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Share Name | Share Symbol | Market | Type |
---|---|---|---|
Molina Healthcare Inc | NYSE:MOH | NYSE | Common Stock |
Price Change | % Change | Share Price | High Price | Low Price | Open Price | Shares Traded | Last Trade | |
---|---|---|---|---|---|---|---|---|
0.00 | 0.00% | 352.35 | 0 | 09:05:14 |
Molina Healthcare, Inc. (NYSE: MOH):
Molina Healthcare, Inc. (NYSE: MOH) today reported its financial results for the fourth quarter of 2015.
“The fourth quarter of 2015 capped off a very strong year for Molina Healthcare. Net income more than doubled compared with 2014, and we are making progress toward our goal of a 1.5% to 2% net income margin by the end of 2017,” said J. Mario Molina M.D., chief executive officer of Molina Healthcare, Inc. “The in-market ‘tuck-in’ acquisitions already announced give us strong momentum going into 2016 and complement the already strong revenue growth we experienced over the past two years. I want to thank all of our employees for a great year.”
2016 Business Outlook and Investor Meeting
As has been the Company’s past practice, it will discuss its 2016 business outlook and strategy at its Investor Day Conference webcast and presentation to be held on February 11, 2016, at the Le Parker Meridien Hotel in New York City from 12:30 p.m. to 4:30 p.m. Eastern Time. The Company will webcast the presentations offered by its management team, which will be followed by question-and-answer sessions. A 30-day online replay of the Investor Day meeting will be available approximately one hour following the conclusion of the live webcast. A link to this webcast can be found on the Company’s website at molinahealthcare.com.
Overview of 2015 Financial Results, Continuing Operations
Earnings per diluted share nearly doubled in 2015 when compared with 2014, while net income more than doubled. Substantial increases in revenue, along with improved operating efficiency, were responsible for the Company’s improved performance. The Company’s after-tax margin increased to 1.0% in 2015 from 0.6% in 2014.
Strong enrollment growth combined with a 4% increase in premium revenue per member generated over $4 billion, or 46% more premium revenue in 2015 compared with 2014.
Enrollment growth was primarily due to increased Medicaid Expansion, Marketplace and integrated Medicare-Medicaid Plan (MMP) enrollment, and the start-up of the Puerto Rico health plan in April 2015.
Medical care costs as a percent of premium revenue (the “medical care ratio”) decreased to 89.0% in 2015, from 89.5% in 2014.
General and administrative expenses as a percentage of total revenue (the “general and administrative expense ratio”) increased slightly to 8.2% in 2015, from 7.9% in 2014, primarily as a result of dramatic growth in the Company’s Marketplace membership. Excluding Marketplace broker and exchange fees from both years, the general and administrative expense ratio decreased to 7.5% in 2015 from 7.8% in 2014.
Other items affecting premium revenue in 2015 included the Affordable Care Act health insurer fee (HIF). During 2015, the Company secured full reimbursement for its expenses under the HIF. Additionally, as the Company has previously disclosed, it has been unable to recognize certain quality related revenue at its Texas health plan because it does not have historical information, clear definitions, and clarity around minimum standards. The Company recognized no such revenue in either the fourth quarter of 2015, or the year as a whole.
Fourth Quarter Developments
Fourth quarter results were favorable for the reasons explained above. The following items are included in results for the fourth quarter of 2015:
Conference Call
The Company’s management will host a conference call and webcast to discuss its fourth quarter and year-end results at 5:00 p.m. Eastern time on Monday, February 8, 2016. The number to call for the interactive teleconference is (212) 271-4657. A telephonic replay of the conference call will be available from 7:00 p.m. Eastern time on Monday, February 8, 2016, through 6:00 p.m. on Tuesday, February 9, 2016, by dialing (800) 633-8284 and entering confirmation number 21802135. A live audio broadcast of Molina Healthcare’s conference call will be available on the Company’s website, molinahealthcare.com. A 30-day online replay will be available approximately an hour following the conclusion of the live broadcast.
