, 2013
, compared with the same prior year period. The decrease in operating income was primarily the result of a change in the mix of transactions processed from fee-for-service claims to managed care encounters (processing fees are lower for encounters than for fee-for-service claims) and changes to state contract revenues implemented during 2012.
Consolidated Expenses
General and Administrative Expenses
General and administrative expenses increased to
10.1%
of total revenue for the
three months ended June 30, 2013
, compared with
8.5%
of total revenue for the
three months ended June 30, 2012
. General and administrative expenses increased to
9.5%
of total revenue for the
six months ended June 30, 2013
, compared with
8.6%
of total revenue for the
six months ended June 30, 2012
. The increased ratio of general and administrative expenses to total revenue for both the three months and
six months ended June 30, 2013
, was primarily due to higher costs incurred as a result of our preparations for significant membership growth in 2014.
Premium Tax Expense
Premium tax expense was
3.0%
of premium revenue in the
three months ended June 30, 2013
, compared with
2.7%
in the
three months ended June 30, 2012
, and
2.7%
of premium revenue in the
six months ended June 30, 2013
, compared with
3.0%
in the
six months ended June 30, 2012
. The year-to-date decrease in 2013 was primarily due to the reduction of premium taxes at the Michigan and California health plans effective in 2012.
Depreciation and Amortization
Depreciation and amortization related to our Health Plans segment is recorded in “Depreciation and amortization” in the consolidated statements of operations. Amortization related to our Molina Medicaid Solutions segment is recorded within three different headings in the consolidated statements of operations as follows:
•
Amortization of purchased intangibles relating to customer relationships is reported as amortization within the heading “Depreciation and amortization;”
•
Amortization of purchased intangibles relating to contract backlog is recorded as a reduction of “Service revenue;” and
•
Amortization of capitalized software is recorded within the heading “Cost of service revenue.”
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The following table presents all depreciation and amortization recorded in our consolidated statements of operations, regardless of whether the item appears as depreciation and amortization, a reduction of service revenue, or as cost of service revenue.
Three Months Ended June 30,
2013
2012
Amount
% of Total
Revenue
Amount
% of Total
Revenue
(Dollar amounts in thousands)
Depreciation and amortization of capitalized software, continuing operations
$
12,896
0.8
%
$
10,674
0.7
%
Amortization of intangible assets, continuing operations
4,119
0.3
5,536
0.4
Depreciation and amortization, continuing operations
17,015
1.1
16,210
1.1
Depreciation and amortization, discontinued operations
—
—
177
—
Amortization recorded as reduction of service revenue
728
—
153
—
Amortization of capitalized software recorded as cost of service revenue
4,365
0.3
3,131
0.2
$
22,108
1.4
%
$
19,671
1.3
%
Six Months Ended June 30,
2013
2012
Amount
% of Total
Revenue
Amount
% of Total
Revenue
(Dollar amounts in thousands)
Depreciation and amortization of capitalized software, continuing operations
$
25,341
0.8
%
$
19,969
0.7
%
Amortization of intangible assets, continuing operations
8,237
0.3
11,089
0.4
Depreciation and amortization, continuing operations
33,578
1.1
31,058
1.1
Depreciation and amortization, discontinued operations
2
—
354
—
Amortization recorded as reduction of service revenue
1,457
—
306
—
Amortization of capitalized software recorded as cost of service revenue
8,870
0.3
6,292
0.2
$
43,907
1.4
%
$
38,010
1.3
%
Interest Expense
Interest expense increased to
$11.7 million
for the
three months ended June 30, 2013
, from
$3.8 million
for the
three months ended June 30, 2012
, and increased to
$24.7 million
for the
six months ended June 30, 2013
, from
$8.1 million
for the
six months ended June 30, 2012
primarily due to the issuance of the 1.125% Notes in February 2013. Interest expense includes amortization of the discount on our convertible senior notes, which amounted to
$6.0 million
and
$1.5 million
for the
three months ended June 30, 2013
, and
2012
, respectively, and
$9.7 million
and
$2.9 million
for the
six months ended June 30, 2013
, and 2012, respectively. Interest expense in the first half of 2013 also includes the immediate recognition of approximately $6 million of interest expense relating to debt issuance costs. The remainder of the fees associated with that issuance, amounting to approximately $12 million, are being expensed over the life of the 1.125% Notes.
As described in further detail below, in "Future Sources and Uses of Liquidity –
Lease Financing Obligations
," lease payments under the sale-leaseback transactions adjust the lease financing obligation, and the imputed interest is recorded to interest expense in our consolidated statements of operations.
Other Expense
Other expense increased to $3.5 million for the three months ended June 30, 2013, from $1.1 million for the three months ended June 30, 2012, with a comparable increase for the six months ended June 30, 2013, over the same period in 2012. Other expense includes primarily gains or losses associated with changes in the fair value of our derivative financial instruments. In the second quarter of 2013 we recorded a one-time non-cash charge of $3.9 million related to warrants issued in conjunction with our convertible senior notes offering in February 2013, as described above in "Second Quarter 2013 Overview." For the three months and six months ended June 30, 2012, we recorded a $1.1 million charge for the fair value of
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Table of Contents
an interest rate swap derivative liability. We settled the interest rate swap in the second quarter of 2013, which resulted in a gain of approximately $0.4 million, which partially offset the $3.9 million charge described above.
Income Taxes
The provision for income taxes in continuing operations is recorded at an effective rate of
49.5%
for the
three months ended June 30, 2013
compared with
39.1%
for the
three months ended June 30, 2012
, and
46.3%
for the
six months ended June 30, 2013
compared with
41.0%
for the
six months ended June 30, 2012
. The increase is primarily due to an increase in non-deductible compensation, and the non-deductibility of the $3.9 million charge related to the warrants, as described above.
Liquidity and Capital Resources
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.
Our regulated subsidiaries generate significant cash flows from premium revenue. Such cash flows are our primary source of liquidity. Thus, any future decline in our profitability may have a negative impact on our liquidity. We generally receive premium revenue in advance of the payment of claims for the related health care services. A majority of the assets held by our regulated subsidiaries are 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 which conform to applicable state laws and regulations. Our investment policies are designed to provide liquidity, preserve capital, and maximize total return on invested assets, all in a manner consistent with state requirements that prescribe the types of instruments in which our subsidiaries may invest. These investment policies require that our investments have final maturities of five years or less (excluding auction rate securities and variable rate securities, for which interest rates are periodically reset) and that the average maturity be two years or less. Professional portfolio managers operating under documented guidelines manage our investments. As of
June 30, 2013
, a substantial portion of our cash was invested in a portfolio of highly liquid money market securities, and our investments consisted solely of investment-grade debt securities. All of our investments are classified as current assets, except for our restricted investments, and our investments in auction rate securities, which are classified as non-current assets. Our restricted investments are invested principally in certificates of deposit and U.S. treasury securities.
Investment income was
$3.1 million
for the
six months ended June 30, 2013
, compared with
$2.7 million
for the
six months ended June 30, 2012
. Our annualized portfolio yield for the
six months ended June 30, 2013
was 0.4% compared with 0.5% for the
six months ended June 30, 2012
.
Investments and restricted investments are subject to interest rate risk and will decrease in value if market rates increase. We have the ability to hold our restricted investments until maturity. Declines in interest rates over time will reduce our investment income.
Cash in excess of the capital needs of our regulated health plans is generally paid to our non-regulated parent company in the form of dividends, when and as permitted by applicable regulations, for general corporate use.
Liquidity
Cash used in operating activities for the
six months ended June 30, 2013
was
$111.7 million
compared with
$236.0 million
provided by operating activities for the
six months ended June 30, 2012
, a change of
$347.7 million
. The decrease in cash from operating activities was primarily due to the changes in deferred revenue and medical claims and benefits payable, partially offset by the change in accounts receivable. Deferred revenue and medical claims and benefits payable were a use of operating cash amounting to
$124.9 million
in the aggregate in the
six months ended June 30, 2013
, compared with a source of operating cash of
$248.5 million
in the aggregate in the same period in 2012. Accounts receivable was a use of operating cash amounting to
$64.1 million
in the
six months ended June 30, 2013
, compared with a source of operating cash of
$6.9 million
in the same period in 2012.
