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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
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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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¨
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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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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.
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Item 6.
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September 30,
2016 |
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December 31,
2015 |
||||
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(Amounts in millions,
except per-share data)
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||||||
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(Unaudited)
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||||
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ASSETS
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|||||||
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Current assets:
|
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||||
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Cash and cash equivalents
|
$
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2,842
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$
|
2,329
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Investments
|
1,735
|
|
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1,801
|
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||
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Receivables
|
1,053
|
|
|
597
|
|
||
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Income taxes refundable
|
—
|
|
|
13
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|
||
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Prepaid expenses and other current assets
|
169
|
|
|
192
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|
||
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Derivative asset
|
314
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374
|
|
||
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Total current assets
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6,113
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|
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5,306
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Property, equipment, and capitalized software, net
|
450
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|
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393
|
|
||
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Deferred contract costs
|
83
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|
|
81
|
|
||
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Intangible assets, net
|
149
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|
|
122
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|
||
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Goodwill
|
619
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|
|
519
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|
||
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Restricted investments
|
116
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|
|
109
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|
||
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Deferred income taxes
|
—
|
|
|
18
|
|
||
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Other assets
|
40
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|
|
28
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|
||
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$
|
7,570
|
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$
|
6,576
|
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||||
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LIABILITIES AND STOCKHOLDERS’ EQUITY
|
|||||||
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Current liabilities:
|
|
|
|
||||
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Medical claims and benefits payable
|
$
|
1,871
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|
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$
|
1,685
|
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Amounts due government agencies
|
1,232
|
|
|
729
|
|
||
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Accounts payable and accrued liabilities
|
383
|
|
|
362
|
|
||
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Deferred revenue
|
380
|
|
|
223
|
|
||
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Income taxes payable
|
19
|
|
|
—
|
|
||
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Current portion of long-term debt
|
466
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|
|
449
|
|
||
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Derivative liability
|
314
|
|
|
374
|
|
||
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Total current liabilities
|
4,665
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|
3,822
|
|
||
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Senior notes
|
971
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|
962
|
|
||
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Lease financing obligations
|
198
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|
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198
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|
||
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Deferred income taxes
|
6
|
|
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—
|
|
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Other long-term liabilities
|
39
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|
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37
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|
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Total liabilities
|
5,879
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5,019
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||||
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Stockholders’ equity:
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||||
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Common stock, $0.001 par value; 150 shares authorized; outstanding: 57 shares at September 30, 2016 and 56 shares at December 31, 2015
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—
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—
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||
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Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding
|
—
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—
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|
||
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Additional paid-in capital
|
831
|
|
|
803
|
|
||
|
Accumulated other comprehensive gain (loss)
|
3
|
|
|
(4
|
)
|
||
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Retained earnings
|
857
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|
|
758
|
|
||
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Total stockholders' equity
|
1,691
|
|
|
1,557
|
|
||
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$
|
7,570
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$
|
6,576
|
|
|
|
Three Months Ended September 30,
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Nine Months Ended September 30,
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||||||||||||
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2016
|
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2015
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2016
|
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2015
|
||||||||
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(In millions, except per-share data)
(Unaudited)
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||||||||||||||
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Revenue:
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||||||||
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Premium revenue
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$
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4,191
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$
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3,377
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$
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12,215
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$
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9,652
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Service revenue
|
133
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|
|
47
|
|
|
408
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|
|
146
|
|
||||
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Premium tax revenue
|
127
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|
|
99
|
|
|
345
|
|
|
289
|
|
||||
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Health insurer fee revenue
|
85
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|
|
81
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|
|
251
|
|
|
203
|
|
||||
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Investment income
|
9
|
|
|
5
|
|
|
25
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|
|
12
|
|
||||
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Other revenue
|
1
|
|
|
2
|
|
|
4
|
|
|
5
|
|
||||
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Total revenue
|
4,546
|
|
|
3,611
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|
|
13,248
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|
|
10,307
|
|
||||
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Operating expenses:
|
|
|
|
|
|
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|
||||||||
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Medical care costs
|
3,748
|
|
|
3,016
|
|
|
10,930
|
|
|
8,581
|
|
||||
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Cost of service revenue
|
119
|
|
|
34
|
|
|
362
|
|
|
103
|
|
||||
|
General and administrative expenses
|
343
|
|
|
287
|
|
|
1,034
|
|
|
830
|
|
||||
|
Premium tax expenses
|
127
|
|
|
99
|
|
|
345
|
|
|
289
|
|
||||
|
Health insurer fee expenses
|
55
|
|
|
36
|
|
|
163
|
|
|
117
|
|
||||
|
Depreciation and amortization
|
36
|
|
|
26
|
|
|
102
|
|
|
76
|
|
||||
|
Total operating expenses
|
4,428
|
|
|
3,498
|
|
|
12,936
|
|
|
9,996
|
|
||||
|
Operating income
|
118
|
|
|
113
|
|
|
312
|
|
|
311
|
|
||||
|
Interest expense
|
26
|
|
|
15
|
|
|
76
|
|
|
45
|
|
||||
|
Income before income tax expense
|
92
|
|
|
98
|
|
|
236
|
|
|
266
|
|
||||
|
Income tax expense
|
50
|
|
|
52
|
|
|
137
|
|
|
153
|
|
||||
|
Net income
|
$
|
42
|
|
|
$
|
46
|
|
|
$
|
99
|
|
|
$
|
113
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Net income per share:
|
|
|
|
|
|
|
|
||||||||
|
Basic
|
$
|
0.77
|
|
|
$
|
0.84
|
|
|
$
|
1.79
|
|
|
$
|
2.21
|
|
|
Diluted
|
$
|
0.76
|
|
|
$
|
0.77
|
|
|
$
|
1.77
|
|
|
$
|
2.07
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2016
|
|
2015
|
|
2016
|
|
2015
|
||||||||
|
|
(Amounts in millions)
(Unaudited)
|
||||||||||||||
|
Net income
|
$
|
42
|
|
|
$
|
46
|
|
|
$
|
99
|
|
|
$
|
113
|
|
|
Other comprehensive (loss) income:
|
|
|
|
|
|
|
|
||||||||
|
Unrealized investment (loss) gain
|
(3
|
)
|
|
2
|
|
|
10
|
|
|
1
|
|
||||
|
Less: effect of income taxes
|
(2
|
)
|
|
—
|
|
|
3
|
|
|
—
|
|
||||
|
Other comprehensive (loss) income, net of tax
|
(1
|
)
|
|
2
|
|
|
7
|
|
|
1
|
|
||||
|
Comprehensive income
|
$
|
41
|
|
|
$
|
48
|
|
|
$
|
106
|
|
|
$
|
114
|
|
|
|
Nine Months Ended September 30,
|
||||||
|
|
2016
|
|
2015
|
||||
|
|
(Amounts in millions)
(Unaudited) |
||||||
|
Operating activities:
|
|
|
|
||||
|
Net income
|
$
|
99
|
|
|
$
|
113
|
|
|
Adjustments to reconcile net income to net cash provided by operating activities:
|
|
|
|
||||
|
Depreciation and amortization
|
135
|
|
|
93
|
|
||
|
Deferred income taxes
|
20
|
|
|
(12
|
)
|
||
|
Share-based compensation
|
24
|
|
|
16
|
|
||
|
Amortization of convertible senior notes and lease financing obligations
|
23
|
|
|
22
|
|
||
|
Other, net
|
14
|
|
|
13
|
|
||
|
Changes in operating assets and liabilities:
|
|
|
|
||||
|
Receivables
|
(427
|
)
|
|
(23
|
)
|
||
|
Prepaid expenses and other assets
|
(116
|
)
|
|
(63
|
)
|
||
|
Medical claims and benefits payable
|
168
|
|
|
359
|
|
||
|
Amounts due government agencies
|
503
|
|
|
453
|
|
||
|
Accounts payable and accrued liabilities
|
1
|
|
|
34
|
|
||
|
Deferred revenue
|
157
|
|
|
(129
|
)
|
||
|
Income taxes
|
32
|
|
|
30
|
|
||
|
Net cash provided by operating activities
|
633
|
|
|
906
|
|
||
|
Investing activities:
|
|
|
|
||||
|
Purchases of investments
|
(1,444
|
)
|
|
(1,311
|
)
|
||
|
Proceeds from sales and maturities of investments
|
1,512
|
|
|
863
|
|
||
|
Purchases of property, equipment and capitalized software
|
(143
|
)
|
|
(101
|
)
|
||
|
Change in restricted investments
|
4
|
|
|
(5
|
)
|
||
|
Net cash paid in business combinations
|
(48
|
)
|
|
(77
|
)
|
||
|
Other, net
|
(12
|
)
|
|
(34
|
)
|
||
|
Net cash used in investing activities
|
(131
|
)
|
|
(665
|
)
|
||
|
Financing activities:
|
|
|
|
||||
|
Proceeds from common stock offering, net of issuance costs
|
—
|
|
|
373
|
|
||
|
Proceeds from employee stock plans
|
10
|
|
|
8
|
|
||
|
Other, net
|
1
|
|
|
3
|
|
||
|
Net cash provided by financing activities
|
11
|
|
|
384
|
|
||
|
Net increase in cash and cash equivalents
|
513
|
|
|
625
|
|
||
|
Cash and cash equivalents at beginning of period
|
2,329
|
|
|
1,539
|
|
||
|
Cash and cash equivalents at end of period
|
$
|
2,842
|
|
|
$
|
2,164
|
|
|
|
Nine Months Ended September 30,
|
||||||
|
|
2016
|
|
2015
|
||||
|
|
(Amounts in millions)
(Unaudited) |
||||||
|
Supplemental cash flow information:
|
|
|
|
||||
|
|
|
|
|
||||
|
Schedule of non-cash investing and financing activities:
|
|
|
|
||||
|
Common stock used for share-based compensation
|
$
|
(8
|
)
|
|
$
|
(9
|
)
|
|
|
|
|
|
||||
|
Details of change in fair value of derivatives, net:
|
|
|
|
||||
|
(Loss) gain on 1.125% Call Option
|
$
|
(60
|
)
|
|
$
|
161
|
|
|
Gain (loss) on 1.125% Conversion Option
|
60
|
|
|
(161
|
)
|
||
|
Change in fair value of derivatives, net
|
$
|
—
|
|
|
$
|
—
|
|
|
|
|
|
|
||||
|
Details of business combinations:
|
|
|
|
||||
|
Fair value of assets acquired
|
$
|
(186
|
)
|
|
$
|
(69
|
)
|
|
Fair value of liabilities assumed
|
28
|
|
|
—
|
|
||
|
Purchase price amounts accrued/received (paid)
|
8
|
|
|
(8
|
)
|
||
|
Reversal of amounts advanced to sellers in prior year
|
102
|
|
|
—
|
|
||
|
Net cash paid in business combinations
|
$
|
(48
|
)
|
|
$
|
(77
|
)
|
|
•
|
Completion of the Aetna-Humana Merger;
|
|
•
|
Resolution, in a manner permitting the Medicare Acquisition, of the pending litigation brought by the United States Department of Justice challenging the Aetna-Humana Merger;
|
|
•
|
Approval by the federal Centers for Medicare & Medicaid Services (CMS) of the novation to us of each of the contracts to be divested under the Medicare Acquisition; and
|
|
•
|
Customary closing conditions, including approvals of state departments of insurance and other regulators.
|
|
|
September 30, 2016
|
|
December 31,
2015 |
||||||||||||
|
|
Current Benefit Year
|
|
Prior Benefit Years
|
|
Total
|
|
|||||||||
|
|
(In millions)
|
||||||||||||||
|
Risk adjustment
|
$
|
(372
|
)
|
|
$
|
2
|
|
|
$
|
(370
|
)
|
|
$
|
(214
|
)
|
|
Reinsurance
|
62
|
|
|
4
|
|
|
66
|
|
|
36
|
|
||||
|
Risk corridor
|
(4
|
)
|
|
(1
|
)
|
|
(5
|
)
|
|
(10
|
)
|
||||
|
Minimum MLR
|
(11
|
)
|
|
(4
|
)
|
|
(15
|
)
|
|
(3
|
)
|
||||
|
•
|
Risk adjustment: Under this permanent program, our health plans' composite risk scores are compared with the overall average risk score for the relevant state and market pool. Generally, our health plans will make a risk transfer payment into the pool if their composite risk scores are below the average risk score, and will receive a risk transfer payment from the pool if their composite risk scores are above the average risk score. We estimate our ultimate premium based on insurance policy year-to-date experience, and recognize estimated premiums relating to the risk adjustment program as an adjustment to premium revenue in our consolidated statements of income. On June 30, 2016, CMS released the final update on risk transfer and reinsurance payments for the 2015 benefit year, and we adjusted our accruals accordingly.
|
|
•
|
Reinsurance: This program is designed to provide reimbursement to insurers for high cost members. Our health plans pay an annual contribution on a per-member basis, and are eligible for recoveries if claims for individual members exceed a specified threshold, up to a maximum amount. This three-year program will end on December 31, 2016. We recognize the assessments to fund the transitional reinsurance program as a reduction to premium revenue in our consolidated statements of income. We recognize recoveries under the reinsurance program as a reduction to medical care costs in our consolidated statements of income.
|
|
•
|
Risk corridor: This program is intended to limit gains and losses of insurers by comparing allowable costs to a target amount as defined by CMS. Variances from the target amount exceeding certain thresholds may result in amounts due to or receivables due from CMS. This three-year program will end on December 31, 2016. Due to uncertainties as to the amount of federal funding available to support the risk corridor program, we do not recognize amounts receivable under this program. Our estimate of the unrecorded receivable for the Marketplace risk corridor amounted to approximately
$80 million
as of September 30, 2016. Of this total amount,
$52 million
relates to the 2015 benefit year and
$28 million
relates to the nine months ended September 30, 2016. All liabilities are recognized as incurred. We estimate our ultimate premium based on insurance policy year-to-date experience, and recognize estimated premiums relating to the risk corridor program as an adjustment to premium revenue in our consolidated statements of income.