About Molina Healthcare
Molina Healthcare, Inc., a FORTUNE 500 company, provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through our locally operated health plans in 11 states across the nation and in the Commonwealth of Puerto Rico, Molina currently serves approximately 3.5 million members. Dr. C. David Molina founded our company in 1980 as a provider organization serving low-income families in Southern California. Today, we continue his mission of providing high quality and cost-effective health care to those who need it most. For more information about Molina Healthcare, please visit our website at molinahealthcare.com.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995: This earnings release contains "forward-looking statements" regarding the Company’s plans, expectations, and anticipated future events. Actual results could differ materially due to numerous known and unknown risks and uncertainties. Those known risks and uncertainties include, but are not limited, to the following:
and numerous other risk factors, including those discussed in the Company’s periodic reports and filings with the Securities and Exchange Commission. These reports can be accessed under the investor relations tab of the Company’s website or on the SEC’s website at sec.gov. Given these risks and uncertainties, we can give no assurances that the Company’s forward-looking statements will prove to be accurate, or that any other results or events projected or contemplated by the Company’s forward-looking statements will in fact occur, and we caution investors not to place undue reliance on these statements. All forward-looking statements in this release represent the Company’s judgment as of February 8, 2016, and we disclaim any obligation to update any forward-looking statements to conform the statement to actual results or changes in the Company’s expectations.
MOLINA HEALTHCARE, INC.
UNAUDITED CONSOLIDATED STATEMENTS OF INCOME
Three Months Ended Year Ended December 31, December 31, 2015 2014 2015 2014 (Dollar amounts in millions, except net income per share) Revenue: Premium revenue $ 3,488 $ 2,599 $ 13,140 $ 9,023 Service revenue 106 54 252 210 Premium tax revenue 104 91 393 294 Health insurer fee revenue 61 52 264 120 Investment income 6 2 18 8 Other revenue — 4 5 12 Total revenue 3,765 2,802 14,072 9,667 Operating expenses: Medical care costs 3,110 2,322 11,691 8,076 Cost of service revenue 90 39 193 157 General and administrative expenses 317 205 1,147 765 Premium tax expenses 104 91 393 294 Health insurer fee expenses 40 23 157 89 Depreciation and amortization 28 25 104 93 Total operating expenses 3,689 2,705 13,685 9,474 Operating income 76 97 387 193 Other expenses, net: Interest expense 22 15 67 57 Other (income) expense, net (2 ) — (2 ) 1 Total other expenses, net 20 15 65 58 Income from continuing operations before income tax expense 56 82 322 135 Income tax expense 26 48 179 73 Income from continuing operations 30 34 143 62 Net income $ 30 $ 34 $ 143 $ 62 Diluted net income per share: (1) Income from continuing operations $ 0.51 $ 0.69 $ 2.57 $ 1.30 Loss from discontinued operations — — — (0.01 ) Diluted net income per share $ 0.51 $ 0.69 $ 2.57 $ 1.29 Diluted weighted average shares outstanding 57.7 48.9 55.6 48.3 Operating Statistics, Continuing Operations: (1) Medical care ratio (2) 89.2 % 89.4 % 89.0 % 89.5 % Service revenue ratio (3) 84.7 % 72.6 % 76.4 % 74.6 % General and administrative expense ratio (4) 8.4 % 7.3 % 8.2 % 7.9 % Premium tax ratio (2) 2.9 % 3.4 % 2.9 % 3.2 % Effective tax rate 47.0 % 58.6 % 55.5 % 53.8 % Net profit margin, continuing operations (4) 0.8 % 1.2 % 1.0 % 0.6 % ____________ (1) Source data for calculations in thousands. (2) Medical care ratio represents medical care costs as a percentage of premium revenue; premium tax ratio represents premium tax expenses as a percentage of premium revenue plus premium tax revenue. Medical care costs include costs incurred for providing long term services and supports (LTSS). (3) Service revenue ratio represents cost of service revenue as a percentage of service revenue. (4) Computed as a percentage of total revenue.MOLINA HEALTHCARE, INC.
