Molina Healthcare Reports First Quarter 2019 Financial Results and Raises Full Year 2019 Earnings Guidance

  • Net income per diluted share was $2.99 in the first quarter of 2019
    compared with $1.64 in the first quarter of 2018, which included a net
    benefit of $0.38 per diluted share for non-run-rate items
  • After-tax margin improved to 4.8% in the first quarter of 2019
    compared with 2.3% in the first quarter of 2018
  • Medical care ratio was 85.3% in the first quarter, an improvement from
    87.7% in the first quarter of 2018, excluding non-run-rate items in
    the first quarter of 2018
  • Premium revenue was $4.0 billion in the first quarter of 2019, a 9%
    decrease compared with the first quarter of 2018, which was in line
    with the Company’s expectations
  • The Company raised full year 2019 earnings guidance to $10.50 – $11.00
    from $9.25 – $9.75, which does not include any future prior-period
    reserve development

LONG BEACH, Calif.–(BUSINESS WIRE)–Molina Healthcare, Inc. (NYSE: MOH) today reported financial results for
the first quarter of 2019 and raised full year 2019 guidance.

“These results are a testament to the achievability of the second phase
of our strategy, which is to sustain the attractive margin position we
had built in 2018,” said Joe Zubretsky, president and CEO. “While
certainly not conclusive, our first quarter results validate our
position that durable financial and operational improvement can and
should allow us to sustain these margins, all while we begin to grow the
top line again.”

Consolidated Results

First Quarter of 2019 Compared with First Quarter of 2018

Net income increased to $198 million from $107 million in the first
quarter of 2018. Net income per diluted share increased to $2.99 from
$1.64 in the first quarter of 2018.

Premium revenue decreased $371 million, or 9%, in the first quarter of
2019 compared with the first quarter of 2018, as expected. The decrease
was primarily due to the previously announced loss of the Company’s New
Mexico Medicaid contract along with the resizing of the Company’s
Florida Medicaid contract and the related transition out of all but two
regions.

The medical care ratio (MCR) was 85.3% in the first quarter of 2019, an
improvement compared with 86.1% in the first quarter of 2018. Excluding
the $70 million benefit of the 2017 Marketplace cost-sharing reduction
(CSR) reimbursement recognized in first quarter of 2018, the MCR would
have been 87.7% in the first quarter of 2018. The change in the overall
MCR was due to:

  • The Medicaid MCR was 88.5% in the first quarter of 2019, an
    improvement compared with 90.8% in the first quarter of 2018. This was
    mainly due to improvements in the Temporary Assistance for Needy
    Families and Aged, Blind or Disabled programs, partially offset by an
    increased MCR in the Medicaid Expansion program, primarily in
    California and Ohio.
  • The Marketplace MCR was 62.2% in the first quarter of 2019, compared
    with 50.6% in the first quarter of 2018. The prior year MCR was
    positively impacted by the benefit of the CSR, without which the
    Marketplace MCR would have been 66.8% in the first quarter of 2018.
    The year-over-year improvement primarily reflected increased premium
    revenue related to rate increases and risk scores that are more
    commensurate with the acuity of the Company’s Marketplace population.

The general and administrative (G&A) expense ratio was 7.3% in the first
quarter of 2019, an improvement compared with 7.6% in the first quarter
of 2018 primarily due to lower expenses and the timing of certain
expenditures, which were partially offset by the impact associated with
lower premium revenue.

Capital Plan Progress

In the first quarter of 2019, the Company repaid $46 million aggregate
principal amount of its 1.125% Convertible Notes and entered into
privately negotiated termination agreements to terminate the respective
portion of the related 1.125% Call Option and 1.125% Warrants.

In April 2019, the Company repaid an additional $128 million aggregate
principal amount of its 1.125% Convertible Notes and entered into
privately negotiated termination agreements to terminate the respective
portion of the related 1.125% Call Option and 1.125% Warrants. Following
these transactions, the remaining principal amount outstanding of the
Company’s 1.125% Convertible Notes is $78 million. In addition, the
Company has received a conversion notice for $7 million principal amount
that will be settled in August 2019.

