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x
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QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
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¨
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
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Delaware
|
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13-4204626
|
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(State or other jurisdiction of
incorporation or organization)
|
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(I.R.S. Employer
Identification No.)
|
|
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|
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200 Oceangate, Suite 100
Long Beach, California
|
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90802
|
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(Address of principal executive offices)
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(Zip Code)
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|
|
|
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Large accelerated filer
|
x
|
Accelerated filer
|
¨
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Non-accelerated filer
|
¨
(Do not check if a smaller reporting company)
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Smaller reporting company
|
¨
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|
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September 30,
2013 |
|
December 31,
2012 |
||||
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|
(Amounts in thousands,
except per-share data)
|
||||||
|
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(Unaudited)
|
|
|
||||
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ASSETS
|
|
|
|
||||
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Current assets:
|
|
|
|
||||
|
Cash and cash equivalents
|
$
|
856,556
|
|
|
$
|
795,770
|
|
|
Investments
|
735,151
|
|
|
342,845
|
|
||
|
Receivables
|
293,967
|
|
|
149,682
|
|
||
|
Deferred income taxes
|
30,480
|
|
|
32,443
|
|
||
|
Prepaid expenses and other current assets
|
50,061
|
|
|
28,386
|
|
||
|
Total current assets
|
1,966,215
|
|
|
1,349,126
|
|
||
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Property, equipment, and capitalized software, net
|
267,277
|
|
|
221,443
|
|
||
|
Deferred contract costs
|
48,768
|
|
|
58,313
|
|
||
|
Intangible assets, net
|
104,635
|
|
|
77,711
|
|
||
|
Goodwill and indefinite-lived intangible assets
|
230,783
|
|
|
151,088
|
|
||
|
Derivative asset
|
191,663
|
|
|
—
|
|
||
|
Restricted investments
|
65,225
|
|
|
44,101
|
|
||
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Auction rate securities
|
11,674
|
|
|
13,419
|
|
||
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Deferred income taxes
|
3,090
|
|
|
—
|
|
||
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Other assets
|
35,736
|
|
|
19,621
|
|
||
|
|
$
|
2,925,066
|
|
|
$
|
1,934,822
|
|
|
LIABILITIES AND STOCKHOLDERS’ EQUITY
|
|
|
|
||||
|
Current liabilities:
|
|
|
|
||||
|
Medical claims and benefits payable
|
$
|
632,706
|
|
|
$
|
494,530
|
|
|
Accounts payable and accrued liabilities
|
282,727
|
|
|
184,034
|
|
||
|
Deferred revenue
|
124,388
|
|
|
141,798
|
|
||
|
Income taxes payable
|
5,508
|
|
|
6,520
|
|
||
|
Current maturities of long-term debt
|
109
|
|
|
1,155
|
|
||
|
Total current liabilities
|
1,045,438
|
|
|
828,037
|
|
||
|
Convertible senior notes
|
591,884
|
|
|
175,468
|
|
||
|
Lease financing obligations
|
178,188
|
|
|
—
|
|
||
|
Other long-term debt
|
—
|
|
|
86,316
|
|
||
|
Derivative liabilities
|
191,556
|
|
|
1,307
|
|
||
|
Deferred income taxes
|
—
|
|
|
37,900
|
|
||
|
Other long-term liabilities
|
25,152
|
|
|
23,480
|
|
||
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Total liabilities
|
2,032,218
|
|
|
1,152,508
|
|
||
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Stockholders’ equity:
|
|
|
|
||||
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Common stock, $0.001 par value; 150,000 shares authorized; outstanding: 45,757 shares at September 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
|
331,958
|
|
|
285,524
|
|
||
|
Accumulated other comprehensive loss
|
(1,411
|
)
|
|
(457
|
)
|
||
|
Treasury stock, at cost; 111 shares at December 31, 2012
|
—
|
|
|
(3,000
|
)
|
||
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Retained earnings
|
562,255
|
|
|
500,200
|
|
||
|
Total stockholders’ equity
|
892,848
|
|
|
782,314
|
|
||
|
|
$
|
2,925,066
|
|
|
$
|
1,934,822
|
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
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|
September 30,
|
|
September 30,
|
||||||||||||
|
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2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
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(Amounts in thousands, except
net income (loss) per share)
(Unaudited)
|
||||||||||||||
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Revenue:
|
|
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|
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|
||||||||
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Premium revenue
|
$
|
1,584,656
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$
|
1,448,600
|
|
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$
|
4,583,818
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|
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$
|
4,066,737
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|
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Premium tax receipts
|
43,723
|
|
|
37,894
|
|
|
127,606
|
|
|
120,953
|
|
||||
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Service revenue
|
51,100
|
|
|
48,422
|
|
|
150,528
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|
|
132,351
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|
||||
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Investment income
|
1,740
|
|
|
1,155
|
|
|
4,884
|
|
|
3,893
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|
||||
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Rental and other income
|
5,860
|
|
|
4,079
|
|
|
16,476
|
|
|
12,315
|
|
||||
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Total revenue
|
1,687,079
|
|
|
1,540,150
|
|
|
4,883,312
|
|
|
4,336,249
|
|
||||
|
Expenses:
|
|
|
|
|
|
|
|
||||||||
|
Medical care costs
|
1,383,213
|
|
|
1,319,991
|
|
|
3,965,834
|
|
|
3,715,455
|
|
||||
|
Cost of service revenue
|
40,113
|
|
|
37,004
|
|
|
119,188
|
|
|
98,111
|
|
||||
|
General and administrative expenses
|
176,233
|
|
|
127,035
|
|
|
478,990
|
|
|
365,564
|
|
||||
|
Premium tax expenses
|
43,723
|
|
|
37,894
|
|
|
127,606
|
|
|
120,953
|
|
||||
|
Depreciation and amortization
|
18,871
|
|
|
15,858
|
|
|
52,449
|
|
|
46,916
|
|
||||
|
Total expenses
|
1,662,153
|
|
|
1,537,782
|
|
|
4,744,067
|
|
|
4,346,999
|
|
||||
|
Operating income (loss)
|
24,926
|
|
|
2,368
|
|
|
139,245
|
|
|
(10,750
|
)
|
||||
|
Other expenses:
|
|
|
|
|
|
|
|
||||||||
|
Interest expense
|
13,532
|
|
|
4,315
|
|
|
38,236
|
|
|
12,421
|
|
||||
|
Other (income) expense
|
(24
|
)
|
|
184
|
|
|
3,347
|
|
|
1,270
|
|
||||
|
Total other expenses
|
13,508
|
|
|
4,499
|
|
|
41,583
|
|
|
13,691
|
|
||||
|
Income (loss) from continuing operations before income tax expense
|
11,418
|
|
|
(2,131
|
)
|
|
97,662
|
|
|
(24,441
|
)
|
||||
|
Income tax expense (benefit)
|
3,865
|
|
|
(1,966
|
)
|
|
43,791
|
|
|
(11,113
|
)
|
||||
|
Income (loss) from continuing operations
|
7,553
|
|
|
(165
|
)
|
|
53,871
|
|
|
(13,328
|
)
|
||||
|
Income (loss) from discontinued operations, net of tax expense (benefit) of $97, $1,474, $(10,046), and $(4,115), respectively
|
16
|
|
|
3,529
|
|
|
8,184
|
|
|
(2,525
|
)
|
||||
|
Net income (loss)
|
$
|
7,569
|
|
|
$
|
3,364
|
|
|
$
|
62,055
|
|
|
$
|
(15,853
|
)
|
|
|
|
|
|
|
|
|
|
||||||||
|
Basic income (loss) per share:
|
|
|
|
|
|
|
|
||||||||
|
Income (loss) from continuing operations
|
$
|
0.17
|
|
|
$
|
(0.01
|
)
|
|
$
|
1.18
|
|
|
$
|
(0.29
|
)
|
|
Income (loss) from discontinued operations
|
—
|
|
|
0.08
|
|
|
0.18
|
|
|
(0.05
|
)
|
||||
|
Basic net income (loss) per share
|
$
|
0.17
|
|
|
$
|
0.07
|
|
|
$
|
1.36
|
|
|
$
|
(0.34
|
)
|
|
Diluted income (loss) per share:
|
|
|
|
|
|
|
|
||||||||
|
Income (loss) from continuing operations
|
$
|
0.16
|
|
|
$
|
(0.01
|
)
|
|
$
|
1.15
|
|
|
$
|
(0.29
|
)
|
|
Income (loss) from discontinued operations
|
—
|
|
|
0.08
|
|
|
0.18
|
|
|
(0.05
|
)
|
||||
|
Diluted net income (loss) per share
|
$
|
0.16
|
|
|
$
|
0.07
|
|
|
$
|
1.33
|
|
|
$
|
(0.34
|
)
|
|
|
|
|
|
|
|
|
|
||||||||
|
Weighted average shares outstanding:
|
|
|
|
|
|
|
|
||||||||
|
Basic
|
45,699
|
|
|
46,546
|
|
|
45,708
|
|
|
46,301
|
|
||||
|
Diluted
|
47,062
|
|
|
46,880
|
|
|
46,767
|
|
|
46,301
|
|
||||
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
|
|
September 30,
|
|
September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
