e10vq
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
(Mark One)
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þ |
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QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934 |
For the quarterly period ended September 30, 2007
Or
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o |
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934 |
For the transition period from to
Commission file number: 001-31719
Molina Healthcare, Inc.
(Exact name of registrant as specified in its charter)
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Delaware
(State or other jurisdiction of
incorporation or organization)
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13-4204626
(I.R.S. Employer
Identification No.) |
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200 Oceangate, Suite 100,
Long Beach, California
(Address of principal executive offices)
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90802
(Zip Code) |
(562) 435-3666
(Registrants telephone number, including area code)
One Golden Shore Drive
Long Beach, California 90802
(Former name, former address, and former fiscal year, if changed since last report)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed
by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days. Yes þ No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated
filer, or a non-accelerated filer. See definition of accelerated filer and large accelerated
filer in Rule 12b-2 of the Exchange Act. (Check one):
Large accelerated filer o Accelerated filer þ Non-accelerated filer o
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of
the Exchange Act). Yes o No þ
The number of shares of the issuers Common Stock, par value $0.001 per share, outstanding as
of November 7, 2007, was 28,361,121.
MOLINA HEALTHCARE, INC.
Index
PART I FINANCIAL INFORMATION
Item 1: Financial Statements.
MOLINA HEALTHCARE, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
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September 30, |
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December 31, |
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2007 |
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2006 |
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(Amounts in thousands, except share data) |
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(Unaudited) |
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ASSETS
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Current assets: |
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Cash and cash equivalents |
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$ |
447,594 |
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$ |
403,650 |
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Investments |
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108,161 |
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81,481 |
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Receivables |
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124,145 |
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110,835 |
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Income tax receivable |
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7,960 |
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Deferred income taxes |
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577 |
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313 |
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Prepaid expenses and other current assets |
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11,424 |
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9,263 |
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Total current assets |
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691,901 |
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613,502 |
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Property and equipment, net |
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47,431 |
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41,903 |
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Goodwill and intangible assets, net |
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133,502 |
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143,139 |
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Restricted investments |
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27,762 |
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20,154 |
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Receivable for ceded life and annuity contracts |
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30,929 |
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32,923 |
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Other assets |
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14,492 |
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12,854 |
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Total assets |
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$ |
946,017 |
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$ |
864,475 |
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LIABILITIES AND STOCKHOLDERS EQUITY
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Current liabilities: |
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Medical claims and benefits payable |
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$ |
308,722 |
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$ |
290,048 |
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Deferred revenue |
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42,043 |
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18,120 |
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Income tax payable |
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1,242 |
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Accounts payable and accrued liabilities |
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61,778 |
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46,725 |
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Total current liabilities |
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413,785 |
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354,893 |
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Long-term debt |
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20,000 |
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45,000 |
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Deferred income taxes |
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1,056 |
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6,700 |
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Liability for ceded life and annuity contracts |
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30,929 |
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32,923 |
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Other long-term liabilities |
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11,808 |
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4,793 |
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Total liabilities |
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477,578 |
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444,309 |
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Stockholders equity: |
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Common stock, $0.001 par value; 80,000,000
shares authorized; issued and outstanding: 28,346,685 shares at September 30, 2007 and 28,119,026 shares at December 31, 2006 |
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28 |
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28 |
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Preferred stock, $0.001 par value; 20,000,000
shares authorized, no shares issued and
outstanding |
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Additional paid-in capital |
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181,841 |
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173,990 |
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Accumulated other comprehensive income (loss) |
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111 |
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(337 |
) |
Retained earnings |
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306,849 |
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266,875 |
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Treasury stock (1,201,174 shares, at cost) |
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(20,390 |
) |
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(20,390 |
) |
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Total stockholders equity |
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468,439 |
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420,166 |
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Total liabilities and stockholders equity |
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$ |
946,017 |
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$ |
864,475 |
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See accompanying notes.
