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ý
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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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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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Large accelerated filer
|
ý
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Accelerated filer
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¨
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Non-accelerated filer
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¨
(Do not check if a smaller reporting company)
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Smaller reporting company
|
¨
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Item 1.
|
||
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Item 2.
|
||
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Item 3.
|
||
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Item 4.
|
||
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|
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Item 1.
|
||
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Item 1A.
|
||
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Item 2.
|
||
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Item 3.
|
||
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Item 4.
|
||
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Item 5.
|
||
|
Item 6.
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||
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September 30,
2014 |
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December 31,
2013 |
||||
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(Amounts in thousands,
except per-share data)
|
||||||
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(Unaudited)
|
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|
||||
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ASSETS
|
|||||||
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Current assets:
|
|
|
|
||||
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Cash and cash equivalents
|
$
|
1,598,596
|
|
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$
|
935,895
|
|
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Investments
|
842,683
|
|
|
703,052
|
|
||
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Receivables
|
425,683
|
|
|
298,935
|
|
||
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Income taxes refundable
|
7,679
|
|
|
32,742
|
|
||
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Deferred income taxes
|
30,817
|
|
|
26,556
|
|
||
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Prepaid expenses and other current assets
|
82,062
|
|
|
42,484
|
|
||
|
Total current assets
|
2,987,520
|
|
|
2,039,664
|
|
||
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Property, equipment, and capitalized software, net
|
328,547
|
|
|
292,083
|
|
||
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Deferred contract costs
|
51,179
|
|
|
45,675
|
|
||
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Intangible assets, net
|
85,035
|
|
|
98,871
|
|
||
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Goodwill
|
236,635
|
|
|
230,738
|
|
||
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Restricted investments
|
93,119
|
|
|
63,093
|
|
||
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Derivative asset
|
222,997
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|
|
186,351
|
|
||
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Other assets
|
51,108
|
|
|
46,462
|
|
||
|
|
$
|
4,056,140
|
|
|
$
|
3,002,937
|
|
|
|
|
|
|
||||
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LIABILITIES AND STOCKHOLDERS’ EQUITY
|
|||||||
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Current liabilities:
|
|
|
|
||||
|
Medical claims and benefits payable
|
$
|
1,123,846
|
|
|
$
|
669,787
|
|
|
Accounts payable and accrued liabilities
|
609,444
|
|
|
319,965
|
|
||
|
Deferred revenue
|
190,856
|
|
|
122,216
|
|
||
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Current maturities of long-term debt
|
11,927
|
|
|
182,008
|
|
||
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Total current liabilities
|
1,936,073
|
|
|
1,293,976
|
|
||
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Convertible senior notes
|
697,210
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|
416,368
|
|
||
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Lease financing obligations
|
160,412
|
|
|
159,394
|
|
||
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Lease financing obligations – related party
|
39,258
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|
27,092
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|
||
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Deferred income taxes
|
7,719
|
|
|
580
|
|
||
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Derivative liability
|
222,877
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|
186,239
|
|
||
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Other long-term liabilities
|
28,300
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|
|
26,351
|
|
||
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Total liabilities
|
3,091,849
|
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|
2,110,000
|
|
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||||
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Stockholders’ equity:
|
|
|
|
||||
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Common stock, $0.001 par value; 150,000 shares authorized; outstanding: 48,279 shares at September 30, 2014 and 45,871 shares at December 31, 2013
|
48
|
|
|
46
|
|
||
|
Preferred stock, $0.001 par value; 20,000 shares authorized, no shares issued and outstanding
|
—
|
|
|
—
|
|
||
|
Additional paid-in capital
|
383,300
|
|
|
340,848
|
|
||
|
Accumulated other comprehensive loss
|
(617
|
)
|
|
(1,086
|
)
|
||
|
Retained earnings
|
581,560
|
|
|
553,129
|
|
||
|
Total stockholders’ equity
|
964,291
|
|
|
892,937
|
|
||
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|
$
|
4,056,140
|
|
|
$
|
3,002,937
|
|
|
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Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
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September 30,
|
|
September 30,
|
||||||||||||
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2014
|
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2013
|
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2014
|
|
2013
|
||||||||
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|
(Amounts in thousands, except net income per share)
(Unaudited)
|
||||||||||||||
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Revenue:
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||||||||
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Premium revenue
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$
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2,316,759
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$
|
1,584,656
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$
|
6,424,238
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$
|
4,583,818
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Service revenue
|
52,557
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|
|
51,100
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|
|
156,419
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|
|
150,528
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|
||||
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Premium tax revenue
|
81,240
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|
|
43,723
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|
|
203,053
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|
|
127,606
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|
||||
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Health insurer fee revenue
|
29,427
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|
|
—
|
|
|
67,785
|
|
|
—
|
|
||||
|
Investment income
|
2,041
|
|
|
1,740
|
|
|
5,615
|
|
|
4,884
|
|
||||
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Other revenue
|
2,327
|
|
|
5,860
|
|
|
8,523
|
|
|
16,476
|
|
||||
|
Total revenue
|
2,484,351
|
|
|
1,687,079
|
|
|
6,865,633
|
|
|
4,883,312
|
|
||||
|
Operating expenses:
|
|
|
|
|
|
|
|
||||||||
|
Medical care costs
|
2,097,836
|
|
|
1,383,213
|
|
|
5,753,793
|
|
|
3,965,834
|
|
||||
|
Cost of service revenue
|
40,067
|
|
|
40,113
|
|
|
117,831
|
|
|
119,188
|
|
||||
|
General and administrative expenses
|
178,879
|
|
|
176,233
|
|
|
560,205
|
|
|
478,990
|
|
||||
|
Premium tax expenses
|
81,240
|
|
|
43,723
|
|
|
203,053
|
|
|
127,606
|
|
||||
|
Health insurer fee expenses
|
22,308
|
|
|
—
|
|
|
66,443
|
|
|
—
|
|
||||
|
Depreciation and amortization
|
24,242
|
|
|
18,871
|
|
|
67,835
|
|
|
52,449
|
|
||||
|
Total operating expenses
|
2,444,572
|
|
|
1,662,153
|
|
|