|
|
(Amounts in thousands)
(Unaudited)
|
||||||||||||||
|
Net income (loss)
|
$
|
7,569
|
|
|
$
|
3,364
|
|
|
$
|
62,055
|
|
|
$
|
(15,853
|
)
|
|
Other comprehensive income (loss):
|
|
|
|
|
|
|
|
||||||||
|
Gross unrealized investment gain (loss)
|
2,087
|
|
|
733
|
|
|
(1,539
|
)
|
|
1,734
|
|
||||
|
Effect of income taxes
|
793
|
|
|
278
|
|
|
(585
|
)
|
|
659
|
|
||||
|
Other comprehensive income (loss), net of tax
|
1,294
|
|
|
455
|
|
|
(954
|
)
|
|
1,075
|
|
||||
|
Comprehensive income (loss)
|
$
|
8,863
|
|
|
$
|
3,819
|
|
|
$
|
61,101
|
|
|
$
|
(14,778
|
)
|
|
|
Nine Months Ended
|
||||||
|
|
September 30,
|
||||||
|
|
2013
|
|
2012
|
||||
|
|
(Amounts in thousands)
(Unaudited)
|
||||||
|
Operating activities:
|
|
|
|
||||
|
Net income (loss)
|
$
|
62,055
|
|
|
$
|
(15,853
|
)
|
|
Adjustments to reconcile net income (loss) to net cash change in operating activities:
|
|
|
|
||||
|
Depreciation and amortization
|
68,035
|
|
|
58,289
|
|
||
|
Deferred income taxes
|
(38,442
|
)
|
|
523
|
|
||
|
Stock-based compensation
|
20,654
|
|
|
15,448
|
|
||
|
Gain on sale of subsidiary
|
—
|
|
|
(1,747
|
)
|
||
|
Amortization of convertible senior notes and lease financing obligations
|
16,128
|
|
|
4,414
|
|
||
|
Change in fair value of derivatives
|
3,383
|
|
|
1,270
|
|
||
|
Amortization of premium/discount on investments
|
8,053
|
|
|
5,166
|
|
||
|
Amortization of deferred financing costs
|
3,042
|
|
|
825
|
|
||
|
Tax deficiency from employee stock compensation
|
(72
|
)
|
|
(159
|
)
|
||
|
Changes in operating assets and liabilities:
|
|
|
|
||||
|
Receivables
|
(144,285
|
)
|
|
10,989
|
|
||
|
Prepaid expenses and other current assets
|
(27,552
|
)
|
|
(10,574
|
)
|
||
|
Medical claims and benefits payable
|
138,176
|
|
|
133,987
|
|
||
|
Accounts payable and accrued liabilities
|
20,991
|
|
|
(9,030
|
)
|
||
|
Deferred revenue
|
(17,410
|
)
|
|
92,354
|
|
||
|
Income taxes
|
(1,012
|
)
|
|
(21,878
|
)
|
||
|
Net cash provided by operating activities
|
111,744
|
|
|
264,024
|
|
||
|
Investing activities:
|
|
|
|
||||
|
Purchases of equipment
|
(64,426
|
)
|
|
(52,548
|
)
|
||
|
Purchases of investments
|
(627,953
|
)
|
|
(234,465
|
)
|
||
|
Sales and maturities of investments
|
227,800
|
|
|
213,665
|
|
||
|
Proceeds from sale of subsidiary, net of cash surrendered
|
—
|
|
|
9,162
|
|
||
|
Net cash paid in business combinations
|
(57,684
|
)
|
|
—
|
|
||
|
Change in deferred contract costs
|
9,545
|
|
|
(18,799
|
)
|
||
|
Increase in restricted investments
|
(21,124
|
)
|
|
(3,034
|
)
|
||
|
Change in other non-current assets and liabilities
|
(7,574
|
)
|
|
(4,775
|
)
|
||
|
Net cash used in investing activities
|
(541,416
|
)
|
|
(90,794
|
)
|
||
|
Financing activities:
|
|
|
|
||||
|
Proceeds from issuance of 1.125% Notes, net of deferred financing 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
|
)
|
|
(20,000
|
)
|
||
|
Amount borrowed under credit facility
|
—
|
|
|
60,000
|
|
||
|
Principal payments on term loan
|
(47,471
|
)
|
|
(846
|
)
|
||
|
Settlement of interest rate swap
|
(875
|
)
|
|
—
|
|
||
|
Proceeds from employee stock plans
|
5,156
|
|
|
5,571
|
|
||
|
Excess tax benefits from employee stock compensation
|
1,238
|
|
|
3,698
|
|
||
|
Net cash provided by financing activities
|
490,458
|
|
|
48,423
|
|
||
|
Net increase in cash and cash equivalents
|
60,786
|
|
|
221,653
|
|
||
|
Cash and cash equivalents at beginning of period
|
795,770
|
|
|
493,827
|
|
||
|
Cash and cash equivalents at end of period
|
$
|
856,556
|
|
|
$
|
715,480
|
|
|
|
Nine Months Ended
|
||||||
|
|
September 30,
|
||||||
|
|
2013
|
|
2012
|
||||
|
|
(Amounts in thousands)
|
||||||
|
|
(Unaudited)
|
||||||
|
Supplemental cash flow information:
|
|
|
|
||||
|
Cash paid during the period for:
|
|
|
|
||||
|
Income taxes
|
$
|
72,156
|
|
|
$
|
1,074
|
|
|
Interest
|
$
|
28,035
|
|
|
$
|
5,663
|
|
|
Schedule of non-cash investing and financing activities:
|
|
|
|
||||
|
Retirement of treasury stock
|
$
|
53,000
|
|
|
$
|
—
|
|
|
Common stock used for stock-based compensation
|
$
|
6,667
|
|
|
$
|
9,852
|
|
|
Non-cash financing obligation for construction projects
|
$
|
19,222
|
|
|
$
|
—
|
|
|
Details of business combinations:
|
|
|
|
||||
|
Fair value of assets acquired
|
$
|
121,845
|
|
|
$
|
—
|
|
|
Fair value of contingent consideration liabilities incurred
|
(59,947
|
)
|
|
—
|
|
||
|
Payable to seller
|
(3,882
|
)
|
|
—
|
|
||
|
Escrow deposit
|
(332
|
)
|
|
$
|
—
|
|
|
|
Net cash paid in business combinations
|
$
|
57,684
|
|
|
$
|
—
|
|
|
Details of change in fair value of derivatives:
|
|
|
|
||||
|
Gain on 1.125% Call Option
|
$
|
42,332
|
|
|
$
|
—
|
|
|
Loss on embedded cash conversion option
|
(42,225
|
)
|
|
—
|
|
||
|
Loss on 1.125% Warrants
|
(3,923
|
)
|
|
—
|
|
||
|
Gain (loss) on interest rate swap
|
433
|
|
|
(1,270
|
)
|
||
|
Change in fair value of derivatives
|
$
|
(3,383
|
)
|
|
$
|
(1,270
|
)
|
|
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
|
|
|
|
Three Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
906
|
|
|
$
|
818
|
|
|
$
|
2
|
|
|
$
|
820
|
|
|
$
|
130,318
|
|
|
Ohio
|
3,080
|
|
|
976
|
|
|
(52
|
)
|
|
924
|
|
|
280,964
|
|
|||||
|
Texas
|
15,744
|
|
|
15,744
|
|
|
—
|
|
|
15,744
|
|
|
320,657
|
|
|||||
|
Wisconsin
|
1,209
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
39,676
|
|
|||||
|
|
$
|
20,939
|
|
|
$
|
17,538
|
|
|
$
|
(50
|
)
|
|
$
|
17,488
|
|
|
$
|
771,615
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
Three Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
560
|
|
|
$
|
532
|
|
|
$
|
—
|
|
|
$
|
532
|
|
|
$
|
80,846
|
|
|
Ohio
|
2,824
|
|
|
1,412
|
|
|
—
|
|
|
1,412
|
|
|
282,489
|
|
|||||
|
Texas
|
17,685
|
|
|
10,453
|
|
|
—
|
|
|
10,453
|
|
|
344,522
|
|
|||||
|
Wisconsin
|
419
|
|
|
—
|
|
|
246
|
|
|
246
|
|
|
16,279
|
|
|||||
|
|
$
|
21,488
|
|
|
$
|
12,397
|
|
|
$
|
246
|
|
|
$
|
12,643
|
|
|
$
|
724,136
|
|
|
|
Nine Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
2,079
|
|
|
$
|
1,685
|
|
|
$
|
159
|
|
|
$
|
1,844
|
|
|
$
|
298,767
|
|
|
Ohio
|
9,049
|
|
|
3,115
|
|
|
501
|
|
|
3,616
|
|
|
819,879
|
|
|||||
|
Texas
|
47,683
|
|
|
47,683
|
|
|
5,995
|
|
|
53,678
|
|
|
969,063
|
|
|||||
|
Wisconsin
|
3,239
|
|
|
—
|
|
|
1,104
|
|
|
1,104
|
|
|
104,540
|
|
|||||
|
|
$
|
62,050
|
|
|
$
|
52,483
|
|
|
$
|
7,759
|
|
|
$
|
60,242
|
|
|
$
|
2,192,249
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
Nine Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
1,676
|
|
|
$
|
1,350
|
|
|
$
|
658
|
|
|
$
|
2,008
|
|
|
$
|
240,568
|
|
|
Ohio
|
8,222
|
|
|
6,810
|
|
|
966
|
|
|
7,776
|
|
|
827,219
|
|
|||||
|
Texas
|
41,687
|
|
|
30,487
|
|
|
—
|
|
|
30,487
|
|
|
892,377
|
|
|||||
|
Wisconsin
|
1,284
|
|
|
—
|
|
|
492
|
|
|
492
|
|
|
52,209
|
|
|||||
|
|
$
|
52,869
|
|
|
$
|
38,647
|
|
|
$
|
2,116
|
|
|
$
|
40,763
|
|
|
$
|
2,012,373
|
|
|
•
|
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).
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||
|
|
(In thousands)
|
||||||||||
|
Shares outstanding at the beginning of the period
|
45,683
|
|
|
46,527
|
|
|
46,762
|
|
|
45,815
|
|
|
Weighted-average number of shares repurchased
|
—
|
|
|
—
|
|
|
(1,375
|
)
|
|
—
|
|
|
Weighted-average number of shares issued
|
16
|
|
|
19
|
|
|
321
|
|
|
486
|
|
|
Denominator for basic net income (loss) per share
|
45,699
|
|
|
46,546
|
|
|
45,708
|
|
|
46,301
|
|
|
Dilutive effect of employee stock options and stock grants (1)
|
453
|
|
|
334
|
|
|
532
|
|
|
—
|
|
|
Dilutive effect of convertible senior notes
|
910
|
|
|
—
|
|
|
527
|
|
|
—
|
|
|
Denominator for diluted net income (loss) per share (2)
|
47,062
|
|
|
46,880
|
|
|
46,767
|
|
|
46,301
|
|
|
(1)
|
Unvested restricted shares are included in the calculation of diluted net 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 net 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 nine months ended
September 30, 2013
there were no anti-dilutive weighted restricted shares. For the three and nine months ended
September 30, 2013
there were approximately
60,000
and
48,600
anti-dilutive weighted options, respectively. For the three months ended
September 30, 2012
, there were approximately
370,000
anti-dilutive weighted restricted shares and
125,000
anti-dilutive weighted options. Potentially dilutive unvested restricted shares and stock options were not included in the computation of diluted loss per share for the nine months ended
September 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
11
, "
Long-Term Debt
") were not included in the computation of diluted income per share for the three and nine month period ended
September 30, 2013
, because to do so would have been anti-dilutive. Potentially dilutive shares issuable pursuant to our 3.75% Notes (defined in Note
11
, "
Long-Term Debt
") were not included in the computation of diluted loss per share for the three and nine month period ended
September 30, 2012
, because to do so would have been anti-dilutive.