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2016
|
|
2015
|
|
2016
|
|
2015
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Maximum available quality incentive premium - current period
|
$
|
33
|
|
|
$
|
28
|
|
|
$
|
114
|
|
|
$
|
86
|
|
|
Amount of quality incentive premium revenue recognized in current period:
|
|
|
|
|
|
|
|
||||||||
|
Earned current period
|
$
|
26
|
|
|
$
|
17
|
|
|
$
|
80
|
|
|
$
|
38
|
|
|
Earned prior periods
|
—
|
|
|
—
|
|
|
54
|
|
|
11
|
|
||||
|
Total
|
$
|
26
|
|
|
$
|
17
|
|
|
$
|
134
|
|
|
49
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Quality incentive premium revenue recognized as a percentage of total premium revenue
|
0.6
|
%
|
|
0.5
|
%
|
|
1.1
|
%
|
|
0.5
|
%
|
||||
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2016
|
|
2015
|
|
2016
|
|
2015
|
||||||||
|
|
(In millions, except net income per share)
|
||||||||||||||
|
Numerator:
|
|
|
|
|
|
|
|
||||||||
|
Net income
|
$
|
42
|
|
|
$
|
46
|
|
|
$
|
99
|
|
|
$
|
113
|
|
|
Denominator:
|
|
|
|
|
|
|
|
||||||||
|
Shares outstanding at the beginning of the period
|
56
|
|
|
55
|
|
|
55
|
|
|
49
|
|
||||
|
Weighted-average number of shares:
|
|
|
|
|
|
|
|
||||||||
|
Issued in common stock offering
|
—
|
|
|
—
|
|
|
—
|
|
|
2
|
|
||||
|
Denominator for basic net income per share
|
56
|
|
|
55
|
|
|
55
|
|
|
51
|
|
||||
|
Effect of dilutive securities:
|
|
|
|
|
|
|
|
||||||||
|
Share-based compensation
|
—
|
|
|
—
|
|
|
—
|
|
|
1
|
|
||||
|
Convertible senior notes (1)
|
—
|
|
|
1
|
|
|
—
|
|
|
1
|
|
||||
|
1.125% Warrants (1)
|
—
|
|
|
4
|
|
|
1
|
|
|
2
|
|
||||
|
Denominator for diluted net income per share
|
56
|
|
|
60
|
|
|
56
|
|
|
55
|
|
||||
|
|
|
|
|
|
|
|
|
||||||||
|
Net income per share (2):
|
|
|
|
|
|
|
|
||||||||
|
Basic
|
$
|
0.77
|
|
|
$
|
0.84
|
|
|
$
|
1.79
|
|
|
$
|
2.21
|
|
|
Diluted
|
$
|
0.76
|
|
|
$
|
0.77
|
|
|
$
|
1.77
|
|
|
$
|
2.07
|
|
|
(1)
|
For more information regarding the convertible senior notes, refer to Note
10
, "
Debt
." For more information regarding the 1.125% Warrants, refer to Note
12
, "
Stockholders' Equity
."
|
|
(2)
|
Source data for calculations in thousands.
|
|
|
Fair Value
|
|
Life
|
||
|
|
(In millions)
|
|
(Years)
|
||
|
Intangible asset type:
|
|
|
|
||
|
Contract rights - member list
|
$
|
38
|
|
|
5
|
|
Provider network
|
7
|
|
|
10
|
|
|
|
$
|
45
|
|
|
|
|
|
Total
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Corporate debt securities
|
$
|
1,127
|
|
|
$
|
—
|
|
|
$
|
1,127
|
|
|
$
|
—
|
|
|
Government-sponsored enterprise securities (GSEs)
|
259
|
|
|
259
|
|
|
—
|
|
|
—
|
|
||||
|
Municipal securities
|
148
|
|
|
—
|
|
|
148
|
|
|
—
|
|
||||
|
Asset-backed securities
|
76
|
|
|
—
|
|
|
76
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
65
|
|
|
65
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
60
|
|
|
—
|
|
|
60
|
|
|
—
|
|
||||
|
Subtotal - current investments
|
1,735
|
|
|
324
|
|
|
1,411
|
|
|
—
|
|
||||
|
1.125% Call Option derivative asset
|
314
|
|
|
—
|
|
|
—
|
|
|
314
|
|
||||
|
Total assets measured at fair value on a recurring basis
|
$
|
2,049
|
|
|
$
|
324
|
|
|
$
|
1,411
|
|
|
$
|
314
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
1.125% Conversion Option derivative liability
|
$
|
314
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
314
|
|
|
Total liabilities measured at fair value on a recurring basis
|
$
|
314
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
314
|
|
|
|
Total
|
|
Level 1
|
|
Level 2
|
|
Level 3
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Corporate debt securities
|
$
|
1,184
|
|
|
$
|
—
|
|
|
$
|
1,184
|
|
|
$
|
—
|
|
|
GSEs
|
211
|
|
|
211
|
|
|
—
|
|
|
—
|
|
||||
|
Municipal securities
|
185
|
|
|
—
|
|
|
185
|
|
|
—
|
|
||||
|
Asset-backed securities
|
63
|
|
|
—
|
|
|
63
|
|
|
—
|
|
||||
|
U.S. treasury notes
|
78
|
|
|
78
|
|
|
—
|
|
|
—
|
|
||||
|
Certificates of deposit
|
80
|
|
|
—
|
|
|
80
|
|
|
—
|
|
||||
|
Subtotal - current investments
|
1,801
|
|
|
289
|
|
|
1,512
|
|
|
—
|
|
||||
|
1.125% Call Option derivative asset
|
374
|
|
|
—
|
|
|
—
|
|
|
374
|
|
||||
|
Total assets measured at fair value on a recurring basis
|
$
|
2,175
|
|
|
$
|
289
|
|
|
$
|
1,512
|
|
|
$
|
374
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
1.125% Conversion Option derivative liability
|
$
|
374
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
374
|
|
|
Total liabilities measured at fair value on a recurring basis
|
$
|
374
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
374
|
|
|
|
September 30, 2016
|
|
December 31, 2015
|
||||||||||||
|
|
Carrying
Value
|
|
Fair Value
|
|
Carrying
Value
|
|
Fair Value
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
5.375% Notes
|
$
|
690
|
|
|
$
|
725
|
|
|
$
|
689
|
|
|
$
|
700
|
|
|
1.125% Convertible Notes
|
466
|
|
|
827
|
|
|
448
|
|
|
865
|
|
||||
|
1.625% Convertible Notes
|
281
|
|
|
358
|
|
|
273
|
|
|
365
|
|
||||
|
|
$
|
1,437
|
|
|
$
|
1,910
|
|
|
$
|
1,410
|
|
|
$
|
1,930
|
|
|
|
September 30, 2016
|
||||||||||||||
|
|
Amortized
|
|
Gross
Unrealized
|
|
Estimated
Fair
|
||||||||||
|
|
Cost
|
|
Gains
|
|
Losses
|
|
Value
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Corporate debt securities
|
$
|
1,123
|
|
|
$
|
4
|
|
|
$
|
—
|
|
|
$
|
1,127
|
|
|
GSEs
|
259
|
|
|
—
|
|
|
—
|
|
|
259
|
|
||||
|
Municipal securities
|
147
|
|
|
1
|
|
|
—
|
|
|
148
|
|
||||
|
Asset-backed securities
|
76
|
|
|
—
|
|
|
—
|
|
|
76
|
|
||||
|
U.S. treasury notes
|
65
|
|
|
—
|
|
|
—
|
|
|
65
|
|
||||
|
Certificates of deposit
|
60
|
|
|
—
|
|
|
—
|
|
|
60
|
|
||||
|
|
$
|
1,730
|
|
|
$
|
5
|
|
|
$
|
—
|
|
|
$
|
1,735
|
|
|
|
December 31, 2015
|
||||||||||||||
|
|
Amortized
|
|
Gross
Unrealized
|
|
Estimated
Fair
|
||||||||||
|
|
Cost
|
|
Gains
|
|
Losses
|
|
Value
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Corporate debt securities
|
$
|
1,189
|
|
|
$
|
—
|
|
|
$
|
5
|
|
|
$
|
1,184
|
|
|
GSEs
|
212
|
|
|
—
|
|
|
1
|
|
|
211
|
|
||||
|
Municipal securities
|
186
|
|
|
—
|
|
|
1
|
|
|
185
|
|
||||
|
Asset-backed securities
|
63
|
|
|
—
|
|
|
—
|
|
|
63
|
|
||||
|
U.S. treasury notes
|
78
|
|
|
—
|
|
|
—
|
|
|
78
|
|
||||
|
Certificates of deposit
|
80
|
|
|
—
|
|
|
—
|
|
|
80
|
|
||||
|
|
$
|
1,808
|
|
|
$
|
—
|
|
|
$
|
7
|
|
|
$
|
1,801
|
|
|
|
Amortized Cost
|
|
Estimated
Fair Value
|
||||
|
|
(In millions)
|
||||||
|
Due in one year or less
|
$
|
887
|
|
|
$
|
887
|
|
|
Due after one year through five years
|
817
|
|
|
821
|
|
||
|
Due after five years through ten years
|
26
|
|
|
27
|
|
||
|
|
$
|
1,730
|
|
|
$
|
1,735
|
|
|
|
In a Continuous Loss Position
for Less than 12 Months
|
|
In a Continuous Loss Position
for 12 Months or More
|
||||||||||||||||||
|
|
Estimated
Fair
Value
|
|
Unrealized
Losses
|
|
Total
Number of
Positions
|
|
Estimated
Fair
Value
|
|
Unrealized
Losses
|
|
Total
Number of
Positions
|
||||||||||
|
|
(Dollars in millions)
|
||||||||||||||||||||
|
Corporate debt securities
|
$
|
825
|
|
|
$
|
4
|
|
|
588
|
|
|
$
|
119
|
|
|
$
|
1
|
|
|
87
|
|
|
GSEs
|
182
|
|
|
1
|
|
|
77
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
Municipal securities
|
128
|
|
|
1
|
|
|
181
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
|
$
|
1,135
|
|
|
$
|
6
|
|
|
846
|
|
|
$
|
119
|
|
|
$
|
1
|
|
|
87
|
|
|
|
September 30,
2016 |
|
December 31,
2015 |
||||
|
|
(In millions)
|
||||||
|
California
|
$
|
174
|
|
|
$
|
104
|
|
|
Florida
|
79
|
|
|
22
|
|
||
|
Illinois
|
81
|
|
|
35
|
|
||
|
Michigan
|
71
|
|
|
39
|
|
||
|
New Mexico
|
78
|
|
|
51
|
|
||
|
New York
|
33
|
|
|
—
|
|
||
|
Ohio
|
133
|
|
|
66
|
|
||
|
Puerto Rico
|
82
|
|
|
33
|
|
||
|
South Carolina
|
12
|
|
|
6
|
|
||
|
Texas
|
62
|
|
|
56
|
|
||
|
Utah
|
32
|
|
|
18
|
|
||
|
Washington
|
94
|
|
|
53
|
|
||
|
Wisconsin
|
27
|
|
|
22
|
|
||
|
Direct delivery and other
|
3
|
|
|
6
|
|
||
|
Total Health Plans segment
|
961
|
|
|
511
|
|
||
|
Molina Medicaid Solutions segment
|
39
|
|
|
37
|
|
||
|
Other segment
|
53
|
|
|
49
|
|
||
|
|
$
|
1,053
|
|
|
$
|
597
|
|
|
|
September 30,
2016 |
|
December 31,
2015 |
||||
|
|
(In millions)
|
||||||
|
Florida
|
$
|
28
|
|
|
$
|
34
|
|
|
Illinois
|
3
|
|
|
—
|
|
||
|
Michigan
|
1
|
|
|
1
|
|
||
|
New Mexico
|
43
|
|
|
43
|
|
||
|
New York
|
9
|
|
|
—
|
|
||
|
Ohio
|
12
|
|
|
12
|
|
||
|
Puerto Rico
|
10
|
|
|
10
|
|
||
|
Texas
|
4
|
|
|
4
|
|
||
|
Utah
|
4
|
|
|
4
|
|
||
|
Wisconsin
|
1
|
|
|
1
|
|
||
|
Other
|
1
|
|
|
—
|
|
||
|
Total Health Plans segment
|
$
|
116
|
|
|
$
|
109
|
|
|
|
Amortized
Cost
|
|
Estimated
Fair Value
|
||||
|
|
(In millions)
|
||||||
|
Due in one year or less
|
$
|
115
|
|
|
$
|
115
|
|
|
Due after one year through five years
|
1
|
|
|
1
|
|
||
|
|
$
|
116
|
|
|
$
|
116
|
|
|
|
September 30,
2016 |
|
December 31,
2015 |
||||
|
|
(In millions)
|
||||||
|
Fee-for-service claims incurred but not paid (IBNP)
|
$
|
1,333
|
|
|
$
|
1,191
|
|
|
Pharmacy payable
|
114
|
|
|
88
|
|
||
|
Capitation payable
|
27
|
|
|
140
|
|
||
|
Other
|
397
|
|
|
266
|
|
||
|
|
$
|
1,871
|
|
|
$
|
1,685
|
|
|
|
Nine Months Ended September 30, 2016
|
|
Year Ended
December 31, 2015 |
||||
|
|
(Dollars in millions)
|
||||||
|
Medical claims and benefits payable, beginning balance
|
$
|
1,685
|
|
|
$
|
1,201
|
|
|
Components of medical care costs related to:
|
|
|
|
||||
|
Current period
|
11,120
|
|
|
11,935
|
|
||
|
Prior periods
|
(190
|
)
|
|
(141
|
)
|
||
|
Total medical care costs
|
10,930
|
|
|
11,794
|
|
||
|
|
|
|
|
||||
|
Change in non-risk provider payables
|
70
|
|
|
48
|
|
||
|
|
|
|
|
||||
|
Payments for medical care costs related to:
|
|
|
|
||||
|
Current period
|
9,536
|
|
|
10,448
|
|
||
|
Prior periods
|
1,278
|
|
|
910
|
|
||
|
Total paid
|
10,814
|
|
|
11,358
|
|
||
|
Medical claims and benefits payable, ending balance
|
$
|
1,871
|
|
|
$
|
1,685
|
|
|
Benefit from prior period as a percentage of:
|
|
|
|
||||
|
Balance at beginning of period
|
11.3
|
%
|
|
11.8
|
%
|
||
|
Premium revenue, trailing twelve months
|
1.2
|
%
|
|
1.1
|
%
|
||
|
Medical care costs, trailing twelve months
|
1.3
|
%
|
|
1.2
|
%
|
||
|
•
|
Our New York health plan acquisition closed on August 1, 2016. This acquisition added approximately
37,000
new members. Because these members are new to Molina, our estimates of the liability we have incurred for services provided to these members are subject to more than the usual amount of uncertainty.