Cash used in investing activities for the
six months ended June 30, 2013
was
$431.8 million
compared with
$61.3 million
for the
six months ended June 30, 2012
, an increase of
$370.5 million
. This increase was primarily due to increased purchases of investments in 2013, a result of increased cash generated in financing activities, described below.
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Cash provided by financing activities for the
six months ended June 30, 2013
was
$490.5 million
compared with
$58.6 million
for the
six months ended June 30, 2012
, an increase of
$431.9 million
. The significant increase was primarily due to
$538.0 million
in proceeds we received from our offering of 1.125% Notes, $158.7 million received from sale-leaseback transactions, and
$75.1 million
from the sale of warrants, partially offset by
$149.3 million
paid for the purchased call option relating to the 1.125% Notes,
$50.0 million
paid for repurchases of our common stock, $47.5 million used to repay our term loan, and
$40.0 million
used to repay our Credit Facility.
Financial Condition
On a consolidated basis, at
June 30, 2013
, we had working capital of
$1,037.6 million
compared with
$521.1 million
at
December 31, 2012
. At
June 30, 2013
, and
December 31, 2012
, we had cash and investments, including restricted investments, of
$1,530.7 million
, and
$1,196.1 million
, respectively. We believe that our cash resources and internally generated funds will be sufficient to support our operations, regulatory requirements, and capital expenditures for at least the next 12 months.
Regulatory Capital and Dividend Restrictions
Our health plans, which are operated by our respective wholly owned subsidiaries in those states, 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. Such state laws and regulations 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. 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
$607.5 million at
June 30, 2013
, and $549.7 million at
December 31, 2012
.
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
$527.8 million and $46.9 million as of
June 30, 2013
, and
December 31, 2012
, respectively.
The National Association of Insurance Commissioners, or NAIC, adopted rules effective December 31, 1998, which, if implemented by the states, set minimum capitalization requirements for insurance companies, HMOs, and other entities bearing risk for health care coverage. The requirements take the form of risk-based capital (RBC) rules. Michigan, New Mexico, Ohio, Texas, Utah, Washington, and Wisconsin have adopted these rules, which may vary from state to state. California and Florida have not adopted NAIC risk-based capital requirements for HMOs and have not formally given notice of their intention to do so. Such requirements, if adopted by California and Florida, may increase the minimum capital required for those states.
As of
June 30, 2013
, our health plans had aggregate statutory capital and surplus of approximately
$627.7 million
compared with the required minimum aggregate statutory capital and surplus of approximately
$363.2 million.
All of our health plans were in compliance with the minimum capital requirements at
June 30, 2013
. We have the ability and commitment to provide additional capital to each of our health plans when necessary to ensure that statutory capital and surplus continue to meet regulatory requirements.
As described in Note 2 to the accompanying Notes to the Consolidated Financial Statements, the ACA imposes an annual fee on health insurers for each calendar year beginning on or after January 1, 2014. The fee will be imposed beginning in 2014 based on a company's share of the industry's net premiums written during the preceding calendar year. If the fee assessment is enacted as written, our minimum capitalization requirements will increase significantly on January 1, 2014; we are currently evaluating the impact of the fee assessment to our financial position, results of operations and cash flows.
Future Sources and Uses of Liquidity
As of June 30, 2013, maturities of long-term debt for the years ending December 31 are as follows (in thousands):
Total
2013
2014
2015
2016
2017
Thereafter
1.125% Notes
$
550,000
$
—
$
—
$
—
$
—
$
—
$
550,000
3.75% Notes
187,000
—
187,000
—
—
—
—
$
737,000
$
—
$
187,000
$
—
$
—
$
—
$
550,000
1.125% Cash Convertible Senior Notes due 2020
On
February 15, 2013
, we settled the issuance of
$550.0 million
aggregate principal amount of 1.125% Cash Convertible Senior Notes due 2020 (the 1.125% Notes). This transaction included the initial issuance of
$450.0 million
on
February 11, 2013
, plus the exercise of the full amount of the
$100.0 million
over-allotment option on
February 13, 2013
. The aggregate net
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Table of Contents
proceeds of the 1.125% Notes were
$458.9 million
, after payment of the net cost of the Call Spread Overlay described below and transaction costs. Additionally, we used
$50.0 million
of the net proceeds to purchase shares of our common stock, and
$40.0 million
to repay the principal owed under our Credit Facility.
Interest on the 1.125% Notes is payable semiannually in arrears on
January 15
and
July 15
of each year, at a rate of
1.125%
per annum commencing on
July 15, 2013
. The 1.125% Notes will mature on
January 15, 2020
unless repurchased or converted in accordance with their terms prior to such date.
The 1.125% Notes are convertible only into cash, and not into shares of our common stock or any other securities. Holders may convert their 1.125% Notes solely into cash at their option at any time prior to the close of business on the business day immediately preceding
July 15, 2019
only under the following circumstances: (1) during any calendar quarter commencing after the calendar quarter ending on
June 30, 2013
(and only during such calendar quarter), if the last reported sale price of the common stock for at least
20
trading days (whether or not consecutive) during a period of
30
consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to
130%
of the conversion price on each applicable trading day; (2) during the five business day period immediately after any five consecutive trading day period in which the trading price per
$1,000
principal amount of 1.125% Notes for each trading day of the measurement period was less than
98%
of the product of the last reported sale price of our common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events. On or after
July 15, 2019
until the close of business on the second scheduled trading day immediately preceding the maturity date, holders may convert their 1.125% Notes solely into cash at any time, regardless of the foregoing circumstances. 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.
The initial conversion rate will be
24.5277
shares of our common stock per
$1,000
principal amount of 1.125% Notes (equivalent to an initial conversion price of approximately
$40.77
per share of common stock). The conversion rate will be subject to adjustment in some events but will not be adjusted for any accrued and unpaid interest. In addition, following certain corporate events that occur prior to the maturity date, we will pay a cash make-whole premium by increasing the conversion rate for a holder who elects to convert its 1.125% Notes in connection with such a corporate event in certain circumstances. We may not redeem the 1.125% Notes prior to the maturity date, and no sinking fund is provided for the 1.125% Notes.
If we undergo a fundamental change (as defined in the indenture to the 1.125% Notes), holders may require us to repurchase for cash all or part of their 1.125% Notes at a repurchase price equal to
100%
of the principal amount of the 1.125% Notes to be repurchased, plus accrued and unpaid interest to, but excluding, the fundamental change repurchase date. The indenture provides for customary events of default, including cross acceleration to certain other indebtedness of ours, and our significant subsidiaries.
The 1.125% Notes are senior unsecured obligations, and rank senior in right of payment to any of our indebtedness that is expressly subordinated in right of payment to the 1.125% Notes; equal in right of payment to any of our unsecured indebtedness that is not so subordinated; effectively junior in right of payment to any of our secured indebtedness to the extent of the value of the assets securing such indebtedness; and structurally junior to all indebtedness and other liabilities (including trade payables) of our subsidiaries.
The 1.125% Notes contain an embedded cash conversion option. We have determined that the embedded cash conversion option is a derivative financial instrument, required to be 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 embedded cash conversion option transaction settles or expires. The initial fair value liability of the embedded cash conversion option was
$149.3 million
, which simultaneously reduced the carrying value of the 1.125% Notes (effectively an original issuance discount).
As noted above, the reduced carrying value on the 1.125% Notes resulted in a debt discount that is amortized to the 1.125% Notes' principal amount through the recognition of interest expense over the expected life of the debt. This has resulted in our recognition of interest expense on the 1.125% Notes at an effective rate approximating what we would have incurred had nonconvertible debt with otherwise similar terms been issued. The effective interest rate of the 1.125% Notes is
5.9%
, which is imputed based on the amortization of the fair value of the embedded cash conversion option over the remaining term of the 1.125% Notes. As of
June 30, 2013
, we expect the 1.125% Notes to be outstanding until their
January 15, 2020
maturity date, for a remaining amortization period of
6.5
years.