2019 Revised Guidance

The following table summarizes 2019 Revised Guidance (1):

         

2019 Revised
Guidance

       

2019 Initial
Guidance

 
Premium revenue   ~$15.9B     ~$15.8B
Premium tax revenue ~$425M ~$375M
  Investment income and other revenue         ~$115M     ~$195M  
Total revenue ~$16.4B ~$16.3B
Medical care costs ~$13.6B ~$13.7B
Medical care ratio (2) ~86% 86.7% – 87.0%
General and administrative expenses ~$1.3B ~$1.2B
G&A ratio (3) ~7.7% 7.5% – 7.7%
Premium tax expenses ~$425M ~$375M
Depreciation and amortization ~$90M ~$85M
Interest expense and other expenses, net ~$90M ~$100M
Income before income taxes $900M – $940M $790M – $840M
Net income $680M – $710M $600M – $630M
EBITDA (4) $1,080M – $1,120M $975M – $1,025M
Effective tax rate ~24.5% 24.5% – 25.0%
After-tax margin (3) 4.1% – 4.3% 3.7% – 3.9%
Diluted weighted average shares ~64.7M ~64.7M
Net income per share $10.50 – $11.00 $9.25 – $9.75
End-of-year membership by government program:
Medicaid and Medicare ~3.1M ~3.2M
Marketplace 270K – 280K 250K – 275K

__________________

(1)   All amounts are estimates and do not include non-recurring
significant items. Earnings per diluted share as shown is calculated
on a GAAP basis; actual results may differ materially. See the
Company’s risk factors as discussed in its 2018 Form 10-K and other
filings and the statements below in this press release after the
heading “Safe Harbor Statement under the Private Securities
Litigation Reform Act of 1995.”
(2) Medical care ratio represents medical care costs as a percentage of
premium revenue.
(3) G&A ratio represents general and administrative expenses as a
percentage of total revenue. After-tax margin represents net income
as a percentage of total revenue.
(4) See reconciliation of non-GAAP financial measures at the end of this
release.
 

Conference Call

Management will host a conference call and webcast to discuss Molina
Healthcare’s first quarter 2019 results at 8:30 a.m. Eastern time on
Tuesday, April 30, 2019. The number to call for the interactive
teleconference is (877) 883-0383 and the confirmation number is 4093086.
A telephonic replay of the conference call will be available through
Tuesday, May 7, 2019, by dialing (877) 344-7529 and entering
confirmation number 10130214. A live audio broadcast of this conference
call will be available on Molina Healthcare’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 its locally operated health plans,
Molina Healthcare served approximately 3.4 million members as of March
31, 2019. For more information about Molina Healthcare, please visit 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 revised 2019 guidance, as well as its plans, expectations, and
anticipated future events. Actual results could differ materially due to
numerous known and unknown risks and uncertainties. Those risks and
uncertainties are discussed in the section entitled “Risk Factors” in
the Company’s Annual Report on Form 10-K for the year ended December
31, 2018, and the section entitled “Forward-Looking Statements” in the
Company’s Quarterly Report on Form 10-Q for the period ended March 31,
2019.

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, the Company can give no assurances
that its forward-looking statements will prove to be accurate, or that
any other results or events projected or contemplated by its
forward-looking statements will in fact occur, and the Company cautions
investors not to place undue reliance on these statements. All
forward-looking statements in this release represent the Company’s
judgment as of April 29, 2019, and, except as otherwise required by law,
the Company disclaims any obligation to update any forward-looking
statements to conform the statement to actual results or changes in its
expectations.

 

MOLINA HEALTHCARE, INC.

UNAUDITED CONSOLIDATED STATEMENTS OF INCOME

 
    Three Months Ended March 31,
2019     2018

(In millions, except per-share
amounts)

Revenue:
Premium revenue $ 3,952 $ 4,323
Premium tax revenue 138 104
Health insurer fees reimbursed 61
Service revenue 134
Investment income and other revenue   29     24  
Total revenue   4,119     4,646  
Operating expenses:
Medical care costs 3,371 3,722
General and administrative expenses 302 352
Premium tax expenses 138 104
Health insurer fees 75
Depreciation and amortization 25 26
Restructuring costs 3 25
Cost of service revenue       120  
Total operating expenses   3,839     4,424  
Operating income   280     222  
Other expenses, net:
Interest expense 23 33
Other (income) expenses, net   (3 )   10  
Total other expenses, net   20     43  
Income before income tax expense 260 179
Income tax expense   62     72  
Net income $ 198   $ 107  
 