|
|
•
|
At our Florida, New Mexico, Puerto Rico, Utah and Washington health plans, we overpaid certain inpatient and outpatient facility claims. We adjusted our claims payment history to reflect the claims payment pattern that would have occurred without these overpayments. For this reason, our liability estimates at these health plans are subject to more than the usual amount of uncertainty.
|
|
•
|
At our Washington health plan, the covered benefits in two counties were expanded effective April 2016 to include behavioral health benefits under the state's new fully integrated managed care program, which impacted about
85,000
members. Because these are new benefits, our liability estimate at this health plan is subject to more than the usual amount of uncertainty.
|
|
•
|
Fluctuations in the volume of claims received in a paper format (rather than an electronic format) during the third quarter have created more than the usual amount of uncertainty regarding our estimate of the liability at our California health plan.
|
|
•
|
A new version of diagnostic codes was required for all claims with dates of service on October 1, 2015, and later. As a result, payment was delayed or denied for a significant number of claims due to provider submission of claims with diagnostic codes that were no longer valid. Once providers were able to submit claims with the correct diagnostic codes, our actual costs were ultimately less than expected.
|
|
•
|
At our New Mexico health plan, we overestimated the impact of several pending high-dollar claims, and our actual costs were ultimately less than expected.
|
|
•
|
At our Washington health plan, we overpaid certain outpatient facility claims in 2015 when the state converted to a new payment methodology. We did not include an estimate in the reserves for this potential recovery as of December 31, 2015.
|
|
•
|
At our California health plan, approximately
55,000
new members were added to our Medicaid Expansion product in 2015. For these new members, our actual costs were ultimately less than expected.
|
|
|
Total
|
|
2016
|
|
2017
|
|
2018
|
|
2019
|
|
2020
|
|
Thereafter
|
||||||||||||||
|
|
(In millions)
|
||||||||||||||||||||||||||
|
5.375% Notes
|
$
|
700
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
700
|
|
|
1.125% Convertible Notes
|
550
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
550
|
|
|
—
|
|
|||||||
|
1.625% Convertible Notes (1)
|
302
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
302
|
|
|||||||
|
|
$
|
1,552
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
550
|
|
|
$
|
1,002
|
|
|
(1)
|
The 1.625% Notes have a contractual maturity date in 2044; however, on contractually specified dates beginning in 2018, holders of the 1.625% Notes may require us to repurchase some or all of the 1.625% Notes, or we may redeem any or all of the 1.625% Notes.
|
|
|
Principal Balance
|
|
Unamortized Discount
|
|
Unamortized Issuance Costs
|
|
Net Carrying Amount
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
September 30, 2016:
|
|
|
|
|
|
|
|
||||||||
|
5.375% Notes
|
$
|
700
|
|
|
$
|
—
|
|
|
$
|
10
|
|
|
$
|
690
|
|
|
1.125% Convertible Notes
|
550
|
|
|
78
|
|
|
6
|
|
|
466
|
|
||||
|
1.625% Convertible Notes
|
302
|
|
|
18
|
|
|
3
|
|
|
281
|
|
||||
|
|
$
|
1,552
|
|
|
$
|
96
|
|
|
$
|
19
|
|
|
$
|
1,437
|
|
|
December 31, 2015:
|
|
|
|
|
|
|
|
||||||||
|
5.375% Notes
|
$
|
700
|
|
|
$
|
—
|
|
|
$
|
11
|
|
|
$
|
689
|
|
|
1.125% Convertible Notes
|
550
|
|
|
95
|
|
|
7
|
|
|
448
|
|
||||
|
1.625% Convertible Notes
|
302
|
|
|
25
|
|
|
4
|
|
|
273
|
|
||||
|
Other
|
1
|
|
|
—
|
|
|
—
|
|
|
1
|
|
||||
|
|
$
|
1,553
|
|
|
$
|
120
|
|
|
$
|
22
|
|
|
$
|
1,411
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2016
|
|
2015
|
|
2016
|
|
2015
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Contractual interest coupon rate
|
$
|
2
|
|
|
$
|
3
|
|
|
$
|
8
|
|
|
$
|
9
|
|
|
Amortization of the discount
|
7
|
|
|
7
|
|
|
22
|
|
|
21
|
|
||||
|
|
$
|
9
|
|
|
$
|
10
|
|
|
$
|
30
|
|
|
$
|
30
|
|
|
|
Balance Sheet Location
|
|
September 30,
2016 |
|
December 31,
2015 |
||||
|
|
|
|
(In millions)
|
||||||
|
Derivative asset:
|
|
|
|
|
|
||||
|
1.125% Call Option
|
Current assets: Derivative asset
|
|
$
|
314
|
|
|
$
|
374
|
|
|
Derivative liability:
|
|
|
|
|
|
||||
|
1.125% Conversion Option
|
Current liabilities: Derivative liability
|
|
$
|
314
|
|
|
$
|
374
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2016
|
|
2015
|
|
2016
|
|
2015
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Restricted stock and performance awards
|
$
|
7
|
|
|
$
|
6
|
|
|
$
|
20
|
|
|
$
|
13
|
|
|
Employee stock purchase plan and stock options
|
1
|
|
|
1
|
|
|
4
|
|
|
3
|
|
||||
|
|
$
|
8
|
|
|
$
|
7
|
|
|
$
|
24
|
|
|
$
|
16
|
|
|
|
Shares
|
|
Weighted
Average
Grant Date
Fair Value
|
|||
|
|
(In thousands)
|
|
|
|||
|
Unvested balance as of December 31, 2015
|
1,035
|
|
|
$
|
46.68
|
|
|
Granted
|
517
|
|
|
63.94
|
|
|
|
Vested
|
(342
|
)
|
|
41.79
|
|
|
|
Forfeited
|
(19
|
)
|
|
52.01
|
|
|
|
Unvested balance as of September 30, 2016
|
1,191
|
|
|
55.50
|
|
|
|
|
|
Health Plans
|
|
Molina Medicaid Solutions
|
|
Other
|
|
Consolidated
|
||||||||
|
|
|
|
|
|
||||||||||||
|
|
|
(In millions)
|
||||||||||||||
|
Three Months Ended September 30, 2016
|
|
|
|
|
|
|
|
|
||||||||
|
Total revenue (1)
|
|
$
|
4,412
|
|
|
$
|
48
|
|
|
$
|
86
|
|
|
$
|
4,546
|
|
|
Gross margin
|
|
443
|
|
|
6
|
|
|
8
|
|
|
457
|
|
||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
Nine Months Ended September 30, 2016
|
|
|
|
|
|
|
|
|
||||||||
|
Total revenue (1)
|
|
$
|
12,835
|
|
|
$
|
146
|
|
|
$
|
267
|
|
|
$
|
13,248
|
|
|
Gross margin
|
|
1,285
|
|
|
17
|
|
|
29
|
|
|
1,331
|
|
||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
Three Months Ended September 30, 2015
|
|
|
|
|
|
|
|
|
||||||||
|
Total revenue (1)
|
|
$
|
3,562
|
|
|
$
|
47
|
|
|
$
|
2
|
|
|
$
|
3,611
|
|
|
Gross margin
|
|
361
|
|
|
13
|
|
|
—
|
|
|
374
|
|
||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
Nine Months Ended September 30, 2015
|
|
|
|
|
|
|
|
|
||||||||
|
Total revenue (1)
|
|
$
|
10,155
|
|
|
$
|
146
|
|
|
$
|
6
|
|
|
$
|
10,307
|
|
|
Gross margin
|
|
1,071
|
|
|
43
|
|
|
—
|
|
|
1,114
|
|
||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
Total Assets
|
|
|
|
|
|
|
|
|
||||||||
|
September 30, 2016
|
|
$
|
5,891
|
|
|
$
|
267
|
|
|
$
|
1,412
|
|
|
$
|
7,570
|
|
|
December 31, 2015
|
|
4,707
|
|
|
213
|
|
|
1,656
|
|
|
6,576
|
|
||||
|
(1)
|
Total revenue consists primarily of premium revenue for the Health Plans segment, and service revenue for the Molina Medicaid Solutions and Other segments.
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
|
2016
|
|
2015
|
|
2016
|
|
2015
|
||||||||
|
|
(In millions)
|
||||||||||||||
|
Gross margin:
|
|
|
|
|
|
|
|
||||||||
|
Health Plans
|
$
|
443
|
|
|
$
|
361
|
|
|
$
|
1,285
|
|
|
$
|
1,071
|
|
|
Molina Medicaid Solutions
|
6
|
|
|
13
|
|
|
17
|
|
|
43
|
|
||||
|
Other
|
8
|
|
|
—
|
|
|
29
|
|
|
—
|
|
||||
|
Total gross margin
|
457
|
|
|
374
|
|
|
1,331
|
|
|
1,114
|
|
||||
|
Add: other operating revenues (1)
|
222
|
|
|
187
|
|
|
625
|
|
|
509
|
|
||||
|
Less: other operating expenses (2)
|
(561
|
)
|
|
(448
|
)
|
|
(1,644
|
)
|
|
(1,312
|
)
|
||||
|
Operating income
|
118
|
|
|
113
|
|
|
312
|
|
|
311
|
|
||||
|
Other expenses, net
|
(26
|
)
|
|
(15
|
)
|
|
(76
|
)
|
|
(45
|
)
|
||||
|
Income before income tax expense
|
$
|
92
|
|
|
$
|
98
|
|
|
$
|
236
|
|
|
$
|
266
|
|
|
(1)
|
Other operating revenues include premium tax revenue, health insurer fee revenue, investment income and other revenue.
|
|
(2)
|
Other operating expenses include general and administrative expenses, premium tax expenses, health insurer fee expenses and depreciation and amortization.