Also in connection with the settlement of the 1.125% Notes, we paid approximately
$16.9 million
in transaction costs. Such costs have been allocated to the 1.125% Notes, the 1.125% Call Option (defined below) and the 1.125% Warrants (defined below) according to their relative fair values. The amount allocated to the 1.125% Notes, or
$12.0 million
, was
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Table of Contents
capitalized and will be amortized over the term of the 1.125% Notes. The aggregate amount allocated to the 1.125% Call Option and 1.125% Warrants, or
$4.9 million
, was recorded to interest expense in the quarter ended March 31, 2013.
1.125% Notes Call Spread Overlay
Concurrent with the issuance of the 1.125% Notes, 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). These transactions represent a Call Spread Overlay, whereby 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 the sales price 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 due upon any conversion of the 1.125% Notes. We used
$149.3 million
of the proceeds from the settlement of the 1.125% Notes to pay for the 1.125% Call Option, and simultaneously received
$75.1 million
for the sale of the 1.125% Warrants, for a net cash outlay of
$74.2 million
for the Call Spread Overlay. The 1.125% Call Option is a derivative financial instrument.
Aside from the initial payment of a premium to the Counterparties of
$149.3 million
for the 1.125% Call Option, we will not be required to make any cash payments to the Counterparties under the 1.125% Call Option, and will be entitled to receive from the Counterparties an amount of cash, generally equal to the amount by which the market price per share of common stock exceeds the strike price of the 1.125% Call Options during the relevant valuation period. The strike price under the 1.125% Call Option is initially equal to the conversion price of the 1.125% Notes. Additionally, if the market value per share of our common stock exceeds the strike price of the 1.125% Warrants on any trading day during the
160
trading day measurement period under the 1.125% Warrants, we will be obligated to issue to the Counterparties a number of shares equal in value to the product of the amount by which such market value exceeds such strike price and 1/160th of the aggregate number of shares of our common stock underlying the 1.125% Warrants, subject to a share delivery cap. We will not receive any additional proceeds if the 1.125% Warrants are exercised. Pursuant to the 1.125% Warrants, we issued
13,490,236
warrants with a strike price of
$53.8475
per share. The number of warrants and the strike price are subject to adjustment under certain circumstances.
3.75% Convertible Senior Notes due 2014
We had
$187.0 million
of
3.75%
Convertible Senior Notes due 2014 (the 3.75% Notes) outstanding as of
June 30, 2013
and
December 31, 2012
, respectively. The 3.75% Notes rank equally in right of payment with our existing and future senior indebtedness. The 3.75% Notes are convertible into cash and, under certain circumstances, shares of our common stock. The initial conversion rate is
31.9601
shares of our common stock per one thousand dollar principal amount of the 3.75% Notes. This represents an initial conversion price of approximately
$31.29
per share of our common stock. In addition, if certain corporate transactions that constitute a change of control occur prior to maturity, we will increase the conversion rate in certain circumstances.
Lease Financing Obligations
On June 12, 2013, we entered into a sale-leaseback transaction for the sale and contemporaneous leaseback of two properties, including the Molina Center located in Long Beach, California, and the building that houses our Ohio health plan located in Columbus, Ohio. We sold the two properties for
$158.6 million
in the aggregate. Due to our continuing involvement with these leased properties, the sale did not qualify for sale-leaseback accounting treatment and we remain the "accounting owner" of the properties. The carrying values of these properties, including the related intangible assets, amounted to
$78.8 million
in the aggregate as of June 30, 2013. These assets continue to be included in our consolidated balance sheets, and also continue to be depreciated and amortized over their remaining useful lives. The sales price of
$158.6 million
was recorded as a lease financing obligation, which is amortized over the 25-year lease term such that there will be no gain or loss recorded if the lease is not extended at the end of its term. Payments under the lease adjust the lease financing obligation, and the imputed interest is recorded to interest expense in our consolidated statements of operations. Transaction costs associated with this transaction, amounting to
$3.5 million
, have been deferred and will be amortized over the initial lease term.
We entered into a lease for office space in February 2013 consisting of two office buildings then under construction. We have concluded that we are the accounting owner of the construction projects because of our continuing involvement in those projects. Therefore, we have recorded
$17.0 million
to property, equipment and capitalized software, net, in the accompanying consolidated balance sheet as of
June 30, 2013
, which represents the total cost, including imputed interest, incurred by the landlord thus far in the construction projects. As of
June 30, 2013
, the aggregate amounts recorded to property, equipment and capitalized software, net, for both Building A and B are also recorded as a corresponding lease financing obligation of
$17.0 million
. Payments under the lease adjust the lease financing obligation, and the imputed interest is recorded to interest expense in our consolidated statements of operations. In addition to the capitalization of the costs incurred by the landlord, we impute and record rent expense relating to the ground leases for the property sites. Such rent expense is computed based on the fair value of the land and our incremental borrowing rate, and was immaterial for the
six months ended June 30, 2013
.
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Term Loan
In December 2011, our wholly owned subsidiary, Molina Center LLC, entered into a term loan agreement with various lenders and East West Bank to borrow
$48.6 million
to finance a portion of the purchase price for the Molina Center, located in Long Beach, California. On June 13, 2013, we repaid the principal balance outstanding under the term loan on that date, with proceeds we received in the sale-leaseback transaction described above.
Credit Facility
On February 15, 2013, we used approximately
$40.0 million
of the net proceeds from the offering of the 1.125% Notes to repay all of the outstanding indebtedness under our
$170 million
revolving Credit Facility, with various lenders and U.S. Bank National Association, as Line of Credit Issuer, Swing Line Lender, and Administrative Agent. As of December 31, 2012, there was
$40.0 million
outstanding under the Credit Facility.
We terminated the Credit Facility in connection with the closing of the offering and sale of the 1.125% Notes. Two letters of credit in the aggregate principal amount of
$10.3 million
that reduced the amount available for borrowing under the Credit Facility as of December 31, 2012, were transferred to direct issue letters of credit with another financial institution. Such direct issue letters of credit are collateralized by restricted investments.
Shelf Registration Statement
In the second quarter of 2012, we filed a shelf registration statement on Form S-3 with the Securities and Exchange Commission covering the registration, issuance, and sale of an indeterminate amount of our securities, including common stock, preferred stock, senior or subordinated debt securities, or warrants. We may publicly offer securities from time to time at prices and terms to be determined at the time of the offering.
Securities Repurchase Program
Effective as of February 13, 2013, our board of directors authorized the repurchase of $75 million in the aggregate of either our common stock or our 3.75% Notes, in addition to the $50 million of our common stock that we repurchased on February 12, 2013. The repurchase program extends through December 31, 2014.
Contractual Obligations
A summary of future obligations under our various contractual obligations and commitments as of
December 31, 2012
, was disclosed in our 2012 Annual Report on Form 10-K. Other than the transactions relating to our February 2013 offering of the 1.125% Notes, and the sale-leaseback transactions discussed above, there were no material changes to this previously filed information outside the ordinary course of business during the three months ended June 30, 2013. For further discussion and maturities of our long-term debt, see Note 10 of Notes to the Consolidated Financial Statements.
Critical Accounting Policies
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 most significant accounting policies relate to:
•
Health plan contractual provisions that may limit revenue based upon the costs incurred or the profits realized under a specific contract;
•
Health plan quality incentives that allow us to recognize incremental revenue if certain quality standards are met;
•
The recognition of revenue and costs associated with contracts held by our Molina Medicaid Solutions segment; and
•
The determination of medical claims and benefits payable.
Premium Revenue – 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.