|
|
|
Fair Value of Assets Acquired - Health Plans Segment
|
||||||||||||||||
|
|
Weighted average useful life
|
|
South Carolina
|
|
New Mexico
|
|
Florida
|
|
Total
|
||||||||
|
|
(Years)
|
|
(In thousands)
|
||||||||||||||
|
Membership conversion rights
|
12.0
|
|
$
|
21,800
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
21,800
|
|
|
Contract rights
|
10.6
|
|
—
|
|
|
18,300
|
|
|
—
|
|
|
18,300
|
|
||||
|
Other finite-lived intangibles
|
7.7
|
|
1,060
|
|
|
—
|
|
|
990
|
|
|
2,050
|
|
||||
|
Goodwill
|
—
|
|
42,140
|
|
|
35,223
|
|
|
2,332
|
|
|
79,695
|
|
||||
|
|
|
|
$
|
65,000
|
|
|
$
|
53,523
|
|
|
$
|
3,322
|
|
|
$
|
121,845
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Restricted stock and performance awards
|
$
|
7,634
|
|
|
$
|
5,093
|
|
|
$
|
18,593
|
|
|
$
|
13,943
|
|
|
Employee stock purchase plan and stock options
|
870
|
|
|
543
|
|
|
2,061
|
|
|
1,505
|
|
||||
|
|
$
|
8,504
|
|
|
$
|
5,636
|
|
|
$
|
20,654
|
|
|
$
|
15,448
|
|
|
|
Shares
|
|
Weighted
Average
Grant Date
Fair Value
|
|||
|
Unvested balance as of December 31, 2012
|
986,577
|
|
|
$
|
23.74
|
|
|
Granted - restricted stock
|
587,706
|
|
|
32.15
|
|
|
|
Granted - performance stock
|
456,174
|
|
|
30.80
|
|
|
|
Vested
|
(581,329
|
)
|
|
24.72
|
|
|
|
Forfeited
|
(31,500
|
)
|
|
25.55
|
|
|
|
Unvested balance as of September 30, 2013
|
1,417,628
|
|
|
29.06
|
|
|
|
|
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
|
(70,000
|
)
|
|
20.11
|
|
|
|
|
|
|
||
|
Forfeited
|
(300
|
)
|
|
17.63
|
|
|
|
|
|
|||
|
Outstanding as of September 30, 2013
|
388,761
|
|
|
24.04
|
|
|
$
|
4,495
|
|
|
3.6
|
|
|
Stock options exercisable and expected to vest as of September 30, 2013
|
388,761
|
|
|
24.04
|
|
|
$
|
4,495
|
|
|
3.6
|
|
|
Exercisable as of September 30, 2013
|
333,761
|
|
|
22.50
|
|
|
$
|
4,371
|
|
|
2.7
|
|
|
|
Total
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Corporate debt securities
|
$
|
467,060
|
|
|
$
|
—
|
|
|
$
|
467,060
|
|
|
$
|
—
|
|
|
GSEs
|
74,951
|
|
|
74,951
|
|
|
—
|
|
|
—
|
|
||||
|
Municipal securities
|
107,844
|
|
|
—
|
|
|
107,844
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
42,207
|
|
|
42,207
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
43,089
|
|
|
—
|
|
|
43,089
|
|
|
—
|
|
||||
|
Auction rate securities
|
11,674
|
|
|
—
|
|
|
—
|
|
|
11,674
|
|
||||
|
1.125% Call Option derivative asset
|
191,663
|
|
|
—
|
|
|
—
|
|
|
191,663
|
|
||||
|
Total assets measured at fair value on a recurring basis
|
$
|
938,488
|
|
|
$
|
117,158
|
|
|
$
|
617,993
|
|
|
$
|
203,337
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Embedded cash conversion option derivative liability
|
$
|
191,556
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
191,556
|
|
|
Contingent consideration liabilities
|
59,947
|
|
|
—
|
|
|
—
|
|
|
59,947
|
|
||||
|
Total liabilities measured at fair value on a recurring basis
|
$
|
251,503
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
251,503
|
|
|
|
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
|
|
|
$
|
—
|
|
|
|
Changes in Level 3 Instruments for the Nine Months Ended September 30, 2013
|
||||||||||||||
|
|
Total
|
|
Auction Rate Securities
|
|
Derivatives, Net
|
|
Contingent Consideration
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Balance at December 31, 2012
|
$
|
13,419
|
|
|
$
|
13,419
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
Net unrealized gains included in other comprehensive income
|
505
|
|
|
505
|
|
|
—
|
|
|
—
|
|
||||
|
Net unrealized losses included in other expense
|
(3,382
|
)
|
|
—
|
|
|
(3,382
|
)
|
|
—
|
|
||||
|
Issuances
|
(75,074
|
)
|
|
—
|
|
|
(75,074
|
)
|
|
—
|
|
||||
|
Auction rate securities settlements and derivative re-designation
|
76,747
|
|
|
(2,250
|
)
|
|
78,997
|
|
|
—
|
|
||||
|
Acquisitions
|
(59,947
|
)
|
|
—
|
|
|
—
|
|
|
(59,947
|
)
|
||||
|
Balance at September 30, 2013
|
$
|
(47,732
|
)
|
|
$
|
11,674
|
|
|
$
|
541
|
|
|
$
|
(59,947
|
)
|
|
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 September 30, 2013
|
$
|
397
|
|
|
$
|
397
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
|
Changes in Level 3 Instruments for the Year Ended December 31, 2012
|
||||||||||||||
|
|
Total
|
|
Auction Rate Securities
|
|
Derivatives, Net
|
|
Contingent Consideration
|
||||||||
|
|
(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
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
|
September 30, 2013
|
||||||||||||||||||
|
|
Carrying
Value
|
|
Total
Fair Value
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
1.125% Notes
|
$
|
411,659
|
|
|
$
|
596,899
|
|
|
$
|
—
|
|
|
$
|
596,899
|
|
|
$
|
—
|
|
|
3.75% Notes
|
180,225
|
|
|
229,556
|
|
|
—
|
|
|
229,556
|
|
|
—
|
|
|||||
|
Lease financing obligations
|
178,188
|
|
|
178,500
|
|
|
—
|
|
|
—
|
|
|
178,500
|
|
|||||
|
|
$
|
770,072
|
|
|
$
|
1,004,955
|
|
|
$
|
—
|
|
|
$
|
826,455
|
|
|
$
|
178,500
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
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
|
|
|
|
September 30, 2013
|
||||||||||||||
|
|
Amortized
|
|
Gross
Unrealized
|
|
Estimated
Fair
|
||||||||||
|
|
Cost
|
|
Gains
|
|
Losses
|
|
Value
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Corporate debt securities
|
$
|
467,785
|
|
|
$
|
306
|
|
|
$
|
1,031
|
|
|
$
|
467,060
|
|
|
GSEs
|
75,022
|
|
|
18
|
|
|
89
|
|
|
74,951
|
|
||||
|
Municipal securities
|
108,647
|
|
|
109
|
|
|
912
|
|
|
107,844
|
|
||||
|
U.S. treasury notes
|
42,159
|
|
|
67
|
|
|
19
|
|
|
42,207
|
|
||||
|
Certificates of deposit
|
43,087
|
|
|
3
|
|
|
1
|
|
|
43,089
|
|
||||
|
Subtotal - current investments
|
736,700
|
|
|
503
|
|
|
2,052
|
|
|
735,151
|
|
||||
|
Auction rate securities
|
12,400
|
|
|
—
|
|
|
726
|
|
|
11,674
|
|
||||
|
|
$
|
749,100
|
|
|
$
|
503
|
|
|
$
|
2,778
|
|
|
$
|
746,825
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
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
|
|
|
|
Cost
|
|
Estimated
Fair Value
|
||||
|
|
(In thousands)
|
||||||
|
Due in one year or less
|
$
|
406,330
|
|
|
$
|
406,342
|
|
|
Due one year through five years
|
330,370
|
|
|
328,809
|
|
||
|
Due after ten years
|
12,400
|
|
|
11,674
|
|
||
|
|
$
|
749,100
|
|
|
$
|
746,825
|
|
|
|
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
|
$
|
254,351
|
|
|
$
|
991
|
|
|
99
|
|
|
$
|
5,580
|
|
|
$
|
40
|
|
|
5
|
|
|
Municipal securities
|
60,428
|
|
|
736
|
|
|
68
|
|
|
12,424
|
|
|
176
|
|
|
29
|
|
||||
|
GSEs
|
24,271
|
|
|
89
|
|
|
15
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
12,487
|
|
|
19
|
|
|
11
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
415
|
|
|
1
|
|
|
2
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
Auction rate securities
|
—
|
|
|
—
|
|
|
—
|
|
|
11,674
|
|
|
726
|
|
|
17
|
|
||||
|
|
$
|
351,952
|
|
|
$
|
1,836
|
|
|
195
|
|
|
$
|
29,678
|
|
|
$
|
942
|
|
|
51
|
|
|
|
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
|
|
|
|
September 30,
2013 |
|
December 31,
2012 |
||||
|
|
(In thousands)
|
||||||
|
Health Plans segment:
|
|
|
|
||||
|
California
|
$
|
130,718
|
|
|
$
|
28,553
|
|
|
Florida
|
2,239
|
|
|
953
|
|
||
|
Michigan
|
16,311
|
|
|
12,873
|
|
||
|
New Mexico
|
14,091
|
|
|
9,059
|
|
||
|
Ohio
|
79,200
|
|
|
40,980
|
|
||
|
Texas
|
5,280
|
|
|
7,459
|
|
||
|
Utah
|
10,375
|
|
|
3,359
|
|
||
|
Washington
|
12,668
|
|
|
17,587
|
|
||
|
Wisconsin
|
5,033
|
|
|
4,098
|
|
||
|
Other
|
633
|
|
|
2,177
|
|
||
|
Total Health Plans segment
|
276,548
|
|
|
127,098
|
|
||
|
Molina Medicaid Solutions segment
|
17,419
|
|
|
22,584
|
|
||
|
|
$
|
293,967
|
|
|
$
|
149,682
|
|
|
|
September 30,
2013 |
|
December 31,
2012 |
||||
|
|
(In thousands)
|
||||||
|
California
|
$
|
373
|
|
|
$
|
373
|
|
|
Florida
|
8,840
|
|
|
5,738
|
|
||
|
Michigan
|
1,014
|
|
|
1,014
|
|
||
|
New Mexico
|
24,620
|
|
|
15,915
|
|
||
|
Ohio
|
9,081
|
|
|
9,082
|
|
||
|
Texas
|
3,500
|
|
|
3,503
|
|
||
|
Utah
|
3,308
|
|
|
3,126
|
|
||
|
Washington
|
151
|
|
|
151
|
|
||
|
Other
|
4,037
|
|
|
5,199
|
|
||
|
Total Health Plans segment
|
54,924
|
|
|
44,101
|
|
||
|
Molina Medicaid Solutions segment
|
10,301
|
|
|
—
|
|
||
|
|
$
|
65,225
|
|
|
$
|
44,101
|
|
|
|
Amortized
Cost
|
|
Estimated
Fair Value
|
||||
|
|
(In thousands)
|
||||||
|
Due in one year or less
|
$
|
59,633
|
|
|
$
|
59,636
|
|
|
Due one year through five years
|
5,592
|
|
|
5,596
|
|
||
|
|
$
|
65,225
|
|
|
$
|
65,232
|
|
|
|
Nine Months Ended
|
|
Three Months Ended
|
|
Year Ended
|
||||||
|
|
September 30, 2013
|
|
September 30, 2013
|
|
December 31, 2012
|
||||||
|
|
(Dollars in thousands)
|
||||||||||
|
Balances at beginning of period
|
$
|
494,530
|
|
|
$
|
465,487
|
|
|
$
|
402,476
|
|
|
Components of medical care costs related to:
|
|
|
|
|
|
||||||
|
Current period
|
4,021,461
|
|
|
1,415,670
|
|
|
5,136,055
|
|
|||
|
Prior periods
|
(54,040
|
)
|
|
(32,575
|
)
|
|
(39,295
|
)
|
|||
|
Total medical care costs
|
3,967,421
|
|
|
1,383,095
|
|
|
5,096,760
|
|
|||
|
Payments for medical care costs related to:
|
|
|
|
|
|
||||||
|
Current period
|
3,410,689
|
|
|
851,025
|
|
|
4,649,363
|
|
|||
|
Prior periods
|
418,556
|
|
|
364,851
|
|
|
355,343
|
|
|||
|
Total paid
|
3,829,245
|
|
|
1,215,876
|
|
|
5,004,706
|
|
|||
|
Balances at end of period
|
$
|
632,706
|
|
|
$
|
632,706
|
|
|
$
|
494,530
|
|
|
Benefit from prior period as a percentage of:
|
|
|
|
|
|
||||||
|
Balance at beginning of period
|
10.9
|
%
|
|
7.0
|
%
|
|
9.8
|
%
|
|||
|
Premium revenue, trailing twelve months
|
0.9
|
%
|
|
0.5
|
%
|
|
0.7
|
%
|
|||
|
Medical care costs, trailing twelve months
|
1.0
|
%
|
|
0.6
|
%
|
|
0.8
|
%
|
|||
|
•
|
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.