|
|
|
September 30, 2016
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
ASSETS
|
|||||||||||||||||||
|
Current assets:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Cash and cash equivalents
|
$
|
125
|
|
|
$
|
37
|
|
|
$
|
2,680
|
|
|
$
|
—
|
|
|
$
|
2,842
|
|
|
Investments
|
263
|
|
|
—
|
|
|
1,472
|
|
|
—
|
|
|
1,735
|
|
|||||
|
Receivables
|
3
|
|
|
84
|
|
|
966
|
|
|
—
|
|
|
1,053
|
|
|||||
|
Due from (to) affiliates
|
98
|
|
|
(5
|
)
|
|
(93
|
)
|
|
—
|
|
|
—
|
|
|||||
|
Prepaid expenses and other current assets
|
51
|
|
|
37
|
|
|
82
|
|
|
(1
|
)
|
|
169
|
|
|||||
|
Derivative asset
|
314
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
314
|
|
|||||
|
Total current assets
|
854
|
|
|
153
|
|
|
5,107
|
|
|
(1
|
)
|
|
6,113
|
|
|||||
|
Property, equipment, and capitalized software, net
|
300
|
|
|
69
|
|
|
81
|
|
|
—
|
|
|
450
|
|
|||||
|
Deferred contract costs
|
—
|
|
|
83
|
|
|
—
|
|
|
—
|
|
|
83
|
|
|||||
|
Intangible assets, net
|
7
|
|
|
21
|
|
|
121
|
|
|
—
|
|
|
149
|
|
|||||
|
Goodwill
|
51
|
|
|
231
|
|
|
337
|
|
|
—
|
|
|
619
|
|
|||||
|
Restricted investments
|
—
|
|
|
—
|
|
|
116
|
|
|
—
|
|
|
116
|
|
|||||
|
Investment in subsidiaries
|
2,526
|
|
|
1
|
|
|
—
|
|
|
(2,527
|
)
|
|
—
|
|
|||||
|
Other assets
|
47
|
|
|
4
|
|
|
5
|
|
|
(16
|
)
|
|
40
|
|
|||||
|
|
$
|
3,785
|
|
|
$
|
562
|
|
|
$
|
5,767
|
|
|
$
|
(2,544
|
)
|
|
$
|
7,570
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
LIABILITIES AND STOCKHOLDERS' EQUITY
|
|||||||||||||||||||
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Medical claims and benefits payable
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
1,871
|
|
|
$
|
—
|
|
|
$
|
1,871
|
|
|
Amounts due government agencies
|
—
|
|
|
—
|
|
|
1,232
|
|
|
—
|
|
|
1,232
|
|
|||||
|
Accounts payable and accrued liabilities
|
146
|
|
|
53
|
|
|
185
|
|
|
(1
|
)
|
|
383
|
|
|||||
|
Deferred revenue
|
—
|
|
|
42
|
|
|
338
|
|
|
—
|
|
|
380
|
|
|||||
|
Income taxes payable
|
(13
|
)
|
|
(5
|
)
|
|
37
|
|
|
—
|
|
|
19
|
|
|||||
|
Current portion of long-term debt
|
466
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
466
|
|
|||||
|
Derivative liability
|
314
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
314
|
|
|||||
|
Total current liabilities
|
913
|
|
|
90
|
|
|
3,663
|
|
|
(1
|
)
|
|
4,665
|
|
|||||
|
Long-term debt
|
1,169
|
|
|
—
|
|
|
16
|
|
|
(16
|
)
|
|
1,169
|
|
|||||
|
Deferred income taxes
|
(7
|
)
|
|
41
|
|
|
(28
|
)
|
|
—
|
|
|
6
|
|
|||||
|
Other long-term liabilities
|
19
|
|
|
2
|
|
|
18
|
|
|
—
|
|
|
39
|
|
|||||
|
Total liabilities
|
2,094
|
|
|
133
|
|
|
3,669
|
|
|
(17
|
)
|
|
5,879
|
|
|||||
|
Total stockholders’ equity
|
1,691
|
|
|
429
|
|
|
2,098
|
|
|
(2,527
|
)
|
|
1,691
|
|
|||||
|
|
$
|
3,785
|
|
|
$
|
562
|
|
|
$
|
5,767
|
|
|
$
|
(2,544
|
)
|
|
$
|
7,570
|
|
|
|
December 31, 2015
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
ASSETS
|
|||||||||||||||||||
|
Current assets:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Cash and cash equivalents
|
$
|
360
|
|
|
$
|
42
|
|
|
$
|
1,927
|
|
|
$
|
—
|
|
|
$
|
2,329
|
|
|
Investments
|
252
|
|
|
—
|
|
|
1,549
|
|
|
—
|
|
|
1,801
|
|
|||||
|
Receivables
|
—
|
|
|
79
|
|
|
518
|
|
|
—
|
|
|
597
|
|
|||||
|
Income tax refundable
|
7
|
|
|
3
|
|
|
3
|
|
|
—
|
|
|
13
|
|
|||||
|
Intercompany
|
86
|
|
|
(4
|
)
|
|
(82
|
)
|
|
—
|
|
|
—
|
|
|||||
|
Prepaid expenses and other current assets
|
46
|
|
|
11
|
|
|
136
|
|
|
(1
|
)
|
|
192
|
|
|||||
|
Derivative asset
|
374
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
374
|
|
|||||
|
Total current assets
|
1,125
|
|
|
131
|
|
|
4,051
|
|
|
(1
|
)
|
|
5,306
|
|
|||||
|
Property, equipment, and capitalized software, net
|
267
|
|
|
52
|
|
|
74
|
|
|
—
|
|
|
393
|
|
|||||
|
Deferred contract costs
|
—
|
|
|
81
|
|
|
—
|
|
|
—
|
|
|
81
|
|
|||||
|
Goodwill and intangible assets, net
|
61
|
|
|
246
|
|
|
334
|
|
|
—
|
|
|
641
|
|
|||||
|
Restricted investments
|
—
|
|
|
—
|
|
|
109
|
|
|
—
|
|
|
109
|
|
|||||
|
Investment in subsidiaries, net
|
2,205
|
|
|
1
|
|
|
—
|
|
|
(2,206
|
)
|
|
—
|
|
|||||
|
Deferred income taxes
|
23
|
|
|
(35
|
)
|
|
30
|
|
|
—
|
|
|
18
|
|
|||||
|
Other assets
|
36
|
|
|
2
|
|
|
6
|
|
|
(16
|
)
|
|
28
|
|
|||||
|
|
$
|
3,717
|
|
|
$
|
478
|
|
|
$
|
4,604
|
|
|
$
|
(2,223
|
)
|
|
$
|
6,576
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
LIABILITIES AND STOCKHOLDERS' EQUITY
|
|||||||||||||||||||
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Medical claims and benefits payable
|
$
|
—
|
|
|
$
|
3
|
|
|
$
|
1,682
|
|
|
$
|
—
|
|
|
$
|
1,685
|
|
|
Amounts due government agencies
|
—
|
|
|
1
|
|
|
728
|
|
|
—
|
|
|
729
|
|
|||||
|
Accounts payable and accrued liabilities
|
157
|
|
|
35
|
|
|
170
|
|
|
—
|
|
|
362
|
|
|||||
|
Deferred revenue
|
—
|
|
|
34
|
|
|
189
|
|
|
—
|
|
|
223
|
|
|||||
|
Current portion of long-term debt
|
449
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
449
|
|
|||||
|
Derivative liability
|
374
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
374
|
|
|||||
|
Total current liabilities
|
980
|
|
|
73
|
|
|
2,769
|
|
|
—
|
|
|
3,822
|
|
|||||
|
Long-term debt
|
1,160
|
|
|
—
|
|
|
16
|
|
|
(16
|
)
|
|
1,160
|
|
|||||
|
Other long-term liabilities
|
20
|
|
|
2
|
|
|
16
|
|
|
(1
|
)
|
|
37
|
|
|||||
|
Total liabilities
|
2,160
|
|
|
75
|
|
|
2,801
|
|
|
(17
|
)
|
|
5,019
|
|
|||||
|
Total stockholders’ equity
|
1,557
|
|
|
403
|
|
|
1,803
|
|
|
(2,206
|
)
|
|
1,557
|
|
|||||
|
|
$
|
3,717
|
|
|
$
|
478
|
|
|
$
|
4,604
|
|
|
$
|
(2,223
|
)
|
|
$
|
6,576
|
|
|
|
Three Months Ended September 30, 2016
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Revenue:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Total revenue
|
$
|
274
|
|
|
$
|
135
|
|
|
$
|
4,424
|
|
|
$
|
(287
|
)
|
|
$
|
4,546
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Medical care costs
|
19
|
|
|
15
|
|
|
3,727
|
|
|
(13
|
)
|
|
3,748
|
|
|||||
|
Cost of service revenue
|
—
|
|
|
109
|
|
|
10
|
|
|
—
|
|
|
119
|
|
|||||
|
General and administrative expenses
|
223
|
|
|
5
|
|
|
389
|
|
|
(274
|
)
|
|
343
|
|
|||||
|
Premium tax expenses
|
—
|
|
|
—
|
|
|
127
|
|
|
—
|
|
|
127
|
|
|||||
|
Health insurer fee expenses
|
—
|
|
|
—
|
|
|
55
|
|
|
—
|
|
|
55
|
|
|||||
|
Depreciation and amortization
|
25
|
|
|
4
|
|
|
7
|
|
|
—
|
|
|
36
|
|
|||||
|
Total operating expenses
|
267
|
|
|
133
|
|
|
4,315
|
|
|
(287
|
)
|
|
4,428
|
|
|||||
|
Operating income
|
7
|
|
|
2
|
|
|
109
|
|
|
—
|
|
|
118
|
|
|||||
|
Interest expense
|
26
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
26
|
|
|||||
|
(Loss) income before income taxes
|
(19
|
)
|
|
2
|
|
|
109
|
|
|
—
|
|
|
92
|
|
|||||
|
Income tax (benefit) expense
|
4
|
|
|
(3
|
)
|
|
49
|
|
|
—
|
|
|
50
|
|
|||||
|
Net (loss) income before equity in earnings of subsidiaries
|
(23
|
)
|
|
5
|
|
|
60
|
|
|
—
|
|
|
42
|
|
|||||
|
Equity in net earnings of subsidiaries
|
65
|
|
|
—
|
|
|
—
|
|
|
(65
|
)
|
|
—
|
|
|||||
|
Net income
|
$
|
42
|
|
|
$
|
5
|
|
|
$
|
60
|
|
|
$
|
(65
|
)
|
|
$
|
42
|
|
|
|
Three Months Ended September 30, 2015
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Revenue:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Total revenue
|
$
|
234
|
|
|
$
|
60
|
|
|
$
|
3,563
|
|
|
$
|
(246
|
)
|
|
$
|
3,611
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Medical care costs
|
14
|
|
|
9
|
|
|
3,005
|
|
|
(12
|
)
|
|
3,016
|
|
|||||
|
Cost of service revenue
|
—
|
|
|
34
|
|
|
—
|
|
|
—
|
|
|
34
|
|
|||||
|
General and administrative expenses
|
200
|
|
|
8
|
|
|
313
|
|
|
(234
|
)
|
|
287
|
|
|||||
|
Premium tax expenses
|
—
|
|
|
—
|
|
|
99
|
|
|
—
|
|
|
99
|
|
|||||
|
Health insurer fee expenses
|
—
|
|
|
—
|
|
|
36
|
|
|
—
|
|
|
36
|
|
|||||
|
Depreciation and amortization
|
21
|
|
|
1
|
|
|
4
|
|
|
—
|
|
|
26
|
|
|||||
|
Total operating expenses
|
235
|
|
|
52
|
|
|
3,457
|
|
|
(246
|
)
|
|
3,498
|
|
|||||
|
Operating (loss) income
|
(1
|
)
|
|
8
|
|
|
106
|
|
|
—
|
|
|
113
|
|
|||||
|
Interest expense
|
15
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
15
|
|
|||||
|
(Loss) income before income taxes
|
(16
|
)
|
|
8
|
|
|
106
|
|
|
—
|
|
|
98
|
|
|||||
|
Income tax (benefit) expense
|
3
|
|
|
3
|
|
|
46
|
|
|
—
|
|
|
52
|
|
|||||
|
Net (loss) income before equity in earnings of subsidiaries
|
(19
|
)
|
|
5
|
|
|
60
|
|
|
—
|
|
|
46
|
|
|||||
|
Equity in net earnings of subsidiaries
|
65
|
|
|
(1
|
)
|
|
—
|
|
|
(64
|
)
|
|
—
|
|
|||||
|
Net income
|
$
|
46
|
|
|
$
|
4
|
|
|
$
|
60
|
|
|
$
|
(64
|
)
|
|
$
|
46
|
|
|
|
Nine Months Ended September 30, 2016
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Revenue:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Total revenue
|
$
|
786
|
|
|
$
|
412
|
|
|
$
|
12,874
|
|
|
$
|
(824
|
)
|
|
$
|
13,248
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Medical care costs
|
50
|
|
|
37
|
|
|
10,884
|
|
|
(41
|
)
|
|
10,930
|
|
|||||
|
Cost of service revenue
|
—
|
|
|
330
|
|
|
32
|
|
|
—
|
|
|
362
|
|
|||||
|
General and administrative expenses
|
659
|
|
|
28
|
|
|
1,130
|
|
|
(783
|
)
|
|
1,034
|
|
|||||
|
Premium tax expenses
|
—
|
|
|
—
|
|
|
345
|
|
|
—
|
|
|
345
|
|
|||||
|
Health insurer fee expenses
|
—
|
|
|
—
|
|
|
163
|
|
|
—
|
|
|
163
|
|
|||||
|
Depreciation and amortization
|
70
|
|
|
10
|
|
|
22
|
|
|
—
|
|
|
102
|
|
|||||
|
Total expenses
|
779
|
|
|
405
|
|
|
12,576
|
|
|
(824
|
)
|
|
12,936
|
|
|||||
|
Operating income
|
7
|
|
|
7
|
|
|
298
|
|
|
—
|
|
|
312
|
|
|||||
|
Interest expense
|
76
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
76
|
|
|||||
|
(Loss) income before income taxes
|
(69
|
)
|
|
7
|
|
|
298
|
|
|
—
|
|
|
236
|
|
|||||
|
Income tax (benefit) expense
|
(24
|
)
|
|
(1
|
)
|
|
162
|
|
|
—
|
|
|
137
|
|
|||||
|
Net (loss) income before equity in earnings of subsidiaries
|
(45
|
)
|
|
8
|
|
|
136
|
|
|
—
|
|
|
99
|
|
|||||
|
Equity in net earnings of subsidiaries
|
144
|
|
|
—
|
|
|
—
|
|
|
(144
|
)
|
|
—
|
|
|||||
|
Net income
|
$
|
99
|
|
|
$
|
8
|
|
|
$
|
136
|
|
|
$
|
(144
|
)
|
|
$
|
99
|
|
|
|
Nine Months Ended September 30, 2015
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Revenue:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Total revenue
|
$
|
677
|
|
|
$
|
183
|
|
|
$
|
10,159
|
|
|
$
|
(712
|
)
|
|
$
|
10,307
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Medical care costs
|
40
|
|
|
26
|
|
|
8,552
|
|
|
(37
|
)
|
|
8,581
|
|
|||||
|
Cost of service revenue
|
—
|
|
|
103
|
|
|
—
|
|
|
—
|
|
|
103
|
|
|||||
|
General and administrative expenses
|
577
|
|
|
23
|
|
|
905
|
|
|
(675
|
)
|
|
830
|
|
|||||
|
Premium tax expenses
|
—
|
|
|
—
|
|
|
289
|
|
|
—
|
|
|
289
|
|
|||||
|
Health insurer fee expenses
|
—
|
|
|
—
|
|
|
117
|
|
|
—
|
|
|
117
|
|
|||||
|
Depreciation and amortization
|
62
|
|
|
2
|
|
|
12
|
|
|
—
|
|
|
76
|
|
|||||
|
Total expenses
|
679
|
|
|
154
|
|
|
9,875
|
|
|
(712
|
)
|
|
9,996
|
|
|||||
|
Operating (loss) income
|
(2
|
)
|
|
29
|
|
|
284
|
|
|
—
|
|
|
311
|
|
|||||
|
Interest expense
|
45
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
45
|
|
|||||
|
(Loss) income before income taxes
|
(47
|
)
|
|
29
|
|
|
284
|
|
|
—
|
|
|
266
|
|
|||||
|
Income tax (benefit) expense
|
(4
|
)
|
|
11
|
|
|
146
|
|
|
—
|
|
|
153
|
|
|||||
|