Certain components of premium revenue are subject to accounting estimates. The components of premium revenue subject to estimation fall into two categories:
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Table of Contents
(1) Contractual provisions that may limit revenue based upon the costs incurred or the profits realized under a specific contract:
These are contractual provisions that require the health plan to return premiums to the extent that certain thresholds are not met. In some instances premiums are returned when medical costs fall below a certain percentage of gross premiums; or when administrative costs or profits exceed a certain percentage of gross premiums. In other instances, premiums are partially determined by the acuity of care provided to members (risk adjustment). To the extent that our expenses and profits change from the amounts previously reported (due to changes in estimates), our revenue earned for those periods will also change. In all of these instances, our revenue is only subject to estimate due to the fact that the thresholds themselves contain elements (expense or profit) that are subject to estimate. While we have adequate experience and data to make sound estimates of our expenses or profits, changes to those estimates may be necessary, which in turn would lead to changes in our estimates of revenue. In general, a change in estimate relating to expense or profit would offset any related change in estimate to premium, resulting in no or small impact to net income. The following contractual provisions fall into this category:
California Health Plan Medical Cost Floors (Minimums):
A portion of certain premiums received by our California health plan may be returned to the state if certain minimum amounts are not spent on defined medical care costs. We recorded a liability under the terms of these contract provisions of approximately
$0.7 million
and
$0.3 million
at
June 30, 2013
, and
December 31, 2012
, respectively.
Florida Health Plan Medical Cost Floor (Minimum):
A portion of premiums received by our Florida health plan may be returned to the state if certain minimum amounts are not spent on defined behavioral health care costs (in all counties except Broward). A similar minimum expenditure is required for total health care costs in Broward county only. At both
June 30, 2013
, and
December 31, 2012
, we had not recorded any liability under the terms of these contract provisions.
New Mexico Health Plan Medical Cost Floors (Minimums) and Administrative Cost and Profit Ceilings (Maximums):
Our contract with the state of New Mexico directs that a portion of premiums received may be returned to the state if certain minimum amounts are not spent on defined medical care costs, or if administrative costs or profit, as defined in the contract, exceed certain amounts. At both
June 30, 2013
, and
December 31, 2012
, we had not recorded any liability under the terms of these contract provisions.
Ohio Health Plan Medical Cost Floors (Minimums):
Sanctions may be levied by the state if certain minimum amounts are not spent on defined medical care costs. These sanctions include the requirements to file a corrective action plan as well as an enrollment freeze.
Texas Health Plan Profit Sharing:
Under our contract with the state of Texas, there is a profit-sharing agreement under which we pay a rebate to the state of Texas if our Texas health plan generates pretax income, as defined in the contract, above a certain specified percentage, as determined in accordance with a tiered rebate schedule. We are limited in the amount of administrative costs that we may deduct in calculating the rebate, if any. As a result of profits in excess of the amount we are allowed to fully retain, we had accrued an aggregate liability of approximately
$3.9 million
and
$3.2 million
pursuant to our profit-sharing agreement with the state of Texas at
June 30, 2013
, and
December 31, 2012
, respectively.
Washington Health Plan Medical Cost Floors (Minimums):
A portion of certain premiums received by our Washington health plan may be returned to the state if certain minimum amounts are not spent on defined medical care costs. At
June 30, 2013
, and
December 31, 2012
, we had not recorded any liability under the terms of this contract provision.
Medicare Revenue Risk Adjustment:
Based on member encounter data that we submit to CMS, our Medicare premiums are subject to retroactive adjustment for both member risk scores and member pharmacy cost experience for up to two years after the original year of service. This adjustment takes into account the acuity of each member’s medical needs relative to what was anticipated when premiums were originally set for that member. In the event that a member requires less acute medical care than was anticipated by the original premium amount, CMS may recover premium from us. In the event that a member requires more acute medical care than was anticipated by the original premium amount, CMS may pay us additional retroactive premium. A similar retroactive reconciliation is undertaken by CMS for our Medicare members’ pharmacy utilization. We estimate the amount of Medicare revenue that will ultimately be realized for the periods presented based on our knowledge of our members’ heath care utilization patterns and CMS practices. Based on our knowledge of member health care utilization patterns and expenses we have recorded a net receivable of approximately
$7.1 million
and
$0.3 million
as of
June 30, 2013
and
December 31, 2012
, respectively for anticipated Medicare risk adjustment premiums.
(2) Quality incentives that allow us to recognize incremental revenue if certain quality standards are met:
These are contract provisions that allow us to earn additional premium revenue in certain states if we achieve certain quality-of-care or administrative measures. We estimate the amount of revenue that will ultimately be realized for the periods presented based on our experience and expertise in meeting the quality and administrative measures as well as our ongoing and current monitoring of our progress in meeting those measures. The amount of the revenue that we will realize under these contractual provisions is determinable based upon that experience. The following contractual provisions fall into this category:
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New Mexico Health Plan Quality Incentive Premiums:
Under our contract with the state of New Mexico, incremental revenue of up to 0.75% of our total premium is earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care and administrative measures dictated by the state.
Ohio Health Plan Quality Incentive Premiums:
Under our contract with the state of Ohio, incremental revenue of up to 1% of our total premium is earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care measures dictated by the state.
Texas Health Plan Quality Incentive Premiums:
Effective March 1, 2012, under our contract with the state of Texas, incremental revenue of up to 5% of our total premium is earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care measures established by the state.
Wisconsin Health Plan Quality Incentive Premiums:
Under our contract with the state of Wisconsin, incremental revenue of up to 3.25% of total premium may be earned if certain performance measures are met. These performance measures are generally linked to various quality-of-care measures dictated by the state.
The following table quantifies the quality incentive premium revenue recognized for the periods presented, including the amounts earned in the period presented and prior periods. Although the reasonably possible effects of a change in estimate related to quality incentive premium revenue as of
June 30, 2013
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
June 30, 2013
.
Three Months Ended June 30, 2013
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
588
$
535
$
49
$
584
$
86,527
Ohio
2,964
1,087
553
1,640
292,706
Texas
15,675
15,675
2,752
18,427
324,600
Wisconsin
1,269
—
495
495
37,740
$
20,496
$
17,297
$
3,849
$
21,146
$
741,573
Three Months Ended June 30, 2012
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
561
$
482
$
630
$
1,112
$
82,706
Ohio
2,720
2,720
—
2,720
297,069
Texas
18,252
14,284
—
14,284
359,486
Wisconsin
449
—
246
246
18,788
$
21,982
$
17,486
$
876
$
18,362
$
758,049
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Six Months Ended June 30, 2013
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
1,173
$
867
$
157
$
1,024
$
172,325
Ohio
5,969
2,139
553
2,692
584,224
Texas
31,939
29,187
8,747
37,934
659,896
Wisconsin
2,030
—
1,104
1,104
64,864
$
41,111
$
32,193
$
10,561
$
42,754
$
1,481,309
Six Months Ended June 30, 2012
Maximum
Available Quality
Incentive
Premium -
Current Year
Amount of
Current Year
Quality Incentive
Premium Revenue
Recognized
Amount of
Quality Incentive
Premium Revenue
Recognized from
Prior Year
Total Quality
Incentive
Premium Revenue
Recognized
Total Revenue
Recognized
(In thousands)
New Mexico
$
1,116
$
818
$
658
$
1,476
$
163,932
Ohio
5,398
5,398
966
6,364
590,594
Texas
24,002
20,034
—
20,034
557,722
Wisconsin
865
—
246
246
35,930
$
31,381
$
26,250
$
1,870
$
28,120
$
1,348,178
Service Revenue and Cost of Service Revenue — Molina Medicaid Solutions Segment
The payments received by our Molina Medicaid Solutions segment under its state contracts are based on the performance of multiple services. The first of these is the design, development and implementation (DDI) of a Medicaid Management Information System (MMIS). An additional service, following completion of DDI, is the operation of the MMIS under a business process outsourcing (BPO) arrangement. While providing BPO services (which include claims payment and eligibility processing), we also provide the state with other services including both hosting and support and maintenance. Our Molina Medicaid Solutions contracts may extend over a number of years, particularly in circumstances where we are delivering extensive and complex DDI services, such as the initial design, development and implementation of a complete MMIS. For example, the terms of our most recently implemented Molina Medicaid Solutions contracts (in Idaho and Maine) were each seven years in total, consisting of two years allocated for the delivery of DDI services, followed by five years for the performance of BPO services. We receive progress payments from the state during the performance of DDI services based upon the attainment of predetermined milestones. We receive a flat monthly payment for BPO services under our Idaho and Maine contracts. The terms of our other Molina Medicaid Solutions contracts – which primarily involve the delivery of BPO services with only minimal DDI activity (consisting of system enhancements) – are shorter in duration than our Idaho and Maine contracts.