UNAUDITED CONSOLIDATED BALANCE SHEETS
December 31, 2015 2014 (Amounts in millions,except per-share data) ASSETS Current assets: Cash and cash equivalents $ 2,329 $ 1,539 Investments 1,801 1,019 Receivables 597 596 Income taxes refundable 13 — Prepaid expenses and other current assets 192 49 Derivative asset 374 — Total current assets 5,306 3,203 Property, equipment, and capitalized software, net 393 341 Deferred contract costs 81 54 Intangible assets, net 122 89 Goodwill 519 272 Restricted investments 109 102 Derivative asset — 329 Deferred income taxes 18 15 Other assets 28 30 $ 6,576 $ 4,435 LIABILITIES AND STOCKHOLDERS’ EQUITY Current liabilities: Medical claims and benefits payable $ 1,582 $ 1,201 Amounts due government agencies 834 527 Accounts payable and accrued liabilities 360 242 Deferred revenue 223 196 Income taxes payable — 9 Current portion of long-term debt 449 — Derivative liability 374 — Total current liabilities 3,822 2,175 Senior notes 962 690 Lease financing obligations 198 157 Lease financing obligations - related party — 40 Derivative liability — 329 Other long-term liabilities 37 34 Total liabilities 5,019 3,425 Stockholders’ equity: Common stock, $0.001 par value; 150 shares authorized; outstanding: 56 shares at December 31, 2015 and 50 shares at December 31, 2014 — — Preferred stock, $0.001 par value; 20 shares authorized, no shares issued and outstanding — — Additional paid-in capital 803 396 Accumulated other comprehensive loss (4 ) (1 ) Retained earnings 758 615 Total stockholders’ equity 1,557 1,010 $ 6,576 $ 4,435 ____________ Note: Certain 2014 amounts have been reclassified to conform to the 2015 presentation. Specifically, current and non-current deferred issuance costs are now reported as direct deductions from “Current portion of long-term debt,” and “Senior notes,” respectively. Additionally, the aggregate amount of deferred income taxes are now reported as non-current. Both reclassifications are a result of recently adopted accounting pronouncements.MOLINA HEALTHCARE, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS,
CONTINUING AND DISCONTINUED OPERATIONS
Three Months Ended Year Ended December 31, December 31, 2015 2014 2015 2014 (Amounts in millions) Operating activities: Net income $ 30 $ 34 $ 143 $ 62 Adjustments to reconcile net income to net cash provided by operating activities: Depreciation and amortization 33 35 126 134 Deferred income taxes 5 9 (7 ) (2 ) Share-based compensation 7 6 23 22 Amortization of convertible senior notes and lease financing obligations 8 7 30 27 Other, net 6 3 19 7 Changes in operating assets and liabilities: Receivables 79 (171 ) 56 (298 ) Prepaid expenses and other current assets 28 32 (35 ) (20 ) Medical claims and benefits payable 20 77 379 531 Amounts due government agencies (146 ) 129 307 470 Accounts payable and accrued liabilities 48 37 82 11 Deferred revenue 153 5 24 74 Income taxes (52 ) 17 (22 ) 42 Net cash provided by operating activities 219 220 1,125 1,060 Investing activities: Purchases of investments (612 ) (337 ) (1,923 ) (953 ) Proceeds from sales and maturities of investments 263 159 1,126 633 Purchases of property, equipment, and capitalized software (31 ) (43 ) (132 ) (115 ) Increase in restricted investments (1 ) (10 ) (6 ) (34 ) Net cash paid in business combinations (373 ) (36 ) (450 ) (44 ) Other, net (1 ) (8 ) (35 ) (23 ) Net cash used in investing activities (755 ) (275 ) (1,420 ) (536 ) Financing activities: Proceeds from senior notes offerings, net of issuance costs 689 — 689 123 Proceeds from common stock offering, net of issuance costs — — 373 — Contingent consideration liabilities settled — — — (50 ) Proceeds from employee stock plans 10 6 18 14 Principal payments on convertible senior notes — (10 ) — (10 ) Other, net 2 — 5 2 Net cash provided by (used in) financing activities 701 (4 ) 1,085 79 Net increase (decrease) in cash and cash equivalents 165 (59 ) 790 603 Cash and cash equivalents at beginning of period 2,164 1,598 1,539 936 Cash and cash equivalents at end of period $ 2,329 $ 1,539 $ 2,329 $ 1,539MOLINA HEALTHCARE, INC.UNAUDITED NON-GAAP FINANCIAL MEASURES
The Company uses two non-GAAP financial measures as supplemental metrics in evaluating its financial performance, making financing and business decisions, and forecasting and planning for future periods. For these reasons, management believes such measures are useful supplemental measures to investors in comparing the Company’s performance to the performance of other public companies in the health care industry. These non-GAAP financial measures should be considered as supplements to, and not as substitutes for or superior to, GAAP measures.