3
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(Unaudited)
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Three Months Ended |
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Nine Months Ended |
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September 30, |
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September 30, |
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2007 |
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2006 |
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2007 |
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2006 |
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(Amounts in thousands, except net income per share) |
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Revenue: |
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Premium revenue |
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$ |
628,402 |
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$ |
512,080 |
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$ |
1,791,764 |
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$ |
1,441,197 |
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Investment income |
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7,632 |
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5,385 |
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21,061 |
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14,278 |
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Total revenue |
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636,034 |
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517,465 |
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1,812,825 |
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1,455,475 |
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Expenses: |
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Medical care costs |
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525,902 |
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430,870 |
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1,519,244 |
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1,215,832 |
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General and administrative expenses |
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74,235 |
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60,504 |
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204,831 |
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168,025 |
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Depreciation and amortization |
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7,082 |
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5,633 |
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20,274 |
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15,265 |
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Impairment charge on purchased software |
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782 |
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Total expenses |
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607,219 |
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497,007 |
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1,745,131 |
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1,399,122 |
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Operating income |
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28,815 |
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20,458 |
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67,694 |
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56,353 |
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Other expense: |
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Interest expense |
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(530 |
) |
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(645 |
) |
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(2,380 |
) |
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(1.636 |
) |
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Total other expense |
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(530 |
) |
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(645 |
) |
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(2,380 |
) |
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(1,636 |
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Income before income taxes |
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28,285 |
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19,813 |
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65,314 |
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54,717 |
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Income tax expense |
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10,772 |
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7,472 |
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24,895 |
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20,634 |
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Net income |
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$ |
17,513 |
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$ |
12,341 |
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$ |
40,419 |
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$ |
34,083 |
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Net income per share: |
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Basic |
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$ |
0.62 |
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$ |
0.44 |
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$ |
1.43 |
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$ |
1.22 |
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Diluted |
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$ |
0.62 |
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$ |
0.44 |
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$ |
1.43 |
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$ |
1.21 |
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Weighted average shares outstanding: |
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Basic |
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28,306 |
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28,022 |
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28,229 |
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27,942 |
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Diluted |
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28,441 |
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28,346 |
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28,356 |
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28,253 |
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See accompanying notes.
4
CONDENSED
CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)
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Nine Months Ended |
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September 30, |
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2007 |
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2006 |
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(Dollars in thousands) |
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Operating activities |
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Net income |
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$ |
40,419 |
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$ |
34,083 |
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Adjustments to reconcile net income to net cash provided by operating activities: |
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Depreciation and amortization |
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20,274 |
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15,265 |
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Amortization of capitalized credit facility fees |
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|
646 |
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|
646 |
|
Deferred income taxes |
|
|
(4,139 |
) |
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|
(2,510 |
) |
Stock-based compensation |
|
|
5,238 |
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|
4,331 |
|
Changes in operating assets and liabilities: |
|
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Receivables |
|
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(13,310 |
) |
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|
(13,099 |
) |
Prepaid expenses and other current assets |
|
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(2,161 |
) |
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|
2,068 |
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Medical claims and benefits payable |
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|
18,674 |
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17,036 |
|
Deferred revenue |
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23,923 |
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Accounts payable and accrued liabilities |
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|
14,763 |
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|
7,411 |
|
Income taxes |