We have evaluated our Molina Medicaid Solutions contracts to determine if such arrangements include a software element. Based on this evaluation, we have concluded that these arrangements do not include a software element. As such, we have concluded that our Molina Medicaid Solutions contracts are multiple-element service arrangements.
Additionally, we evaluate each required deliverable under our multiple-element service arrangements to determine whether it qualifies as a separate unit of accounting. Such evaluation is generally based on whether the deliverable has standalone value to the customer. The arrangement’s consideration that is fixed or determinable is then allocated to each separate unit of accounting based on the relative selling price of each deliverable. In general, the consideration allocated to each unit of accounting is recognized as the related goods or services are delivered, limited to the consideration that is not contingent.
We have concluded that the various service elements in our Molina Medicaid Solutions contracts represent a single unit of accounting due to the fact that DDI, which is the only service performed in advance of the other services (all other services are performed over an identical period), does not have standalone value because our DDI services are not sold separately by any vendor and the customer could not resell our DDI services. Further, we have no objective and reliable evidence of fair value for any of the individual elements in these contracts, and at no point in the contract will we have objective and reliable evidence of fair value for the undelivered elements in the contracts. We lack objective and reliable evidence of the fair value of the individual elements of our Molina Medicaid Solutions contracts for the following reasons:
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•
Each contract calls for the provision of its own specific set of services. While all contracts support the system of record for state MMIS, the actual services we provide vary significantly between contracts; and
•
The nature of the MMIS installed varies significantly between our older contracts (proprietary mainframe systems) and our new contracts (commercial off-the-shelf technology solutions).
Because we have determined the services provided under our Molina Medicaid Solutions contracts represent a single unit of accounting and because we are unable to determine a pattern of performance of services during the contract period, we recognize all revenue (both the DDI and BPO elements) associated with such contracts on a straight-line basis over the period during which BPO, hosting, and support and maintenance services are delivered. As noted above, the period of performance of BPO services under our Idaho and Maine contracts is five years. Therefore, absent any contingencies as discussed in the following paragraph, we would recognize all revenue associated with those contracts over a period of five years. In cases where there is no DDI element associated with our contracts, BPO revenue is recognized on a monthly basis as specified in the applicable contract or contract extension.
Provisions specific to each contract may, however, lead us to modify this general principle. In those circumstances, the right of the state to refuse acceptance of services, as well as the related obligation to compensate us, may require us to delay recognition of all or part of our revenue until that contingency (the right of the state to refuse acceptance) has been removed. In those circumstances we defer recognition of any contingent revenue (whether DDI, BPO services, hosting, and support and maintenance services) until the contingency has been removed. These types of contingency features are present in our Maine and Idaho contracts. In those states, we deferred recognition of revenue until the contingencies were removed.
Costs associated with our Molina Medicaid Solutions contracts include software-related costs and other costs. With respect to software related costs, we apply the guidance for internal-use software and capitalize external direct costs of materials and services consumed in developing or obtaining the software, and payroll and payroll-related costs associated with employees who are directly associated with and who devote time to the computer software project. With respect to all other direct costs, such costs are expensed as incurred, unless corresponding revenue is being deferred. If revenue is being deferred, direct costs relating to delivered service elements are deferred as well and are recognized on a straight-line basis over the period of revenue recognition, in a manner consistent with our recognition of revenue that has been deferred. Such direct costs can include:
•
Transaction processing costs
•
Employee costs incurred in performing transaction services
•
Vendor costs incurred in performing transaction services
•
Costs incurred in performing required monitoring of and reporting on contract performance
•
Costs incurred in maintaining and processing member and provider eligibility
•
Costs incurred in communicating with members and providers
The recoverability of deferred contract costs associated with a particular contract is analyzed on a periodic basis using the undiscounted estimated cash flows of the whole contract over its remaining contract term. If such undiscounted cash flows are insufficient to recover the long-lived assets and deferred contract costs, the deferred contract costs are written down by the amount of the cash flow deficiency. If a cash flow deficiency remains after reducing the balance of the deferred contract costs to zero, any remaining long-lived assets are evaluated for impairment. Any such impairment recognized would equal the amount by which the carrying value of the long-lived assets exceeds the fair value of those assets
.
Medical Claims and Benefits Payable — Health Plans Segment
The following table provides the details of our medical claims and benefits payable as of the dates indicated:
June 30,
2013
December 31,
2012
June 30,
2012
(In thousands)
Fee-for-service claims incurred but not paid (IBNP)
$
360,153
$
377,614
$
378,782
Capitation payable
47,474
49,066
79,739
Pharmacy
37,241
38,992
34,848
Other
20,619
28,858
32,169
$
465,487
$
494,530
$
525,538
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The determination of our liability for claims and medical benefits payable is particularly important to the determination of our financial position and results of operations in any given period. Such determination of our liability requires the application of a significant degree of judgment by our management.
As a result, the determination of our liability for claims and medical benefits payable is subject to an inherent degree of uncertainty. Our medical care costs include amounts that have been paid by us through the reporting date, as well as estimated liabilities for medical care costs incurred but not paid by us as of the reporting date. Such medical care cost liabilities include, among other items, unpaid fee-for-service claims, capitation payments owed providers, unpaid pharmacy invoices, and various medically related administrative costs that have been incurred but not paid. We use judgment to determine the appropriate assumptions for determining the required estimates.
The most important element in estimating our medical care costs is our estimate for fee-for-service claims which have been incurred but not paid by us. These fee-for-service costs that have been incurred but have not been paid at the reporting date are collectively referred to as medical costs that are “Incurred But Not Paid,” or IBNP. Our IBNP, as reported on our balance sheet, represents our best estimate of the total amount of claims we will ultimately pay with respect to claims that we have incurred as of the balance sheet date. We estimate our IBNP monthly using actuarial methods based on a number of factors. As indicated in the table above, our estimated IBNP liability represented $360.2 million of our total medical claims and benefits payable of $465.5 million as of
June 30, 2013
. Excluding amounts that we anticipate paying on behalf of a capitated provider in Ohio (which we will subsequently withhold from that provider’s monthly capitation payment), our IBNP liability at
June 30, 2013
, was $354.0 million.
The factors we consider when estimating our IBNP include, without limitation, claims receipt and payment experience (and variations in that experience), changes in membership, provider billing practices, health care service utilization trends, cost trends, product mix, seasonality, prior authorization of medical services, benefit changes, known outbreaks of disease or increased incidence of illness such as influenza, provider contract changes, changes to Medicaid fee schedules, and the incidence of high dollar or catastrophic claims. Our assessment of these factors is then translated into an estimate of our IBNP liability at the relevant measuring point through the calculation of a base estimate of IBNP, a further reserve for adverse claims development, and an estimate of the administrative costs of settling all claims incurred through the reporting date. The base estimate of IBNP is derived through application of claims payment completion factors and trended PMPM cost estimates.
For the fifth month of service prior to the reporting date and earlier, we estimate our outstanding claims liability based on actual claims paid, adjusted for estimated completion factors. Completion factors seek to measure the cumulative percentage of claims expense that will have been paid for a given month of service as of the reporting date, based on historical payment patterns.
The following table reflects the change in our estimate of claims liability as of
June 30, 2013
that would have resulted had we changed our completion factors for the fifth through the twelfth months preceding
June 30, 2013
, by the percentages indicated. A reduction in the completion factor results in an increase in medical claims liabilities. Dollar amounts are in thousands.