The first of these non-GAAP measures is earnings before interest, taxes, depreciation and amortization (EBITDA). The following table reconciles net income, which the Company believes to be the most comparable GAAP measure, to EBITDA.
Three Months Ended Year Ended December 31, December 31, 2015 2014 2015 2014 (Amounts in millions) Net income $ 30 $ 34 $ 143 $ 62 Adjustments: Depreciation, and amortization of intangible assets and capitalized software 33 30 120 114 Interest expense 22 15 67 57 Income tax expense 26 48 179 72 EBITDA $ 111 $ 127 $ 509 $ 305The second of these non-GAAP measures is adjusted net income, continuing operations (including adjusted net income per diluted share). The following table reconciles net income from continuing operations, which the Company believes to be the most comparable GAAP measure, to adjusted net income, continuing operations. The source data for per diluted share calculations below is in thousands.
Three Months Ended December 31, Year Ended December 31, 2015 2014 2015 2014 (In millions, except per diluted share amounts) Amount Per share Amount Per share Amount Per share Amount Per share Net income, continuing operations $ 30 $ 0.51 $ 34 $ 0.69 $ 143 $ 2.57 $ 62 $ 1.30 Adjustments, net of tax: Amortization of convertible senior notes and lease financing obligations 5 0.08 4 0.09 19 0.34 17 0.36 Amortization of intangible assets 3 0.06 3 0.06 11 0.20 13 0.27 Adjusted net income, continuing operations (1) $ 38 $ 0.65 $ 41 $ 0.84 $ 173 $ 3.11 $ 92 $ 1.93 ________________________ (1) Beginning in the first quarter of 2015, the Company revised its calculation of adjusted net income, continuing operations. The Company no longer subtracts “depreciation, and amortization of capitalized software” and “share-based compensation” from net income, continuing operations to arrive at adjusted net income, continuing operations. The Company made this change to better reflect the way in which it evaluates its financial performance, makes financing and business decisions, and forecasts and plans for future periods. All periods presented conform to this presentation.MOLINA HEALTHCARE, INC.
UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP, CONTINUING OPERATIONS
As of December 31, 2015 2014 2013 Ending Membership by Health Plan: California 620,000 531,000 368,000 Florida 440,000 164,000 89,000 Illinois 98,000 100,000 4,000 Michigan 328,000 242,000 213,000 New Mexico 231,000 212,000 168,000 Ohio 327,000 347,000 255,000 Puerto Rico (1) 348,000 — — South Carolina 99,000 118,000 — Texas 260,000 245,000 252,000 Utah 102,000 83,000 86,000 Washington 582,000 497,000 403,000 Wisconsin 98,000 84,000 93,000 3,533,000 2,623,000 1,931,000 Ending Membership by Program: Temporary Assistance for Needy Families (TANF), CHIP(2) 2,312,000 1,809,000 1,603,000 Medicaid Expansion(3) 557,000 385,000 — Aged, Blind or Disabled (ABD) 366,000 347,000 289,000 Marketplace(3) 205,000 15,000 — Medicare-Medicaid Plan (MMP) - Integrated(4) 51,000 18,000 — Medicare Special Needs Plans 42,000 49,000 39,000 3,533,000 2,623,000 1,931,000 _______________________ (1) The Puerto Rico health plan began serving members effective April 1, 2015. (2) CHIP stands for Children’s Health Insurance Program. (3) Medicaid Expansion membership phased in, and Marketplace became available for consumers to access coverage, beginning January 1, 2014. (4) MMP members who receive both Medicaid and Medicare coverage from the Company. The Company began serving members under this program in the second quarter of 2014.MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA,