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|
8,989 |
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|
1,955 |
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Net cash provided by operating activities |
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|
113,316 |
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|
67,186 |
|
Investing activities |
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Purchases of equipment |
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(16,514 |
) |
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(13,285 |
) |
Purchases of investments |
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(85,252 |
) |
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(103,702 |
) |
Sales and maturities of investments |
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|
59,292 |
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|
115,866 |
|
Increase in restricted cash |
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(7,608 |
) |
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|
(738 |
) |
Net cash acquired in purchase transactions |
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|
5,820 |
|
Increase in other long-term liabilities |
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|
6,569 |
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|
42 |
|
Increase in other assets |
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(2,921 |
) |
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(1,218 |
) |
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Net cash used in investing activities |
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|
(46,434 |
) |
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|
2,785 |
|
Financing activities |
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Borrowings under credit facility |
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|
20.000 |
|
Repayment of amounts borrowed under credit facility |
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(25,000 |
) |
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(5,000 |
) |
Payment of credit facility fees |
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|
(551 |
) |
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Repurchase and retirement of common stock |
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(480 |
) |
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Tax benefit from exercise of employee stock options recorded as additional paid-in capital |
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|
554 |
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|
1,094 |
|
Proceeds from exercise of stock options and employee stock purchases |
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|
2,539 |
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|
1,816 |
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Net cash (used in) provided by financing activities |
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(22,938 |
) |
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|
17,910 |
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Net increase in cash and cash equivalents |
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|
43,944 |
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|
87,881 |
|
Cash and cash equivalents at beginning of period |
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|
403,650 |
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|
249,203 |
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Cash and cash equivalents at end of period |
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$ |
447,594 |
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$ |
337,084 |
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Supplemental cash flow information |
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Cash paid during the period for: |
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Income taxes |
|
$ |
15,003 |
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|
$ |
19,969 |
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|
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Interest |
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$ |
2,695 |
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|
$ |
1,589 |
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|
Schedule of non-cash investing and financing activities: |
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Change in unrealized loss on investments |
|
$ |
720 |
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|
$ |
386 |
|
Deferred taxes |
|
|
(272 |
) |
|
|
(148 |
) |
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|
|
|
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|
Change in net unrealized loss on investments |
|
$ |
448 |
|
|
$ |
238 |
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|
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|
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Value of stock issued for employee compensation earned in previous year |
|
$ |
|
|
|
$ |
2,178 |
|
|
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|
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Details of acquisitions: |
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Fair value of assets acquired |
|
$ |
|
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|
$ |
86,024 |
|
Less cash acquired in purchase transaction |
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|
|
|
|
|
(49,820 |
) |
Deferred taxes |
|
|
|
|
|
|
(42,024 |
) |
|
|
|
|
|
|
|
Change in net unrealized gain on investments |
|
$ |
|
|
|
$ |
(5,820 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cumulative effect of adoption of Financial Interpretation No. 48, Accounting for
Uncertainty in Income Taxes |
|
$ |
446 |
|
|
|
|
|
|
|
|
|
|
|
|
Deferred tax asset related to business purchase |
|
$ |
2,041 |
|
|
$ |
|
|
|
|
|
|
|
|
|
Accrual for capital expenditures |
|
$ |
290 |
|
|
$ |
|
|
|
|
|
|
|
|
|
See accompanying notes.
5
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
(Dollar amounts in thousands, except share data)
September 30, 2007
1. The Reporting Entity
Molina Healthcare, Inc., or the Company, is a multi-state managed care organization that
arranges for the delivery of health care services to persons eligible for Medicaid, the State
Childrens Health Insurance Program, or SCHIP, and other government-sponsored health care programs
for low-income families and individuals. Beginning on January 1, 2006, we began to serve a small
number of individuals who are eligible to receive health care benefits under both the Medicaid and
the Medicare programs members who are commonly known as dual eligibles. We operate our
business through wholly owned corporate subsidiary health plans in the states of California,
Indiana (only through December 31, 2006), Michigan, Nevada, New Mexico, Ohio, Texas, Utah, and
Washington.
The
comparability of our consolidated financial statements between certain time periods may be
affected by our acquisitions and start-up activities over the past two years. Effective as of May
15, 2006, we acquired Cape Health Plan, Inc. in Michigan. Our Texas health plan began serving
members in September 2006. The Medicaid contract of our Indiana health plan expired without renewal
on December 31, 2006 and that health plan is currently winding up its operations. On November 1,
2007, we acquired and began operating Mercy CarePlus, a licensed health plan in Missouri. Our
Nevada health plan serves only a limited number of dual eligible members.
2. Basis of Presentation
The unaudited condensed consolidated interim financial statements have been prepared under the
assumption that users of the interim financial data have either read or have access to our audited
consolidated financial statements for the fiscal year ended December 31, 2006. Accordingly, certain
disclosures that would substantially duplicate the disclosures contained in the December 31, 2006
audited consolidated financial statements have been omitted. These unaudited condensed consolidated
interim financial statements should be read in conjunction with our December 31, 2006 audited
financial statements.
The condensed consolidated financial statements include the accounts of the Company and all
majority owned subsidiaries. In the opinion of management, all adjustments considered necessary for
a fair presentation of the results as of the date and for the interim periods presented, which
consist solely of normal recurring adjustments, have been included. All significant inter-company
balances and transactions have been eliminated in consolidation. The condensed consolidated results
of income for the current interim period are not necessarily indicative of the results for the
entire year ending December 31, 2007.
Stock-Based Compensation
At September 30, 2007, we had two stock-based employee compensation plans: the 2000 Omnibus
Stock and Incentive Plan and the 2002 Equity Incentive Plan. The 2000 Omnibus Stock and Incentive
Plan has been frozen since 2003. The Company accounts for stock-based compensation in accordance
with SFAS No. 123R, Share-Based Payment, which was adopted January 1, 2006, utilizing the
modified prospective method.