Increase (Decrease) in Estimated Completion Factors
Increase (Decrease) in
Medical Claims and
Benefits Payable
(6)%
$
154,224
(4)%
102,816
(2)%
51,408
2%
(51,408
)
4%
(102,816
)
6%
(154,224
)
For the four months of service immediately prior to the reporting date, actual claims paid are not a reliable measure of our ultimate liability, given the inherent delay between the patient/physician encounter and the actual submission of a claim for payment. For these months of service, we estimate our claims liability based on trended PMPM cost estimates. These estimates are designed to reflect recent trends in payments and expense, utilization patterns, authorized services, and other relevant factors. The following table reflects the change in our estimate of claims liability as of
June 30, 2013
that would have resulted had we altered our trend factors by the percentages indicated. An increase in the PMPM costs results in an increase in medical
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claims liabilities. Dollar amounts are in thousands.
(Decrease) Increase in Trended Per member Per Month Cost Estimates
(Decrease) Increase in
Medical Claims and
Benefits Payable
(6)%
$
(77,698
)
(4)%
(51,799
)
(2)%
(25,899
)
2%
25,899
4%
51,799
6%
77,698
The following per-share amounts are based on a combined federal and state statutory tax rate of 37%, and 46.5 million diluted shares outstanding for the
six months ended June 30, 2013
. Assuming a hypothetical 1% change in completion factors from those used in our calculation of IBNP at
June 30, 2013
, net income for the
six months ended June 30, 2013
would increase or decrease by approximately $16.2 million, or $0.35 per diluted share. Assuming a hypothetical 1% change in PMPM cost estimates from those used in our calculation of IBNP at
June 30, 2013
, net income for the
six months ended June 30, 2013
would increase or decrease by approximately $8.2 million, or $0.18 per diluted share. The corresponding figures for a 5% change in completion factors and PMPM cost estimates would be $81.0 million, or $1.74 per diluted share, and $40.8 million, or $0.88 per diluted share, respectively.
It is important to note that any change in the estimate of either completion factors or trended PMPM costs would usually be accompanied by a change in the estimate of the other component, and that a change in one component would almost always compound rather than offset the resulting distortion to net income. When completion factors are
overestimated
, trended PMPM costs tend to be
underestimated
. Both circumstances will create an overstatement of net income. Likewise, when completion factors are
underestimated
, trended PMPM costs tend to be
overestimated
, creating an understatement of net income. In other words, errors in estimates involving both completion factors and trended PMPM costs will usually act to drive estimates of claims liabilities and medical care costs in the same direction. If completion factors were overestimated by 1%, resulting in an overstatement of net income by approximately $16.2 million, it is likely that trended PMPM costs would be underestimated, resulting in an additional overstatement of net income.
After we have established our base IBNP reserve through the application of completion factors and trended PMPM cost estimates, we then compute an additional liability, once again using actuarial techniques, to account for adverse developments in our claims payments which the base actuarial model is not intended to and does not account for. We refer to this additional liability as the provision for adverse claims development. The provision for adverse claims development is a component of our overall determination of the adequacy of our IBNP. It is intended to capture the potential inadequacy of our IBNP estimate as a result of our inability to adequately assess the impact of factors such as changes in the speed of claims receipt and payment, the relative magnitude or severity of claims, known outbreaks of disease such as influenza, our entry into new geographical markets, our provision of services to new populations such as the aged, blind or disabled (ABD), changes to state-controlled fee schedules upon which a large proportion of our provider payments are based, modifications and upgrades to our claims processing systems and practices, and increasing medical costs. Because of the complexity of our business, the number of states in which we operate, and the need to account for different health care benefit packages among those states, we make an overall assessment of IBNP after considering the base actuarial model reserves and the provision for adverse claims development. We also include in our IBNP liability an estimate of the administrative costs of settling all claims incurred through the reporting date. The development of IBNP is a continuous process that we monitor and refine on a monthly basis as additional claims payment information becomes available. As additional information becomes known to us, we adjust our actuarial model accordingly to establish IBNP.
On a monthly basis, we review and update our estimated IBNP and the methods used to determine that liability. Any adjustments, if appropriate, are reflected in the period known. While we believe our current estimates are adequate, we have in the past been required to increase significantly our claims reserves for periods previously reported, and may be required to do so again in the future. Any significant increases to prior period claims reserves would materially decrease reported earnings for the period in which the adjustment is made.
In our judgment, the estimates for completion factors will likely prove to be more accurate than trended PMPM cost estimates because estimated completion factors are subject to fewer variables in their determination. Specifically, completion factors are developed over long periods of time, and are most likely to be affected by changes in claims receipt and payment experience and by provider billing practices. Trended PMPM cost estimates, while affected by the same factors, will also be influenced by health care service utilization trends, cost trends, product mix, seasonality, prior authorization of medical services, benefit changes, outbreaks of disease or increased incidence of illness, provider contract changes, changes to
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Medicaid fee schedules, and the incidence of high dollar or catastrophic claims. As discussed above, however, errors in estimates involving trended PMPM costs will almost always be accompanied by errors in estimates involving completion factors, and vice versa. In such circumstances, errors in estimation involving both completion factors and trended PMPM costs will act to drive estimates of claims liabilities (and therefore medical care costs) in the same direction.
Assuming that our initial estimate of claims incurred but not paid (IBNP) is accurate, we believe that amounts ultimately paid out would generally be between 8% and 10% less than the liability recorded at the end of the period as a result of the inclusion in that liability of the allowance for adverse claims development and the accrued cost of settling those claims. Because the amount of our initial liability is merely an estimate (and therefore not perfectly accurate), 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.
Furthermore, 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 only know when the circumstances for any one or more factors are out of the ordinary.
As shown in greater detail in the table below, the amounts ultimately paid out on our liabilities in fiscal years
2013
and
2012
were less than what we had expected when we had established our reserves. For example, for the year ended December 31, 2012, the amounts ultimately paid out were less than the amount of the reserves we had established as of December 31, 2011 by
9.8%
. While many related factors working in conjunction with one another determine the accuracy of our estimates, we are seldom able to quantify the impact that any single factor has on a change in estimate. In addition, given the variability inherent in the reserving process, 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 recognized favorable prior period claims development in the amount of
$62.8 million
for the
six months ended June 30, 2013
. This amount represents our estimate as of
June 30, 2013
of the extent to which our initial estimate of medical claims and benefits payable at
December 31, 2012
was more than the amount that will ultimately be paid out in satisfaction of that liability. We believe the overestimation of our claims liability at
December 31, 2012
was due primarily to the following factors:
•
At our Texas health plan, STAR+PLUS (the state’s program for ABD members) membership declined during mid– to late– 2012. This caused a reduction in costs per member that we did not fully recognize in our December 31, 2012 reserve estimates.
•
At our Washington health plan, prior to July 2012, certain high-cost newborns that were approved for supplemental security income (SSI) coverage by the state were retroactively dis-enrolled from our Healthy Options (TANF) coverage, and the health plan was reimbursed for the claims paid on behalf of these members. Starting July 1, 2012, these newborns, as well as other high-cost disabled members, are now covered by the health plan under the Healthy Options Blind and Disabled (HOBD) program. At the end of 2012, we had limited claims history with which to estimate the claims liability of the HOBD members, and as a result the liability for these high-cost members was overstated.
•
For our New Mexico health plan, we overestimated the impact of certain high-dollar outstanding claim payments as of December 31, 2012.
We recognized favorable prior period claims development in the amount of
$50.0 million
for the
three months ended June 30, 2013
. This amount represents our estimate as of
June 30, 2013
of the extent to which our initial estimate of medical claims and benefits payable at March 31, 2013 was more than the amount that will ultimately be paid out in satisfaction of that liability. We believe the overestimation of our claims liability at March 31, 2013 was due primarily to the following factors:
•
At our Washington health plan, we had limited claims history with which to estimate the incurred claims for members enrolled in the HOBD program. Because claims on this group of members were being paid at a rate faster than expected, the reserves for unpaid claims were overstated.