CONTINUING OPERATIONS
(In millions, except percentages and per-member per-month amounts)
Three Months Ended December 31, 2015 MemberMonths(1)
Premium Revenue Medical Care Costs MCR(2)MedicalMargin
Total PMPM Total PMPM California 1.8 $ 563 $ 309.31 $ 474 $ 260.44 84.2 % $ 89 Florida 1.2 329 277.71 318 268.98 96.9 11 Illinois 0.3 85 287.88 79 266.91 92.7 6 Michigan 1.0 329 334.44 282 287.00 85.8 47 New Mexico 0.7 304 438.82 263 379.10 86.4 41 Ohio 1.0 500 501.11 437 436.77 87.2 63 Puerto Rico 1.1 192 184.79 159 153.04 82.8 33 South Carolina 0.3 78 261.07 69 229.48 87.9 9 Texas 0.7 543 693.06 496 633.77 91.4 47 Utah 0.4 89 290.05 77 251.55 86.7 12 Washington 1.7 416 241.28 376 217.77 90.3 40 Wisconsin 0.3 55 186.57 53 182.41 97.8 2 Other(3) — 5 — 27 — — (22 ) 10.5 $ 3,488 $ 334.62 $ 3,110 $ 298.43 89.2 % $ 378 Three Months Ended December 31, 2014 MemberMonths(1)
Premium Revenue Medical Care Costs MCR(2)MedicalMargin
Total PMPM Total PMPM California 1.6 $ 463 $ 291.27 $ 379 $ 238.49 81.9 % $ 84 Florida 0.4 126 348.60 129 356.76 102.3 (3 ) Illinois 0.2 84 353.71 78 323.76 91.5 6 Michigan 0.7 213 294.14 185 254.41 86.5 28 New Mexico 0.7 299 456.40 294 448.99 98.4 5 Ohio 1.1 492 475.15 426 412.02 86.7 66 Puerto Rico — — — — — — — South Carolina 0.4 93 263.97 73 208.10 78.8 20 Texas 0.8 339 458.42 299 404.88 88.3 40 Utah 0.2 76 300.28 69 277.44 92.4 7 Washington 1.4 364 246.91 342 232.08 94.0 22 Wisconsin 0.2 38 148.99 36 139.75 93.8 2 Other(3) — 12 — 12 — — — 7.7 $ 2,599 $ 338.52 $ 2,322 $ 302.60 89.4 % $ 277 ____________ (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. Source data in thousands. (3) “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA,
CONTINUING OPERATIONS
(In millions, except percentages and per-member per-month amounts)
Year Ended December 31, 2015 MemberMonths(1)
Premium Revenue Medical Care Costs MCR(2)MedicalMargin
Total PMPM Total PMPM California 7.1 $ 2,101 $ 296.93 $ 1,823 $ 257.67 86.8 % $ 278 Florida 4.1 1,197 289.38 1,081 261.49 90.4 116 Illinois 1.2 397 328.93 367 303.72 92.3 30 Michigan 3.4 1,067 317.15 903 268.27 84.6 164 New Mexico 2.8 1,237 446.27 1,106 398.98 89.4 131 Ohio 4.1 2,034 499.34 1,718 421.61 84.4 316 Puerto Rico 3.2 567 178.31 505 158.80 89.1 62 South Carolina 1.3 348 267.25 278 213.30 79.8 70 Texas 3.1 1,961 621.25 1,809 573.32 92.3 152 Utah 1.2 331 286.22 300 259.32 90.6 31 Washington 6.6 1,602 242.36 1,470 222.36 91.7 132 Wisconsin 1.2 261 213.48 215 176.01 82.4 46 Other(3) — 37 — 116 — — (79 ) 39.3 $ 13,140 $ 334.71 $ 11,691 $ 297.81 89.0 % $ 1,449 Year Ended December 31, 2014 MemberMonths(1)
Premium Revenue Medical Care Costs MCR(2)MedicalMargin
Total PMPM Total PMPM California 5.6 $ 1,523 $ 270.51 $ 1,269 $ 225.37 83.3 % $ 254 Florida 1.1 439 397.79 419 379.95 95.5 20 Illinois 0.3 153 498.48 141 456.88 91.7 12 Michigan 2.8 781 278.68 661 235.81 84.6 120 New Mexico 2.5 1,076 435.17 996 402.92 92.6 80 Ohio 3.7 1,553 425.47 1,335 365.87 86.0 218 Puerto Rico — — — — — — — South Carolina 1.5 381 260.72 323 220.89 84.7 58 Texas 3.0 1,318 442.32 1,197 401.81 90.8 121 Utah 1.0 310 310.64 285 286.43 92.2 25 Washington 5.5 1,305 236.27 1,219 220.75 93.4 86 Wisconsin 1.0 156 150.87 136 130.91 86.8 20 Other(3) — 28 — 95 — — (67 ) 28.0 $ 9,023 $ 322.68 $ 8,076 $ 288.84 89.5 % $ 947 ____________ (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. Source data in thousands. (3) “Other” medical care costs include primarily medically related administrative costs at the parent company, and direct delivery costs.MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA,