6
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
The fair value of each option grant is estimated on the date of grant using the Black-Scholes
option-pricing model. The related expenses for the fair value of stock grants were charged to
general and administrative expenses. Total stock-based compensation expense (net of tax) for the
three months and nine months ended September 30, 2007 and 2006 are summarized below:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Nine Months Ended |
|
|
|
September 30, |
|
|
September 30, |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
Stock options (including shares issued under our
employee stock purchase plan) |
|
$ |
312 |
|
|
$ |
592 |
|
|
$ |
1,398 |
|
|
$ |
1,673 |
|
Stock grants |
|
|
677 |
|
|
|
395 |
|
|
|
1,850 |
|
|
|
1,025 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total stock-based compensation expense, net of tax |
|
$ |
989 |
|
|
$ |
987 |
|
|
$ |
3,248 |
|
|
$ |
2,698 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Stock option activity during the nine months ended September 30, 2007 is summarized below:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Average |
|
|
|
|
|
|
|
Weighted |
|
|
|
|
|
|
Remaining |
|
|
|
|
|
|
|
Average |
|
|
Aggregate |
|
|
Contractual |
|
|
|
|
|
|
|
Exercise |
|
|
Intrinsic |
|
|
Term |
|
|
|
Shares |
|
|
Price |
|
|
Value |
|
|
(Years) |
|
Outstanding as of December 31, 2006 |
|
|
789,965 |
|
|
$ |
25.78 |
|
|
|
|
|
|
|
|
|
Granted |
|
|
256,100 |
|
|
|
31.50 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(145,793 |
) |
|
|
12.93 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(82,922 |
) |
|
|
30.47 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding as of September 30, 2007 |
|
|
817,350 |
|
|
$ |
29.39 |
|
|
$ |
6,345 |
|
|
|
7.88 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable as of September 30, 2007 |
|
|
377,883 |
|
|
$ |
27.12 |
|
|
$ |
3,959 |
|
|
|
6.71 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The fair value of each option grant is estimated on the date of the grant using the
Black-Scholes option-pricing model based on the following weighted-average assumptions:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, |
|
Nine Months Ended September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Risk-free interest rate |
|
|
4.55 |
% |
|
|
N/A |
|
|
|
4.52 |
% |
|
|
4.54 |
% |
Expected volatility |
|
|
37.95 |
% |
|
|
N/A |
|
|
|
48.18 |
% |
|
|
53.1 |
% |
Expected option life (in years) |
|
|
6.00 |
|
|
|
N/A |
|
|
|
6.11 |
|
|
|
6.00 |
|
Expected dividend yield |
|
None |
|
N/A |
|
None |
|
None |
The risk-free interest rate is based on the implied yield currently available on U.S. Treasury
zero coupon issues. The expected volatility is primarily based on historical volatility levels
along with the implied volatility of exchange traded options to purchase our common stock. The
expected option life of each award granted was calculated using the simplified method in
accordance with Staff Accounting Bulletin No. 107. There were no material changes made to the
methodology used to determine the assumptions during the third quarter of 2007.
The weighted-average fair value of options granted during the three and nine months ended
September 30, 2007 were $12.05 and $16.30, respectively. No options were granted during the third
quarter of 2006. The weighted-average fair value of options granted during the nine months ended
September 30, 2006 was $12.87.
The total intrinsic value of stock options exercised during the three and nine months ended
September 30, 2007 amounted to $304 and $2,862, respectively. The total intrinsic value of stock
options exercised during the three and nine months ended September 30, 2006 amounted to $1,295 and
$3,164, respectively.
The total fair value of restricted shares granted during the three and nine months ended
September 30, 2007 was $523 and $7,071, respectively. The total fair value of restricted shares
granted during the three and nine months ended September 30, 2006 were $590 and $2,249,
respectively.
7
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
The total fair value of restricted shares vested during the three and nine months ended
September 30, 2007 was $1,336 and $2,322, respectively. The total fair value of restricted shares
vested during the three and nine months ended September 30, 2006 was $1,128 and $1,709,
respectively.
Non-vested restricted stock and restricted stock unit activity for the nine months ended
September 30, 2007 is summarized below:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted |
|
|
|
|
|
|
|
Average |
|
|
|
|
|
|
|
Grant Date |
|
|
|
Shares |
|
|
Fair Value |
|
Non-vested balance as of December 31, 2006 |
|
|
101,758 |
|
|
$ |
39.10 |
|
Granted |
|
|
223,250 |
|
|
|
31.67 |
|
Vested |
|
|
(71,205 |
) |
|
|
36.09 |
|
Forfeited |
|
|
(23,490 |
) |
|
|
33.39 |
|
|
|
|
|
|
|
|
|
Non-vested balance as of September 30, 2007 |
|
|
230,313 |
|
|
$ |
33.41 |
|
|
|
|
|
|
|
|
As of September 30, 2007, there was $12,622 of total unrecognized compensation cost related to
non-vested share-based compensation arrangements granted under the plans. That cost is expected to
be recognized over a weighted-average period of two years.