Net (loss) income before equity in earnings of subsidiaries
|
(43
|
)
|
|
18
|
|
|
138
|
|
|
—
|
|
|
113
|
|
|||||
|
Equity in net earnings of subsidiaries
|
156
|
|
|
(1
|
)
|
|
—
|
|
|
(155
|
)
|
|
—
|
|
|||||
|
Net income
|
$
|
113
|
|
|
$
|
17
|
|
|
$
|
138
|
|
|
$
|
(155
|
)
|
|
$
|
113
|
|
|
|
Three Months Ended September 30, 2016
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Net income
|
$
|
42
|
|
|
$
|
5
|
|
|
$
|
60
|
|
|
$
|
(65
|
)
|
|
$
|
42
|
|
|
Other comprehensive loss, net of tax
|
(1
|
)
|
|
—
|
|
|
(1
|
)
|
|
1
|
|
|
(1
|
)
|
|||||
|
Comprehensive income
|
$
|
41
|
|
|
$
|
5
|
|
|
$
|
59
|
|
|
$
|
(64
|
)
|
|
$
|
41
|
|
|
|
Three Months Ended September 30, 2015
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Net income
|
$
|
46
|
|
|
$
|
4
|
|
|
$
|
60
|
|
|
$
|
(64
|
)
|
|
$
|
46
|
|
|
Other comprehensive income, net of tax
|
2
|
|
|
—
|
|
|
1
|
|
|
(1
|
)
|
|
2
|
|
|||||
|
Comprehensive income
|
$
|
48
|
|
|
$
|
4
|
|
|
$
|
61
|
|
|
$
|
(65
|
)
|
|
$
|
48
|
|
|
|
Nine Months Ended September 30, 2016
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Net income
|
$
|
99
|
|
|
$
|
8
|
|
|
$
|
136
|
|
|
$
|
(144
|
)
|
|
$
|
99
|
|
|
Other comprehensive income, net of tax
|
7
|
|
|
—
|
|
|
6
|
|
|
(6
|
)
|
|
7
|
|
|||||
|
Comprehensive income
|
$
|
106
|
|
|
$
|
8
|
|
|
$
|
142
|
|
|
$
|
(150
|
)
|
|
$
|
106
|
|
|
|
Nine Months Ended September 30, 2015
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Net income
|
$
|
113
|
|
|
$
|
17
|
|
|
$
|
138
|
|
|
$
|
(155
|
)
|
|
$
|
113
|
|
|
Other comprehensive income, net of tax
|
1
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
1
|
|
|||||
|
Comprehensive income
|
$
|
114
|
|
|
$
|
17
|
|
|
$
|
138
|
|
|
$
|
(155
|
)
|
|
$
|
114
|
|
|
|
Nine Months Ended September 30, 2016
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Operating activities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Net cash provided by operating activities
|
$
|
43
|
|
|
35
|
|
|
555
|
|
|
—
|
|
|
$
|
633
|
|
|||
|
Investing activities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Purchases of investments
|
(114
|
)
|
|
—
|
|
|
(1,330
|
)
|
|
—
|
|
|
(1,444
|
)
|
|||||
|
Proceeds from sales and maturities of investments
|
103
|
|
|
—
|
|
|
1,409
|
|
|
—
|
|
|
1,512
|
|
|||||
|
Purchases of property, equipment and capitalized software
|
(102
|
)
|
|
(28
|
)
|
|
(13
|
)
|
|
—
|
|
|
(143
|
)
|
|||||
|
Decrease in restricted investments
|
—
|
|
|
—
|
|
|
4
|
|
|
—
|
|
|
4
|
|
|||||
|
Net cash paid in business combinations
|
—
|
|
|
(11
|
)
|
|
(37
|
)
|
|
—
|
|
|
(48
|
)
|
|||||
|
Capital contributions to subsidiaries
|
(221
|
)
|
|
18
|
|
|
203
|
|
|
—
|
|
|
—
|
|
|||||
|
Dividends received from subsidiaries
|
50
|
|
|
—
|
|
|
(50
|
)
|
|
—
|
|
|
—
|
|
|||||
|
Change in amounts due to/from affiliates
|
(12
|
)
|
|
1
|
|
|
11
|
|
|
—
|
|
|
—
|
|
|||||
|
Other, net
|
6
|
|
|
(19
|
)
|
|
1
|
|
|
—
|
|
|
(12
|
)
|
|||||
|
Net cash (used in) provided by investing activities
|
(290
|
)
|
|
(39
|
)
|
|
198
|
|
|
—
|
|
|
(131
|
)
|
|||||
|
Financing activities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Proceeds from employee stock plans
|
10
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
10
|
|
|||||
|
Other, net
|
2
|
|
|
(1
|
)
|
|
—
|
|
|
—
|
|
|
1
|
|
|||||
|
Net cash provided by (used in) financing activities
|
12
|
|
|
(1
|
)
|
|
—
|
|
|
—
|
|
|
11
|
|
|||||
|
Net (decrease) increase in cash and cash equivalents
|
(235
|
)
|
|
(5
|
)
|
|
753
|
|
|
—
|
|
|
513
|
|
|||||
|
Cash and cash equivalents at beginning of period
|
360
|
|
|
42
|
|
|
1,927
|
|
|
—
|
|
|
2,329
|
|
|||||
|
Cash and cash equivalents at end of period
|
$
|
125
|
|
|
$
|
37
|
|
|
$
|
2,680
|
|
|
$
|
—
|
|
|
$
|
2,842
|
|
|
|
Nine Months Ended September 30, 2015
|
||||||||||||||||||
|
|
Parent Guarantor
|
|
Other Guarantors
|
|
Non-Guarantors
|
|
Eliminations
|
|
Consolidated
|
||||||||||
|
|
(In millions)
|
||||||||||||||||||
|
Operating activities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Net cash provided by operating activities
|
$
|
93
|
|
|
70
|
|
|
743
|
|
|
—
|
|
|
$
|
906
|
|
|||
|
Investing activities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Purchases of investments
|
(23
|
)
|
|
—
|
|
|
(1,288
|
)
|
|
—
|
|
|
(1,311
|
)
|
|||||
|
Proceeds from sales and maturities of investments
|
90
|
|
|
—
|
|
|
773
|
|
|
—
|
|
|
863
|
|
|||||
|
Purchases of property, equipment and capitalized software
|
(68
|
)
|
|
(19
|
)
|
|
(14
|
)
|
|
—
|
|
|
(101
|
)
|
|||||
|
Decrease in restricted investments
|
—
|
|
|
5
|
|
|
(10
|
)
|
|
—
|
|
|
(5
|
)
|
|||||
|
Net cash paid in business combinations
|
—
|
|
|
—
|
|
|
(77
|
)
|
|
—
|
|
|
(77
|
)
|
|||||
|
Capital contributions to subsidiaries
|
(167
|
)
|
|
3
|
|
|
164
|
|
|
—
|
|
|
—
|
|
|||||
|
Dividends received from subsidiaries
|
42
|
|
|
(17
|
)
|
|
(25
|
)
|
|
—
|
|
|
—
|
|
|||||
|
Change in amounts due to/from affiliates
|
(15
|
)
|
|
—
|
|
|
15
|
|
|
—
|
|
|
—
|
|
|||||
|
Other, net
|
(1
|
)
|
|
(25
|
)
|
|
(8
|
)
|
|
—
|
|
|
(34
|
)
|
|||||
|
Net cash used in investing activities
|
(142
|
)
|
|
(53
|
)
|
|
(470
|
)
|
|
—
|
|
|
(665
|
)
|
|||||
|
Financing activities:
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Proceeds from common stock offering, net of issuance costs
|
373
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
373
|
|
|||||
|
Proceeds from employee stock plans
|
8
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
8
|
|
|||||
|
Other, net
|
3
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
3
|
|
|||||
|
Net cash provided by financing activities
|
384
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
384
|
|
|||||
|
Net increase in cash and cash equivalents
|
335
|
|
|
17
|
|
|
273
|
|
|
—
|
|
|
625
|
|
|||||
|
Cash and cash equivalents at beginning of period
|
75
|
|
|
15
|
|
|
1,449
|
|
|
—
|
|
|
1,539
|
|
|||||
|
Cash and cash equivalents at end of period
|
$
|
410
|
|
|
$
|
32
|
|
|
$
|
1,722
|
|
|
$
|
—
|
|
|
$
|
2,164
|
|
|
•
|
the success of our profit improvement and cost-cutting initiatives;
|
|
•
|
uncertainties and evolving market and provider economics associated with the implementation of the Affordable Care Act (the “ACA”), the Medicaid expansion, the insurance marketplaces, the effect of various implementing regulations, and uncertainties regarding the Medicare-Medicaid dual eligible demonstration programs in California, Illinois, Michigan, Ohio, South Carolina, and Texas;
|
|
•
|
management of our medical costs, including our ability to reduce over time the high medical costs commonly associated with new patient populations;
|
|
•
|
our ability to predict with a reasonable degree of accuracy utilization rates, including utilization rates in new plans, geographies, and programs where we have less experience with patient and provider populations, and also including utilization rates associated with seasonal flu patterns or other newly emergent diseases;
|
|
•
|
our ability to manage growth, including maintaining and creating adequate internal systems and controls relating to authorizations, approvals, provider payments, and the overall success of our care management initiatives;
|
|
•
|
our ability to consummate and realize benefits from proposed acquisitions, including the pending Aetna-Humana Medicare Advantage divestiture transaction;
|
|
•
|
our receipt of adequate premium rates to support increasing pharmacy costs, including costs associated with specialty drugs and costs resulting from formulary changes that allow the option of higher-priced non-generic drugs;
|
|
•
|
our ability to operate profitably in an environment where the trend in premium rate increases lags behind the trend in increasing medical costs;
|
|
•
|
the interpretation and implementation of federal or state medical cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit sharing arrangements, and risk adjustment provisions;
|
|
•
|
our estimates of amounts owed for such cost expenditure floors, administrative cost and profit ceilings, premium stabilization programs, profit-sharing arrangements, and risk adjustment provisions, including but not limited to cost-plus reimbursement for retroactively eligible members in New Mexico, the Medicaid expansion cost corridors in New Mexico and Washington, and any other retroactive adjustment to revenue where methodologies and procedures are subject to interpretation, or are at least partially dependent upon information about the health status of state or federal program participants who are not Molina members;
|
|
•
|
the interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures, and our ability to recognize revenue amounts associated therewith;
|
|
•
|
the interpretation and implementation of state contract performance requirements regarding the achievement of certain quality measures, and our ability to avoid liquidated damages associated therewith;
|
|
•
|
cyber-attacks or other privacy or data security incidents resulting in an inadvertent unauthorized disclosure of protected health information;
|
|
•
|
the success of our health plan in Puerto Rico, including the resolution of the Puerto Rico debt crisis, payment of all amounts due under our Medicaid contract, the effect of the newly enacted PROMESA law, and our efforts to better manage the health care costs of our Puerto Rico health plan;
|
|
•
|
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, including the resolution of the Illinois budget impasse and continued payment of all amounts due to our Illinois health plan;
|
|
•
|
the accurate estimation of incurred but not reported or paid medical costs across our health plans;
|
|
•
|
subsequent adjustments to reported premium revenue based upon subsequent developments or new information, including changes to estimated amounts payable or receivable related to Marketplace risk adjustment/risk transfer, risk corridors, and reinsurance;
|
|
•
|
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;
|
|
•
|
the continuation and renewal of the government contracts of our health plans, Molina Medicaid Solutions, and Pathways, and the terms under which such contracts are renewed;
|
|
•
|
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;
|
|
•
|
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;
|
|
•
|
the relatively small number of states in which we operate health plans;
|
|
•
|
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;
|
|
•
|
changes generally affecting the managed care or Medicaid management information systems industries;
|
|
•
|
increases in government surcharges, taxes, and assessments, including but not limited to the deductibility of certain compensation costs;
|
|
•
|
newly emergent viruses or widespread epidemics, including the Zika virus, public catastrophes or terrorist attacks, and associated public alarm;
|
|
•
|
changes in general economic conditions, including unemployment rates;
|
|
•
|
the sufficiency of our funds on hand to pay the amounts due upon conversion of our outstanding notes;
and
|
|
•
|
increasing competition and consolidation in the Medicaid industry
.
|
|
•
|
Improved profitability among products other than the Marketplace, partially offset by lower profitability for the Marketplace product.