|
|
•
|
At our New Mexico health plan, we overestimated the impact of certain high-dollar outstanding claim payments as of December 31, 2012.
|
|
•
|
At our Ohio health plan, we overestimated the impact of several potential high-dollar claims relating to our aged, blind or disabled (ABD) members.
|
|
•
|
At our Ohio health plan, we overestimated the impact of several potential high-dollar claims relating to critically ill members.
|
|
•
|
At our Michigan health plan, we underestimated the impact of future claims overpayment recoveries when establishing reserves at June 30, 2013.
|
|
•
|
The overestimation of our liability for medical claims and benefits payable was partially offset by an underestimation of that liability at our Texas health plan as a result of the costs associated with an unusually large number of older claims. This anomaly was caused primarily by the payment of claims that were delayed as a result of hospital provider disputes that have been resolved. The underestimation of the liability at our Texas health plan was responsible for the relatively small amount of prior period development noted above.
|
|
•
|
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.
|
|
•
|
At our Texas health plan, we have noted an unusually large number of older claims dated older than 12 months. This has caused some distortion in the claims lag pattern that we use to estimate the incurred claims.
|
|
•
|
At 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 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 September 30, 2013.
|
|
•
|
Our New Mexico health plan acquired approximately
80,000
new members in August 2013 from another health plan. This acquisition roughly doubled the size of the membership in a single month. For the September 30, 2013 reserve calculation, we have assumed that these new members will incur costs at about the same rate as the New Mexico members that were previously enrolled. With only two months of paid claims for these new members, it is too soon to know whether that assumption is correct or not.
|
|
|
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
|
|
|
|
Principal Balance
|
|
Unamortized Discount
|
|
Net Carrying Amount
|
||||||
|
|
(In thousands)
|
||||||||||
|
September 30, 2013:
|
|
|
|
|
|
||||||
|
1.125% Notes
|
$
|
550,000
|
|
|
$
|
138,341
|
|
|
$
|
411,659
|
|
|
3.75% Notes
|
187,000
|
|
|
6,775
|
|
|
180,225
|
|
|||
|
|
$
|
737,000
|
|
|
$
|
145,116
|
|
|
$
|
591,884
|
|
|
December 31, 2012:
|
|
|
|
|
|
||||||
|
3.75% Notes
|
$
|
187,000
|
|
|
$
|
11,532
|
|
|
$
|
175,468
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Interest cost recognized for the period relating to the:
|
|
|
|
|
|
|
|
||||||||
|
Contractual interest coupon rate
|
$
|
3,300
|
|
|
$
|
1,753
|
|
|
$
|
9,127
|
|
|
$
|
5,259
|
|
|
Amortization of the discount
|
6,059
|
|
|
1,499
|
|
|
15,747
|
|
|
4,414
|
|
||||
|
Total interest cost recognized
|
$
|
9,359
|
|
|
$
|
3,252
|
|
|
$
|
24,874
|
|
|
$
|
9,673
|
|
|
|
Balance Sheet Location
|
|
September 30, 2013
|
||
|
|
|
|
(In thousands)
|
||
|
Derivative asset:
|
|
|
|
||
|
1.125% Call Option
|
Non-current assets: Derivative asset
|
|
$
|
191,663
|
|
|
|
|
|
|
|
|
|
Derivative liability:
|
|
|
|
||
|
Embedded cash conversion option
|
Non-current liabilities: Derivative liability
|
|
$
|
191,556
|
|
|
|
Three Months Ended September 30,
|
|
Nine months ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Derivative gains (losses):
|
|
|
|
|
|
|
|
||||||||
|
1.125% Call Option
|
$
|
(15,460
|
)
|
|
$
|
—
|
|
|
$
|
42,332
|
|
|
$
|
—
|
|
|
Embedded cash conversion option
|
15,461
|
|
|
—
|
|
|
(42,225
|
)
|
|
—
|
|
||||
|
1.125% Warrants
|
—
|
|
|
—
|
|
|
(3,923
|
)
|
|
—
|
|
||||
|
Interest rate swap
|
—
|
|
|
(184
|
)
|
|
433
|
|
|
(1,270
|
)
|
||||
|
|
$
|
1
|
|
|
$
|
(184
|
)
|
|
$
|
(3,383
|
)
|
|
$
|
(1,270
|
)
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Revenue from continuing operations:
|
|
|
|
|
|
|
|
||||||||
|
Health Plans:
|
|
|
|
|
|
|
|
||||||||
|
Premium revenue
|
$
|
1,584,656
|
|
|
$
|
1,448,600
|
|
|
$
|
4,583,818
|
|
|
$
|
4,066,737
|
|
|
Premium tax receipts
|
43,723
|
|
|
37,894
|
|
|
127,606
|
|
|
120,953
|
|
||||
|
Investment income
|
1,740
|
|
|
1,155
|
|
|
4,884
|
|
|
3,893
|
|
||||
|
Rental and other income
|
5,860
|
|
|
4,079
|
|
|
16,476
|
|
|
12,315
|
|
||||
|
Molina Medicaid Solutions:
|
|
|
|
|
|
|
|
||||||||
|
Service revenue
|
51,100
|
|
|
48,422
|
|
|
150,528
|
|
|
132,351
|
|
||||
|
|
$
|
1,687,079
|
|
|
$
|
1,540,150
|
|
|
$
|
4,883,312
|
|
|
$
|
4,336,249
|
|
|
Depreciation and amortization reported in the consolidated statements of cash flows:
|
|
|
|
|
|
|
|
||||||||
|
Health Plans
|
$
|
17,545
|
|
|
$
|
14,753
|
|
|
$
|
48,467
|
|
|
$
|
43,600
|
|
|
Molina Medicaid Solutions
|
6,583
|
|
|
5,526
|
|
|
19,568
|
|
|
14,689
|
|
||||
|
|
$
|
24,128
|
|
|
$
|
20,279
|
|
|
$
|
68,035
|
|
|
$
|
58,289
|
|
|
Operating income (loss) from continuing operations:
|
|
|
|
|
|
|
|
||||||||
|
Health Plans
|
$
|
16,929
|
|
|
$
|
(5,788
|
)
|
|
$
|
118,600
|
|
|
$
|
(33,957
|
)
|
|
Molina Medicaid Solutions
|
7,997
|
|
|
8,156
|
|
|
20,645
|
|
|
23,207
|
|
||||
|
Total operating income (loss) from continuing operations
|
24,926
|
|
|
2,368
|
|
|
139,245
|
|
|
(10,750
|
)
|
||||
|
Interest expense
|
13,532
|
|
|
4,315
|
|
|
38,236
|
|
|
12,421
|
|
||||
|
Other (income) expense
|
(24
|
)
|
|
184
|
|
|
3,347
|
|
|
1,270
|
|
||||
|
Income (loss) from continuing operations before
|
|
|
|
|
|
|
|
||||||||
|
income taxes
|
$
|
11,418
|
|
|
$
|
(2,131
|
)
|
|
$
|
97,662
|
|
|
$
|
(24,441
|
)
|
|
|
September 30,
2013 |
|
December 31,
2012 |
||||
|
|
(In thousands)
|
||||||
|
Goodwill and intangible assets, net:
|
|
|
|
||||
|
Health Plans
|
$
|
252,360
|
|
|
$
|
139,710
|
|
|
Molina Medicaid Solutions
|
83,058
|
|
|
89,089
|
|
||
|
|
$
|
335,418
|
|
|
$
|
228,799
|
|
|
Total assets:
|
|
|
|
||||
|
Health Plans
|
$
|
2,748,724
|
|
|
$
|
1,702,212
|
|
|
Molina Medicaid Solutions
|
176,342
|
|
|
232,610
|
|
||
|
|
$
|
2,925,066
|
|
|
$
|
1,934,822
|
|
|
|
(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
|
|
|
•
|
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.