Earnings Per Share
The denominators for the computation of basic and diluted earnings per share are calculated as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, |
|
|
Nine Months Ended September 30, |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
Shares outstanding
at the beginning of
the period |
|
|
28,284,000 |
|
|
|
27,996,000 |
|
|
|
28,119,000 |
|
|
|
27,792,000 |
|
Weighted average
number of shares
issued for stock
options, stock
grants, and
employee stock
purchases |
|
|
22,000 |
|
|
|
26,000 |
|
|
|
110,000 |
|
|
|
150,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for
basic earnings per
share |
|
|
28,306,000 |
|
|
|
28,022,000 |
|
|
|
28,229,000 |
|
|
|
27,942,000 |
|
Dilutive effect of
employee stock
options and
restricted stock |
|
|
135,000 |
|
|
|
324,000 |
|
|
|
127,000 |
|
|
|
311,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for
diluted earnings
per share |
|
|
28,441,000 |
|
|
|
28,346,000 |
|
|
|
28,356,000 |
|
|
|
28,253,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As discussed in Note 8, Subsequent Events, we issued and sold $200 million aggregate principal
amounts of our 3.75% Convertible Senior Notes (the Notes). The Notes are convertible, under
certain circumstances, at an initial conversion rate of 21.3067 shares of our common stock per one
thousand dollar principal amount of notes, subject to adjustment.
As of September 30, 2007, because the conversion price per share of common stock exceeded our
share price, these contingently issuable shares were ignored in the computation of diluted earnings
per share.
New Accounting Pronouncements
In June 2006, the Financial Accounting Standards Board (FASB) ratified the Emerging Issues
Task Force (EITF) consensus on EITF Issue No. 06-3 How Taxes Collected From Customers and Remitted
to Governmental Authorities Should Be Presented in the Income Statement (That Is, Gross versus Net
Presentation) (EITF 06-3). The scope of EITF 06-3 includes any tax assessed by a governmental
authority that is directly imposed on a revenue-producing transaction between a seller and a
customer, and provides that a company may adopt a policy of presenting taxes either gross within
revenue or on a net basis. For any such taxes that are reported on a gross basis, a company should
disclose the amounts of those taxes for each period for which an income statement is presented if
those amounts are significant. This statement is effective for financial reports for interim and
annual reporting periods beginning after December 15, 2006. The Company adopted EITF 06-3 effective
January 1, 2007. The Company collects premium taxes from various states on premium revenue, which
are accounted for on a gross basis.
8
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
Premium taxes included in premium revenue totaled $21,100 and $16,200 for the three months
ended September 30, 2007 and 2006, respectively. Premium taxes included in premium revenue totaled
$60,300 and $43,400 for the nine months ended September 30, 2007 and 2006, respectively. Premium
taxes are included in General and administrative expenses in our Condensed Consolidated
Statements of Income.
On July 13, 2006, the FASB issued Interpretation No. 48, Accounting for Uncertainty in Income
Taxes An Interpretation of FASB Statement No. 109 (FIN 48). FIN 48 clarifies the accounting and
disclosure for uncertainty in income taxes recognized in an entitys financial statements in
accordance with FASB Statement No. 109, Accounting for Income Taxes and prescribes a recognition
threshold and measurement attributes for financial statement disclosure of tax positions taken or
expected to be taken on a tax return. Under FIN 48, the impact of an uncertain income tax position
on the income tax return must be recognized at the largest amount that is more-likely-than-not to
be sustained upon audit by the relevant tax authority. An uncertain income tax position will not be
recognized if it has less than 50% likelihood of being sustained. Additionally, FIN 48 provides
guidance on derecognition, classification, interest and penalties, accounting in interim periods,
disclosure and transition. FIN 48 is effective for fiscal years beginning after December 15, 2006.
The Company adopted the provisions of FIN 48 effective January 1, 2007. As a result of the
implementation, the Company recognized a $446 increase to liabilities for uncertain tax positions
of which the entire increase was accounted for as an adjustment to the beginning balance of
retained earnings. Including the cumulative effect increase, at the beginning of 2007, the Company
had $4,355 of total gross unrecognized tax benefits including accrued interest. Of this total,
$1,524 (net of federal benefit of state issues) represents the amount of unrecognized tax benefits
that, if recognized, would favorably affect the effective income tax rate in any future period. As
of September 30, 2007, the Company had $4,888 of total gross unrecognized tax benefits of which
$1,146 (net of federal benefit of state issues) represents the amount of unrecognized tax benefits
that, if recognized, could favorably affect the effective income tax rate in any future period.