6,769,160
|
|
|
4,744,067
|
|
||||
|
Operating income
|
39,779
|
|
|
24,926
|
|
|
96,473
|
|
|
139,245
|
|
||||
|
Other expenses, net:
|
|
|
|
|
|
|
|
||||||||
|
Interest expense
|
14,419
|
|
|
13,532
|
|
|
42,234
|
|
|
38,236
|
|
||||
|
Other expense (income), net
|
863
|
|
|
(24
|
)
|
|
810
|
|
|
3,347
|
|
||||
|
Total other expenses, net
|
15,282
|
|
|
13,508
|
|
|
43,044
|
|
|
41,583
|
|
||||
|
Income from continuing operations before income tax expense
|
24,497
|
|
|
11,418
|
|
|
53,429
|
|
|
97,662
|
|
||||
|
Income tax expense
|
8,427
|
|
|
3,865
|
|
|
24,784
|
|
|
43,791
|
|
||||
|
Income from continuing operations
|
16,070
|
|
|
7,553
|
|
|
28,645
|
|
|
53,871
|
|
||||
|
Income (loss) from discontinued operations, net of tax
|
52
|
|
|
16
|
|
|
(214
|
)
|
|
8,184
|
|
||||
|
Net income
|
$
|
16,122
|
|
|
$
|
7,569
|
|
|
$
|
28,431
|
|
|
$
|
62,055
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Basic net income (loss) per share:
|
|
|
|
|
|
|
|
||||||||
|
Continuing operations
|
$
|
0.34
|
|
|
$
|
0.17
|
|
|
$
|
0.62
|
|
|
$
|
1.18
|
|
|
Discontinued operations
|
—
|
|
|
—
|
|
|
(0.01
|
)
|
|
0.18
|
|
||||
|
Basic net income per share
|
$
|
0.34
|
|
|
$
|
0.17
|
|
|
$
|
0.61
|
|
|
$
|
1.36
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Diluted net income (loss) per share:
|
|
|
|
|
|
|
|
||||||||
|
Continuing operations
|
$
|
0.33
|
|
|
$
|
0.16
|
|
|
$
|
0.60
|
|
|
$
|
1.15
|
|
|
Discontinued operations
|
—
|
|
|
—
|
|
|
(0.01
|
)
|
|
0.18
|
|
||||
|
Diluted net income per share
|
$
|
0.33
|
|
|
$
|
0.16
|
|
|
$
|
0.59
|
|
|
$
|
1.33
|
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
|
|
September 30,
|
|
September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||||||
|
|
(Amounts in thousands)
(Unaudited)
|
||||||||||||||
|
Net income
|
$
|
16,122
|
|
|
$
|
7,569
|
|
|
$
|
28,431
|
|
|
$
|
62,055
|
|
|
Other comprehensive (loss) income:
|
|
|
|
|
|
|
|
||||||||
|
Unrealized investment (loss) gain
|
(1,061
|
)
|
|
2,087
|
|
|
756
|
|
|
(1,539
|
)
|
||||
|
Effect of income taxes
|
(404
|
)
|
|
793
|
|
|
287
|
|
|
(585
|
)
|
||||
|
Other comprehensive (loss) income, net of tax
|
(657
|
)
|
|
1,294
|
|
|
469
|
|
|
(954
|
)
|
||||
|
Comprehensive income
|
$
|
15,465
|
|
|
$
|
8,863
|
|
|
$
|
28,900
|
|
|
$
|
61,101
|
|
|
|
Nine Months Ended
|
||||||
|
|
September 30,
|
||||||
|
|
2014
|
|
2013
|
||||
|
|
(Amounts in thousands)
(Unaudited)
|
||||||
|
Operating activities:
|
|
|
|
||||
|
Net income
|
$
|
28,431
|
|
|
$
|
62,055
|
|
|
Adjustments to reconcile net income to net cash provided by operating activities:
|
|
|
|
||||
|
Depreciation and amortization
|
99,464
|
|
|
68,035
|
|
||
|
Deferred income taxes
|
(10,705
|
)
|
|
(38,442
|
)
|
||
|
Stock–based compensation
|
16,115
|
|
|
20,654
|
|
||
|
Amortization of convertible senior notes and lease financing obligations
|
20,195
|
|
|
16,128
|
|
||
|
Other, net
|
3,875
|
|
|
14,406
|
|
||
|
Changes in operating assets and liabilities:
|
|
|
|
||||
|
Receivables
|
(126,748
|
)
|
|
(144,285
|
)
|
||
|
Prepaid expenses and other assets
|
(51,582
|
)
|
|
(27,552
|
)
|
||
|
Medical claims and benefits payable
|
454,059
|
|
|
138,176
|
|
||
|
Accounts payable and accrued liabilities
|
314,391
|
|
|
20,991
|
|
||
|
Deferred revenue
|
68,640
|
|
|
(17,410
|
)
|
||
|
Income taxes
|
25,063
|
|
|
(1,012
|
)
|
||
|
Net cash provided by operating activities
|
841,198
|
|
|
111,744
|
|
||
|
Investing activities:
|
|
|
|
||||
|
Purchases of investments
|
(616,324
|
)
|
|
(627,953
|
)
|
||
|
Proceeds from sales and maturities of investments
|
473,836
|
|
|
227,800
|
|
||
|
Purchases of equipment
|
(71,771
|
)
|
|
(64,426
|
)
|
||
|
Increase in restricted investments
|
(24,301
|
)
|
|
(21,124
|
)
|
||
|
Net cash paid in business combinations
|
(7,500
|
)
|
|
(57,684
|
)
|
||
|
Other, net
|
(15,220
|
)
|
|
1,971
|
|
||
|
Net cash used in investing activities
|
(261,280
|
)
|
|
(541,416
|
)
|
||
|
Financing activities:
|
|
|
|
||||
|
Proceeds from issuance of convertible senior notes, net of deferred financing costs
|
123,387
|
|
|
537,973
|
|
||
|
Proceeds from sale-leaseback transactions
|
—
|
|
|
158,694
|
|
||
|
Purchase of call option
|
—
|
|
|
(149,331
|
)
|
||
|
Proceeds from issuance of warrants
|
—
|
|
|
75,074
|
|
||
|
Treasury stock purchases
|
—
|
|
|
(50,000
|
)
|
||
|
Principal payments on term loan
|
—
|
|
|
(47,471
|
)
|
||
|
Repayment of amounts borrowed under credit facility
|
—
|
|
|
(40,000
|
)
|
||
|
Contingent consideration liabilities settled
|
(50,349
|
)
|
|
—
|
|
||
|
Proceeds from employee stock plans
|
7,628
|
|
|
5,156
|
|
||
|
Other, net
|
2,117
|
|
|
363
|
|
||
|
Net cash provided by financing activities
|
82,783
|
|
|
490,458
|
|
||
|
Net increase in cash and cash equivalents
|
662,701
|
|
|
60,786
|
|
||
|
Cash and cash equivalents at beginning of period
|
935,895
|
|
|
795,770
|
|
||
|
Cash and cash equivalents at end of period
|
$
|
1,598,596
|
|
|
$
|
856,556
|
|
|
|
Nine Months Ended
|
||||||
|
|
September 30,
|
||||||
|
|
2014
|
|
2013
|
||||
|
|
(Amounts in thousands)
(Unaudited) |
||||||
|
Supplemental cash flow information:
|
|
|
|
||||
|
|
|
|
|
||||
|
Cash paid during the period for:
|
|
|
|
||||
|
Income taxes
|
$
|
7,991
|
|
|
$
|
72,156
|
|
|
Interest
|
$
|
24,384
|
|
|
$
|
28,035
|
|
|
|
|
|
|
||||
|
Schedule of non-cash investing and financing activities:
|
|
|
|
||||
|
3.75% Notes exchanged for 1.625% Notes
|
$
|
176,551
|
|
|
$
|
—
|
|
|
Retirement of treasury stock
|
$
|
—
|
|
|
$
|
53,000
|
|
|
Increase in non-cash lease financing obligation – related party
|
$
|
13,841
|
|
|
$
|
19,222
|
|
|
Common stock used for stock-based compensation
|
$
|
8,595
|
|
|
$
|
6,667
|
|
|
|
|
|
|
||||
|
Details of change in fair value of derivatives, net:
|
|
|
|
||||
|
Gain on 1.125% Call Option
|
$
|
36,646
|
|
|
$
|
42,332
|
|
|
Loss on 1.125% Notes Conversion Option
|
(36,638
|
)
|
|
(42,225
|
)
|
||
|
Loss on 1.125% Warrants
|
—
|
|
|
(3,923
|
)
|
||
|
Gain on interest rate swap
|
—
|
|
|
433
|
|
||
|
Change in fair value of derivatives, net
|
$
|
8
|
|
|
$
|
(3,383
|
)
|
|
|
|
|
|
||||
|
Details of business combinations:
|
|
|
|
||||
|
Fair value of assets acquired
|
$
|
7,500
|
|
|
$
|
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
|
$
|
7,500
|
|
|
$
|
57,684
|
|
|
(1)
|
Contractual provisions that may adjust or limit revenue or profit:
|
|
(2)
|
Quality incentives:
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
|
|
September 30,
|
|
September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Maximum available quality incentive premium - current period
|
$
|
24,477
|
|
|
$
|
20,939
|
|
|
$
|
68,941
|
|
|
$
|
62,050
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Amount of quality incentive premium revenue recognized in current period:
|
|
|
|
|
|
|
|
|
|||||||
|
Earned current period
|
$
|
12,921
|
|
|
$
|
17,538
|
|
|
$
|
30,935
|
|
|
$
|
52,483
|
|
|
Earned prior periods
|
208
|
|
|
(50
|
)
|
|
3,412
|
|
|
7,759
|
|
||||
|
Total
|
$
|
13,129
|
|
|
$
|
17,488
|
|
|
$
|
34,347
|
|
|
60,242
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Total premium revenue recognized for state health plans with quality incentive premiums
|
$
|
1,818,375
|
|
|
$
|
771,615
|
|
|
$
|
5,005,444
|
|
|
$
|
2,192,249
|
|
|
(3)
|
California health plan rate settlement agreement:
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||
|
|
September 30,
|
|
September 30,
|
||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||
|
|
(In thousands)
|
||||||||||
|
Shares outstanding at the beginning of the period
|
46,494
|
|
|
45,683
|
|
|
45,871
|
|
|
46,762
|
|
|
Weighted-average number of shares:
|
|
|
|
|
|
|
|
||||
|
Repurchased
|
—
|
|
|
—
|
|
|
—
|
|
|
(1,375
|
)
|
|
Issued, 3.75% Exchange (1)
|
460
|
|
|
—
|
|
|
155
|
|
|
—
|
|
|
Issued, stock-based compensation and other
|
37
|
|
|
16
|
|
|
409
|
|
|
321
|
|
|
Denominator for basic net income per share
|
46,991
|
|
|
45,699
|
|
|
46,435
|
|
|
45,708
|
|
|
Effect of dilutive securities:
|
|
|
|
|
|
|
|
||||
|
Stock-based compensation
|
365
|
|
|
453
|
|
|
441
|
|
|
532
|
|
|
3.75% Notes and 3.75% Exchange (1)
|
1,288
|
|
|
910
|
|
|
1,212
|
|
|
527
|
|
|
Denominator for diluted net income per share
|
48,644
|
|
|
47,062
|
|
|
48,088
|
|
|
46,767
|
|
|
|
|
|
|
|
|
|
|
||||
|
Potentially dilutive common shares excluded from calculations (2):
|
|
|
|
|
|
|
|
||||
|
Stock options
|
—
|
|
|
60
|
|
|
—
|
|
|
49
|
|
|
1.125% Warrants
|
13,490
|
|
|
13,490
|
|
|
13,490
|
|
|
11,464
|
|
|
(1)
|
For more information regarding the 3.75% Exchange and 3.75% Notes, refer to Note
11
, "
Long-Term Debt
."
|
|
(2)
|
Potentially dilutive shares issuable pursuant to certain of our employee stock options, 1.125% Warrants (defined in Note
12
, "
Derivative Financial Instruments
"), and 1.625% Notes (defined in Note
11
, "
Long-Term Debt
") were not included in the computation of diluted net income per share because to do so would have been anti-dilutive.