CONTINUING OPERATIONS
(In millions, except percentages and per-member per-month amounts)
Three Months Ended December 31, 2015 (1) MemberMonths(2)
Premium Revenue Medical Care Costs MCR(3)MedicalMargin
Total PMPM Total PMPM TANF and CHIP 6.9 $ 1,203 $ 175.96 $ 1,092 $ 159.83 90.8 % $ 111 Medicaid Expansion 1.7 637 386.27 503 305.28 79.0 134 ABD 1.1 1,059 967.72 995 910.11 94.0 64 Marketplace 0.6 126 223.57 111 194.80 87.1 15 MMP 0.1 330 2,160.91 290 1,905.00 88.2 40 Medicare 0.1 133 1,076.00 119 954.40 88.7 14 10.5 $ 3,488 $ 334.62 $ 3,110 $ 298.43 89.2 % $ 378 Year Ended December 31, 2015 (1) MemberMonths(2)
Premium Revenue Medical Care Costs MCR(3)MedicalMargin
Total PMPM Total PMPM TANF and CHIP 25.5 $ 4,483 $ 175.64 $ 4,122 $ 161.50 92.0 % $ 361 Medicaid Expansion 5.9 2,291 391.62 1,828 312.58 79.8 463 ABD 4.3 4,122 966.37 3,784 887.27 91.8 338 Marketplace 2.6 651 251.96 481 185.85 73.8 170 MMP 0.5 1,063 2,033.76 974 1,863.93 91.6 89 Medicare 0.5 530 1,038.15 502 982.50 94.6 28 39.3 $ 13,140 $ 334.71 $ 11,691 $ 297.81 89.0 % $ 1,449 _______________________ (1) Three and twelve months ended December 31, 2014 data not presented due to lack of comparability. (2) A member month is defined as the aggregate of each month’s ending membership for the period presented. (3) The MCR represents medical costs as a percentage of premium revenue. Source data in thousands.MOLINA HEALTHCARE, INC.
UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA,
CONTINUING OPERATIONS
(In millions, except percentages and per-member per-month amounts)
The following tables provide the details of the Company’s medical care costs from continuing operations for the periods indicated:
Three Months Ended December 31, 2015 2014 Amount PMPM % ofTotal
Amount PMPM % ofTotal
Fee for service $ 2,297 $ 220.34 73.9 % $ 1,644 $ 214.14 70.8 % Pharmacy 449 43.08 14.4 354 46.12 15.3 Capitation 257 24.69 8.3 211 27.60 9.1 Direct delivery 43 4.14 1.4 26 3.42 1.1 Other 64 6.18 2.0 87 11.32 3.7 $ 3,110 $ 298.43 100.0 % $ 2,322 $ 302.60 100.0 % Year Ended December 31, 2015 2014 Amount PMPM % ofTotal
Amount PMPM % ofTotal
Fee for service $ 8,572 $ 218.35 73.3 % $ 5,673 $ 202.87 70.2 % Pharmacy 1,610 41.01 13.8 1,273 45.54 15.8 Capitation 982 25.02 8.4 748 26.77 9.3 Direct delivery 128 3.26 1.1 96 3.44 1.2 Other 399 10.17 3.4 286 10.22 3.5 $ 11,691 $ 297.81 100.0 % $ 8,076 $ 288.84 100.0 %The following table provides the details of the Company’s medical claims and benefits payable as of the dates indicated:
December 31, 2015 2014 Fee-for-service claims incurred but not paid (IBNP) $ 1,191 $ 871 Pharmacy payable 88 71 Capitation payable 37 28 Other (1) 266 231 $ 1,582 $ 1,201 ______________________ (1) “Other” medical claims and benefits payable include amounts payable to certain providers for which the Company acts as an intermediary on behalf of various state agencies without assuming financial risk. Such receipts and payments do not impact the Company’s consolidated statements of income. As of December 31, 2015 and 2014, the Company had recorded non-risk provider payables of approximately $167 million and $119 million, respectively.MOLINA HEALTHCARE, INC.UNAUDITED CHANGE IN MEDICAL CLAIMS AND BENEFITS PAYABLE(Dollars in millions, except per-member amounts)