|
|
•
|
those identified and discussed in our periodic reports and filings with the SEC;
|
|
•
|
uncertainties associated with the implementation of the Affordable Care Act, including the impact of, and state rate development associated with, 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 insurance exchanges or marketplaces and related technical problems, 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, Illinois, and Ohio;
|
|
•
|
the success of our medical cost containment initiatives in Texas;
|
|
•
|
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;
|
|
•
|
our management of a portion of CHE's hospital in Long Beach, California;
|
|
•
|
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;
|
|
•
|
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.
|
|
•
|
Net income for continuing operations for the third quarter of 2013 increased when compared with the third quarter of 2012 as a result of higher medical margins. Those medical margins were partially offset by increased administrative expense related to the Company's preparations for significant membership growth expected in 2014.
|
|
•
|
Premium revenue for the third quarter of 2013 increased 9% over the third quarter of 2012, due to a 5% increase in enrollment, and a 4% increase in revenue per member per month (PMPM). The 5% enrollment increase was primarily due to the acquisition of a contract covering approximately 80,000 members in New Mexico effective August 1, 2013.
|
|
•
|
Our consolidated medical care ratio decreased to
87.3%
in the third quarter of 2013, from
91.1%
in the third quarter of 2012. The decline in the consolidated medical care ratio was the result of improved operating results at most of our health plans. Medical care ratios decreased in eight of our nine health plans, while medical margin (measured as the excess of premium revenue over medical care costs) increased in the same eight of nine health plans.
|
|
•
|
General and administrative expenses increased to
10.4%
of revenue in the third quarter of 2013, from
8.2%
in the third quarter of 2012, primarily due to higher costs incurred as a result of our preparations for significant membership growth in 2014 in connection with the Affordable Care Act. Increased administrative expense related to anticipated membership growth in 2014 represented approximately 1.8% of premium revenue, or $30 million, during the third quarter of 2013.
|
|
•
|
California - San Diego, Riverside and San Bernardino counties commence April 1, 2014
|
|
•
|
Illinois - 15 counties in the Central Region commence February 1, 2014
|
|
•
|
Ohio - 13 counties in Southwest, Central and West Central Regions commence March 1, 2014
|
|
|
September 30,
2013 |
|
June 30,
2013 |
|
December 31,
2012 |
|
September 30,
2012 |
||||
|
Total Ending Membership by Health Plan:
|
|
|
|
|
|
|
|
||||
|
California
|
363,000
|
|
|
355,000
|
|
|
336,000
|
|
|
346,000
|
|
|
Florida
|
84,000
|
|
|
81,000
|
|
|
73,000
|
|
|
71,000
|
|
|
Michigan
|
213,000
|
|
|
215,000
|
|
|
220,000
|
|
|
219,000
|
|
|
New Mexico
|
172,000
|
|
|
92,000
|
|
|
91,000
|
|
|
90,000
|
|
|
Ohio
|
261,000
|
|
|
240,000
|
|
|
244,000
|
|
|
272,000
|
|
|
Texas
|
258,000
|
|
|
266,000
|
|
|
282,000
|
|
|
291,000
|
|
|
Utah
|
87,000
|
|
|
87,000
|
|
|
87,000
|
|
|
85,000
|
|
|
Washington
|
409,000
|
|
|
413,000
|
|
|
418,000
|
|
|
411,000
|
|
|
Wisconsin
|
95,000
|
|
|
98,000
|
|
|
46,000
|
|
|
41,000
|
|
|
Total
|
1,942,000
|
|
|
1,847,000
|
|
|
1,797,000
|
|
|
1,826,000
|
|
|
Total Ending Membership for our Medicare Advantage Plans:
|
|
|
|
|
|
|
|
||||
|
California
|
8,600
|
|
|
8,100
|
|
|
7,700
|
|
|
7,300
|
|
|
Florida
|
600
|
|
|
600
|
|
|
900
|
|
|
900
|
|
|
Michigan
|
10,000
|
|
|
9,500
|
|
|
9,700
|
|
|
9,300
|
|
|
New Mexico
|
900
|
|
|
900
|
|
|
900
|
|
|
900
|
|
|
Ohio
|
400
|
|
|
400
|
|
|
300
|
|
|
200
|
|
|
Texas
|
2,500
|
|
|
2,300
|
|
|
1,500
|
|
|
1,100
|
|
|
Utah
|
8,200
|
|
|
7,800
|
|
|
8,200
|
|
|
8,300
|
|
|
Washington
|
6,900
|
|
|
6,600
|
|
|
6,500
|
|
|
6,100
|
|
|
Total
|
38,100
|
|
|
36,200
|
|
|
35,700
|
|
|
34,100
|
|
|
Total Ending Membership for our Aged, Blind or Disabled Population:
|
|
|
|
|
|
|
|
||||
|
California
|
46,300
|
|
|
45,400
|
|
|
44,700
|
|
|
44,100
|
|
|
Florida
|
12,200
|
|
|
11,200
|
|
|
10,300
|
|
|
10,300
|
|
|
Michigan
|
45,400
|
|
|
45,000
|
|
|
41,900
|
|
|
40,700
|
|
|
New Mexico
|
11,400
|
|
|
6,000
|
|
|
5,700
|
|
|
5,600
|
|
|
Ohio
|
33,000
|
|
|
28,000
|
|
|
28,200
|
|
|
29,000
|
|
|
Texas
|
90,800
|
|
|
92,000
|
|
|
95,900
|
|
|
101,300
|
|
|
Utah
|
9,500
|
|
|
9,400
|
|
|
9,000
|
|
|
8,900
|
|
|
Washington
|
33,000
|
|
|
31,700
|
|
|
30,000
|
|
|
23,400
|
|
|
Wisconsin
|
1,700
|
|
|
1,600
|
|
|
1,700
|
|
|
1,600
|
|
|
Total
|
283,300
|
|
|
270,300
|
|
|
267,400
|
|
|
264,900
|
|
|
•
|
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, injectable, and immunization costs paid through our pharmacy benefit manager.
|
|
•
|
Other
— Expenses for medically related administrative costs of approximately $107.0 million, and $94.6 million, for the
nine months ended
September 30, 2013
and
2012
, respectively, as well as certain provider incentive costs, reinsurance, costs to operate our medical clinics, and other medical expenses.
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
|
2013
|
|
2012
|
||||||||
|
|
(Dollar amounts in thousands, except per share data)
|
||||||||||||||
|
Net income (loss) per diluted share
|
$
|
0.16
|
|
|
$
|
(0.01
|
)
|
|
$
|
1.15
|
|
|
$
|
(0.29
|
)
|
|
Premium revenue
|
$
|
1,584,656
|
|
|
$
|
1,448,600
|
|
|
$
|
4,583,818
|
|
|
$
|
4,066,737
|
|
|
Service revenue
|
$
|
51,100
|
|
|
$
|
48,422
|
|
|
$
|
150,528
|
|
|
$
|
132,351
|
|
|
Operating income (loss)
|
$
|
24,926
|
|
|
$
|
2,368
|
|
|
$
|
139,245
|
|
|
$
|
(10,750
|
)
|
|
Net income (loss)
|
$
|
7,553
|
|
|
$
|
(165
|
)
|
|
$
|
53,871
|
|
|
$
|
(13,328
|
)
|
|
Total ending membership
|
1,942,000
|
|
|
1,826,000
|
|
|
1,942,000
|
|
|
1,826,000
|
|
||||
|
Premium revenue
|
93.9
|
%
|
|
94.1
|
%
|
|
93.9
|
%
|
|
93.8
|
%
|
||||
|
Premium tax receipts
|
2.6
|
%
|
|
2.4
|
%
|
|
2.6
|
%
|
|
2.8
|
%
|
||||
|
Service revenue
|
3.0
|
%
|
|
3.1
|
%
|
|
3.1
|
%
|
|
3.0
|
%
|
||||
|
Investment income
|
0.2
|
%
|
|
0.1
|
%
|
|
0.1
|
%
|
|
0.1
|
%
|
||||
|
Rental and other income
|
0.3
|
%
|
|
0.3
|
%
|
|
0.3
|
%
|
|
0.3
|
%
|
||||
|
Total revenue
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
||||
|
|
|
|
|
|
|
|
|
||||||||
|
Medical care ratio
|
87.3
|
%
|
|
91.1
|
%
|
|
86.5
|
%
|
|
91.4
|
%
|
||||
|
General and administrative expense ratio
|
10.4
|
%
|
|
8.2
|
%
|
|
9.8
|
%
|
|
8.4
|
%
|
||||
|
Premium tax ratio
|
2.7
|
%
|
|
2.5
|
%
|
|
2.7
|
%
|
|
2.9
|
%
|
||||
|
Operating income (loss)
|
1.5
|
%
|
|
0.2
|
%
|
|
2.9
|
%
|
|
(0.2
|
)%
|
||||
|
Net income (loss)
|
0.4
|
%
|
|
—
|
%
|
|
1.1
|
%
|
|
(0.3
|
)%
|
||||
|
Effective tax rate
|
33.9
|
%
|
|
(92.3
|
)%
|
|
44.8
|
%
|
|
(45.5
|
)%
|
||||
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
2013
|
|
2012
|
|
2013
|
|
2012
|
|||||||||
|
|
(In thousands)
|
||||||||||||||
|
Net income (loss)
|
$
|
7,569
|
|
|
$
|
3,364
|
|
|
$
|
62,055
|
|
|
$
|
(15,853
|
)
|
|
Adjustments:
|
|
|
|
|
|
|
|
||||||||
|
Depreciation and amortization reported in the consolidated statements of cash flows
|
24,128
|
|
|
20,279
|
|
|
68,035
|
|
|
58,289
|
|
||||
|
Interest expense
|
13,532
|
|
|
4,315
|
|
|
38,236
|
|
|
12,421
|
|
||||
|
Income tax expense (benefit)
|
3,962
|
|
|
(492
|
)
|
|
33,745
|
|
|
(15,228
|
)
|
||||
|
EBITDA
|
$
|
49,191
|
|
|
$
|
27,466
|
|
|
$
|
202,071
|
|
|
$
|
39,629
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
2013
|
|
2012
|
|
2013
|
|
2012
|
|||||||||
|
|
(In thousands)
|
||||||||||||||
|
Net income (loss) per diluted share, continuing operations
|
$
|
0.16
|
|
|
$
|
(0.01
|
)
|
|
$
|
1.15
|
|
|
$
|
(0.29
|
)
|
|
Adjustments, net of tax:
|
|
|
|
|
|
|
|
||||||||
|
Depreciation and amortization of capitalized software
|
0.25
|
|
|
0.20
|
|
|
0.71
|
|
|
0.56
|
|
||||
|
Stock-based compensation
|
0.15
|
|
|
0.09
|
|
|
0.36
|
|
|
0.24
|
|
||||
|
Amortization of intangible assets
|
0.07
|
|
|