•
At our Ohio and New Mexico health plans, we overestimated the impact of several potential high-dollar claims on critically ill members.
We recognized favorable prior period claims development in the amount of
$36.4 million
and
$39.3 million
for the
six months ended June 30, 2012
, and the year ended
December 31, 2012
, respectively. This was primarily caused by the overestimation of our liability claims and medical benefits at
December 31, 2011
, as a result of the following factors:
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•
At our Washington health plan, we underestimated the amount of recoveries we would collect for certain high-cost newborn claims, resulting in an overestimation of reserves at year end.
•
At our Texas health plan, we overestimated the cost of new members in STAR+PLUS, in the Dallas region.
•
The overestimation of our liability for medical claims and benefits payable was partially offset by an underestimation of that liability at our Missouri health plan, as a result of the costs associated with an unusually large number of premature infants during the fourth quarter of 2011.
In estimating our claims liability at
June 30, 2013
, we adjusted our base calculation to take account of the following factors which we believe are reasonably likely to change our final claims liability amount:
•
In our Texas health plan, we have noted an unusually large number of claims with incurred dates older than 10 months. This has caused some distortion in the claims lag pattern that we use to estimate the incurred claims.
•
Our Wisconsin health plan is experiencing significant membership increases, and approximately doubled in size during the first four months of 2013. This new membership is transitioning to our health plan from a terminated health plan. We enrolled approximately
50,000
new members in February, March and April 2013.
We have computed a separate reserve analysis for these members and have noted that paid claims thus far are less than what we would expect for newly transitioned members. It has been our experience that when members move to new health plans, there is a delay in the submission of claims for payment. Therefore, we have increased the reserves for this membership, in anticipation of higher claims costs eventually being reported for these members.
•
In our Michigan health plan, there were a large number of claim recoveries recorded in June 2013 due to overpayments that resulted from a system configuration issue. These recoveries impacted the completion factors used to estimate incurred claims. While we have attempted to remove this distortion from the claims data to develop a more accurate reserve estimate, this type of correction in claims data adds a degree of uncertainty for the Michigan reserves as of June 30, 2013.
The use of a consistent methodology in estimating our liability for claims and medical benefits payable minimizes the degree to which the under- or overestimation of that liability at the close of one period may affect consolidated results of operations in subsequent periods. In particular, the use of a consistent methodology should result in the replenishment of reserves during any given period in a manner that generally offsets the benefit of favorable prior period development in that period. Facts and circumstances unique to the estimation process at any single date, however, may still lead to a material impact on consolidated results of operations in subsequent periods. Any absence of adverse claims development (as well as the expensing through general and administrative expense of the costs to settle claims held at the start of the period) will lead to the recognition of a benefit from prior period claims development in the period subsequent to the date of the original estimate. In
2012
and for the
six months ended June 30, 2013
, the absence of adverse development of the liability for claims and medical benefits payable at the close of the previous period resulted in the recognition of substantial favorable prior period development. In both years, however, the recognition of a benefit from prior period claims development did not have a material impact on our consolidated results of operations because the replenishment of reserves in the respective periods generally offset the benefit from the prior period.
The following table presents the components of the change in our medical claims and benefits payable for the periods indicated. The amounts displayed for “Components of medical care costs related to: Prior periods” represent the amount by which our original estimate of claims and benefits payable at the beginning of the period were (more) or less than the actual amount of the liability based on information (principally the payment of claims) developed since that liability was first reported. The following table shows the components of the change in medical claims and benefits payable from continuing and discontinued operations as of the periods indicated:
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Six Months Ended June 30,
Three Months Ended June 30,
Year Ended December 31, 2012
2013
2012
2013
2012
(Dollars in thousands, except per-member amounts)
Balances at beginning of period
$
494,530
$
402,476
$
491,145
$
455,833
$
402,476
Components of medical care costs related to:
Current period
2,647,083
2,544,922
1,345,592
1,377,084
5,136,055
Prior periods
(62,757
)
(36,357
)
(50,020
)
493
(39,295
)
Total medical care costs
2,584,326
2,508,565
1,295,572
1,377,577
5,096,760
Payments for medical care costs related to:
Current period
2,206,474
2,033,611
940,186
891,573
4,649,363
Prior periods
406,895
351,892
381,044
416,299
355,343
Total paid
2,613,369
2,385,503
1,321,230
1,307,872
5,004,706
Balances at end of period
$
465,487
$
525,538
$
465,487
$
525,538
$
494,530
Benefit from prior period as a percentage of:
Balance at beginning of period
12.7
%
9.0
%
10.2
%
(0.1
)%
9.8
%
Premium revenue, trailing twelve months
1.0
%
0.7
%
0.8
%
—
%
0.7
%
Medical care costs, trailing twelve months
1.2
%
0.8
%
1.0
%
—
%
0.8
%
Claims Data:
Days in claims payable, fee for service
38
44
38
44
40
Number of members at end of period
1,847,000
1,853,000
1,847,000
1,853,000
1,797,000
Number of claims in inventory at end of period
109,900
209,200
109,900
209,200
122,700
Billed charges of claims in inventory at end of period
$
200,400
$
324,500
$
200,400
$
324,500
$
255,200
Claims in inventory per member at end of period
0.06
0.11
0.06
0.11
0.07
Billed charges of claims in inventory per member at end of period
$
108.50
$
175.12
$
108.50
$
175.12
$
142.01
Number of claims received during the period
10,524,500
10,375,700
5,253,500
5,520,100
20,842,400
Billed charges of claims received during the period
$
10,477,900
$
9,388,700
$
5,307,200
$
5,051,800
$
19,429,300
Compliance Costs
Our health plans are regulated by both state and federal government agencies. Regulation of managed care products and health care services is an evolving area of law that varies from jurisdiction to jurisdiction. Regulatory agencies generally have discretion to issue regulations and interpret and enforce laws and rules. Changes in applicable laws and rules occur frequently. Compliance with such laws and rules may lead to additional costs related to the implementation of additional systems, procedures and programs that we have not yet identified.
Inflation
We use various strategies to mitigate the negative effects of health care cost inflation. Specifically, our health plans try to control medical and hospital costs through contracts with independent providers of health care services. Through these contracted providers, our health plans emphasize preventive health care and appropriate use of specialty and hospital services. There can be no assurance, however, that our strategies to mitigate health care cost inflation will be successful. Competitive pressures, new health care and pharmaceutical product introductions, demands from health care providers and customers, applicable regulations, or other factors may affect our ability to control health care costs.
Item 3.
Quantitative and Qualitative Disclosures About Market Risk
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. We invest a substantial portion of our cash in the PFM Fund Prime Series — Institutional Class, and the PFM Fund Government Series. These funds represent a portfolio of highly liquid money market securities that are managed by PFM Asset Management LLC, a Virginia business trust registered as an open-end management investment fund. Our investments and a portion of our cash equivalents are managed by professional portfolio managers operating under documented investment guidelines. No investment that is in a loss position can be sold by our managers without our prior approval. Our investments consist solely of investment grade debt securities with a maximum
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maturity of five years and an average duration of two 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 limited due to payors consisting principally of the governments of each state in which our Health Plans segment and our Molina Medicaid Solutions segment operate.
Item 4.
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 Securities and Exchange Commission’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
June 30, 2013
that has materially affected, or is reasonably likely to materially affect, our internal controls over financial reporting.
PART II — OTHER INFORMATION
Item 1.
Legal Proceedings
The health care and business process outsourcing industries are subject to numerous laws and regulations of federal, state, and local governments. Compliance with these laws and regulations can be subject to government review and interpretation, as well as regulatory actions unknown and unasserted at this time. Penalties associated with violations of these laws and regulations include significant fines and penalties, exclusion from participating in publicly funded programs, and the repayment of previously billed and collected revenues.