Excluding adjustments related to 2015 dates of service, the medical care ratio for all products combined (excluding Marketplace) declined to 89.6% in the third quarter from 90.3% in the second quarter. The medical care ratio for the Marketplace program (also excluding adjustments related to 2015 dates of service) increased to 89.0% in the third quarter from 79.7% in the second quarter. Although third quarter results for the Marketplace business were lower than anticipated, we believe that Marketplace performance for full year 2016 dates of service will be approximately breakeven. We continue to record substantial liabilities for Marketplace risk transfer payments
under the risk adjustment program.
We estimate that such payments reduced our Marketplace premium revenue by approximately 25% for the nine months ended September 30, 2016. We have recommended that the risk transfer formula be modified so that payments between health plans are allocated based solely upon medical costs, rather than upon premiums. Such a change would have lowered the percentage of premium revenue returned as a result of risk transfer from 25% to 20% for the nine months ended September 30, 2016. We believe that the methodology used to calculate Marketplace risk transfer payments penalizes comparatively efficient and affordable health plans and, as a result, those purchasing affordable Marketplace policies ultimately pay higher premiums.
|
|
•
|
Improved administrative efficiency
. Our general and administrative expense ratio fell to
7.6%
in the third quarter of 2016 from 8.1% in the second quarter.
|
|
•
|
Lower effective tax rate.
The benefit of approximately $5 million in discrete items reduced our effective tax rate to
54.0%
in the third quarter of 2016, from 59.8% in the second quarter.
|
|
•
|
The ultimate savings to be realized from various cost savings initiatives and the speed at which such savings will be realized.
|
|
•
|
Medicaid rate increases (excluding Medicaid Expansion) of approximately 3.0% in California (effective July 1, 2016); approximately 2.5% in Puerto Rico (effective July 1, 2016); approximately 3.0% in Texas (effective September 1, 2016); and approximately 4.0% in Florida (effective September 1, 2016). All rate changes are consistent with our previous expectations.
|
|
•
|
Medicaid Expansion rate decreases of approximately 11.0% in California (effective July 1, 2016) and approximately 2.0% in Ohio (effective July 1, 2016). All rate changes are consistent with our previous expectations.
|
|
•
|
The implementation of a medical care ratio floor of 86.0% for the South Carolina Medicaid program effective July 1, 2016.
|
|
•
|
Declining margins for our Marketplace business during the second half of 2016 due to normal membership attrition; the addition of higher cost members through the special enrollment process; higher costs as members reach the limits of the cost-sharing provisions of their insurance coverage; and increasing utilization as members become more engaged with our care networks.
|
|
|
September 30,
2016 |
|
December 31,
2015 |
|
September 30,
2015 |
|||
|
Ending Membership by Health Plan:
|
|
|
|
|
|
|||
|
California
|
683,000
|
|
|
620,000
|
|
|
611,000
|
|
|
Florida
|
563,000
|
|
|
440,000
|
|
|
349,000
|
|
|
Illinois
|
195,000
|
|
|
98,000
|
|
|
101,000
|
|
|
Michigan
|
387,000
|
|
|
328,000
|
|
|
340,000
|
|
|
New Mexico
|
253,000
|
|
|
231,000
|
|
|
231,000
|
|
|
New York (1)
|
37,000
|
|
|
—
|
|
|
—
|
|
|
Ohio
|
339,000
|
|
|
327,000
|
|
|
344,000
|
|
|
Puerto Rico
|
331,000
|
|
|
348,000
|
|
|
356,000
|
|
|
South Carolina
|
109,000
|
|
|
99,000
|
|
|
102,000
|
|
|
Texas
|
352,000
|
|
|
260,000
|
|
|
263,000
|
|
|
Utah
|
150,000
|
|
|
102,000
|
|
|
102,000
|
|
|
Washington
|
716,000
|
|
|
582,000
|
|
|
568,000
|
|
|
Wisconsin
|
131,000
|
|
|
98,000
|
|
|
103,000
|
|
|
|
4,246,000
|
|
|
3,533,000
|
|
|
3,470,000
|
|
|
Ending Membership by Program:
|
|
|
|
|
|
|||
|
Temporary Assistance for Needy Families (TANF) and Children's Health Insurance Program (CHIP)
|
2,529,000
|
|
|
2,312,000
|
|
|
2,249,000
|
|
|
Medicaid Expansion
|
658,000
|
|
|
557,000
|
|
|
540,000
|
|
|
Marketplace
|
568,000
|
|
|
205,000
|
|
|
226,000
|
|
|
Aged, Blind or Disabled (ABD)
|
395,000
|
|
|
366,000
|
|
|
359,000
|
|
|
Medicare-Medicaid Plan (MMP) – Integrated (2)
|
51,000
|
|
|
51,000
|
|
|
56,000
|
|
|
Medicare Special Needs Plans (Medicare)
|
45,000
|
|
|
42,000
|
|
|
40,000
|
|
|
|
4,246,000
|
|
|
3,533,000
|
|
|
3,470,000
|
|
|
(1)
|
The New York health plan was acquired on August 1, 2016.
|
|
(2)
|
MMP members who receive both Medicaid and Medicare coverage from Molina Healthcare.
|
|
|
PMPM Premiums
|
||||||||||
|
|
Low
|
|
High
|
|
Consolidated
|
||||||
|
TANF and CHIP
|
$
|
120.00
|
|
|
$
|
320.00
|
|
|
$
|
180.00
|
|
|
Medicaid Expansion
|
320.00
|
|
|
480.00
|
|
|
380.00
|
|
|||
|
Marketplace
|
160.00
|
|
|
360.00
|
|
|
230.00
|
|
|||
|
ABD
|
390.00
|
|
|
1,530.00
|
|
|
990.00
|
|
|||
|
MMP – Integrated
|
1,170.00
|
|
|
3,290.00
|
|
|
2,160.00
|
|
|||
|
Medicare
|
780.00
|
|
|
1,110.00
|
|
|
1,020.00
|
|
|||
|
|
Three Months Ended September 30,
|
||||||||||||||||||||
|
|
2016
|
|
2015
|
||||||||||||||||||
|
|
Amount
|
|
PMPM
|
|
% of Total
|
|
Amount
|
|
PMPM
|
|
% of Total
|
||||||||||
|
Fee for service
|
$
|
2,799
|
|
|
$
|
220.29
|
|
|
74.7
|
%
|
|
$
|
2,224
|
|
|
$
|
218.69
|
|
|
73.8
|
%
|
|
Pharmacy
|
567
|
|
|
44.65
|
|
|
15.1
|
|
|
418
|
|
|
41.07
|
|
|
13.9
|
|
||||
|
Capitation
|
302
|
|
|
23.83
|
|
|
8.1
|
|
|
260
|
|
|
25.57
|
|
|
8.6
|
|
||||
|
Direct delivery
|
21
|
|
|
1.66
|
|
|
0.5
|
|
|
31
|
|
|
2.97
|
|
|
1.0
|
|
||||
|
Other
|
59
|
|
|
4.58
|
|
|
1.6
|
|
|
83
|
|
|
8.19
|
|
|
2.7
|
|
||||
|
|
$
|
3,748
|
|
|
$
|
295.01
|
|
|
100.0
|
%
|
|
$
|
3,016
|
|
|
$
|
296.49
|
|
|
100.0
|
%
|
|
|
Nine Months Ended September 30,
|
||||||||||||||||||||
|
|
2016
|
|
2015
|
||||||||||||||||||
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
|
Amount
|
|
PMPM
|
|
% of
Total
|
||||||||||
|
Fee for service
|
$
|
8,156
|
|
|
$
|
215.96
|
|
|
74.6
|
%
|
|
$
|
6,275
|
|
|
$
|
217.63
|
|
|
73.1
|
%
|
|
Pharmacy
|
1,621
|
|
|
42.93
|
|
|
14.8
|
|
|
1,161
|
|
|
40.26
|
|
|
13.5
|
|
||||
|
Capitation
|
901
|
|
|
23.86
|
|
|
8.3
|
|
|
725
|
|
|
25.13
|
|
|
8.5
|
|
||||
|
Direct delivery
|
55
|
|
|
1.46
|
|
|
0.5
|
|
|
85
|
|
|
2.94
|
|
|
1.0
|
|
||||
|
Other
|
197
|
|
|
5.20
|
|
|
1.8
|
|
|
335
|
|
|
11.62
|
|
|
3.9
|
|
||||
|
|
$
|
10,930
|
|
|
$
|
289.41
|
|
|
100.0
|
%
|
|
$
|
8,581
|
|
|
$
|
297.58
|
|
|
100.0
|
%
|
|
|
Three Months Ended September 30,
|
|
Change
|
|
Nine Months Ended September 30,
|
|
Change
|
||||||||||||||||||||||
|
|
2016
|
|
2015
|
|
$
|
|
%
|
|
2016
|
|
2015
|
|
$
|
|
%
|
||||||||||||||
|
|
(Dollars in millions)
|
||||||||||||||||||||||||||||
|
Health Plans:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||
|
Premium revenue
|
$
|
4,191
|
|
|
$
|
3,377
|
|
|
$
|
814
|
|
|
24
|
%
|
|
$
|
12,215
|
|
|
$
|
9,652
|
|
|
$
|
2,563
|
|
|
27
|
%
|
|
Less: medical care costs
|
3,748
|
|
|
3,016
|
|
|
732
|
|
|
24
|
|
|
10,930
|
|
|
8,581
|
|
|
2,349
|
|
|
27
|
|
||||||
|
Medical margin
|
$
|
443
|
|
|
$
|
361
|
|
|
$
|
82
|
|
|
23
|
|
|
$
|
1,285
|
|
|
$
|
1,071
|
|
|
$
|
214
|
|
|
20
|
|
|
Medical care ratio
|
89.4
|
%
|
|
89.3
|
%
|
|
|
|
|
|
89.5
|
%
|
|
88.9
|
%
|
|
|
|
|
||||||||||
|
Molina Medicaid Solutions:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||
|
Service revenue
|
$
|
48
|
|
|
$
|
47
|
|
|
$
|
1
|
|
|
2
|
|
|
$
|
146
|
|
|
$
|
146
|
|
|
$
|
—
|
|
|
—
|
|
|
Less: cost of service revenue
|
42
|
|
|
34
|
|
|
8
|
|
|
24
|
|
|
129
|
|
|
103
|
|
|
26
|
|
|
25
|
|
||||||
|
Service margin
|
$
|
6
|
|
|
$
|
13
|
|
|
$
|
(7
|
)
|
|
(54
|
)
|
|
$
|
17
|
|
|
$
|
43
|
|
|
$
|
(26
|
)
|
|
(60
|
)
|
|
Service cost ratio
|
86.7
|
%
|
|
72.7
|
%
|
|
|
|
|
|
88.3
|
%
|
|
70.4
|
%
|
|
|
|
|
||||||||||
|
Other:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||
|
Service revenue
|
$
|
85
|
|
|
$
|
—
|
|
|
|
|
|
|
$
|
262
|
|
|
$
|
—
|
|
|
|
|
|
||||||
|
Less: cost of service revenue
|
77
|
|
|
—
|
|
|
|
|
|
|
233
|
|
|
—
|
|
|
|
|
|
||||||||||
|
Service margin
|
$
|
8
|
|
|
$
|
—
|
|
|
|
|
|
|
$
|
29
|
|
|
$
|
—
|
|
|
|
|
|
||||||
|
Service cost ratio
|
90.3
|
%
|
|
—
|
%
|
|
|
|
|
|
89.0
|
%
|
|
—
|
%
|
|
|
|
|
||||||||||
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||
|
2016
|
|
2015
|
|
2016
|
|
2015
|
|||||||||
|
|
(In millions)
|
||||||||||||||
|
Net income
|
$
|
42
|
|
|
$
|
46
|
|
|
$
|
99
|
|
|
$
|
113
|
|
|
Adjustments:
|
|
|
|
|
|
|
|
||||||||
|
Depreciation, and amortization of intangible assets and capitalized software
|
42
|
|
|
29
|
|
|
118
|
|
|
87
|
|
||||
|
Interest expense
|
26
|
|
|
15
|
|
|
76
|
|
|
45
|
|
||||
|
Income tax expense
|
50
|
|
|
52
|
|
|
137
|
|
|
153
|
|
||||
|
EBITDA
|
$
|
160
|
|
|
$
|
142
|
|
|
$
|
430
|
|
|
$
|
398
|
|
|
|
Three Months Ended September 30,
|
|
Nine Months Ended September 30,
|
||||||||||||||||||||||||||||
|
2016
|
|
2015
|
|
2016
|
|
2015
|
|||||||||||||||||||||||||
|
|
(In millions, except diluted per-share amounts)
|
||||||||||||||||||||||||||||||
|
Net income
|
$
|
42
|
|
|
$
|
0.76
|
|
|
$
|
46
|
|
|
$
|
0.77
|
|
|
$
|
99
|
|
|
$
|
1.77
|
|
|
$
|
113
|
|
|
2.07
|
|
|
|
Adjustment, net of tax:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||
|
Amortization of intangible assets
|
5
|
|
|
0.09
|
|
|
2
|
|
|
0.04
|
|
|
15
|
|
|
0.26
|
|
|
8
|
|
|
0.15
|
|
||||||||
|
Adjusted net income (1)
|
$
|
47
|
|
|
$
|
0.85
|
|
|
$
|
48
|
|
|
$
|
0.81
|
|
|
$
|
114
|
|
|
$
|
2.03
|
|
|
$
|
121
|
|
|
$
|
2.22
|
|
|
(1)
|
Beginning in the first quarter of 2016, we revised our calculation of adjusted net income. We no longer subtract “Amortization of convertible senior notes and lease financing obligations” from net income to arrive at adjusted net income. We made this change because various capital transactions completed in 2015 reduced our relative reliance on convertible notes and lease financing as sources of capital. We believe that this change enhances the comparability of these non-GAAP measures with the corresponding non-GAAP measures used by our competitors. All periods presented conform to this presentation.