0.07
|
|
|
0.20
|
|
|
0.22
|
|
||||
|
Amortization of convertible senior notes and lease financing obligations
|
0.08
|
|
|
0.02
|
|
|
0.21
|
|
|
0.06
|
|
||||
|
Change in fair value of derivatives
|
—
|
|
|
—
|
|
|
0.08
|
|
|
0.02
|
|
||||
|
Adjusted net income per diluted share, continuing operations
|
$
|
0.71
|
|
|
$
|
0.37
|
|
|
$
|
2.71
|
|
|
$
|
0.81
|
|
|
|
Three Months Ended September 30,
|
||||||||||||||||||||
|
|
2013
|
|
2012
|
||||||||||||||||||
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
||||||||||
|
Fee for service
|
$
|
928,165
|
|
|
$
|
161.39
|
|
|
67.1
|
%
|
|
$
|
913,137
|
|
|
$
|
166.88
|
|
|
69.2
|
%
|
|
Pharmacy
|
237,073
|
|
|
41.22
|
|
|
17.1
|
|
|
219,823
|
|
|
40.17
|
|
|
16.7
|
|
||||
|
Capitation
|
162,554
|
|
|
28.27
|
|
|
11.8
|
|
|
142,724
|
|
|
26.08
|
|
|
10.8
|
|
||||
|
Other
|
55,421
|
|
|
9.64
|
|
|
4.0
|
|
|
44,307
|
|
|
8.10
|
|
|
3.3
|
|
||||
|
Total
|
$
|
1,383,213
|
|
|
$
|
240.52
|
|
|
100.0
|
%
|
|
$
|
1,319,991
|
|
|
$
|
241.23
|
|
|
100.0
|
%
|
|
|
Three Months Ended September 30, 2013
|
||||||||||||||||||||||||
|
|
Member
Months (1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR (2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
1,076
|
|
|
$
|
184,235
|
|
|
$
|
171.16
|
|
|
$
|
166,774
|
|
|
$
|
154.93
|
|
|
90.5
|
%
|
|
$
|
17,461
|
|
|
Florida
|
251
|
|
|
67,688
|
|
|
269.58
|
|
|
60,127
|
|
|
239.46
|
|
|
88.8
|
|
|
7,561
|
|
|||||
|
Michigan
|
641
|
|
|
174,706
|
|
|
272.65
|
|
|
143,498
|
|
|
223.95
|
|
|
82.1
|
|
|
31,208
|
|
|||||
|
New Mexico
|
435
|
|
|
130,318
|
|
|
299.19
|
|
|
111,599
|
|
|
256.21
|
|
|
85.6
|
|
|
18,719
|
|
|||||
|
Ohio
|
786
|
|
|
280,964
|
|
|
357.66
|
|
|
245,148
|
|
|
312.07
|
|
|
87.3
|
|
|
35,816
|
|
|||||
|
Texas
|
780
|
|
|
320,657
|
|
|
411.17
|
|
|
287,446
|
|
|
368.59
|
|
|
89.6
|
|
|
33,211
|
|
|||||
|
Utah
|
261
|
|
|
84,525
|
|
|
323.83
|
|
|
66,555
|
|
|
254.98
|
|
|
78.7
|
|
|
17,970
|
|
|||||
|
Washington
|
1,234
|
|
|
294,808
|
|
|
238.96
|
|
|
254,430
|
|
|
206.23
|
|
|
86.3
|
|
|
40,378
|
|
|||||
|
Wisconsin
|
287
|
|
|
39,676
|
|
|
138.36
|
|
|
27,694
|
|
|
96.58
|
|
|
69.8
|
|
|
11,982
|
|
|||||
|
Other
(3)
|
—
|
|
|
7,079
|
|
|
—
|
|
|
19,942
|
|
|
—
|
|
|
—
|
|
|
(12,863
|
)
|
|||||
|
|
5,751
|
|
|
$
|
1,584,656
|
|
|
$
|
275.55
|
|
|
$
|
1,383,213
|
|
|
$
|
240.52
|
|
|
87.3
|
%
|
|
$
|
201,443
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
Three Months Ended September 30, 2012
|
||||||||||||||||||||||||
|
|
Member
Months (1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR (2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
1,041
|
|
|
$
|
162,389
|
|
|
$
|
156.00
|
|
|
$
|
156,106
|
|
|
$
|
149.96
|
|
|
96.1
|
%
|
|
$
|
6,283
|
|
|
Florida
|
214
|
|
|
57,433
|
|
|
268.58
|
|
|
48,250
|
|
|
225.64
|
|
|
84.0
|
|
|
9,183
|
|
|||||
|
Michigan
|
656
|
|
|
159,591
|
|
|
243.32
|
|
|
143,513
|
|
|
218.80
|
|
|
89.9
|
|
|
16,078
|
|
|||||
|
New Mexico
|
269
|
|
|
80,846
|
|
|
300.79
|
|
|
73,721
|
|
|
274.28
|
|
|
91.2
|
|
|
7,125
|
|
|||||
|
Ohio
|
805
|
|
|
282,489
|
|
|
350.63
|
|
|
253,447
|
|
|
314.58
|
|
|
89.7
|
|
|
29,042
|
|
|||||
|
Texas
|
890
|
|
|
344,522
|
|
|
387.03
|
|
|
316,716
|
|
|
355.80
|
|
|
91.9
|
|
|
27,806
|
|
|||||
|
Utah
|
256
|
|
|
73,484
|
|
|
287.21
|
|
|
62,630
|
|
|
244.79
|
|
|
85.2
|
|
|
10,854
|
|
|||||
|
Washington
|
1,217
|
|
|
269,191
|
|
|
221.28
|
|
|
236,928
|
|
|
194.76
|
|
|
88.0
|
|
|
32,263
|
|
|||||
|
Wisconsin
|
124
|
|
|
16,279
|
|
|
131.21
|
|
|
15,217
|
|
|
122.65
|
|
|
93.5
|
|
|
1,062
|
|
|||||
|
Other
(3)
|
—
|
|
|
2,376
|
|
|
—
|
|
|
13,463
|
|
|
—
|
|
|
—
|
|
|
(11,087
|
)
|
|||||
|
|
5,472
|
|
|
$
|
1,448,600
|
|
|
$
|
264.74
|
|
|
$
|
1,319,991
|
|
|
$
|
241.23
|
|
|
91.1
|
%
|
|
$
|
128,609
|
|
|
(1)
|
A member month is defined as the aggregate of each month’s ending membership for the period presented.
|
|
(2)
|
"MCR" represents medical costs as a percentage of premium revenue.
|
|
(3)
|
“Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.
|
|
|
Three Months Ended September 30,
|
||||||
|
|
2013
|
|
2012
|
||||
|
|
(In thousands)
|
||||||
|
Service revenue before amortization
|
$
|
51,829
|
|
|
$
|
48,958
|
|
|
Amortization recorded as reduction of service revenue
|
(729
|
)
|
|
(536
|
)
|
||
|
Service revenue
|
51,100
|
|
|
48,422
|
|
||
|
Cost of service revenue
|
40,113
|
|
|
37,004
|
|
||
|
General and administrative costs
|
1,708
|
|
|
1,980
|
|
||
|
Amortization of customer relationship intangibles recorded as amortization
|
1,282
|
|
|
1,282
|
|
||
|
Operating income
|
$
|
7,997
|
|
|
$
|
8,156
|
|
|
|
Nine Months Ended September 30,
|
||||||||||||||||||||
|
|
2013
|
|
2012
|
||||||||||||||||||
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
||||||||||
|
Fee for service
|
$
|
2,674,785
|
|
|
$
|
160.14
|
|
|
67.5
|
%
|
|
$
|
2,566,161
|
|
|
$
|
162.76
|
|
|
69.1
|
%
|
|
Pharmacy
|
691,903
|
|
|
41.42
|
|
|
17.4
|
|
|
606,004
|
|
|
38.44
|
|
|
16.3
|
|
||||
|
Capitation
|
441,287
|
|
|
26.42
|
|
|
11.1
|
|
|
412,692
|
|
|
26.17
|
|
|
11.1
|
|
||||
|
Other
|
157,859
|
|
|
9.45
|
|
|
4.0
|
|
|
130,598
|
|
|
8.28
|
|
|
3.5
|
|
||||
|
Total
|
$
|
3,965,834
|
|
|
$
|
237.43
|
|
|
100.0
|
%
|
|
$
|
3,715,455
|
|
|
$
|
235.65
|
|
|
100.0
|
%
|
|
|
Nine Months Ended September 30, 2013
|
||||||||||||||||||||||||
|
|
Member
Months (1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR (2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
3,132
|
|
|
$
|
552,950
|
|
|
$
|
176.54
|
|
|
$
|
497,314
|
|
|
$
|
158.78
|
|
|
89.9
|
%
|
|
$
|
55,636
|
|
|
Florida
|
712
|
|
|
187,689
|
|
|
263.62
|
|
|
161,446
|
|
|
226.76
|
|
|
86.0
|
|
|
26,243
|
|
|||||
|
Michigan
|
1,941
|
|
|
508,748
|
|
|
262.14
|
|
|
432,105
|
|
|
222.65
|
|
|
84.9
|
|
|
76,643
|
|
|||||
|
New Mexico
|
984
|
|
|
298,767
|
|
|
303.59
|
|
|
252,001
|
|
|
256.07
|
|
|
84.3
|
|
|
46,766
|
|
|||||
|
Ohio
|
2,234
|
|
|
819,879
|
|
|
367.03
|
|
|
688,266
|
|
|
308.11
|
|
|
83.9
|
|
|
131,613
|
|
|||||
|
Texas
|
2,417
|
|
|
969,063
|
|
|
400.90
|
|
|
829,854
|
|
|
343.31
|
|
|
85.6
|
|
|
139,209
|
|
|||||
|
Utah
|
781
|
|
|
236,992
|
|
|
303.41
|
|
|
193,261
|
|
|
247.42
|
|
|
81.5
|
|
|
43,731
|
|
|||||
|
Washington
|
3,722
|
|
|
892,627
|
|
|
239.85
|
|
|
779,339
|
|
|
209.41
|
|
|
87.3
|
|
|
113,288
|
|
|||||
|
Wisconsin
|
780
|
|
|
104,540
|
|
|
134.04
|
|
|
82,543
|
|
|
105.84
|
|
|
79.0
|
|
|
21,997
|
|
|||||
|
Other
(3)
|
—
|
|
|
12,563
|
|
|
—
|
|
|
49,705
|
|
|
—
|
|
|
—
|
|
|
(37,142
|
)
|
|||||
|
|
16,703
|
|
|
$
|
4,583,818
|
|
|
$
|
274.43
|
|
|
$
|
3,965,834
|
|
|
$
|
237.43
|
|
|
86.5
|
%
|
|
$
|
617,984
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
Nine Months Ended September 30, 2012
|
||||||||||||||||||||||||
|
|
Member
Months (1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR (2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
3,156
|
|
|
$
|
486,714
|
|
|
$
|
154.21
|
|
|
$
|
446,694
|
|
|
$
|
141.53
|
|
|
91.8
|
%
|
|
$
|
40,020
|
|
|
Florida
|
632
|
|
|
170,940
|
|
|
270.50
|
|
|
146,261
|
|
|
231.44
|
|
|
85.6
|
|
|
24,679
|
|
|||||
|
Michigan
|
1,983
|
|
|
480,098
|
|
|
242.13
|
|
|
419,406
|
|
|
211.52
|
|
|
87.4
|
|
|
60,692
|
|
|||||
|
New Mexico
|
801
|
|
|
240,568
|
|
|
300.51
|
|
|
208,668
|
|
|
260.66
|
|
|
86.7
|
|
|
31,900
|
|
|||||
|
Ohio
|
2,313
|
|
|
827,219
|
|
|
357.61
|
|
|
735,432
|
|
|
317.93
|
|
|
88.9
|
|
|
91,787
|
|
|||||
|
Texas
|
2,389
|
|
|
892,377
|
|
|
373.54
|
|
|
890,042
|
|
|
372.57
|
|
|
99.7
|
|
|
2,335
|
|
|||||
|
Utah
|
767
|
|
|
225,533
|
|
|
293.93
|
|
|
183,930
|
|
|
239.71
|
|
|
81.6
|
|
|
41,603
|
|
|||||
|
Washington
|
3,352
|
|
|
684,466
|
|
|
204.22
|
|
|
592,398
|
|
|
176.75
|
|
|
86.5
|
|
|
92,068
|
|
|||||
|
Wisconsin
|
374
|
|
|
52,209
|
|
|
139.46
|
|
|
54,861
|
|
|
146.54
|
|
|
105.1
|
|
|
(2,652
|
)
|
|||||
|
Other
(3)
|
—
|
|
|
6,613
|
|
|
—
|
|
|
37,763
|
|
|
—
|
|
|
—
|
|
|
(31,150
|
)
|
|||||
|
|
15,767
|
|
|
$
|
4,066,737
|
|
|
$
|
257.93
|
|
|
$
|
3,715,455
|
|
|
$
|
235.65
|
|
|
91.4
|
%
|
|
$
|
351,282
|
|
|
(1)
|
A member month is defined as the aggregate of each month’s ending membership for the period presented.