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
|
|
September 30,
|
|
September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Restricted stock and performance awards
|
$
|
4,774
|
|
|
$
|
7,634
|
|
|
$
|
13,596
|
|
|
$
|
18,593
|
|
|
Employee stock purchase plan and stock options
|
885
|
|
|
870
|
|
|
2,519
|
|
|
2,061
|
|
||||
|
|
$
|
5,659
|
|
|
$
|
8,504
|
|
|
$
|
16,115
|
|
|
$
|
20,654
|
|
|
|
Shares
|
|
Weighted
Average
Grant Date
Fair Value
|
|||
|
Unvested balance as of December 31, 2013
|
1,299,852
|
|
|
$
|
29.03
|
|
|
Granted
|
656,452
|
|
|
36.68
|
|
|
|
Vested
|
(597,301
|
)
|
|
27.70
|
|
|
|
Forfeited
|
(60,742
|
)
|
|
31.20
|
|
|
|
Unvested balance as of September 30, 2014
|
1,298,261
|
|
|
33.40
|
|
|
|
|
Total
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Corporate debt securities
|
$
|
553,936
|
|
|
$
|
—
|
|
|
$
|
553,936
|
|
|
$
|
—
|
|
|
Municipal securities
|
96,873
|
|
|
—
|
|
|
96,873
|
|
|
—
|
|
||||
|
GSEs
|
99,254
|
|
|
99,254
|
|
|
—
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
41,031
|
|
|
41,031
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
51,589
|
|
|
—
|
|
|
51,589
|
|
|
—
|
|
||||
|
Auction rate securities
|
6,891
|
|
|
—
|
|
|
—
|
|
|
6,891
|
|
||||
|
1.125% Call Option derivative asset
|
222,997
|
|
|
—
|
|
|
—
|
|
|
222,997
|
|
||||
|
Total assets measured at fair value on a recurring basis
|
$
|
1,072,571
|
|
|
$
|
140,285
|
|
|
$
|
702,398
|
|
|
$
|
229,888
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
1.125% Notes Conversion Option derivative liability
|
$
|
222,877
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
222,877
|
|
|
Contingent consideration liability
|
1,500
|
|
|
—
|
|
|
—
|
|
|
1,500
|
|
||||
|
Total liabilities measured at fair value on a recurring basis
|
$
|
224,377
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
224,377
|
|
|
|
Total
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Corporate debt securities
|
$
|
449,772
|
|
|
$
|
—
|
|
|
$
|
449,772
|
|
|
$
|
—
|
|
|
Municipal securities
|
113,330
|
|
|
—
|
|
|
113,330
|
|
|
—
|
|
||||
|
GSEs
|
68,817
|
|
|
68,817
|
|
|
—
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
37,376
|
|
|
37,376
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
33,757
|
|
|
—
|
|
|
33,757
|
|
|
—
|
|
||||
|
Auction rate securities
|
10,898
|
|
|
—
|
|
|
—
|
|
|
10,898
|
|
||||
|
1.125% Call Option derivative asset
|
186,351
|
|
|
—
|
|
|
—
|
|
|
186,351
|
|
||||
|
Total assets measured at fair value on a recurring basis
|
$
|
900,301
|
|
|
$
|
106,193
|
|
|
$
|
596,859
|
|
|
$
|
197,249
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
1.125 % Notes Conversion Option derivative liability
|
$
|
186,239
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
186,239
|
|
|
Contingent consideration liabilities
|
57,548
|
|
|
—
|
|
|
—
|
|
|
57,548
|
|
||||
|
Total liabilities measured at fair value on a recurring basis
|
$
|
243,787
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
243,787
|
|
|
|
Change in Level 3 Instruments
|
||||||||||
|
|
Auction Rate Securities
|
|
Derivatives, Net
|
|
Contingent Consideration Liabilities
|
||||||
|
|
(In thousands)
|
||||||||||
|
Balance at December 31, 2013
|
$
|
10,898
|
|
|
$
|
112
|
|
|
$
|
(57,548
|
)
|
|
Total gains for the period recognized in:
|
|
|
|
|
|
|
|||||
|
General and administrative expenses
|
—
|
|
|
—
|
|
|
5,699
|
|
|||
|
Other expenses, net
|
—
|
|
|
8
|
|
|
—
|
|
|||
|
Other comprehensive income
|
193
|
|
|
—
|
|
|
—
|
|
|||
|
|
|
|
|
|
|
||||||
|
Settlements
|
(4,200
|
)
|
|
—
|
|
|
50,349
|
|
|||
|
Balance at September 30, 2014
|
$
|
6,891
|
|
|
$
|
120
|
|
|
$
|
(1,500
|
)
|
|
|
September 30, 2014
|
||||||||||||||||||
|
|
Carrying
Value
|
|
Total
Fair Value
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
1.125% Notes
|
$
|
430,484
|
|
|
$
|
649,770
|
|
|
$
|
—
|
|
|
$
|
649,770
|
|
|
$
|
—
|
|
|
1.625% Notes
|
266,726
|
|
|
302,908
|
|
|
—
|
|
|
302,908
|
|
|
—
|
|
|||||
|
3.75% Notes
|
10,449
|
|
|
15,290
|
|
|
—
|
|
|
15,290
|
|
|
—
|
|
|||||
|
|
$
|
707,659
|
|
|
$
|
967,968
|
|
|
$
|
—
|
|
|
$
|
967,968
|
|
|
$
|
—
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
December 31, 2013
|
||||||||||||||||||
|
|
Carrying
Value
|
|
Total
Fair Value
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||||
|
|
(In thousands)
|
||||||||||||||||||
|
1.125% Notes
|
$
|
416,368
|
|
|
$
|
572,627
|
|
|
$
|
—
|
|
|
$
|
572,627
|
|
|
$
|
—
|
|
|
3.75% Notes
|
181,872
|
|
|
219,491
|
|
|
—
|
|
|
219,491
|
|
|
—
|
|
|||||
|
|
$
|
598,240
|
|
|
$
|
792,118
|
|
|
$
|
—
|
|
|
$
|
792,118
|
|
|
$
|
—
|
|
|
|
September 30, 2014
|
||||||||||||||
|
|
Amortized
|
|
Gross
Unrealized
|
|
Estimated
Fair
|
||||||||||
|
|
Cost
|
|
Gains
|
|
Losses
|
|
Value
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Corporate debt securities
|
$
|
554,359
|
|
|
$
|
448
|
|
|
$
|
871
|
|
|
$
|
553,936
|
|
|
Municipal securities
|
96,899
|
|
|
179
|
|
|
205
|
|
|
96,873
|
|
||||
|
GSEs
|
99,436
|
|
|
16
|
|
|
198
|
|
|
99,254
|
|
||||
|
U.S. treasury notes
|
41,074
|
|
|
13
|
|
|
56
|
|
|
41,031
|
|
||||
|
Certificates of deposit
|
51,601
|
|
|
3
|
|
|
15
|
|
|
51,589
|
|
||||
|
Subtotal - current investments
|
843,369
|
|
|
659
|
|
|
1,345
|
|
|
842,683
|
|
||||
|
Auction rate securities
|
7,200
|
|
|
—
|
|
|
309
|
|
|
6,891
|
|
||||
|
|
$
|
850,569
|
|
|
$
|
659
|
|
|
$
|
1,654
|
|
|
$
|
849,574
|
|
|
|
December 31, 2013
|
||||||||||||||
|
|
Amortized
|
|
Gross
Unrealized
|
|
Estimated
Fair
|
||||||||||
|
|
Cost
|
|
Gains
|
|
Losses
|
|
Value
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Corporate debt securities
|
$
|
450,162
|
|
|
$
|
442
|
|
|
$
|
832
|
|
|
$
|
449,772
|
|
|
Municipal securities
|
114,126
|
|
|
119
|
|
|
915
|
|
|
113,330
|
|
||||
|
GSEs
|
68,898
|
|
|
6
|
|
|
87
|
|
|
68,817
|
|
||||
|
U.S. treasury notes
|
37,360
|
|
|
44
|
|
|
28
|
|
|
37,376
|
|
||||
|
Certificates of deposit
|
33,756
|
|
|
2
|
|
|
1
|
|
|
33,757
|
|
||||
|
Subtotal - current investments
|
704,302
|
|
|
613
|
|
|
1,863
|
|
|
703,052
|
|
||||
|
Auction rate securities
|
11,400
|
|
|
—
|
|
|
502
|
|
|
10,898
|
|
||||
|
|
$
|
715,702
|
|
|
$
|
613
|
|
|
$
|
2,365
|
|
|
$
|
713,950
|
|
|
|
Amortized Cost
|
|
Estimated
Fair Value
|
||||
|
|
(In thousands)
|
||||||
|
Due in one year or less
|
$
|
312,449
|
|
|
$
|
312,493
|
|
|
Due one year through five years
|
530,920
|
|
|
530,190
|
|
||
|
Due after ten years
|
7,200
|
|
|
6,891
|
|
||
|
|
$
|
850,569
|
|
|
$
|
849,574
|
|
|
|
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
|
$
|
231,598
|
|
|
$
|
639
|
|
|
163
|
|
|
$
|
43,112
|
|
|
$
|
232
|
|
|
13
|
|
|
Municipal securities
|
39,331
|
|
|
90
|
|
|
34
|
|
|
13,419
|
|
|
115
|
|
|
14
|
|
||||
|
GSEs
|
71,602
|
|
|
161
|
|
|
21
|
|
|
5,992
|
|
|
37
|
|
|
6
|
|
||||
|
U.S. treasury notes
|
21,545
|
|
|
51
|
|
|
12
|
|
|
4,245
|
|
|
5
|
|
|
2
|
|
||||
|
Certificates of deposit
|
11,762
|
|
|
15
|
|
|
49
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
Auction rate securities
|
—
|
|
|
—
|
|
|
—
|
|
|
6,891
|
|
|
309
|
|
|
10
|
|
||||
|
|
$
|
375,838
|
|
|
$
|
956
|
|
|
279
|
|
|
$
|
73,659
|
|
|
$
|
698
|
|
|
45
|
|
|
|
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
|
$
|
210,057
|
|
|
$
|
802
|
|
|
91
|
|
|
$
|
2,540
|
|
|
$
|
30
|
|
|
3
|
|
|
Municipal securities
|
30,715
|
|
|
398
|
|
|
49
|
|
|
31,091
|
|
|
517
|
|
|
39
|
|
||||
|
GSEs
|
53,308
|
|
|
87
|
|
|
21
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
12,037
|
|
|
28
|
|
|
11
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
414
|
|
|
1
|
|
|
2
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
Auction rate securities
|
—
|
|
|
—
|
|
|
—
|
|
|
10,898
|
|
|
502
|
|
|
15
|
|
||||
|
|
$
|
306,531
|
|
|
$
|
1,316
|
|
|
174
|
|
|
$
|
44,529
|
|
|
$
|
1,049
|
|
|
57
|
|
|
|
September 30,
2014 |
|
December 31,
2013 |
||||
|
|
(In thousands)
|
||||||
|
California
|
$
|
184,368
|
|
|
$
|
148,654
|
|
|
Florida
|
7,599
|
|
|
2,901
|
|
||
|
Illinois
|
3,412
|
|
|
5,773
|
|
||
|
Michigan
|
21,327
|
|
|
15,253
|
|
||
|
New Mexico
|
28,393
|
|
|
17,056
|
|
||
|
Ohio
|
66,839
|
|
|
43,969
|
|
||
|
South Carolina
|
4,229
|
|
|
—
|
|
||
|
Texas
|
14,608
|
|
|
9,736
|
|
||
|
Utah
|
9,274
|
|
|
10,953
|
|
||
|
Washington
|
33,214
|
|
|
13,455
|
|
||
|
Wisconsin
|
12,492
|
|
|
8,087
|
|
||
|
Direct delivery and other
|
8,240
|
|
|
2,463
|
|
||
|
Total Health Plans segment
|
393,995
|
|
|
278,300
|
|
||
|
Molina Medicaid Solutions segment
|
31,688
|
|
|
20,635
|
|
||
|
|
$
|
425,683
|
|
|
$
|
298,935
|
|
|
|
September 30,
2014 |
|
December 31,
2013 |
||||
|
|
(In thousands)
|
||||||
|
California
|
$
|
373
|
|
|
$
|
373
|
|
|
Florida
|
23,291
|
|
|
9,242
|
|
||
|
Illinois
|
312
|
|
|
310
|
|
||
|
Michigan
|
1,014
|
|
|
1,014
|
|
||
|
New Mexico
|
31,132
|
|
|
24,622
|
|
||
|
Ohio
|
12,719
|
|
|
9,080
|
|
||
|
South Carolina
|
6,038
|
|
|
310
|
|
||
|
Texas
|
3,500
|
|
|
3,500
|
|
||
|
Utah
|
3,601
|
|
|
3,301
|
|
||
|
Washington
|
151
|
|
|
151
|
|
||
|
Other
|
5,987
|
|
|
886
|
|
||
|
Total Health Plans segment
|
88,118
|
|
|
52,789
|
|
||
|
Molina Medicaid Solutions segment
|
5,001
|
|
|
10,304
|
|
||
|
|
$
|
93,119
|
|
|
$
|
63,093
|
|
|
|
Amortized
Cost
|
|
Estimated
Fair Value
|
||||
|
|
(In thousands)
|
||||||
|
Due in one year or less
|
$
|
92,807
|
|
|
$
|
92,817
|
|
|
Due one year through five years
|
312
|
|
|
312
|
|
||
|
|
$
|
93,119
|
|
|
$
|
93,129
|
|
|
|
September 30,
2014 |
|
December 31,
2013 |
||||
|
|
(In thousands)
|
||||||
|
Fee-for-service claims incurred but not paid (IBNP)
|
$
|
796,433
|
|
|
$
|
424,173
|
|
|
Pharmacy payable
|
62,322
|
|
|
45,037
|
|
||
|
Capitation payable
|
31,535
|
|
|
20,267
|
|
||
|
Other
|
233,556
|
|
|
180,310
|
|
||
|
|
$
|
1,123,846
|
|
|
$
|
669,787
|
|
|
|
Nine Months Ended
|
|
Year Ended
|
||||
|
|
September 30, 2014
|
|
December 31, 2013
|
||||
|
|
(Dollars in thousands)
|
||||||
|
Balances at beginning of period
|
$
|
669,787
|
|
|
$
|
494,530
|
|
|
Components of medical care costs related to:
|
|
|
|
||||
|
Current period
|
5,795,404
|
|
|
5,434,443
|
|
||
|
Prior period
|
(41,033
|
)
|
|
(52,779
|
)
|
||
|
Total medical care costs
|
5,754,371
|
|
|
5,381,664
|
|
||
|
|
|
|
|
||||
|
Change in non-risk provider payables
|
(15,344
|
)
|
|
111,267
|
|
||
|
|
|
|
|
||||
|
Payments for medical care costs related to:
|
|
|
|
||||
|
Current period
|
4,841,429
|
|
|
4,932,195
|
|
||
|
Prior period
|
443,539
|
|
|
385,479
|
|
||
|
Total paid
|
5,284,968
|
|
|
5,317,674
|
|
||
|
Balances at end of period
|
$
|
1,123,846
|
|
|
$
|
669,787
|
|
|
|
|
|
|
||||
|
Benefit from prior period as a percentage of:
|
|
|
|
||||
|
Balance at beginning of period
|
6.1
|
%
|
|
10.7
|
%
|
||
|
Premium revenue, trailing twelve months
|
0.5
|
%
|
|
0.9
|
%
|
||
|
Medical care costs, trailing twelve months
|
0.6
|
%
|
|
1.0
|
%
|
||
|
•
|
Since January 1, 2014, we have added
314,500
members under Medicaid expansion in six of our health plans. Because these members are transitioning into managed care, and have different demographics than those of our legacy membership, we have little insight into their utilization of medical services. Additionally, as of
September 30, 2014
, we have relatively little medical claims payment history related to Medicaid expansion membership in Illinois, Michigan and Ohio because such membership was enrolled in these states later in the year. Accordingly, our estimates of the claims liability for this population are subject to a higher degree of uncertainty.