|
|
|
Three Months Ended September 30, 2016
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
TANF and CHIP
|
7.6
|
|
|
$
|
1,373
|
|
|
$
|
180.74
|
|
|
$
|
1,246
|
|
|
$
|
164.04
|
|
|
90.8
|
%
|
|
$
|
127
|
|
|
Medicaid Expansion
|
2.0
|
|
|
763
|
|
|
386.98
|
|
|
642
|
|
|
325.68
|
|
|
84.2
|
|
|
121
|
|
|||||
|
Marketplace
|
1.7
|
|
|
399
|
|
|
238.86
|
|
|
352
|
|
|
210.38
|
|
|
88.1
|
|
|
47
|
|
|||||
|
ABD
|
1.1
|
|
|
1,186
|
|
|
1,008.28
|
|
|
1,094
|
|
|
929.93
|
|
|
92.2
|
|
|
92
|
|
|||||
|
MMP
|
0.2
|
|
|
334
|
|
|
2,165.26
|
|
|
280
|
|
|
1,818.75
|
|
|
84.0
|
|
|
54
|
|
|||||
|
Medicare
|
0.1
|
|
|
136
|
|
|
1,019.19
|
|
|
134
|
|
|
1,003.85
|
|
|
98.5
|
|
|
2
|
|
|||||
|
|
12.7
|
|
|
$
|
4,191
|
|
|
$
|
329.88
|
|
|
$
|
3,748
|
|
|
$
|
295.01
|
|
|
89.4
|
%
|
|
$
|
443
|
|
|
|
Three Months Ended September 30, 2015
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
TANF and CHIP
|
6.6
|
|
|
$
|
1,139
|
|
|
$
|
171.16
|
|
|
$
|
1,070
|
|
|
$
|
160.85
|
|
|
94.0
|
%
|
|
$
|
69
|
|
|
Medicaid Expansion
|
1.5
|
|
|
565
|
|
|
366.80
|
|
|
458
|
|
|
297.16
|
|
|
81.0
|
|
|
107
|
|
|||||
|
Marketplace
|
0.6
|
|
|
170
|
|
|
262.74
|
|
|
124
|
|
|
192.21
|
|
|
73.2
|
|
|
46
|
|
|||||
|
ABD
|
1.1
|
|
|
1,070
|
|
|
1,017.68
|
|
|
979
|
|
|
931.11
|
|
|
91.5
|
|
|
91
|
|
|||||
|
MMP
|
0.2
|
|
|
310
|
|
|
1,975.10
|
|
|
271
|
|
|
1,718.13
|
|
|
87.0
|
|
|
39
|
|
|||||
|
Medicare
|
0.1
|
|
|
123
|
|
|
1,002.50
|
|
|
114
|
|
|
930.43
|
|
|
92.8
|
|
|
9
|
|
|||||
|
|
10.1
|
|
|
$
|
3,377
|
|
|
$
|
332.05
|
|
|
$
|
3,016
|
|
|
$
|
296.49
|
|
|
89.3
|
%
|
|
$
|
361
|
|
|
(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.
|
|
|
Three Months Ended September 30, 2016
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
2.1
|
|
|
$
|
612
|
|
|
$
|
298.05
|
|
|
$
|
523
|
|
|
$
|
254.11
|
|
|
85.3
|
%
|
|
$
|
89
|
|
|
Florida
|
1.6
|
|
|
494
|
|
|
297.24
|
|
|
462
|
|
|
277.79
|
|
|
93.5
|
|
|
32
|
|
|||||
|
Illinois
|
0.6
|
|
|
163
|
|
|
275.26
|
|
|
145
|
|
|
244.86
|
|
|
89.0
|
|
|
18
|
|
|||||
|
Michigan
|
1.2
|
|
|
387
|
|
|
334.25
|
|
|
337
|
|
|
290.16
|
|
|
86.8
|
|
|
50
|
|
|||||
|
New Mexico
|
0.8
|
|
|
338
|
|
|
440.12
|
|
|
304
|
|
|
396.35
|
|
|
90.1
|
|
|
34
|
|
|||||
|
New York (3)
|
0.1
|
|
|
32
|
|
|
427.40
|
|
|
30
|
|
|
403.71
|
|
|
94.5
|
|
|
2
|
|
|||||
|
Ohio
|
1.0
|
|
|
501
|
|
|
491.51
|
|
|
424
|
|
|
415.87
|
|
|
84.6
|
|
|
77
|
|
|||||
|
Puerto Rico
|
1.0
|
|
|
184
|
|
|
183.46
|
|
|
167
|
|
|
167.44
|
|
|
91.3
|
|
|
17
|
|
|||||
|
South Carolina
|
0.3
|
|
|
102
|
|
|
312.28
|
|
|
94
|
|
|
285.97
|
|
|
91.6
|
|
|
8
|
|
|||||
|
Texas
|
1.1
|
|
|
597
|
|
|
559.98
|
|
|
525
|
|
|
493.07
|
|
|
88.1
|
|
|
72
|
|
|||||
|
Utah
|
0.4
|
|
|
106
|
|
|
236.31
|
|
|
104
|
|
|
230.53
|
|
|
97.6
|
|
|
2
|
|
|||||
|
Washington
|
2.1
|
|
|
569
|
|
|
265.48
|
|
|
521
|
|
|
243.49
|
|
|
91.7
|
|
|
48
|
|
|||||
|
Wisconsin
|
0.4
|
|
|
103
|
|
|
262.32
|
|
|
90
|
|
|
231.86
|
|
|
88.4
|
|
|
13
|
|
|||||
|
Other (4)
|
—
|
|
|
3
|
|
|
—
|
|
|
22
|
|
|
—
|
|
|
—
|
|
|
(19
|
)
|
|||||
|
|
12.7
|
|
|
$
|
4,191
|
|
|
$
|
329.88
|
|
|
$
|
3,748
|
|
|
$
|
295.01
|
|
|
89.4
|
%
|
|
$
|
443
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
Three Months Ended September 30, 2015
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
1.9
|
|
|
$
|
524
|
|
|
$
|
288.45
|
|
|
$
|
438
|
|
|
$
|
241.09
|
|
|
83.6
|
%
|
|
$
|
86
|
|
|
Florida
|
0.9
|
|
|
300
|
|
|
299.33
|
|
|
265
|
|
|
264.39
|
|
|
88.3
|
|
|
35
|
|
|||||
|
Illinois
|
0.3
|
|
|
106
|
|
|
347.34
|
|
|
100
|
|
|
327.61
|
|
|
94.3
|
|
|
6
|
|
|||||
|
Michigan
|
0.9
|
|
|
281
|
|
|
330.00
|
|
|
236
|
|
|
276.61
|
|
|
83.8
|
|
|
45
|
|
|||||
|
New Mexico
|
0.7
|
|
|
297
|
|
|
421.76
|
|
|
275
|
|
|
390.26
|
|
|
92.5
|
|
|
22
|
|
|||||
|
New York (3)
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
Ohio
|
1.0
|
|
|
510
|
|
|
498.36
|
|
|
436
|
|
|
425.98
|
|
|
85.5
|
|
|
74
|
|
|||||
|
Puerto Rico
|
1.0
|
|
|
181
|
|
|
170.91
|
|
|
162
|
|
|
152.69
|
|
|
89.3
|
|
|
19
|
|
|||||
|
South Carolina
|
0.3
|
|
|
86
|
|
|
264.37
|
|
|
68
|
|
|
211.76
|
|
|
80.1
|
|
|
18
|
|
|||||
|
Texas
|
0.8
|
|
|
524
|
|
|
661.69
|
|
|
493
|
|
|
622.84
|
|
|
94.1
|
|
|
31
|
|
|||||
|
Utah
|
0.3
|
|
|
85
|
|
|
276.72
|
|
|
77
|
|
|
250.50
|
|
|
90.5
|
|
|
8
|
|
|||||
|
Washington
|
1.7
|
|
|
400
|
|
|
238.03
|
|
|
371
|
|
|
221.14
|
|
|
92.9
|
|
|
29
|
|
|||||
|
Wisconsin
|
0.3
|
|
|
71
|
|
|
232.32
|
|
|
57
|
|
|
184.94
|
|
|
79.6
|
|
|
14
|
|
|||||
|
Other (4)
|
—
|
|
|
12
|
|
|
—
|
|
|
38
|
|
|
—
|
|
|
—
|
|
|
(26
|
)
|
|||||
|
|
10.1
|
|
|
$
|
3,377
|
|
|
$
|
332.05
|
|
|
$
|
3,016
|
|
|
$
|
296.49
|
|
|
89.3
|
%
|
|
$
|
361
|
|
|
(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)
|
The New York health plan was acquired effective August 1, 2016.
|
|
(4)
|
"Other" medical care costs include primarily medically related administrative costs of the parent company, and direct delivery costs.
|
|
|
Nine Months Ended September 30, 2016
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
TANF and CHIP
|
22.5
|
|
|
$
|
3,999
|
|
|
$
|
177.60
|
|
|
$
|
3,646
|
|
|
$
|
161.93
|
|
|
91.2
|
%
|
|
$
|
353
|
|
|
Medicaid Expansion
|
5.8
|
|
|
2,184
|
|
|
376.98
|
|
|
1,850
|
|
|
319.38
|
|
|
84.7
|
|
|
334
|
|
|||||
|
Marketplace
|
5.1
|
|
|
1,181
|
|
|
231.69
|
|
|
1,009
|
|
|
197.77
|
|
|
85.4
|
|
|
172
|
|
|||||
|
ABD
|
3.5
|
|
|
3,466
|
|
|
987.20
|
|
|
3,173
|
|
|
903.85
|
|
|
91.6
|
|
|
293
|
|
|||||
|
MMP
|
0.5
|
|
|
989
|
|
|
2,160.14
|
|
|
867
|
|
|
1,894.38
|
|
|
87.7
|
|
|
122
|
|
|||||
|
Medicare
|
0.4
|
|
|
396
|
|
|
1,015.14
|
|
|
385
|
|
|
986.40
|
|
|
97.2
|
|
|
11
|
|
|||||
|
|
37.8
|
|
|
$
|
12,215
|
|
|
$
|
323.44
|
|
|
$
|
10,930
|
|
|
$
|
289.41
|
|
|
89.5
|
%
|
|
$
|
1,285
|
|
|
|
Nine Months Ended September 30, 2015
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
TANF and CHIP
|
18.6
|
|
|
$
|
3,280
|
|
|
$
|
175.52
|
|
|
$
|
3,030
|
|
|
$
|
162.16
|
|
|
92.4
|
%
|
|
$
|
250
|
|
|
Medicaid Expansion
|
4.2
|
|
|
1,654
|
|
|
393.71
|
|
|
1,325
|
|
|
315.33
|
|
|
80.1
|
|
|
329
|
|
|||||
|
Marketplace
|
2.0
|
|
|
525
|
|
|
259.97
|
|
|
370
|
|
|
183.33
|
|
|
70.5
|
|
|
155
|
|
|||||
|
ABD
|
3.2
|
|
|
3,063
|
|
|
965.91
|
|
|
2,789
|
|
|
879.27
|
|
|
91.0
|
|
|
274
|
|
|||||
|
MMP
|
0.4
|
|
|
733
|
|
|
1,981.40
|
|
|
684
|
|
|
1,847.03
|
|
|
93.2
|
|
|
49
|
|
|||||
|
Medicare
|
0.4
|
|
|
397
|
|
|
1,026.00
|
|
|
383
|
|
|
991.53
|
|
|
96.6
|
|
|
14
|
|
|||||
|
|
28.8
|
|
|
$
|
9,652
|
|
|
$
|
334.74
|
|
|
$
|
8,581
|
|
|
$
|
297.58
|
|
|
88.9
|
%
|
|
$
|
1,071
|
|
|
(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.