|
|
(2)
|
“MCR” represents medical costs as a percentage of premium revenue.
|
|
(3)
|
“Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.
|
|
|
Nine Months Ended September 30,
|
||||||
|
|
2013
|
|
2012
|
||||
|
|
(In thousands)
|
||||||
|
Service revenue before amortization
|
$
|
152,714
|
|
|
$
|
133,193
|
|
|
Amortization recorded as reduction of service revenue
|
(2,186
|
)
|
|
(842
|
)
|
||
|
Service revenue
|
150,528
|
|
|
132,351
|
|
||
|
Cost of service revenue
|
119,188
|
|
|
98,111
|
|
||
|
General and administrative costs
|
6,849
|
|
|
7,187
|
|
||
|
Amortization of customer relationship intangibles recorded as amortization
|
3,846
|
|
|
3,846
|
|
||
|
Operating income
|
$
|
20,645
|
|
|
$
|
23,207
|
|
|
•
|
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.”
|
|
|
Three Months Ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
||||||||||
|
|
Amount
|
|
% of Total
Revenue
|
|
Amount
|
|
% of Total
Revenue
|
||||||
|
|
(Dollar amounts in thousands)
|
||||||||||||
|
Depreciation, and amortization of capitalized software, continuing operations
|
$
|
14,237
|
|
|
0.8
|
%
|
|
$
|
11,352
|
|
|
0.7
|
%
|
|
Amortization of intangible assets, continuing operations
|
4,634
|
|
|
0.3
|
|
|
4,506
|
|
|
0.3
|
|
||
|
Depreciation and amortization, continuing operations
|
18,871
|
|
|
1.1
|
|
|
15,858
|
|
|
1.0
|
|
||
|
Depreciation and amortization, discontinued operations
|
—
|
|
|
—
|
|
|
176
|
|
|
—
|
|
||
|
Amortization recorded as reduction of service revenue
|
729
|
|
|
—
|
|
|
536
|
|
|
0.1
|
|
||
|
Amortization of capitalized software recorded as cost of service revenue
|
4,528
|
|
|
0.3
|
|
|
3,709
|
|
|
0.2
|
|
||
|
Depreciation and amortization reported in the consolidated statements of cash flows
|
$
|
24,128
|
|
|
1.4
|
%
|
|
$
|
20,279
|
|
|
1.3
|
%
|
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2013
|
|
2012
|
||||||||||
|
|
Amount
|
|
% of Total
Revenue |
|
Amount
|
|
% of Total
Revenue |
||||||
|
|
(Dollar amounts in thousands)
|
||||||||||||
|
Depreciation, and amortization of capitalized software, continuing operations
|
$
|
39,578
|
|
|
0.8
|
%
|
|
$
|
31,321
|
|
|
0.7
|
%
|
|
Amortization of intangible assets, continuing operations
|
12,871
|
|
|
0.3
|
|
|
15,595
|
|
|
0.4
|
|
||
|
Depreciation and amortization, continuing operations
|
52,449
|
|
|
1.1
|
|
|
46,916
|
|
|
1.1
|
|
||
|
Depreciation and amortization, discontinued operations
|
2
|
|
|
—
|
|
|
530
|
|
|
—
|
|
||
|
Amortization recorded as reduction of service revenue
|
2,186
|
|
|
—
|
|
|
842
|
|
|
—
|
|
||
|
Amortization of capitalized software recorded as cost of service revenue
|
13,398
|
|
|
0.3
|
|
|
10,001
|
|
|
0.2
|
|
||
|
Depreciation and amortization reported in the consolidated statements of cash flows
|
$
|
68,035
|
|
|
1.4
|
%
|
|
$
|
58,289
|
|
|
1.3
|
%
|
|
|
Nine Months Ended September 30,
|
||||||||||
|
|
2013
|
|
2012
|
|
Change
|
||||||
|
|
(In thousands)
|
||||||||||
|
Net cash provided by operating activities
|
$
|
111,744
|
|
|
$
|
264,024
|
|
|
$
|
(152,280
|
)
|
|
Net cash used in investing activities
|
(541,416
|
)
|
|
(90,794
|
)
|
|
(450,622
|
)
|
|||
|
Net cash provided by financing activities
|
490,458
|
|
|
48,423
|
|
|
442,035
|
|
|||
|
Net increase in cash and cash equivalents
|
$
|
60,786
|
|
|
$
|
221,653
|
|
|
$
|
(160,867
|
)
|
|
|
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
|
|
|
•
|
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.
|
|
|
Three Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
906
|
|
|
$
|
818
|
|
|
$
|
2
|
|
|
$
|
820
|
|
|
$
|
130,318
|
|
|
Ohio
|
3,080
|
|
|
976
|
|
|
(52
|
)
|
|
924
|
|
|
280,964
|
|
|||||
|
Texas
|
15,744
|
|
|
15,744
|
|
|
—
|
|
|
15,744
|
|
|
320,657
|
|
|||||
|
Wisconsin
|
1,209
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
39,676
|
|
|||||
|
|
$
|
20,939
|
|
|
$
|
17,538
|
|
|
$
|
(50
|
)
|
|
$
|
17,488
|
|
|
$
|
771,615
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
Three Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
560
|
|
|
$
|
532
|
|
|
$
|
—
|
|
|
$
|
532
|
|
|
$
|
80,846
|
|
|
Ohio
|
2,824
|
|
|
1,412
|
|
|
—
|
|
|
1,412
|
|
|
282,489
|
|
|||||
|
Texas
|
17,685
|
|
|
10,453
|
|
|
—
|
|
|
10,453
|
|
|
344,522
|
|
|||||
|
Wisconsin
|
419
|
|
|
—
|
|
|
246
|
|
|
246
|
|
|
16,279
|
|
|||||
|
|
$
|
21,488
|
|
|
$
|
12,397
|
|
|
$
|
246
|
|
|
$
|
12,643
|
|
|
$
|
724,136
|
|
|
|
Nine Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
2,079
|
|
|
$
|
1,685
|
|
|
$
|
159
|
|
|
$
|
1,844
|
|
|
$
|
298,767
|
|
|
Ohio
|
9,049
|
|
|
3,115
|
|
|
501
|
|
|
3,616
|
|
|
819,879
|
|
|||||
|
Texas
|
47,683
|
|
|
47,683
|
|
|
5,995
|
|
|
53,678
|
|
|
969,063
|
|
|||||
|
Wisconsin
|
3,239
|
|
|
—
|
|
|
1,104
|
|
|
1,104
|
|
|
104,540
|
|
|||||
|
|
$
|
62,050
|
|
|
$
|
52,483
|
|
|
$
|
7,759
|
|
|
$
|
60,242
|
|
|
$
|
2,192,249
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
Nine Months Ended September 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 Premium Revenue
Recognized
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
New Mexico
|
$
|
1,676
|
|
|
$
|
1,350
|
|
|
$
|
658
|
|
|
$
|
2,008
|
|
|
$
|
240,568
|
|
|
Ohio
|
8,222
|
|
|
6,810
|
|
|
966
|
|
|
7,776
|
|
|
827,219
|
|
|||||
|
Texas
|
41,687
|
|
|
30,487
|
|
|
—
|
|
|
30,487
|
|
|
892,377
|
|
|||||
|
Wisconsin
|
1,284
|
|
|
—
|
|
|
492
|
|
|
492
|
|
|
52,209
|
|
|||||
|
|
$
|
52,869
|
|
|
$
|
38,647
|
|
|
$
|
2,116
|
|
|
$
|
40,763
|
|
|
$
|
2,012,373
|
|
|
•
|
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).
|
|
•
|
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.