|
|
•
|
Since January 1, 2014, we have added
118,000
new members at our South Carolina health plan. Because we have only nine months of claims payment history, the reserves are subject to greater uncertainty than that of our legacy Medicaid membership.
|
|
•
|
At our New Mexico health plan, the state has been adding approximately
10,000
to
15,000
members per month on a retroactive basis since March 2014. Because we have no claims payment history for these members, our estimates of the claims liability for this population are subject to a higher degree of uncertainty. However, for these members, the state will reimburse the health plan for claims with dates of service during the retroactive period on a cost-plus basis, i.e., for claims paid plus an administration fee.
|
|
•
|
Beginning in the third quarter of 2014, there was a substantial backlog of inpatient claims at our Washington health plan. This backlog was a result of payments held as the state of Washington considered whether to adjust its payment methodology for inpatient claims. We have adjusted the inpatient reserves to reflect the estimated impact of the claims backlog.
|
|
|
Total
|
|
2014
|
|
2015
|
|
2016
|
|
2017
|
|
2018
|
|
Thereafter
|
||||||||||||||
|
1.125% Notes
|
$
|
550,000
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
550,000
|
|
|
1.625% Notes (1)
|
301,551
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
301,551
|
|
|||||||
|
3.75% Notes
|
10,449
|
|
|
10,449
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||||
|
|
$
|
862,000
|
|
|
$
|
10,449
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
851,551
|
|
|
(1)
|
The 1.625% Notes have a contractual maturity date in 2044; however, on specified dates beginning in 2018 as described below, holders of the 1.625% Notes may require us to repurchase some or all of the 1.625% Notes.
|
|
|
Principal Balance
|
|
Unamortized Discount
|
|
Net Carrying Amount
|
||||||
|
|
(In thousands)
|
||||||||||
|
September 30, 2014:
|
|
|
|
|
|
||||||
|
1.125% Notes
|
$
|
550,000
|
|
|
$
|
119,516
|
|
|
$
|
430,484
|
|
|
1.625% Notes
|
301,551
|
|
|
34,825
|
|
|
266,726
|
|
|||
|
3.75% Notes
|
10,449
|
|
|
—
|
|
|
10,449
|
|
|||
|
|
$
|
862,000
|
|
|
$
|
154,341
|
|
|
$
|
707,659
|
|
|
December 31, 2013:
|
|
|
|
|
|
||||||
|
1.125% Notes
|
$
|
550,000
|
|
|
$
|
133,632
|
|
|
$
|
416,368
|
|
|
3.75% Notes
|
187,000
|
|
|
5,128
|
|
|
181,872
|
|
|||
|
|
$
|
737,000
|
|
|
$
|
138,760
|
|
|
$
|
598,240
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Interest cost recognized for the period relating to the:
|
|
|
|
|
|
|
|
||||||||
|
Contractual interest coupon rate
|
$
|
3,132
|
|
|
$
|
3,300
|
|
|
$
|
9,732
|
|
|
$
|
9,127
|
|
|
Amortization of the discount
|
6,455
|
|
|
6,059
|
|
|
19,183
|
|
|
15,747
|
|
||||
|
Total interest cost recognized
|
$
|
9,587
|
|
|
$
|
9,359
|
|
|
$
|
28,915
|
|
|
$
|
24,874
|
|
|
|
Balance Sheet Location
|
|
September 30, 2014
|
|
December 31, 2013
|
||||
|
|
|
|
(In thousands)
|
||||||
|
Derivative asset:
|
|
|
|
|
|
||||
|
1.125% Call Option
|
Non-current assets: Derivative asset
|
|
$
|
222,997
|
|
|
$
|
186,351
|
|
|
|
|
|
|
|
|
|
|||
|
Derivative liability:
|
|
|
|
|
|
||||
|
1.125% Notes Conversion Option
|
Non-current liabilities: Derivative liability
|
|
$
|
222,877
|
|
|
$
|
186,239
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||||||
|
|
(In thousands)
|
||||||||||||||
|
Revenue from continuing operations:
|
|
|
|
|
|
|
|
||||||||
|
Health Plans segment:
|
|
|
|
|
|
|
|
||||||||
|
Premium revenue
|
$
|
2,316,759
|
|
|
$
|
1,584,656
|
|
|
$
|
6,424,238
|
|
|
$
|
4,583,818
|
|
|
Premium tax revenue
|
81,240
|
|
|
43,723
|
|
|
203,053
|
|
|
127,606
|
|
||||
|
Health insurer fee revenue
|
29,427
|
|
|
—
|
|
|
67,785
|
|
|
—
|
|
||||
|
Investment income
|
2,041
|
|
|
1,740
|
|
|
5,615
|
|
|
4,884
|
|
||||
|
Other revenue
|
2,327
|
|
|
5,860
|
|
|
8,523
|
|
|
16,476
|
|
||||
|
Molina Medicaid Solutions segment:
|
|
|
|
|
|
|
|
||||||||
|
Service revenue
|
52,557
|
|
|
51,100
|
|
|
156,419
|
|
|
150,528
|
|
||||
|
Total revenue
|
$
|
2,484,351
|
|
|
$
|
1,687,079
|
|
|
$
|
6,865,633
|
|
|
$
|
4,883,312
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Income from continuing operations before income tax:
|
|
|
|
|
|
|
|
||||||||
|
Health Plans segment
|
$
|
29,874
|
|
|
$
|
16,929
|
|
|
$
|
65,879
|
|
|
$
|
118,600
|
|
|
Molina Medicaid Solutions segment
|
9,905
|
|
|
7,997
|
|
|
30,594
|
|
|
20,645
|
|
||||
|
Total operating income from continuing operations
|
39,779
|
|
|
24,926
|
|
|
96,473
|
|
|
139,245
|
|
||||
|
Other expenses, net
|
15,282
|
|
|
13,508
|
|
|
43,044
|
|
|
41,583
|
|
||||
|
Income from continuing operations before income tax expense
|
$
|
24,497
|
|
|
$
|
11,418
|
|
|
$
|
53,429
|
|
|
$
|
97,662
|
|
|
•
|
uncertainties associated with the implementation of the Affordable Care Act, including the full grossed up reimbursement by states of the non-deductible health insurer fee, the expansion of Medicaid eligibility in the states that participate to previously uninsured populations unfamiliar with managed care, the implementation of state insurance marketplaces, the effect of various implementing regulations, and uncertainties regarding the impact of other federal or state health care and insurance reform measures, including the dual eligibles demonstration programs in California, Illinois, Michigan, Ohio, and South Carolina;
|
|
•
|
newly FDA-approved specialty drugs such as Sovaldi, Olysio, Harvoni, and other specialty drugs that are exorbitantly priced but not factored into the calculation of our capitated rates;
|
|
•
|
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 ability to reduce over time the high medical costs commonly associated with new patient populations;
|
|
•
|
the accurate estimation of incurred but not paid medical costs across our health plans;
|
|
•
|
retroactive adjustments to premium revenue or accounting estimates which require adjustment based upon subsequent developments, including Medicaid pharmaceutical rebates or retroactive premium rate increases;
|
|
•
|
efforts by states to recoup previously paid amounts;
|
|
•
|
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, including the success of the proposal of Molina Medicaid Solutions in New Jersey;
|
|
•
|
the 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, including the extension of the Louisiana contract of Molina Medicaid Solutions through 2015;
|
|
•
|
complications, member confusion, or enrollment backlogs related to the annual renewal of Medicaid coverage;
|
|
•
|
government audits and reviews, and any fine, enrollment freeze, or monitoring program that may result therefrom;
|
|
•
|
changes with respect to our provider contracts and the loss of providers;
|
|
•
|
federal or state medical cost expenditure floors, administrative cost and profit ceilings, and profit sharing arrangements;
|
|
•
|
the interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures, including 2014 at-risk premium rules in the state of Texas;
|
|
•
|
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 or unfavorable resolution of litigation, arbitration, or administrative proceedings, including pending qui tam actions in Florida and California, and the litigation commenced against us by the state of Louisiana alleging that Molina Medicaid Solutions and its predecessors used an incorrect reimbursement formula for the payment of pharmaceutical claims;
|
|
•
|
the relatively small number of states in which we operate health plans;
|
|
•
|
our management of a portion of College Health Enterprises’ hospital in Long Beach, California;
|
|
•
|
the availability of adequate financing on acceptable terms to fund and capitalize our expansion and growth, repay our outstanding indebtedness at maturity and meet our liquidity needs, including the interest expense and other costs associated with such financing;
|
|
•
|
the failure of a state in which we operate to renew its federal Medicaid waiver;
|
|
•
|
cyber-attacks or other privacy or data security incidents resulting in an 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;
|
|
•
|
public alarm associated with the Ebola virus, or any actual widespread epidemic;
|
|
•
|
changes in general economic conditions, including unemployment rates;
and
|
|
•
|
increasing consolidation in the Medicaid industry
.