The Companys continuing practice is to recognize interest and/or penalties related to income
tax matters in income tax expense. As of September 30, 2007 and December 31, 2006, the Company had
accrued cumulative $539 and $384 (before federal and state tax benefit), respectively, for the
payment of interest and penalties.
During the three months ended March 31, 2007, the Company settled an examination by the
Internal Revenue Service (IRS) in connection with certain tax positions taken by a subsidiary that
was acquired in 2006. As the result of this settlement, the Company reduced its FIN 48 liability by
$213 which included interest of $33.
During the three months ended June 30, 2007, the Company settled an examination with the state
taxing authority. As a result of the settlement, the Company made a payment to reduce its FIN 48
liability by $361.
During the three months ended September 30, 2007, the Company settled with a state taxing
authority for certain refund claims filed based on additional state tax credits identified for
years between 1998 and 2001. As a result of the settlement, the Company reduced its FIN 48
liability by $494.
The Company is subject to taxation in the United States and various states. With few
exceptions, the Company is no longer subject to U.S. federal tax examination for tax years
including or before 2003 and state as well as local income tax examination for tax years including
or before 2002.
Other recent accounting pronouncements issued by the FASB (including the EITF), the AICPA, and
the SEC did not have, nor does management believe they will have, a material impact on our present
or future consolidated financial statements.
9
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
3. Receivables
Receivables consist primarily of amounts due from the various states in which we operate.
Accounts receivable by operating subsidiary for the periods indicated were:
|
|
|
|
|
|
|
|
|
|
|
September 30, |
|
|
December 31, |
|
|
|
2007 |
|
|
2006 |
|
California HMO |
|
$ |
32,672 |
|
|
$ |
32,404 |
|
Utah HMO |
|
|
43,800 |
|
|
|
46,570 |
|
Ohio HMO |
|
|
30,505 |
|
|
|
11,611 |
|
Washington HMO |
|
|
8,192 |
|
|
|
7,447 |
|
Others |
|
|
8,976 |
|
|
|
12,803 |
|
|
|
|
|
|
|
|
Total receivables |
|
$ |
124,145 |
|
|
$ |
110,835 |
|
|
|
|
|
|
|
|
Substantially
all receivables due our California health plan at September 30, 2007 and December 31,
2006 were collected in October 2007 and January 2007, respectively.
Our
agreement with the State of Utah calls for the reimbursement of our
Utah health plan for medical
costs incurred in serving our members, plus an administrative fee of 9% of such medical costs, plus
a portion of any cost savings realized, if any, as measured against a fee-for-service Medicaid
model. Our Utah health plan bills the State of Utah monthly for actual paid health care claims plus
administrative fees. Our receivable balance from the State of Utah includes: 1) amounts billed to
the state for actual paid health care claims plus administrative fees; 2) amounts estimated to be
due under the savings sharing provision of the agreement; and 3) amounts estimated for incurred but
not reported claims, which, along with the related administrative fees, are not billable to the
State of Utah until such claims are actually paid.
We have estimated the amount that we believe we will recover under our savings sharing
agreement with the State of Utah based on the information we have to date and our interpretation of
our contract with the state. The state may not agree with our interpretation or our application of
the contract language, and it may also not agree with the manner in which we have processed and
analyzed our member claims and encounter records. Thus, the ultimate amount of savings sharing
revenue that we realize may be subject to negotiation with the state. During the third quarter of
2007, we recorded an adjustment to reduce this receivable by $1,700. Our Utah health plan continues
to work with the state to assure an appropriate determination of amounts due under the savings
share agreement. At September 30, 2007, we have recorded approximately $3,000 in receivables
associated with the Utah savings sharing plan. When additional information is known, or agreement
is reached with the state regarding the appropriate savings sharing payment amount, we will adjust
the amount of savings sharing revenue recorded in our financial statements.