|
|
|
September 30,
2013 |
|
December 31,
2012 |
|
September 30,
2012 |
||||||
|
|
(In thousands)
|
||||||||||
|
Fee-for-service claims incurred but not paid (IBNP)
|
$
|
393,318
|
|
|
$
|
377,614
|
|
|
$
|
414,725
|
|
|
Capitation payable
|
77,051
|
|
|
49,066
|
|
|
55,314
|
|
|||
|
Pharmacy
|
45,451
|
|
|
38,992
|
|
|
42,681
|
|
|||
|
Other
(1)
|
116,886
|
|
|
28,858
|
|
|
23,743
|
|
|||
|
|
$
|
632,706
|
|
|
$
|
494,530
|
|
|
$
|
536,463
|
|
|
(1)
|
“Other” medical claims and benefits payable include amounts payable to certain providers for which we act as an intermediary on behalf of various state agencies without assuming financial risk. Such receipts and payments do not impact our consolidated statements of operations. As of September 30, 2013, we recorded provider payables of approximately
$64.1 million
for new intermediary arrangements that began in the third quarter of 2013.
|
|
Increase (Decrease) in Estimated Completion Factors
|
Increase (Decrease) in
Medical Claims and
Benefits Payable
|
||
|
(6)%
|
$
|
145,282
|
|
|
(4)%
|
96,854
|
|
|
|
(2)%
|
48,427
|
|
|
|
2%
|
(48,427
|
)
|
|
|
4%
|
(96,854
|
)
|
|
|
6%
|
(145,282
|
)
|
|
|
(Decrease) Increase in Trended Per member Per Month Cost Estimates
|
(Decrease) Increase in
Medical Claims and
Benefits Payable
|
||
|
(6)%
|
$
|
(134,294
|
)
|
|
(4)%
|
(89,529
|
)
|
|
|
(2)%
|
(44,765
|
)
|
|
|
2%
|
44,765
|
|
|
|
4%
|
89,529
|
|
|
|
6%
|
134,294
|
|
|
|
•
|
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.
|
|
•
|
At our New Mexico health plan, we overestimated the impact of certain high-dollar outstanding claim payments as of December 31, 2012.
|
|
•
|
At our Ohio health plan, we overestimated the impact of several potential high-dollar claims relating to our aged, blind or disabled (ABD) members.
|
|
•
|
At our Ohio health plan, we overestimated the impact of several potential high-dollar claims relating to critically ill members.
|
|
•
|
At our Michigan health plan, we underestimated the impact of future claims overpayment recoveries when establishing reserves at June 30, 2013.
|
|
•
|
The overestimation of our liability for medical claims and benefits payable was partially offset by an underestimation of that liability at our Texas health plan as a result of the costs associated with an unusually large number of older claims. This anomaly was caused primarily by the payment of claims that were delayed as a result of hospital provider disputes that have been resolved. The underestimation of the liability at our Texas health plan was responsible for the relatively small amount of prior period development noted above.
|
|
•
|
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.
|
|
•
|
At our Texas health plan, we have noted an unusually large number of older claims dated older than 12 months. This has caused some distortion in the claims lag pattern that we use to estimate the incurred claims.
|
|
•
|
At 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 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 September 30, 2013.
|
|
•
|
Our New Mexico health plan acquired approximately
80,000
new members in August 2013 from another health plan. This acquisition roughly doubled the size of the membership in a single month. For the September 30, 2013 reserve calculation, we have assumed that these new members will incur costs at about the same rate as the New Mexico members that were previously enrolled. With only two months of paid claims for these new members, it is too soon to know whether that assumption is correct or not.
|
|
|
Nine Months Ended September 30,
|
|
Three Months Ended September 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
|
|
|
$
|
465,487
|
|
|
$
|
525,538
|
|
|
$
|
402,476
|
|
|
Components of medical care costs related to:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Current period
|
4,021,461
|
|
|
3,860,825
|
|
|
1,415,670
|
|
|
1,361,539
|
|
|
5,136,055
|
|
|||||
|
Prior periods
|
(54,040
|
)
|
|
(37,689
|
)
|
|
(32,575
|
)
|
|
(46,968
|
)
|
|
(39,295
|
)
|
|||||
|
Total medical care costs
|
3,967,421
|
|
|
3,823,136
|
|
|
1,383,095
|
|
|
1,314,571
|
|
|
5,096,760
|
|
|||||
|
Payments for medical care costs related to:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Current period
|
3,410,689
|
|
|
3,332,896
|
|
|
851,025
|
|
|
875,236
|
|
|
4,649,363
|
|
|||||
|
Prior periods
|
418,556
|
|
|
356,253
|
|
|
364,851
|
|
|
428,410
|
|
|
355,343
|
|
|||||
|
Total paid
|
3,829,245
|
|
|
3,689,149
|
|
|
1,215,876
|
|
|
1,303,646
|
|
|
5,004,706
|
|
|||||
|
Balances at end of period
|
$
|
632,706
|
|
|
$
|
536,463
|
|
|
$
|
632,706
|
|
|
$
|
536,463
|
|
|
$
|
494,530
|
|
|
Benefit from prior period as a percentage of:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Balance at beginning of period
|
10.9
|
%
|
|
9.0
|
%
|
|
7.0
|
%
|
|
8.9
|
%
|
|
9.8
|
%
|
|||||
|
Premium revenue, trailing twelve months
|
0.9
|
%
|
|
0.7
|
%
|
|
0.5
|
%
|
|
0.8
|
%
|
|
0.7
|
%
|
|||||
|
Medical care costs, trailing twelve months
|
1.0
|
%
|
|
0.8
|
%
|
|
0.6
|
%
|
|
1.0
|
%
|
|
0.8
|
%
|
|||||
|
Claims Data:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Days in claims payable, fee for service
|
41
|
|
|
45
|
|
|
41
|
|
|
45
|
|
|
40
|
|
|||||
|
Number of members at end of period
|
1,942,000
|
|
|
1,826,000
|
|
|
1,942,000
|
|
|
1,826,000
|
|
|
1,797,000
|
|
|||||
|
Number of claims in inventory at end of period
|
137,100
|
|
|
163,600
|
|
|
137,100
|
|
|
163,600
|
|
|
122,700
|
|
|||||
|
Billed charges of claims in inventory at end of period
|
$
|
257,600
|
|
|
$
|
304,600
|
|
|
$
|
257,600
|
|
|
$
|
304,600
|
|
|
$
|
255,200
|
|
|
Claims in inventory per member at end of period
|
0.07
|
|
|
0.09
|
|
|
0.07
|
|
|
0.09
|
|
|
0.07
|
|
|||||
|
Billed charges of claims in inventory per member at end of period
|
$
|
132.65
|
|
|
$
|
166.81
|
|
|
$
|
132.65
|
|
|
$
|
166.81
|
|
|
$
|
142.01
|
|
|
Number of claims received during the period
|
15,751,500
|
|
|
15,455,000
|
|
|
5,227,000
|
|
|
5,079,200
|
|
|
20,842,400
|
|
|||||
|
Billed charges of claims received during the period
|
$
|
15,848,900
|
|
|
$
|
14,339,700
|
|
|
$
|
5,371,100
|
|
|
$
|
4,951,000
|
|
|
$
|
19,429,300
|
|
|
Item 3.
|
Quantitative and Qualitative Disclosures About Market Risk
|
|
Item 4.
|
Controls and Procedures
|
|
|
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
|
||||||
|
July 1 - July 31
|
815
|
|
|
$
|
37.89
|
|
|
—
|
|
|
$
|
50,000,000
|
|
|
August 1 - August 31
|
1,969
|
|
|
$
|
37.45
|
|
|
—
|
|
|
$
|
50,000,000
|
|
|
September 1 - September 30
|
25,171
|
|
|
$
|
34.94
|
|
|
—
|
|
|
$
|
50,000,000
|
|
|
Total
|
27,955
|
|
|
$
|
35.76
|
|
|
—
|
|
|
|
||
|
(a)
|
During the
three months ended September 30, 2013
, we withheld 27,955 shares of common stock under our 2002 Equity Incentive Plan and 2011 Equity Incentive Plan to settle our employees’ income tax obligations.
|
|
Exhibit No.
|
|
Title
|
|
|
|
|
|
10.1
|
|
Settlement Agreement entered into on October 30, 2013, by and between the Department of Health Care Services and Molina Healthcare of California and Molina Healthcare of California Partner Plan, Inc.
|
|
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
|
|
XBRL Taxonomy Instance Document.
|
|
101.SCH
|
|
XBRL Taxonomy Extension Schema Document.
|
|
101.CAL
|
|
XBRL Taxonomy Extension Calculation Linkbase Document.
|
|
101.DEF
|
|
XBRL Taxonomy Extension Definition Linkbase Document.
|
|
101.LAB
|
|
XBRL Taxonomy Extension Label Linkbase Document.
|
|
101.PRE
|
|
XBRL Taxonomy Extension Presentation Linkbase Document.
|
|
|
|
|
MOLINA HEALTHCARE, INC.
|
|
|
|
|
(Registrant)
|
|
|
|
|
|
|
Dated:
|
October 30, 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:
|
October 30, 2013
|
|
/s/ JOHN C. MOLINA, J.D.
|
|
|
|
|
John C. Molina, J.D.
|
|
|
|
|
Chief Financial Officer and Treasurer
|
|
|
|
|
(Principal Financial Officer)
|
|
Exhibit No.
|
|
Title
|
|
|
|
|
|
10.1
|
|
Settlement Agreement entered into on October 30, 2013, by and between the Department of Health Care Services and Molina Healthcare of California and Molina Healthcare of California Partner Plan, Inc.
|
|
|
|
|
|
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
|
|
XBRL Taxonomy Instance Document.
|
|
|
|
|
|
101.SCH
|
|
XBRL Taxonomy Extension Schema Document.
|
|
|
|
|
|
101.CAL
|
|
XBRL Taxonomy Extension Calculation Linkbase Document.
|
|
|
|
|
|
101.DEF
|
|
XBRL Taxonomy Extension Definition Linkbase Document.
|
|
|
|
|
|
101.LAB
|
|
XBRL Taxonomy Extension Label Linkbase Document.
|
|
|
|
|
|
101.PRE
|
|
XBRL Taxonomy Extension Presentation Linkbase Document.
|
No information found
* THE VALUE IS THE MARKET VALUE AS OF THE LAST DAY OF THE QUARTER FOR WHICH THE 13F WAS FILED.
| FUND | NUMBER OF SHARES | VALUE ($) | PUT OR CALL |
|---|
| DIRECTORS | AGE | BIO | OTHER DIRECTOR MEMBERSHIPS |
|---|
No information found
No Customers Found
No Suppliers Found
Price
Yield
| Owner | Position | Direct Shares | Indirect Shares |
|---|