Net income per diluted share $ 2.99   $ 1.64  
 
Diluted weighted average shares outstanding   66.2     65.2  
 
Operating Statistics:
Medical care ratio 85.3 % 86.1 %
G&A ratio 7.3 % 7.6 %
Premium tax ratio 3.4 % 2.3 %
Effective income tax expense rate 23.8 % 40.3 %
After-tax margin 4.8 % 2.3 %
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED CONSOLIDATED BALANCE SHEETS

 
    March 31,     December 31,
2019 2018

(Dollars in millions,
except per-share
amounts)

ASSETS
Current assets:
Cash and cash equivalents $ 3,224 $ 2,826
Investments 1,508 1,681
Receivables 1,359 1,330
Prepaid expenses and other current assets 124 149
Derivative asset   516     476  
Total current assets 6,731 6,462
Property, equipment, and capitalized software, net 376 241
Goodwill and intangible assets, net 185 190
Restricted investments 100 120
Deferred income taxes 76 117
Other assets   111     24  
$ 7,579   $ 7,154  
 
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Medical claims and benefits payable $ 1,995 $ 1,961
Amounts due government agencies 932 967
Accounts payable and accrued liabilities 444 390
Deferred revenue 207 211
Current portion of long-term debt 198 241
Derivative liability   516     476  
Total current liabilities 4,292 4,246
Long-term debt 1,121 1,020
Finance lease liabilities 234 197
Other long-term liabilities   97     44  
Total liabilities   5,744     5,507  
Stockholders’ equity:
Common stock, $0.001 par value, 150 million shares authorized;
outstanding: 63 million shares at March 31, 2019 and 62 million
shares at December 31, 2018
Preferred stock, $0.001 par value; 20 million shares authorized, no
shares issued and outstanding
Additional paid-in capital 543 643
Accumulated other comprehensive loss (3 ) (8 )
Retained earnings   1,295     1,012  
Total stockholders’ equity   1,835     1,647  
$ 7,579   $ 7,154  
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

 
    Three Months Ended March 31,
2019     2018
(In millions)
Operating activities:
Net income $ 198 $ 107
Adjustments to reconcile net income to net cash provided by
operating activities:
Depreciation and amortization 25 37
Deferred income taxes 15 (6 )
Share-based compensation 9 6
Amortization of convertible senior notes and finance lease
liabilities
3 7
(Gain) loss on debt extinguishment (3 ) 10
Non-cash restructuring costs 17
Other, net 3 2
Changes in operating assets and liabilities:
Receivables (29 ) (83 )
Prepaid expenses and other current assets 20 (239 )
Medical claims and benefits payable 34 (163 )
Amounts due government agencies (35 ) 172
Accounts payable and accrued liabilities (30 ) 319
Deferred revenue (4 ) 130
Income taxes   43     78  
Net cash provided by operating activities   249     394  
Investing activities:
Purchases of investments (185 ) (389 )
Proceeds from sales and maturities of investments 366 543
Purchases of property, equipment, and capitalized software (6 ) (4 )
Other, net   (4 )   (5 )
Net cash provided by investing activities   171     145  
Financing activities:
Repayment of principal amount of 1.125% Convertible Notes (46 )
Cash paid for partial settlement of 1.125% Conversion Option (115 )
Cash received for partial termination of 1.125% Call Option 115
Cash paid for partial termination of 1.125% Warrants (103 )
Proceeds from borrowings under Term Loan 100
Other, net   1     (5 )
Net cash used in financing activities   (48 )   (5 )
Net increase in cash, cash equivalents, and restricted cash and cash
equivalents
372 534
Cash, cash equivalents, and restricted cash and cash equivalents at
beginning of period
  2,926     3,290  
Cash, cash equivalents, and restricted cash and cash equivalents at
end of period
$ 3,298   $ 3,824  
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED HEALTH PLANS SEGMENT MEMBERSHIP

 
   

March 31,
2019

   

December 31,
2018

   