The receivable due our Ohio health plan includes approximately $9,000 of accrued delivery payments due
from the State of Ohio and approximately $20,800 due from a capitated provider group. Our agreement
with that group calls for us to pay for certain medical services incurred by the groups members,
and then to deduct the amount of such payments from the monthly capitation paid to the group. This
receivable also includes an estimate of our liability for claims incurred by members of this group
for which we have not made payment. The offsetting liability for the amount of this receivable
established for claims incurred but not paid is included in Medical claims and benefits payable
in our Condensed Consolidated Balance Sheets. At September 30, 2007, this receivable comprised
approximately $12,300 paid on behalf of the provider group, which is to be deducted from capitation
payments in the months of October and November. An additional $8,500 receivable has been recorded
to offset amounts included in Medical claims and benefits payable in our Condensed Consolidated
Balance Sheets that are the responsibility of the capitated provider
group. Our Ohio health plan has withheld approximately $8,800 from
capitation payments due this provider group and placed the funds in
an escrow account. The Ohio health plan is entitled to the escrow
amount if the provider is unable to repay amounts owed to us. The
escrow amount is included in Restricted Investments in
our Consolidated Balance Sheets. Monthly gross
capitation paid to the provider group is approximately $8,300.
4. Other Assets
Other assets include an investment in a vision services provider (see Note 7. Related Party
Transactions), deferred financing costs associated with our secured credit agreement, and certain
investments held in connection with our deferred employee compensation program. A liability
approximately equal to the assets held in connection with our deferred employee compensation
program is included in other long-term liabilities.
5. Long-Term Debt
On March 9, 2005, we entered into an amended and restated secured credit agreement with a
syndicate of lenders providing for a $180,000 revolving credit facility. Effective May 25, 2007, we
entered into a third amendment of the credit agreement increasing the size of the credit facility
to $200,000. The credit facility is used for working capital
10
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
and general corporate purposes. Subject to obtaining commitments from existing or new lenders
and satisfaction of other specified conditions, we may increase the credit facility to up to
$250,000. The credit facility matures on May 24, 2012.
Borrowings under the credit facility are based, at our election, on the London interbank
offered rate, or LIBOR, or the base rate plus an applicable margin. The base rate will equal the
higher of Bank of Americas prime rate or 0.5% above the federal funds rate. We also pay a
commitment fee on the total unused commitments of the lenders under the credit facility. The
applicable margins and commitment fee are based on our ratio of consolidated funded debt to
consolidated EBITDA. The applicable margins range between 0.75% and 1.75% for LIBOR loans and
between 0% and 0.75% for base rate loans. The commitment fee ranges between 0.15% and 0.275%. In
addition, we are required to pay a fee for each letter of credit issued under the credit facility
equal to the applicable margin for LIBOR loans and a customary fronting fee.
Our obligations under the credit facility are secured by a lien on substantially all of our
assets and by a pledge of the capital stock of our Michigan, New Mexico, Ohio, Utah, and Washington
health plan subsidiaries.
The amended credit agreement includes usual and customary covenants for credit facilities of
this type, including covenants limiting liens, mergers, asset sales, other fundamental changes,
debt, acquisitions, dividends and other distributions, capital expenditures, investments, and our
fixed charge coverage ratio. The credit agreement also requires us to maintain a ratio of total
consolidated debt to total consolidated EBITDA of not more than 2.75 to 1.00 at any time. At
September 30, 2007, we were in compliance with all financial covenants in the credit agreement.
During the first nine months of 2007, we repaid $25,000 of our borrowings under the credit
facility. At September 30, 2007 and December 31, 2006, the amounts outstanding under the credit
facility were $20,000 and $45,000, respectively.
6. Commitments and Contingencies
Legal
The health care industry is subject to numerous federal, state, and local laws and
regulations. Compliance with these laws and regulations can be subject to government review and
interpretation, as well as regulatory actions unknown and unasserted at this time. Violations of
these laws and regulations can result in significant fines and penalties, exclusion from
participating in publicly-funded programs, and the repayment of previously billed and collected
revenues.
Derivative Action. On August 8, 2005, plaintiff Perry Jarrell filed a shareholder derivative
complaint in the Superior Court of the State of California for the County of Los Angeles, Case No.