|
|
•
|
Medicaid Expansion
. In the states that have elected to participate, the Affordable Care Act provides for the expansion of the Medicaid program to provide eligibility to nearly all low-income people under age 65 with incomes at or below 138 percent of the federal poverty line. Medicaid expansion membership phased in beginning January 1, 2014. Since that date, our health plans in California, Illinois, Michigan, New Mexico, Ohio, and Washington have begun participating in Medicaid expansion. In the
nine months ended September 30, 2014
, we added approximately
314,500
Medicaid expansion members, or
13%
of total membership.
|
|
•
|
Health Insurance Marketplace
. On October 1, 2013, Marketplace became available for consumers to access and begin the enrollment process for coverage beginning January 1, 2014. The Marketplace allows individuals and small groups to purchase health insurance that is federally subsidized. We participate in the Marketplace in all of the states in which we operate, except Illinois and South Carolina. At
September 30, 2014
, we had fewer than
20,000
Marketplace members.
|
|
•
|
Medicare-Medicaid Plans
. Policymakers at the federal and state levels are increasingly focused on the design and implementation of programs that improve the coordination of care for those who qualify to receive both Medicare and Medicaid services (the "dual eligible"), and to deliver services to the dual eligible in a more financially efficient manner. As a result of these efforts, 15 states have undertaken demonstration programs to integrate Medicare and Medicaid services for dual-eligible individuals. The health plans participating in such demonstrations are referred to as Medicare-Medicaid Plans (MMPs). Our MMPs in California, Illinois, and Ohio offered coverage beginning in the second quarter of 2014.
|
|
|
Ending
|
|
PMPM Premiums
|
|||||||||||
|
|
Membership
|
|
Low
|
|
High
|
|
Consolidated
|
|||||||
|
Temporary Assistance for Needy Families (TANF)
|
1,608,900
|
|
|
$
|
110.00
|
|
|
$
|
250.00
|
|
|
$
|
160.00
|
|
|
Medicaid Expansion
|
314,500
|
|
|
330.00
|
|
|
530.00
|
|
|
420.00
|
|
|||
|
Aged, Blind or Disabled (ABD)
|
314,400
|
|
|
380.00
|
|
|
1,410.00
|
|
|
820.00
|
|
|||
|
Children's Health Insurance Program (CHIP)
|
69,000
|
|
|
90.00
|
|
|
130.00
|
|
|
120.00
|
|
|||
|
Medicare Special Needs Plans (Medicare)
|
46,400
|
|
|
990.00
|
|
|
1,320.00
|
|
|
1,210.00
|
|
|||
|
MMP–Medicaid Only (1) (2)
|
20,500
|
|
|
1,380.00
|
|
|
1,520.00
|
|
|
1,490.00
|
|
|||
|
MMP–Integrated (1) (3)
|
14,400
|
|
|
1,320.00
|
|
|
3,510.00
|
|
|
2,030.00
|
|
|||
|
Marketplace
|
15,900
|
|
|
170.00
|
|
|
610.00
|
|
|
340.00
|
|
|||
|
(1)
|
MMP members are dually eligible for Medicare and Medicaid.
|
|
(2)
|
MMP members who receive Medicaid coverage only from Molina Healthcare.
|
|
(3)
|
MMP members who receive both Medicaid and Medicare coverage from Molina Healthcare.
|
|
|
September 30,
2014 |
|
June 30,
2014 |
|
December 31,
2013 |
|
September 30,
2013 |
||||
|
Ending Membership by Health Plan:
|
|
|
|
|
|
|
|
||||
|
California
|
496,000
|
|
|
455,000
|
|
|
368,000
|
|
|
363,000
|
|
|
Florida (1)
|
98,000
|
|
|
58,000
|
|
|
89,000
|
|
|
84,000
|
|
|
Illinois
|
21,000
|
|
|
6,000
|
|
|
4,000
|
|
|
—
|
|
|
Michigan
|
238,000
|
|
|
244,000
|
|
|
213,000
|
|
|
213,000
|
|
|
New Mexico
|
207,000
|
|
|
195,000
|
|
|
168,000
|
|
|
172,000
|
|
|
Ohio
|
337,000
|
|
|
302,000
|
|
|
255,000
|
|
|
261,000
|
|
|
South Carolina (2)
|
118,000
|
|
|
119,000
|
|
|
—
|
|
|
—
|
|
|
Texas
|
249,000
|
|
|
247,000
|
|
|
252,000
|
|
|
258,000
|
|
|
Utah
|
83,000
|
|
|
83,000
|
|
|
86,000
|
|
|
87,000
|
|
|
Washington
|
473,000
|
|
|
461,000
|
|
|
403,000
|
|
|
409,000
|
|
|
Wisconsin
|
84,000
|
|
|
85,000
|
|
|
93,000
|
|
|
95,000
|
|
|
|
2,404,000
|
|
|
2,255,000
|
|
|
1,931,000
|
|
|
1,942,000
|
|
|
|
|
|
|
|
|
|
|
||||
|
Ending Membership by Program:
|
|
|
|
|
|
|
|
||||
|
TANF
|
1,608,900
|
|
|
1,564,500
|
|
|
1,503,800
|
|
|
1,519,200
|
|
|
Medicaid Expansion (3)
|
314,500
|
|
|
232,300
|
|
|
—
|
|
|
—
|
|
|
ABD
|
314,400
|
|
|
305,300
|
|
|
288,600
|
|
|
283,200
|
|
|
CHIP
|
69,000
|
|
|
77,000
|
|
|
99,200
|
|
|
101,500
|
|
|
Medicare
|
46,400
|
|
|
44,000
|
|
|
39,400
|
|
|
38,100
|
|
|
MMP–Medicaid Only
|
20,500
|
|
|
8,400
|
|
|
—
|
|
|
—
|
|
|
MMP–Integrated
|
14,400
|
|
|
5,200
|
|
|
—
|
|
|
—
|
|
|
Marketplace (3)
|
15,900
|
|
|
18,300
|
|
|
—
|
|
|
—
|
|
|
|
2,404,000
|
|
|
2,255,000
|
|
|
1,931,000
|
|
|
1,942,000
|
|
|
(1)
|
Enrollment at the Florida health plan declined between the first and second quarters of 2014 due to a reassignment of membership as part of the implementation of Florida’s Managed Medical Assistance (MMA) program. In the third quarter of 2014, such enrollment increased by approximately 40,000 members due primarily to the addition of certain service areas effective August 1, 2014.
|
|
(2)
|
Our South Carolina health plan began serving members under the state of South Carolina’s new full-risk Medicaid managed care program effective January 1, 2014.
|
|
(3)
|
Medicaid expansion membership phased in, and the Marketplace became available for consumers to access coverage, beginning January 1, 2014.
|
|
•
|
Fee-for-service expenses:
Under fee-for-service arrangements, we retain the financial responsibility for medical care provided and incur costs based on actual utilization of services. Such expenses are recorded in the period in which the related services are dispensed. Nearly all hospital services and the majority of our primary care and physician specialist services are paid on a fee-for-service basis.
|
|
•
|
Pharmacy expenses:
All drug, injectables, and immunization costs paid through our pharmacy benefit manager are classified as pharmacy expenses.
|
|
•
|
Capitation expenses:
Under capitation arrangements, we pay a fixed amount PMPM to the provider without regard to the frequency, extent, or nature of the medical services actually furnished.
|
|
•
|
Direct delivery expenses:
All costs associated with our direct delivery of medical care are separately identified.
|
|
•
|
Other medical expenses:
All medically related administrative costs, certain provider incentive costs, reinsurance costs and other health care expenses are classified as other medical expenses.