March 31,
2018

Ending Membership by Government Program:
Temporary Assistance for Needy Families (“TANF”) and Children’s
Health Insurance Program (“CHIP”)
2,016,000 2,295,000 2,435,000
Medicaid Expansion 596,000 660,000 662,000
Aged, Blind or Disabled (“ABD”) 352,000 406,000 411,000
Total Medicaid 2,964,000 3,361,000 3,508,000
Medicare-Medicaid Plan (“MMP”) – Integrated 56,000 54,000 56,000
Medicare Special Needs Plans 41,000 44,000 44,000
Total Medicare 97,000 98,000 100,000
Total Medicaid and Medicare 3,061,000 3,459,000 3,608,000
Marketplace 332,000 362,000 453,000
3,393,000 3,821,000 4,061,000
 
Ending Membership by Health Plan:
California 600,000 608,000 656,000
Florida (1) 144,000 313,000 414,000
Illinois 219,000 224,000 151,000
Michigan 369,000 383,000 388,000
New Mexico (1) 27,000 222,000 250,000
Ohio 295,000 302,000 328,000
Puerto Rico 207,000 252,000 316,000
South Carolina 126,000 120,000 117,000
Texas 377,000 423,000 476,000
Washington 815,000 781,000 779,000
Other (2) 214,000 193,000 186,000
3,393,000 3,821,000 4,061,000
__________________
(1)   As reported throughout 2018, the Company’s Medicaid contracts in New
Mexico and in all but two regions in Florida terminated in late 2018
and early 2019. During 2019, the Company continues to serve Medicare
and Marketplace members in both Florida and New Mexico, as well as
Medicaid members in two regions in Florida.
(2) “Other” includes the Idaho, Mississippi, New York, Utah and
Wisconsin health plans, which are not individually significant to
the Company’s consolidated operating results.
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—

BY GOVERNMENT PROGRAM

(In millions, except percentages and per-member per-month
amounts)

 
    Three Months Ended March 31, 2019

Member
Months (1)

    Premium Revenue     Medical Care Costs     MCR (2)    

Medical
Margin

Total     PMPM Total     PMPM
TANF and CHIP 6.2 $ 1,173 $ 189.36 $ 1,022 $ 165.05 87.2 % $ 151
Medicaid Expansion 1.8 664 369.62 594 330.45 89.4 70
ABD 1.1   1,167 1,068.43   1,042 953.48 89.2   125
Total Medicaid 9.1   3,004 330.75   2,658 292.60 88.5   346
MMP 0.2 388 2,355.29 333 2,026.83 86.1 55
Medicare 0.1   163 1,284.70   133 1,047.78 81.6   30
Total Medicare 0.3   551 1,889.47   466 1,600.84 84.7   85
Total Medicaid and Medicare 9.4   3,555 379.19   3,124 333.26 87.9   431
Marketplace 1.0   397 393.53   247 244.61 62.2   150
10.4 $ 3,952 $ 380.59 $ 3,371 $ 324.65 85.3 % $ 581
 
 
Three Months Ended March 31, 2018

Member
Months

Premium Revenue Medical Care Costs MCR

Medical
Margin

Total PMPM Total PMPM
TANF and CHIP 7.4 $ 1,373 $ 185.14 $ 1,272 $ 171.56 92.7 % $ 101
Medicaid Expansion 2.0 752 372.75 641 317.46 85.2 111
ABD 1.2   1,254 1,014.23   1,155 934.55 92.1   99
Total Medicaid 10.6   3,379 316.69   3,068 287.56 90.8   311
MMP 0.2 357 2,137.88 305 1,824.21 85.3 52
Medicare 0.1   157 1,188.97   131 994.81 83.7   26
Total Medicare 0.3   514 1,718.61   436 1,457.75 84.8   78
Total Medicaid and Medicare 10.9   3,893 354.94   3,504 319.48 90.0   389
Marketplace 1.4   430 312.87   218 158.40 50.6   212
12.3 $ 4,323 $ 350.25 $ 3,722 $ 301.55 86.1 % $ 601
__________________
(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.
 
   

MOLINA HEALTHCARE, INC.

UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—

MEDICAID AND MEDICARE BY HEALTH PLAN

(In millions, except percentages and per-member per-month
amounts)

 
Three Months Ended March 31, 2019

Member
Months

    Premium Revenue     Medical Care Costs     MCR    

Medical
Margin

Total     PMPM Total     PMPM
California 1.7 $ 499 $ 299.83 $ 448 $ 269.33 89.8 % $ 51
Florida 0.4 162 387.48 127 303.05 78.2 35
Illinois 0.7 227 348.04 185 282.70 81.2 42
Michigan 1.1 395 363.04 326 299.99 82.6 69
Ohio 0.9 590 659.09 537 600.07 91.0 53
Puerto Rico 0.6 102 165.02 90 145.38 88.1 12
South Carolina 0.4 136 363.14 115 308.87 85.1 21
Texas 0.6 599 902.56 532 801.53 88.8 67
Washington 2.4 614 258.41 586 246.69 95.5 28
Other (1) (2) 0.6   231 370.26   178 285.13 77.0   53
9.4 $ 3,555 $ 379.19 $ 3,124 $ 333.26 87.9 % $ 431
 
 
Three Months Ended March 31, 2018

Member
Months

Premium Revenue Medical Care Costs MCR

Medical
Margin

Total PMPM Total PMPM
California 1.8 $ 494 $ 272.61 $ 412 $ 227.31 83.4 % $ 82
Florida 1.0 382 351.58 345 317.41 90.3 37
Illinois 0.5 141 298.17 122 257.50 86.4 19
Michigan 1.1 376 336.64 331 296.19 88.0 45
New Mexico (2) 0.7 319 466.17 310 453.30 97.2 9
Ohio 0.9 551 576.60 460 481.26 83.5 91
Puerto Rico 1.0 186 193.13 174 181.39 93.9 12
South Carolina 0.3 122 348.08 104 297.52 85.5 18
Texas 0.7 562 809.90 519 747.53 92.3 43
Washington 2.3 584 256.66 574 252.41 98.3 10
Other (1) 0.6   176 314.93   153 273.36 86.8   23
10.9 $ 3,893 $ 354.94 $ 3,504 $ 319.48 90.0 % $ 389
__________________
(1)   “Other” includes the Idaho, Mississippi, New York, Utah and
Wisconsin health plans, which are not individually significant to
the Company’s consolidated operating results.
(2) In 2019, “Other” includes the New Mexico health plan. The New Mexico
health plan’s Medicaid contract terminated on December 31, 2018, and
therefore its 2019 results are not individually significant to the
Company’s consolidated operating results.
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—

MARKETPLACE BY HEALTH PLAN

(In millions, except percentages and per-member per-month
amounts)

 
    Three Months Ended March 31, 2019

Member
Months

    Premium Revenue     Medical Care Costs     MCR    

Medical
Margin

Total     PMPM Total     PMPM
California 0.1 $ 56 $ 342.00 $ 33 $ 201.46 58.9 % $ 23
Florida 0.2 61 421.17 26 177.31 42.1 35
Michigan 10 467.25 5 211.50 45.3 5
Ohio 30 853.87 15 448.51 52.5 15
Texas 0.6 148 306.36 109 226.36 73.9 39
Washington 47 711.60 29 435.90 61.3 18
Other (1) 0.1   45   476.11   30   314.70 66.1   15
1.0 $ 397   $ 393.53 $ 247   $ 244.61 62.2 % $ 150
 
 
Three Months Ended March 31, 2018

Member
Months

Premium Revenue Medical Care Costs MCR

Medical
Margin

Total PMPM Total PMPM
California 0.2 $ 49 $ 253.93 $ 31 $ 162.64 64.0 % $ 18
Florida 0.2 45 271.12 (16 ) (95.60 ) (35.3 ) 61
Michigan 0.1 13 224.11 9 144.16 64.3 4
New Mexico 0.1 34 438.67 19 246.50 56.2 15
Ohio 0.1 26 403.44 17 262.87 65.2 9
Texas 0.7 229 308.74 146 196.89 63.8 83
Washington 39 526.36 30 405.40 77.0 9
Other (2)   (5 ) NM   (18 ) NM NM   13
1.4 $ 430   $ 312.87 $ 218   $ 158.40 50.6 % $ 212
__________________
(1)   “Other” includes the New Mexico, Utah and Wisconsin health plans,
which are not individually significant to the Company’s consolidated
operating results in 2019.
(2) “Other” includes the Utah and Wisconsin health plans, where the
Company did not participate in the Marketplace in 2018. Therefore,
the ratios for 2018 periods are not meaningful (NM).
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED SELECTED HEALTH PLANS SEGMENT FINANCIAL DATA—