|
|
|
Nine Months Ended September 30, 2016
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
|||||||||||||||
|
California
|
6.1
|
|
|
$
|
1,707
|
|
|
$
|
280.21
|
|
|
$
|
1,485
|
|
|
$
|
243.64
|
|
|
86.9
|
%
|
|
$
|
222
|
|
|
Florida
|
5.0
|
|
|
1,447
|
|
|
288.74
|
|
|
1,301
|
|
|
259.60
|
|
|
89.9
|
|
|
146
|
|
|||||
|
Illinois
|
1.8
|
|
|
466
|
|
|
266.11
|
|
|
414
|
|
|
236.39
|
|
|
88.8
|
|
|
52
|
|
|||||
|
Michigan
|
3.6
|
|
|
1,143
|
|
|
322.08
|
|
|
1,018
|
|
|
286.77
|
|
|
89.0
|
|
|
125
|
|
|||||
|
New Mexico
|
2.3
|
|
|
1,016
|
|
|
447.07
|
|
|
905
|
|
|
398.22
|
|
|
89.1
|
|
|
111
|
|
|||||
|
New York (3)
|
0.1
|
|
|
32
|
|
|
427.40
|
|
|
30
|
|
|
403.71
|
|
|
94.5
|
|
|
2
|
|
|||||
|
Ohio
|
3.0
|
|
|
1,472
|
|
|
484.82
|
|
|
1,306
|
|
|
430.14
|
|
|
88.7
|
|
|
166
|
|
|||||
|
Puerto Rico
|
3.0
|
|
|
535
|
|
|
176.44
|
|
|
516
|
|
|
170.46
|
|
|
96.6
|
|
|
19
|
|
|||||
|
South Carolina
|
0.9
|
|
|
273
|
|
|
288.93
|
|
|
232
|
|
|
245.13
|
|
|
84.8
|
|
|
41
|
|
|||||
|
Texas
|
3.3
|
|
|
1,852
|
|
|
570.65
|
|
|
1,599
|
|
|
492.79
|
|
|
86.4
|
|
|
253
|
|
|||||
|
Utah
|
1.3
|
|
|
330
|
|
|
246.78
|
|
|
312
|
|
|
233.14
|
|
|
94.5
|
|
|
18
|
|
|||||
|
Washington
|
6.2
|
|
|
1,634
|
|
|
261.91
|
|
|
1,479
|
|
|
237.15
|
|
|
90.5
|
|
|
155
|
|
|||||
|
Wisconsin
|
1.2
|
|
|
299
|
|
|
252.45
|
|
|
278
|
|
|
235.25
|
|
|
93.2
|
|
|
21
|
|
|||||
|
Other (4)
|
—
|
|
|
9
|
|
|
—
|
|
|
55
|
|
|
—
|
|
|
—
|
|
|
(46
|
)
|
|||||
|
|
37.8
|
|
|
$
|
12,215
|
|
|
$
|
323.44
|
|
|
$
|
10,930
|
|
|
$
|
289.41
|
|
|
89.5
|
%
|
|
$
|
1,285
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
Nine Months Ended September 30, 2015
|
||||||||||||||||||||||||
|
|
Member
Months
(1)
|
|
Premium Revenue
|
|
Medical Care Costs
|
|
MCR
(2)
|
|
Medical Margin
|
||||||||||||||||
|
|
Total
|
|
PMPM
|
|
Total
|
|
PMPM
|
|
|
||||||||||||||||
|
California
|
5.3
|
|
|
$
|
1,538
|
|
|
$
|
292.64
|
|
|
$
|
1,349
|
|
|
$
|
256.71
|
|
|
87.7
|
%
|
|
$
|
189
|
|
|
Florida
|
2.9
|
|
|
868
|
|
|
294.05
|
|
|
763
|
|
|
258.49
|
|
|
87.9
|
|
|
105
|
|
|||||
|
Illinois
|
0.9
|
|
|
312
|
|
|
342.27
|
|
|
288
|
|
|
315.68
|
|
|
92.2
|
|
|
24
|
|
|||||
|
Michigan
|
2.4
|
|
|
738
|
|
|
310.01
|
|
|
621
|
|
|
260.53
|
|
|
84.0
|
|
|
117
|
|
|||||
|
New Mexico
|
2.1
|
|
|
933
|
|
|
448.75
|
|
|
843
|
|
|
405.60
|
|
|
90.4
|
|
|
90
|
|
|||||
|
New York (3)
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
|
Ohio
|
3.1
|
|
|
1,534
|
|
|
498.76
|
|
|
1,281
|
|
|
416.69
|
|
|
83.5
|
|
|
253
|
|
|||||
|
Puerto Rico
|
2.1
|
|
|
375
|
|
|
175.17
|
|
|
346
|
|
|
161.60
|
|
|
92.3
|
|
|
29
|
|
|||||
|
South Carolina
|
1.0
|
|
|
270
|
|
|
269.11
|
|
|
209
|
|
|
208.45
|
|
|
77.5
|
|
|
61
|
|
|||||
|
Texas
|
2.4
|
|
|
1,418
|
|
|
597.53
|
|
|
1,313
|
|
|
553.35
|
|
|
92.6
|
|
|
105
|
|
|||||
|
Utah
|
0.8
|
|
|
242
|
|
|
284.83
|
|
|
223
|
|
|
262.14
|
|
|
92.0
|
|
|
19
|
|
|||||
|
Washington
|
4.9
|
|
|
1,186
|
|
|
242.75
|
|
|
1,094
|
|
|
223.99
|
|
|
92.3
|
|
|
92
|
|
|||||
|
Wisconsin
|
0.9
|
|
|
206
|
|
|
221.97
|
|
|
162
|
|
|
173.99
|
|
|
78.4
|
|
|
44
|
|
|||||
|
Other (4)
|
—
|
|
|
32
|
|
|
—
|
|
|
89
|
|
|
—
|
|
|
—
|
|
|
(57
|
)
|
|||||
|
|
28.8
|
|
|
$
|
9,652
|
|
|
$
|
334.74
|
|
|
$
|
8,581
|
|
|
$
|
297.58
|
|
|
88.9
|
%
|
|
$
|
1,071
|
|
|
(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)
|
The New York health plan was acquired effective August 1, 2016.
|
|
(4)
|
"Other" medical care costs include primarily medically related administrative costs of the parent company, and direct delivery costs.
|
|
|
Nine Months Ended September 30,
|
||||||||||
|
|
2016
|
|
2015
|
|
Change
|
||||||
|
|
(In millions)
|
||||||||||
|
Net cash provided by operating activities
|
$
|
633
|
|
|
$
|
906
|
|
|
$
|
(273
|
)
|
|
Net cash used in investing activities
|
(131
|
)
|
|
(665
|
)
|
|
534
|
|
|||
|
Net cash provided by financing activities
|
11
|
|
|
384
|
|
|
(373
|
)
|
|||
|
Net increase in cash and cash equivalents
|
$
|
513
|
|
|
$
|
625
|
|
|
$
|
(112
|
)
|
|
•
|
Receivables and deferred revenue. Cash flows from operations in each year were impacted by the timing of payments we receive from our states. In general, states may delay our premium payment, which we record as a receivable, or they may prepay the following month premium payment, which we record as deferred revenue. We typically receive capitation payments monthly; however, the states in which we operate may decide to adjust their payment schedules which could positively or negatively impact our reported cash flows from operating activities in any given period. In the current year, the net effect of the timing of premiums received in California and Washington negatively impacted our cash flows from operating activities.
|
|
•
|
Medical claims and benefits payable. In the
nine months ended September 30, 2016
, medical claims and benefits payable increased at a slower pace than the same period in 2015. In particular, our Puerto Rico health plan commenced operations on April 1, 2015, leading to a significant increase in medical claims and benefits payable at
September 30, 2015
, compared with a much smaller increase in the current year as the membership base has stabilized.
|
|
•
|
Health Plans segment medical claims and benefits payable
. Refer to Part I, Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, Note
9
, "
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. Other than the discussion as noted above, there have been no significant changes during the
nine months ended September 30, 2016
, to our disclosure reported in Part II, Item 7 of our Annual Report on Form 10-K for the year ended
December 31, 2015
.
|
|
•
|
Health Plans segment contractual provisions that may adjust or limit revenue or profit
. For a discussion of this topic, including amounts recorded to our consolidated financial statements, refer to Part I, Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, Note
2
, "
Significant Accounting Policies
."
|
|
•
|
Health Plans segment quality incentives
. For a discussion of this topic, including amounts recorded to our consolidated financial statements, refer to Part I, Item 1 of this Form 10-Q, Notes to Consolidated Financial Statements, Note
2
, "
Significant Accounting Policies
."
|
|
•
|
Molina Medicaid Solutions segment revenue and cost recognition
. There have been no significant changes during the
nine months ended September 30, 2016
, to our disclosure reported in Part II, Item 7 of our Annual Report on Form 10-K for the year ended
December 31, 2015
.
|
|
|
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
|
667
|
|
|
$
|
49.83
|
|
|
—
|
|
|
$
|
50,000,000
|
|
|
August 1 - August 31
|
573
|
|
|
$
|
56.16
|
|
|
—
|
|
|
$
|
50,000,000
|
|
|
September 1 - September 30
|
329
|
|
|
$
|
53.54
|
|
|
—
|
|
|
$
|
50,000,000
|
|
|
Total
|
1,569
|
|
|
$
|
52.92
|
|
|
—
|
|
|
|
||
|
(a)
|
During the
three months ended September 30, 2016
, we withheld
1,569
shares of common stock under our 2011 Equity Incentive Plan to settle our employees' income tax obligations.
|
|
(b)
|
Effective as of December 16, 2015, our board of directors authorized the repurchase of up to $50 million in aggregate of our common stock or senior notes. This repurchase program extends through December 31, 2016.
|
|
|
|
|
MOLINA HEALTHCARE, INC.
|
|
|
|
|
(Registrant)
|
|
|
|
|
|
|
Dated:
|
October 27, 2016
|
|
/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 27, 2016
|
|
/s/ JOHN C. MOLINA, J.D.
|
|
|
|
|
John C. Molina, J.D.
|
|
|
|
|
Chief Financial Officer and Treasurer
|
|
|
|
|
(Principal Financial Officer)
|
|
Exhibit No.
|
|
Title
|
|
|
|
|
|
2.1
|
|
Asset Purchase Agreement, dated as of August 6, 2016, between Molina Healthcare, Inc. and Aetna Inc. (Incorporated herein by reference to Exhibit 2.1 to Molina Healthcare, Inc.'s Current Report on Form 8-K filed on August 5, 2016.)
|
|
|
|
|
|
2.2
|
|
Asset Purchase Agreement, dated as of August 6, 2016, between Molina Healthcare, Inc. and Humana Inc. (Incorporated herein by reference to Exhibit 2.2 to Molina Healthcare, Inc.'s Current Report on Form 8-K filed on August 5, 2016.)
|
|
|
|
|
|
10.1
|
|
Commitment Letter, dated August 2, 2016, between Molina Healthcare, Inc. and Barclays Bank PLC (Incorporated herein by reference to Exhibit 10.1 to Molina Healthcare, Inc.'s Current Report on Form 8-K filed August 5, 2016.)
|
|
|
|
|
|
10.2*
|
|
Molina Healthcare, Inc. 2011 Employee Stock Purchase Plan (Filed to reflect immaterial amendments approved by the Board of Directors on July 26, 2016).
|
|
|
|
|
|
10.3*
|
|
Amendment No. 3, dated as of August 8, 2016, to the Molina Healthcare, Inc. Amended and Restated Deferred Compensation Plan (2013).
|
|
|
|
|
|
10.4*
|
|
Molina Healthcare, Inc. 2011 Equity Incentive Plan (Filed to reflect amendment to Section 16.2 approved by the Compensation Committee on October 25, 2016).
|
|
|
|
|
|
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 |
|---|