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
|
|
September 30,
|
|
September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
|
2014
|
|
2013
|
||||||||
|
|
(Dollar amounts in thousands, except per share data)
|
||||||||||||||
|
Net income per diluted share
|
$
|
0.33
|
|
|
$
|
0.16
|
|
|
$
|
0.60
|
|
|
$
|
1.15
|
|
|
Premium revenue
|
$
|
2,316,759
|
|
|
$
|
1,584,656
|
|
|
$
|
6,424,238
|
|
|
$
|
4,583,818
|
|
|
Service revenue
|
$
|
52,557
|
|
|
$
|
51,100
|
|
|
$
|
156,419
|
|
|
$
|
150,528
|
|
|
Operating income
|
$
|
39,779
|
|
|
$
|
24,926
|
|
|
$
|
96,473
|
|
|
$
|
139,245
|
|
|
Net income
|
$
|
16,070
|
|
|
$
|
7,553
|
|
|
$
|
28,645
|
|
|
$
|
53,871
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Total ending membership
|
2,404,000
|
|
|
1,942,000
|
|
|
2,404,000
|
|
|
1,942,000
|
|
||||
|
|
|
|
|
|
|
|
|
||||||||
|
Premium revenue
|
93.3
|
%
|
|
93.9
|
%
|
|
93.6
|
%
|
|
93.9
|
%
|
||||
|
Service revenue
|
2.1
|
|
|
3.0
|
|
|
2.3
|
|
|
3.1
|
|
||||
|
Premium tax revenue
|
3.2
|
|
|
2.6
|
|
|
2.9
|
|
|
2.6
|
|
||||
|
Health insurer fee revenue
|
1.2
|
|
|
—
|
|
|
1.0
|
|
|
—
|
|
||||
|
Investment income
|
0.1
|
|
|
0.2
|
|
|
0.1
|
|
|
0.1
|
|
||||
|
Other revenue
|
0.1
|
|
|
0.3
|
|
|
0.1
|
|
|
0.3
|
|
||||
|
Total revenue
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
||||
|
|
|
|
|
|
|
|
|
||||||||
|
Operating Statistics:
|
|
|
|
|
|
|
|
||||||||
|
Medical care ratio
|
90.6
|
%
|
|
87.3
|
%
|
|
89.6
|
%
|
|
86.5
|
%
|
||||
|
Service revenue ratio
|
76.2
|
%
|
|
78.5
|
%
|
|
75.3
|
%
|
|
79.2
|
%
|
||||
|
General and administrative expense ratio
|
7.2
|
%
|
|
10.4
|
%
|
|
8.2
|
%
|
|
9.8
|
%
|
||||
|
Premium tax ratio
|
3.4
|
%
|
|
2.7
|
%
|
|
3.1
|
%
|
|
2.7
|
%
|
||||
|
Operating income
|
1.6
|
%
|
|
1.5
|
%
|
|
1.4
|
%
|
|
2.9
|
%
|
||||
|
Net income
|
0.6
|
%
|
|
0.4
|
%
|
|
0.4
|
%
|
|
1.1
|
%
|
||||
|
Effective tax rate
|
34.4
|
%
|
|
33.9
|
%
|
|
46.4
|
%
|
|
44.8
|
%
|
||||
|
|
|
|
|
|
|
|
|
||||||||
|
Medical Claims Data:
|
|
|
|
|
|
|
|
||||||||
|
Days in claims payable, fee for service
|
50
|
|
|
41
|
|
|
50
|
|
|
41
|
|
||||
|
Number of claims in inventory at end of period
|
315,900
|
|
|
137,100
|
|
|
315,900
|
|
|
137,100
|
|
||||
|
Billed charges of claims in inventory at end of period
|
$
|
749,300
|
|
|
$
|
257,600
|
|
|
$
|
749,300
|
|
|
$
|
257,600
|
|
|
Claims in inventory per member at end of period
|
0.13
|
|
|
0.07
|
|
|
0.13
|
|
|
0.07
|
|
||||
|
Billed charges of claims in inventory per member at end of period
|
$
|
311.69
|
|
|
$
|
132.65
|
|
|
$
|
311.69
|
|
|
$
|
132.65
|
|
|
Number of claims received during the period
|
7,062,100
|
|
|
5,227,000
|
|
|
19,703,300
|
|
|
15,751,500
|
|
||||
|
Billed charges of claims received during the period
|
$
|
7,897,500
|
|
|
$
|
5,371,100
|
|
|
$
|
21,506,500
|
|
|
$
|
15,848,900
|
|
|
|
Three Months Ended
|
|
Nine Months Ended
|
||||||||||||
|
|
September 30,
|
|
September 30,
|
||||||||||||
|
2014
|
|
2013
|
|
2014
|
|
2013
|
|||||||||
|
|
(In thousands)
|
||||||||||||||
|
Net income
|
$
|
16,122
|
|
|
$
|
7,569
|
|
|
$
|
28,431
|
|
|
$
|
62,055
|
|
|
Adjustments:
|
|
|
|
|
|
|
|
||||||||
|
Depreciation, and amortization of intangible assets and capitalized software
|
29,307
|
|
|
24,128
|
|
|
83,513
|
|
|
68,035
|
|
||||
|
Interest expense
|
14,419
|
|
|
13,532
|
|
|
42,234
|
|
|
38,236
|
|
||||
|
Income tax expense
|
8,439
|
|
|
3,962
|
|
|
24,436
|
|
|
33,745
|
|
||||
|
EBITDA
|
$
|
68,287
|
|
|
$
|
49,191
|
|
|
$
|
178,614
|
|
|
$
|
202,071
|
|
|
|
Three Months Ended September 30,
|
||||||||||||||
|
2014
|
|
2013
|
|||||||||||||
|
|
(In thousands, except diluted per-share amounts)
|
||||||||||||||
|
Net income, continuing operations
|
$
|
16,070
|
|
|
$
|
0.33
|
|
|
$
|
7,553
|
|
|
$
|
0.16
|
|
|
Adjustments, net of tax:
|
|
|
|
|
|
|
|
||||||||
|
Depreciation, and amortization of capitalized software
|
15,275
|
|
|
0.31
|
|
|
11,821
|
|
|
0.25
|
|
||||
|
Amortization of convertible senior notes and lease financing obligations
|
4,246
|
|
|
0.09
|
|
|
4,058
|
|
|
0.08
|
|
||||
|
Stock-based compensation
|
1,739
|
|
|
0.04
|
|
|
7,010
|
|
|
0.15
|
|
||||
|
Amortization of intangible assets
|
3,189
|
|
|
0.06
|
|
|
3,378
|
|
|
0.07
|
|
||||
|
Change in fair value of derivatives, net
|
1
|
|
|
—
|
|
|
(1
|
)
|
|
—
|
|
||||
|
Adjusted net income, continuing operations
|
$
|
40,520
|
|
|
$
|
0.83
|
|
|
$
|
33,819
|
|
|
$
|
0.71
|
|
|
|
Nine Months Ended September 30,
|
||||||||||||||
|
2014
|
|
2013
|
|||||||||||||
|
|
(In thousands, except diluted per-share amounts)
|
||||||||||||||
|
Net income, continuing operations
|
$
|
28,645
|
|
|
$
|
0.60
|
|
|
$
|
53,871
|
|
|
$
|
1.15
|
|
|
Adjustments, net of tax:
|
|
|
|
|
|
|
|
||||||||
|
Depreciation, and amortization of capitalized software
|
42,887
|
|
|
0.89
|
|
|
33,375
|
|
|
0.71
|
|
||||
|
Amortization of convertible senior notes and lease financing obligations
|
12,723
|
|
|
0.26
|
|
|
10,161
|
|
|
0.21
|
|
||||
|
Stock-based compensation
|
10,960
|
|
|
0.23
|
|
|
17,026
|
|
|
0.36
|
|
||||
|
Amortization of intangible assets
|
9,727
|
|
|
0.20
|
|
|
9,485
|
|
|
0.20
|
|
||||
|
Change in fair value of derivatives, net
|
(5
|
)
|
|
—
|
|
|
3,582
|
|
|
0.08
|
|
||||
|
Adjusted net income, continuing operations
|
$
|
104,937
|
|
|
$
|
2.18
|
|
|
$
|
127,500
|
|
|
$
|
2.71
|
|
|
•
|
Much of our revenue growth has come from participation in Medicaid programs covering long-term services and supports (LTSS). Percentage profit margins for LTSS benefits are generally lower than percentage profit margins for acute medical benefits. The addition of members eligible for LTSS benefits at the Florida and New Mexico health
|
|
•
|
Increases to our base premiums in recent years have not kept pace with medical cost trends.
|
|
•
|
Lack of coordination in the design of profit caps and medical cost floors in some of our contracts is resulting in counterproductive outcomes. In some instances, givebacks due to profitable performance in one product cannot be offset against losses in other products.
|
|
|
HIF Medicaid Revenue
|
||||||||||
|
|
Recognized
|
|
Required Reimbursement through Sept. 30, 2014
|
|
Not Recognized
|
||||||
|
|
(In millions)
|
||||||||||
|
Quarter 1
|
$
|
16.6
|
|
|
$
|
32.7
|
|
|
$
|
16.1
|
|
|
Quarter 2
|
17.2
|
|
|
32.7
|
|
|
15.5
|
|
|||
|
Quarter 3
|
27.0
|
|
|
32.7
|
|
|
5.7
|
|
|||
|
Nine months ended September 30, 2014
|
$
|
60.8
|
|
|
$
|
98.1
|
|
|
$
|
37.3
|
|
|
|
Texas Quality Revenue
|
||||||||||
|
|
Recognized
|
|
Available
|
|
Not Recognized
|
||||||
|
|
(In millions)
|
||||||||||
|
Quarter 1
|
$
|
2.6
|
|
|
$
|
8.6
|
|
|
$
|
6.0
|
|
|
Quarter 2
|
1.1
|
|
|
8.6
|
|
|
7.5
|
|
|||
|
Quarter 3
|
4.6
|
|
|
8.8
|
|
|
4.2
|
|
|||
|
Nine months ended September 30, 2014
|
$
|
8.3
|
|
|
$
|
26.0
|
|
|
$
|
17.7
|
|
|
|
Three Months Ended September 30,
|
||||||||||||||||||||
|
|
2014
|
|
2013
|
||||||||||||||||||
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
||||||||||
|
Fee for service
|
$
|
1,469,765
|
|
|
$
|
206.43
|
|
|
70.1
|
%
|
|
$
|
928,165
|
|
|
$
|
161.39
|
|
|
67.1
|
%
|
|
Pharmacy
|
337,150
|
|
|
47.35
|
|
|
16.1
|
|
|
237,073
|
|
|
41.22
|
|
|
17.1
|
|
||||
|
Capitation
|
190,277
|
|
|
26.73
|
|
|
9.1
|
|
|
162,554
|
|
|
28.27
|
|
|
11.8
|
|
||||
|
Direct delivery
|
24,863
|
|
|
3.49
|
|
|
1.1
|
|
|
9,612
|
|
|
1.67
|
|
|
0.7
|
|
||||
|
Other
|
75,781
|
|
|
10.65
|
|
|
3.6
|
|
|
45,809
|
|
|
7.97
|
|
|
3.3
|
|
||||
|
Total
|
$
|
2,097,836
|
|
|
$
|
294.65
|
|
|
100.0
|
%
|
|
$
|
1,383,213
|
|
|
$
|
240.52
|
|
|
100.0
|
%
|
|
|
Three Months Ended September 30, 2014
|
||||||||||||||||||||||||
|
|
Member
Months (1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR (2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
1,451
|
|
|
$
|
384,147
|
|
|
$
|
264.79
|
|
|
$
|
327,389
|
|
|
$
|
225.66
|
|
|
85.2
|
%
|
|
$
|
56,758
|
|
|
Florida
|
243
|
|
|
106,275
|
|
|
437.47
|
|
|
103,898
|
|
|
427.69
|
|
|
97.8
|
|
|
2,377
|
|
|||||
|
Illinois (3)
|
38
|
|
|
34,514
|
|
|
906.78
|
|
|
28,333
|
|
|
744.41
|
|
|
82.1
|
|
|
6,181
|
|
|||||
|
Michigan
|
727
|
|
|
208,873
|
|
|
287.15
|
|
|
177,680
|
|
|
244.27
|
|
|
85.1
|
|
|
31,193
|
|
|||||
|
New Mexico
|
652
|
|
|
284,058
|
|
|
435.67
|
|
|
265,697
|
|
|
407.51
|
|
|
93.5
|
|
|
18,361
|
|
|||||
|
Ohio
|
994
|
|
|
454,410
|
|
|
457.17
|
|
|
395,098
|
|
|
397.49
|
|
|
86.9
|
|
|
59,312
|
|
|||||
|
South Carolina
|
355
|
|
|
95,455
|
|
|
268.97
|
|
|
74,489
|
|
|
209.89
|
|
|
78.0
|
|
|
20,966
|
|
|||||
|
Texas
|
748
|
|
|
337,430
|
|
|
451.24
|
|
|
306,577
|
|
|
409.98
|
|
|
90.9
|
|
|
30,853
|
|
|||||
|
Utah
|
250
|
|
|
78,703
|
|
|
315.04
|
|
|
75,270
|
|
|
301.30
|
|
|
95.6
|
|
|
3,433
|
|
|||||
|
Washington
|
1,410
|
|
|
280,883
|
|
|
199.18
|
|
|
274,213
|
|
|
194.45
|
|
|
97.6
|
|
|
6,670
|
|
|||||
|
Wisconsin
|
252
|
|
|
42,933
|
|
|
170.40
|
|
|
38,107
|
|
|
151.25
|
|
|
88.8
|
|
|
4,826
|
|
|||||
|
Other (4)
|
—
|
|
|
9,078
|
|
|
—
|
|
|
31,085
|
|
|
—
|
|
|
—
|
|
|
(22,007
|
)
|
|||||
|
|
7,120
|
|
|
$
|
2,316,759
|
|
|
$
|
325.40
|
|
|
$
|
2,097,836
|
|
|
$
|
294.65
|
|
|
90.6
|
%
|
|
$
|
218,923
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
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
|
|
|||||
|
Illinois (3)
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
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
|
|
|||||
|
South Carolina
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
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)(4)
|
—
|
|
|
7,079
|
|
|
—
|
|
|
19,942
|
|
|
—
|
|
|
—
|
|
|
(12,863
|
)
|
|||||
|
|
5,751
|
|
|
$
|
1,584,656
|
|
|
$
|
275.55
|
|
|
$
|
1,383,213
|
|
|
$
|
240.52
|
|
|
87.3
|
%
|
|
$
|
201,443
|
|
|
(1)
|
A member month is defined as the aggregate of each month’s ending membership for the period presented.