We are involved in legal actions in the ordinary course of business, 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 estimable. Although we believe that our estimates of such losses are reasonable, these estimates could change as a result of further developments of these matters. The outcome of legal actions is inherently uncertain and such pending matters for which accruals have not been established have not progressed sufficiently through discovery and/or development of important factual information and legal issues to enable us to estimate a range of possible loss, if any. While it is not possible to accurately predict or determine the eventual outcomes of these items, 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.
Item 1A.
Risk Factors
Certain risk factors may have a material adverse effect on our business, financial condition, cash flows, or results of operations, and you should carefully consider them. In addition to the other information set forth in this report, the following risk factors were identified by the Company during the second quarter of 2013, and is a supplement to, and should be read together with, the risk factors discussed in Part I, Item 1A - Risk Factors, in our Annual Report on Form 10-K for the year ended December 31, 2012. The risk factors described herein and in our 2012 Annual Report on Form 10-K are not the only risks facing our Company. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely affect our business, financial condition, cash flows, or results of operations.
Reductions in Medicare payments could reduce our earnings potential for our Medicare Advantage plans.
The American Taxpayer Relief Act (ATRA) of 2012, known as the “fiscal cliff” deal, delayed the sequestration mandated under the Sequestration Transparency Act of 2012 until March 1, 2013. Although Medicaid is exempt from cuts under ATRA, ATRA triggered automatic across-the-board budget cuts (known as “sequestration”), which included a 2% reduction of payments from the Centers for Medicare and Medicaid Services to our Medicare Advantage plans beginning April 1, 2013. Medicare Advantage plans will continue to be affected until Congress lifts the sequestration mandated under the Sequestration Transparency Act of 2012. The impact of sequestration cuts on our Medicare Advantage revenues is partially mitigated by reductions in provider reimbursements paid to those providers with rates indexed to the Medicare fee-for-service reimbursement rates. Such reduction in our Medicare payments may have an adverse effect on our earnings potential for our Medicare Advantage plans and our duals demonstration programs. In addition, reductions to provider reimbursement rates associated with sequestration may adversely impact our relations with the impacted providers.
Item 2.
Unregistered Sales of Equity Securities and Use of Proceeds
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Issuer Purchases of Equity Securities
Common Stock Repurchase in Connection with Offering of 1.125% Cash Convertible Senior Notes Due 2020.
We used a portion of the net proceeds in this offering to repurchase $50.0 million of our common stock in negotiated transactions with institutional investors in the offering, concurrently with the pricing of the offering. On February 12, 2013, we repurchased a total of 1,624,959 shares at $30.77 per share, which was our closing stock price on that date.
Securities Repurchase Program.
Effective as of February 13, 2013, our board of directors authorized the repurchase of $75 million in aggregate of either our common stock or the 3.75% Notes, in addition to the $50.0 million common stock repurchase discussed above. The repurchase program extends through December 31, 2014.
Purchases of common stock made by or on our behalf during the quarter ended
June 30, 2013
, including shares withheld by us to satisfy our employees’ income tax obligations, are set forth below:
Total Number
of
Shares
Purchased (a)
Average Price Paid
per Share
Total Number of Shares
Purchased as Part of
Publicly Announced Plans
or Programs
Maximum Number (or
Approximate Dollar Value)
of Shares that May Yet Be
Purchased Under the Plans
or Programs
April 1 - April 30
590
$
30.76
—
$
75,000,000
May 1 - May 31
541
$
33.15
—
$
75,000,000
June 1 - June 30
26,550
$
37.26
—
$
75,000,000
Total
27,681
$
37.04
—
(a)
During the
three months ended June 30, 2013
, we withheld 27,681 shares of common stock under our 2002 Equity Incentive Plan and 2011 Equity Incentive Plan to settle our employees’ income tax obligations.
Item 6. Exhibits
Exhibit No.
Title
3.1
Certificate of Amendment to Certificate of Incorporation.
3.2
Second Amendment and Restated Bylaws - Filed as Exhibit 3.1 to registrant's Form 8-K filed July 24, 2013.
10.1
Agreement of Purchase and Sale, dated as of June 12, 2013, by and between Molina Healthcare, Inc. and Molina Center, LLC, and AG Net Lease Acquisition Corp.
10.2
Lease Agreement, dated as of June 13, 2013, by and between AGNL Clinic, L.P., and Molina Healthcare, Inc.
10.3
Employment Agreement with Terry Bayer dated June 14, 2013 - Filed as Exhibit 10.1 to registrant's Form 8-K filed June 14, 2013.
10.4
Employment Agreement with Joseph White dated June 14, 2013 - Filed as Exhibit 10.2 to registrant's Form 8-K filed June 14, 2013.
10.5
Employment Agreement with Jeff Barlow dated June 14, 2013 - Filed as Exhibit 10.3 to registrant's Form 8-K filed June 14, 2013.
31.1
Certification of Chief Executive Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended.
31.2
Certification of Chief Financial Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended.
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.
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.
101.INS (1)
XBRL Taxonomy Instance Document.
101.SCH (1)
XBRL Taxonomy Extension Schema Document.
101.CAL (1)
XBRL Taxonomy Extension Calculation Linkbase Document.
101.DEF (1)
XBRL Taxonomy Extension Definition Linkbase Document.
101.LAB (1)
XBRL Taxonomy Extension Label Linkbase Document.
101.PRE (1)
XBRL Taxonomy Extension Presentation Linkbase Document.
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(1)
Pursuant to Rule 406T of Regulation S-T, XBRL (eXtensible Business Reporting Language) information is furnished and not filed or a part of a registration statement or prospectus for purposes of Sections 11 or 12 of the Securities Act of 1933, as amended, is deemed not filed for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, and otherwise is not subject to liability under these sections.
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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:
July 25, 2013
/s/ JOSEPH M. MOLINA, M.D.
Joseph M. Molina, M.D.
Chairman of the Board,
Chief Executive Officer and President
(Principal Executive Officer)
Dated:
July 25, 2013
/s/ JOHN C. MOLINA, J.D.
John C. Molina, J.D.
Chief Financial Officer and Treasurer
(Principal Financial Officer)
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EXHIBIT INDEX
Exhibit No.
Title
3.1
Certificate of Amendment to Certificate of Incorporation.
3.2
Second Amendment and Restated Bylaws - Filed as Exhibit 3.1 to registrant's Form 8-K filed July 24, 2013.
10.1
Agreement of Purchase and Sale, dated as of June 12, 2013, by and between Molina Healthcare, Inc. and Molina Center, LLC, and AG Net Lease Acquisition Corp.
10.2
Lease Agreement, dated as of June 13, 2013, by and between AGNL Clinic, L.P., and Molina Healthcare, Inc.
10.3
Employment Agreement with Terry Bayer dated June 14, 2013 - Filed as Exhibit 10.1 to registrant's Form 8-K filed June 14, 2013.
10.4
Employment Agreement with Joseph White dated June 14, 2013 - Filed as Exhibit 10.2 to registrant's Form 8-K filed June 14, 2013.
10.5
Employment Agreement with Jeff Barlow dated June 14, 2013 - Filed as Exhibit 10.3 to registrant's Form 8-K filed June 14, 2013.
31.1
Certification of Chief Executive Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended.
31.2
Certification of Chief Financial Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended.
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.
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.
101.INS (1)
XBRL Taxonomy Instance Document.
101.SCH (1)
XBRL Taxonomy Extension Schema Document.
101.CAL (1)
XBRL Taxonomy Extension Calculation Linkbase Document.
101.DEF (1)
XBRL Taxonomy Extension Definition Linkbase Document.
101.LAB (1)
XBRL Taxonomy Extension Label Linkbase Document.
101.PRE (1)
XBRL Taxonomy Extension Presentation Linkbase Document.
(1)
Pursuant to Rule 406T of Regulation S-T, XBRL (eXtensible Business Reporting Language) information is furnished and not filed or a part of a registration statement or prospectus for purposes of Sections 11 or 12 of the Securities Act of 1933, as amended, is deemed not filed for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, and otherwise is not subject to liability under these sections.
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