The Company’s claims liability includes a provision for adverse claims deviation based on historical experience and other factors including, but not limited to, variations in claims payment patterns, changes in utilization and cost trends, known outbreaks of disease, and large claims. The Company’s reserving methodology is consistently applied across all periods presented. The amounts displayed for “Components of medical care costs related to: Prior period” represent the amount by which the Company’s original estimate of claims and benefits payable at the beginning of the period were more than the actual amount of the liability based on information (principally the payment of claims) developed since that liability was first reported. The following table presents the components of the change in medical claims and benefits payable from continuing and discontinued operations combined for the periods indicated:
Year Ended December 31, 2015 2014 Medical claims and benefits payable, beginning balance $ 1,201 $ 670 Components of medical care costs related to: Current period 11,832 8,123 Prior period (141 ) (46 ) Total medical care costs 11,691 8,077 Change in non-risk provider payables 48 (32 ) Payments for medical care costs related to: Current period 10,448 7,064 Prior period 910 450 Total paid 11,358 7,514 Medical claims and benefits payable, ending balance $ 1,582 $ 1,201 Benefit from prior period as a percentage of: Balance at beginning of period 11.8 % 6.9 % Premium revenue, trailing twelve months 1.1 % 0.5 % Medical care costs, trailing twelve months 1.2 % 0.6 % Fee-For-Service Claims Data: Days in claims payable, fee for service 48 49 Number of members at end of year 3,533,000 2,623,000 Number of claims in inventory at end of year 380,800 307,700 Billed charges of claims in inventory at end of year $ 816 $ 719 Claims in inventory per member at end of year 0.11 0.12 Billed charges of claims in inventory per member at end of year $ 230.91 $ 273.92 Number of claims received during the year 40,173,300 27,597,000 Billed charges of claims received during the year $ 46,211 $ 30,316MOLINA HEALTHCARE, INC.
HEALTH INSURER FEE DETAILS BY HEALTH PLAN
(In millions)
HIF Reimbursement Revenue, Gross(1) Year Ended December 31, 2015 RecognizedNecessary forFullReimbursement
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Total 2015 HIF: California $ — $ 17 $ 6 $ 8 $ 31 $ 31 Florida 2 2 2 2 8 8 Illinois 1 1 1 1 4 4 Michigan — — 21 7 28 28 New Mexico 7 8 8 7 30 30 Ohio 12 12 12 12 48 48 South Carolina 3 3 3 3 12 12 Texas 6 6 6 5 23 23 Utah — — 4 2 6 6 Washington 11 11 6 9 37 37 Wisconsin 1 1 1 2 5 5 Subtotal, Medicaid 43 61 70 58 232 232 Marketplace — — 1 1 2 2 Medicare 6 4 4 5 19 19 49 65 75 64 253 $ 253 2014 HIF: California — 12 — — 12 Michigan — — 7 — 7 Utah — — 1 — 1 $ 49 $ 77 $ 83 $ 64 $ 273 Recognized in: Health insurer fee revenue $ 48 $ 74 $ 81 $ 61 $ 264 Premium tax revenue 1 3 2 3 9 $ 49 $ 77 $ 83 $ 64 $ 273 _____________ (1) Amounts in the table include the Company’s estimate of the full economic impact of the excise tax including premium tax and the income tax effect.
View source version on businesswire.com: http://www.businesswire.com/news/home/20160208006217/en/
Molina Healthcare, Inc.Juan José Orellana, 562-435-3666, ext. 111143Investor Relations
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