|
|
(2)
|
The MCR represents medical costs as a percentage of premium revenue.
|
|
(3)
|
The Illinois health plan's results prior to October 1, 2013, were insignificant and reported in "Other."
|
|
(4)
|
"Other" medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.
|
|
|
Three Months Ended September 30,
|
||||||
|
|
2014
|
|
2013
|
||||
|
|
(In thousands)
|
||||||
|
Service revenue before amortization
|
$
|
53,286
|
|
|
$
|
51,829
|
|
|
Amortization recorded as reduction of service revenue
|
(729
|
)
|
|
(729
|
)
|
||
|
Service revenue
|
52,557
|
|
|
51,100
|
|
||
|
Cost of service revenue
|
40,067
|
|
|
40,113
|
|
||
|
General and administrative costs
|
1,791
|
|
|
1,708
|
|
||
|
Amortization of customer relationship intangibles recorded as amortization
|
794
|
|
|
1,282
|
|
||
|
Operating income
|
$
|
9,905
|
|
|
$
|
7,997
|
|
|
|
Nine Months Ended September 30,
|
||||||||||||||||||||
|
|
2014
|
|
2013
|
||||||||||||||||||
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
||||||||||
|
Fee for service
|
$
|
4,028,863
|
|
|
$
|
198.61
|
|
|
70.0
|
%
|
|
$
|
2,674,785
|
|
|
$
|
160.14
|
|
|
67.5
|
%
|
|
Pharmacy
|
919,374
|
|
|
45.32
|
|
|
16.0
|
|
|
691,903
|
|
|
41.42
|
|
|
17.4
|
|
||||
|
Capitation
|
536,533
|
|
|
26.45
|
|
|
9.3
|
|
|
441,287
|
|
|
26.42
|
|
|
11.1
|
|
||||
|
Direct delivery
|
69,947
|
|
|
3.45
|
|
|
1.2
|
|
|
27,739
|
|
|
1.66
|
|
|
0.7
|
|
||||
|
Other
|
199,076
|
|
|
9.81
|
|
|
3.5
|
|
|
130,120
|
|
|
7.79
|
|
|
3.3
|
|
||||
|
Total
|
$
|
5,753,793
|
|
|
$
|
283.64
|
|
|
100.0
|
%
|
|
$
|
3,965,834
|
|
|
$
|
237.43
|
|
|
100.0
|
%
|
|
•
|
Higher enrollment, primarily as a result of Medicaid expansion;
|
|
•
|
Premium increases effective October 1, 2013 (2.5%), and July 1, 2014 (5.5%); and
|
|
•
|
Approximately $15 million benefit from recognition, in the second quarter of 2014, of certain premium revenue which related to the year ended December 31, 2013.
|
|
|
Nine Months Ended September 30, 2014
|
||||||||||||||||||||||||
|
|
Member
Months (1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR (2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
4,040
|
|
|
$
|
1,059,860
|
|
|
$
|
262.34
|
|
|
$
|
889,656
|
|
|
$
|
220.21
|
|
|
83.9
|
%
|
|
$
|
170,204
|
|
|
Florida
|
742
|
|
|
312,864
|
|
|
421.80
|
|
|
290,224
|
|
|
391.28
|
|
|
92.8
|
|
|
22,640
|
|
|||||
|
Illinois (3)
|
69
|
|
|
68,948
|
|
|
998.03
|
|
|
63,299
|
|
|
916.26
|
|
|
91.8
|
|
|
5,649
|
|
|||||
|
Michigan
|
2,077
|
|
|
567,706
|
|
|
273.28
|
|
|
476,392
|
|
|
229.33
|
|
|
83.9
|
|
|
91,314
|
|
|||||
|
New Mexico
|
1,818
|
|
|
777,120
|
|
|
427.55
|
|
|
702,257
|
|
|
386.36
|
|
|
90.4
|
|
|
74,863
|
|
|||||
|
Ohio
|
2,615
|
|
|
1,061,335
|
|
|
405.81
|
|
|
909,142
|
|
|
347.62
|
|
|
85.7
|
|
|
152,193
|
|
|||||
|
South Carolina
|
1,109
|
|
|
287,928
|
|
|
259.69
|
|
|
249,437
|
|
|
224.97
|
|
|
86.6
|
|
|
38,491
|
|
|||||
|
Texas
|
2,239
|
|
|
978,492
|
|
|
437.00
|
|
|
897,434
|
|
|
400.80
|
|
|
91.7
|
|
|
81,058
|
|
|||||
|
Utah
|
745
|
|
|
233,931
|
|
|
314.13
|
|
|
215,564
|
|
|
289.47
|
|
|
92.1
|
|
|
18,367
|
|
|||||
|
Washington
|
4,050
|
|
|
941,303
|
|
|
232.40
|
|
|
877,418
|
|
|
216.63
|
|
|
93.2
|
|
|
63,885
|
|
|||||
|
Wisconsin
|
782
|
|
|
118,386
|
|
|
151.48
|
|
|
100,059
|
|
|
128.03
|
|
|
84.5
|
|
|
18,327
|
|
|||||
|
Other (4)
|
—
|
|
|
16,365
|
|
|
—
|
|
|
82,911
|
|
|
—
|
|
|
—
|
|
|
(66,546
|
)
|
|||||
|
|
20,286
|
|
|
$
|
6,424,238
|
|
|
$
|
316.69
|
|
|
$
|
5,753,793
|
|
|
$
|
283.64
|
|
|
89.6
|
%
|
|
$
|
670,445
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
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
|
|
|||||
|
Illinois (3)
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
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
|
|
|||||
|
South Carolina
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
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)(4)
|
—
|
|
|
12,563
|
|
|
—
|
|
|
49,705
|
|
|
—
|
|
|
—
|
|
|
(37,142
|
)
|
|||||
|
|
16,703
|
|
|
$
|
4,583,818
|
|
|
$
|
274.43
|
|
|
$
|
3,965,834
|
|
|
$
|
237.43
|
|
|
86.5
|
%
|
|
$
|
617,984
|
|
|
(1)
|
A member month is defined as the aggregate of each month’s ending membership for the period presented.
|
|
(2)
|
The MCR represents medical costs as a percentage of premium revenue.
|
|
(3)
|
The Illinois health plan's results prior to October 1, 2013, were insignificant and reported in "Other."
|
|
(4)
|
"Other" medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.