TOTAL BY HEALTH PLAN

(In millions, except percentages and per-member per-month
amounts)

 
    Three Months Ended March 31, 2019

Member
Months

    Premium Revenue     Medical Care Costs     MCR    

Medical
Margin

Total     PMPM Total     PMPM
California 1.8 $ 555 $ 303.64 $ 481 $ 263.20 86.7 % $ 74
Florida 0.6 223 396.13 153 270.76 68.4 70
Illinois 0.7 227 348.04 185 282.70 81.2 42
Michigan 1.1 405 365.09 331 298.25 81.7 74
Ohio 0.9 620 666.41 552 594.38 89.2 68
Puerto Rico 0.6 102 165.02 90 145.38 88.1 12
South Carolina 0.4 136 363.14 115 308.87 85.1 21
Texas 1.2 747 651.67 641 559.49 85.9 106
Washington 2.4 661 270.72 615 251.83 93.0 46
Other (1) (2) 0.7   276 384.08   208 288.99 75.2   68
10.4 $ 3,952 $ 380.59 $ 3,371 $ 324.65 85.3 % $ 581
 
 
Three Months Ended March 31, 2018

Member
Months

Premium Revenue Medical Care Costs MCR

Medical
Margin

Total PMPM Total PMPM
California 2.0 $ 543 $ 270.80 $ 443 $ 221.03 81.6 % $ 100
Florida 1.2 427 340.91 329 262.65 77.0 98
Illinois 0.5 141 298.17 122 257.50 86.4 19
Michigan 1.2 389 331.08 340 288.68 87.2 49
New Mexico (2) 0.8 353 463.33 329 431.94 93.2 24
Ohio 1.0 577 565.62 477 467.41 82.6 100
Puerto Rico 1.0 186 193.13 174 181.39 93.9 12
South Carolina 0.3 122 348.08 104 297.52 85.5 18
Texas 1.4 791 551.28 665 463.37 84.1 126
Washington 2.3 623 265.20 604 257.25 97.0 19
Other (1) 0.6   171 305.94   135 240.95 78.8   36
12.3 $ 4,323 $ 350.25 $ 3,722 $ 301.55 86.1 % $ 601
__________________
(1)   “Other” includes the Idaho, Mississippi, New York, Utah and
Wisconsin health plans, which are not individually significant to
the Company’s consolidated operating results.
(2) In 2019, “Other” includes the New Mexico health plan. The New Mexico
health plan’s Medicaid contract terminated on December 31, 2018, and
therefore its 2019 results are not individually significant to the
Company’s consolidated operating results.
 
 

MOLINA HEALTHCARE, INC.

UNAUDITED SELECTED FINANCIAL DATA

(In millions, except percentages and per-member per-month
amounts)

 

The following table provides details of the Company’s medical care
costs for the periods indicated:

 
    Three Months Ended March 31,
2019     2018
Amount     PMPM    

% of
Total

Amount     PMPM    

% of
Total

Fee for service $ 2,514 $ 242.12 74.6 % $ 2,745 $ 222.38 73.8 %
Pharmacy 413 39.73 12.2 583 47.25 15.6
Capitation 285 27.46 8.5 312 25.28 8.4
Other   159   15.34 4.7     82   6.64   2.2  
$ 3,371 $ 324.65 100.0 % $ 3,722 $ 301.55   100.0 %
 

The following table provides details of the Company’s medical
claims and benefits payable as of the dates indicated:

 
March 31, December 31,
2019 2018
Fee-for-service claims incurred but not paid (IBNP) $ 1,411 $ 1,562
Pharmacy payable 114 115
Capitation payable 59 52
Other (1)   411   232  
$ 1,995 $ 1,961  
__________________
(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 March 31, 2019 and December 31, 2018,
the Company had recorded non-risk provider payables of approximately
$278 million and $107 million, respectively.
 

MOLINA HEALTHCARE, INC.
UNAUDITED CHANGE IN MEDICAL
CLAIMS AND BENEFITS PAYABLE

(Dollars in millions)

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.

Contacts

Ryan Kubota
Investor Relations
562-435-3666, ext. 119057

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