|
|
|
Nine Months Ended September 30,
|
||||||
|
|
2014
|
|
2013
|
||||
|
|
(In thousands)
|
||||||
|
Service revenue before amortization
|
$
|
158,605
|
|
|
$
|
152,714
|
|
|
Amortization recorded as reduction of service revenue
|
(2,186
|
)
|
|
(2,186
|
)
|
||
|
Service revenue
|
156,419
|
|
|
150,528
|
|
||
|
Cost of service revenue
|
117,831
|
|
|
119,188
|
|
||
|
General and administrative costs
|
5,432
|
|
|
6,849
|
|
||
|
Amortization of customer relationship intangibles recorded as amortization
|
2,562
|
|
|
3,846
|
|
||
|
Operating income
|
$
|
30,594
|
|
|
$
|
20,645
|
|
|
|
Three Months Ended September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
||||||||||
|
|
Amount
|
|
% of Total
Revenue
|
|
Amount
|
|
% of Total
Revenue
|
||||||
|
|
(Dollar amounts in thousands)
|
||||||||||||
|
Depreciation, and amortization of capitalized software, continuing operations
|
$
|
19,910
|
|
|
0.8
|
%
|
|
$
|
14,237
|
|
|
0.8
|
%
|
|
Amortization of intangible assets, continuing operations
|
4,332
|
|
|
0.2
|
|
|
4,634
|
|
|
0.3
|
|
||
|
Depreciation and amortization, continuing operations
|
24,242
|
|
|
1.0
|
|
|
18,871
|
|
|
1.1
|
|
||
|
Amortization recorded as reduction of service revenue
|
729
|
|
|
—
|
|
|
729
|
|
|
—
|
|
||
|
Amortization recorded as cost of service revenue
|
8,839
|
|
|
0.4
|
|
|
4,528
|
|
|
0.3
|
|
||
|
Depreciation and amortization reported in the consolidated statements of cash flows
|
$
|
33,810
|
|
|
1.4
|
%
|
|
$
|
24,128
|
|
|
1.4
|
%
|
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2014
|
|
2013
|
||||||||||
|
|
Amount
|
|
% of Total
Revenue
|
|
Amount
|
|
% of Total
Revenue
|
||||||
|
|
(Dollar amounts in thousands)
|
||||||||||||
|
Depreciation, and amortization of capitalized software, continuing operations
|
$
|
54,582
|
|
|
0.8
|
%
|
|
$
|
39,578
|
|
|
0.8
|
%
|
|
Amortization of intangible assets, continuing operations
|
13,253
|
|
|
0.2
|
|
|
12,871
|
|
|
0.3
|
|
||
|
Depreciation and amortization, continuing operations
|
67,835
|
|
|
1.0
|
|
|
52,449
|
|
|
1.1
|
|
||
|
Depreciation and amortization, discontinued operations
|
—
|
|
|
—
|
|
|
2
|
|
|
—
|
|
||
|
Amortization recorded as reduction of service revenue
|
2,186
|
|
|
—
|
|
|
2,186
|
|
|
—
|
|
||
|
Amortization recorded as cost of service revenue
|
29,443
|
|
|
0.4
|
|
|
13,398
|
|
|
0.3
|
|
||
|
Depreciation and amortization reported in the consolidated statements of cash flows
|
$
|
99,464
|
|
|
1.4
|
%
|
|
$
|
68,035
|
|
|
1.4
|
%
|
|
|
Nine Months Ended September 30,
|
||||||||||
|
|
2014
|
|
2013
|
|
Change
|
||||||
|
|
(In thousands)
|
||||||||||
|
Net cash provided by operating activities
|
$
|
841,198
|
|
|
$
|
111,744
|
|
|
$
|
729,454
|
|
|
Net cash used in investing activities
|
(261,280
|
)
|
|
(541,416
|
)
|
|
280,136
|
|
|||
|
Net cash provided by financing activities
|
82,783
|
|
|
490,458
|
|
|
(407,675
|
)
|
|||
|
Net increase in cash and cash equivalents
|
$
|
662,701
|
|
|
$
|
60,786
|
|
|
$
|
601,915
|
|
|
|
Three Months Ended
|
|
Nine Months Ended Sept. 30, 2014
|
|
Required ACA HIF Reimbursement through Dec. 31, 2014
|
||||||||||||||
|
|
March 31, 2014
|
|
June 30, 2014
|
|
Sept. 30, 2014
|
|
|
||||||||||||
|
|
Gross (1)
|
||||||||||||||||||
|
California
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
11,616
|
|
|
Florida
|
1,416
|
|
|
1,473
|
|
|
1,487
|
|
|
4,376
|
|
|
5,835
|
|
|||||
|
Illinois
|
40
|
|
|
42
|
|
|
40
|
|
|
122
|
|
|
162
|
|
|||||
|
Michigan
|
—
|
|
|
—
|
|
|
8,011
|
|
|
8,011
|
|
|
17,471
|
|
|||||
|
New Mexico
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
11,322
|
|
|||||
|
Ohio
|
7,791
|
|
|
8,117
|
|
|
6,912
|
|
|
22,820
|
|
|
30,426
|
|
|||||
|
Texas
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
18,518
|
|
|||||
|
Utah
|
—
|
|
|
—
|
|
|
3,000
|
|
|
3,000
|
|
|
5,332
|
|
|||||
|
Washington
|
6,229
|
|
|
6,489
|
|
|
6,217
|
|
|
18,935
|
|
|
25,246
|
|
|||||
|
Wisconsin
|
1,080
|
|
|
1,126
|
|
|
1,372
|
|
|
3,578
|
|
|
4,771
|
|
|||||
|
Medicaid
|
16,556
|
|
|
17,247
|
|
|
27,039
|
|
|
60,842
|
|
|
130,699
|
|
|||||
|
Medicare
|
2,892
|
|
|
3,199
|
|
|
3,068
|
|
|
9,159
|
|
|
12,212
|
|
|||||
|
|
$
|
19,448
|
|
|
$
|
20,446
|
|
|
$
|
30,107
|
|
|
$
|
70,001
|
|
|
$
|
142,911
|
|
|
(1)
|
Amounts in the table include the full economic impact of the excise tax including premium tax and the income tax effect.
|
|
|
Total
|
|
2014
|
|
2015-2016
|
|
2017-2018
|
|
2019 and Beyond
|
||||||||||
|
Significant changes from December 31, 2013: (1)
|
|||||||||||||||||||
|
Medical claims and benefits payable (2)
|
$
|
1,123,846
|
|
|
$
|
1,123,846
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
Principal amount of convertible senior notes (3)
|
862,000
|
|
|
10,449
|
|
|
—
|
|
|
—
|
|
|
851,551
|
|
|||||
|
Amounts due under various contractual provisions (4)
|
297,083
|
|
|
297,083
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
Interest (coupon) on long-term debt (3)
|
179,176
|
|
|
2,772
|
|
|
22,175
|
|
|
22,175
|
|
|
132,054
|
|
|||||
|
Contingent consideration liability (5)
|
1,500
|
|
|
1,500
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
No significant changes from December 31, 2013: (6)
|
|||||||||||||||||||
|
Lease financing obligations
|
392,021
|
|
|
11,065
|
|
|
23,136
|
|
|
24,545
|
|
|
333,275
|
|
|||||
|
Operating leases
|
109,038
|
|
|
29,117
|
|
|
39,086
|
|
|
27,266
|
|
|
13,569
|
|
|||||
|
Lease financing obligations - related party
|
84,974
|
|
|
3,330
|
|
|
14,018
|
|
|
15,088
|
|
|
52,538
|
|
|||||
|
Purchase commitments
|
27,522
|
|
|
21,548
|
|
|
5,974
|
|
|
—
|
|
|
—
|
|
|||||
|
Total contractual obligations
|
$
|
3,077,160
|
|
|
$
|
1,500,710
|
|
|
$
|
104,389
|
|
|
$
|
89,074
|
|
|
$
|
1,382,987
|
|
|
(1)
|
These categories of contractual obligations have changed significantly since December 31, 2013. The amounts presented represent the remaining obligation for 2014 as of September 30, 2014.
|
|
(2)
|
Increase due to significantly increased membership in 2014, as described further in Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
10
, "
Medical Claims and Benefits Payable
," and Item 2, "Management's Discussion and Analysis of Financial Condition and Results of Operations."
|
|
(3)
|
Increases due to our third quarter 2014 issuance of 1.625% Convertible Senior Notes due 2044 (1.625% Notes), including an exchange transaction, as described in Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
11
, "
Long-Term Debt
." The 1.625% Notes have a contractual maturity date in 2044; however, on specified dates beginning in 2018, holders of the 1.625% Notes may require us to repurchase some or all of the 1.625% Notes.
|
|
(4)
|
Represents amounts due under various contractual provisions that may adjust or limit revenue or profit, as discussed in Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
2
, "
Significant Accounting Policies
." The increase is primarily driven by contractual provisions relating to the Medicaid expansion program, which began to phase in effective January 1, 2014.
|
|
(5)
|
Decrease due to settlement of contingent consideration liabilities during 2014 as described in Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
4
, "
Business Combinations
."
|
|
(6)
|
Amounts presented reflect the amounts reported in our 2013 Annual Report on Form 10-K because there have been no significant changes since that date.
|
|
•
|
Health Plans segment medical claims and benefits payable
. Refer to Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
10
, "
Medical Claims and Benefits Payable
," for a table which presents the components of the change in medical claims and benefits payable, and for additional information regarding the factors used to determine our changes in estimates for all periods presented in the accompanying consolidated financial statements.
|
|
•
|
Health Plans segment contractual provisions that may adjust or limit revenue or profit
. Refer to Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
2
, "
Significant Accounting Policies
," for a discussion of amounts recorded in the
third quarter
of
2014
in connection with such contractual provisions.
|
|
•
|
Health Plans segment quality incentives
. Refer to Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, in Note
2
, "
Significant Accounting Policies
," for a discussion of amounts recorded in the
third quarter
of
2014
in connection with such quality incentives.
|
|
•
|
Molina Medicaid Solutions segment revenue and cost recognition
.
|
|
|
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 (b)
|
||||||
|
July 1 - July 31
|
276
|
|
|
$
|
46.10
|
|
|
—
|
|
|
$
|
47,338,505
|
|
|
August 1 - August 31
|
2,108
|
|
|
$
|
41.19
|
|
|
—
|
|
|
$
|
47,338,505
|
|
|
September 1 - September 30
|
897
|
|
|
$
|
47.84
|
|
|
—
|
|
|
$
|
47,338,505
|
|
|
Total
|
3,281
|
|
|
$
|
43.42
|
|
|
—
|
|
|
|
||
|
(a)
|
During the
three months ended September 30, 2014
, we withheld 3,281 shares of common stock under our 2002 Equity Incentive Plan and 2011 Equity Incentive Plan to settle our employees' income tax obligations.
|
|
(b)
|
Effective as of September 30, 2013, our board of directors authorized the repurchase of up to $50.0 million in aggregate of our common stock. Stock repurchases under this program may be made through open-market and/or privately negotiated transactions at times and in such amounts as management deems appropriate. The timing and actual number of shares repurchased will depend on a variety of factors including price, corporate and regulatory requirements and market conditions. This repurchase program extends through December 31, 2014.
|
|
|
|
|
MOLINA HEALTHCARE, INC.
|
|
|
|
|
(Registrant)
|
|
|
|
|
|
|
Dated:
|
October 30, 2014
|
|
/s/ JOSEPH M. MOLINA, M.D.
|
|
|
|
|
Joseph M. Molina, M.D.
|
|
|
|
|
Chairman of the Board,
|
|
|
|
|
Chief Executive Officer and President
|
|
|
|
|
(Principal Executive Officer)
|
|
|
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Dated:
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October 30, 2014
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/s/ JOHN C. MOLINA, J.D.
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John C. Molina, J.D.
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Chief Financial Officer and Treasurer
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(Principal Financial Officer)
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Exhibit No.
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Title
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31.1
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Certification of Chief Executive Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended.
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31.2
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Certification of Chief Financial Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended.
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32.1
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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.
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32.2
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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.
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101.INS
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XBRL Taxonomy Instance Document.
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101.SCH
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XBRL Taxonomy Extension Schema Document.
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101.CAL
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XBRL Taxonomy Extension Calculation Linkbase Document.
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101.DEF
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XBRL Taxonomy Extension Definition Linkbase Document.
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101.LAB
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XBRL Taxonomy Extension Label Linkbase Document.
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101.PRE
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XBRL Taxonomy Extension Presentation Linkbase Document.
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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 |
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| DIRECTORS | AGE | BIO | OTHER DIRECTOR MEMBERSHIPS |
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No information found
No Customers Found
No Suppliers Found
Price
Yield
| Owner | Position | Direct Shares | Indirect Shares |
|---|