BC 337912 (the Derivative Action). The Derivative Action purported to allege claims on behalf of
Molina Healthcare, Inc. against certain current and former officers and directors for breach of
fiduciary duty, breach of the duty of loyalty, gross negligence, and violation of California
Corporations Code Section 25402, arising out of the Companys announcement of its guidance for the
2005 fiscal year. On February 7, 2006, the Superior Court ordered that the Derivative Action be
stayed pending the outcome of the securities class action lawsuit that had been filed against the
Company in late July 2005 in the United States District Court for the Central District of
California, Case No. CV 05-5460 GPS (SHx), which lawsuit also arose out of the Companys
announcement of its guidance for the 2005 fiscal year (the Federal Class Action). In November
2006, the Federal Class Action was dismissed with prejudice and without liability. As a result of
the final disposition of the Federal Class Action, on June 21, 2007, the Los Angeles Superior Court
held a hearing on the Companys demurrer to the derivative complaint. The Superior Court sustained
the Companys demurrer, but granted the plaintiff leave to amend its complaint. On October 12,
2007, the Superior Court held a hearing on the Companys demurrer to the plaintiffs amended
derivative complaint. At that hearing, the Superior Court sustained the Companys demurrer with
prejudice and without leave to amend.
Malpractice Action. On February 1, 2007, a complaint was filed in the Superior Court of the
State of California for the County of Riverside by plaintiff Staci Robyn Ward through her guardian
ad litem, Case No. 465374. The complaint purports to allege claims for medical malpractice against
Molina Medical Centers and certain other defendants. The plaintiff alleges that the defendants
failed to properly diagnose her medical condition which
11
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
resulted in her severe and permanent disability. On July 22, 2007, the plaintiff passed away.
The proceeding is in the early stages, and no prediction can be made as to the outcome.
Starko. Our New Mexico health plan is named as a defendant in a class action lawsuit brought by New
Mexico pharmacies and pharmacists, Starko, Inc., et al. v. NMHSD, et al., No. CV-97-06599, Second
Judicial District Court, State of New Mexico. The lawsuit was originally filed in August 1997
against the New Mexico Human Services Department (NMHSD). In February 2001, the plaintiffs named
health maintenance organizations participating in the New Mexico Medicaid program as defendants,
including Cimarron Health Plan, the predecessor of our New Mexico health plan. The plaintiffs assert that
NMHSD and the defendant HMOs failed to pay pharmacy dispensing fees under an alleged New Mexico
statutory mandate. Discovery is currently underway. On July 10, 2007, the court dismissed all
damages claims against Molina Healthcare of New Mexico, leaving only a pending action for
injunctive and declaratory relief. On August 15, 2007, the court held a hearing on the motion of
Molina Healthcare of New Mexico to dismiss the plaintiffs claims for injunctive and declaratory
relief. At that hearing, the court dismissed all remaining claims against Molina Healthcare of New
Mexico. The plaintiffs have filed a Notice of Appeal of the courts dismissal orders. It is not
currently possible to assess the amount or range of potential loss or probability of a favorable or
unfavorable outcome. Under the terms of the stock purchase agreement pursuant to which the Company
acquired Health Care Horizons, Inc., the parent company to our New Mexico health plan, an indemnification
escrow account was established and funded with $6,000 in order to indemnify our New Mexico health plan
against the costs of such litigation and any eventual liability or settlement costs. Currently,
approximately $4,100 remains in the indemnification escrow fund.
We are involved in other legal actions in the normal course of business, some of which seek
monetary damages, including claims for punitive damages, which are not covered by insurance. These
actions, when finally concluded and determined, are not likely, in our opinion, to have a material
adverse effect on our consolidated financial position, results of operations, or cash flows.
Provider Claims
Many of our medical contracts are complex in nature and may be subject to differing
interpretations regarding amounts due for the provision of various services. Such differing
interpretations may lead medical providers to pursue us for additional compensation. The claims
made by providers in such circumstances often involve issues of contract compliance,
interpretation, payment methodology, and intent. These claims often extend to services provided by
the providers over a number of years.
Various providers have contacted us seeking additional compensation for claims that we believe
to have been settled. These matters, when finally concluded and determined, will not, in our
opinion, have a material adverse effect on our consolidated financial position, results of
operations, or cash flows.
Regulatory Capital and Dividend Restrictions
Our principal operations are conducted through our HMO subsidiaries operating in California,
Michigan, Nevada, New Mexico, Ohio, Texas, Washington, and Utah. Our HMOs are subject to state
regulations that, among other things, require the maintenance of minimum levels of statutory
capital, as defined by each state, and restrict the timing, payment, and amount of dividends and
other distributions that may be paid to us as the sole stockholder. To the extent the subsidiaries
must comply with these regulations, they may not have the financial flexibility to transfer funds
to us. The net assets in these subsidiaries (after intercompany eliminations), which may not be
transferable to us in the form of cash dividends, loans, or advances, was $263,800 at September 30,
2007 and $236,800 at December 31, 2006. The National Association of Insurance Commissioners (NAIC)
adopted model rules effective December 31, 1998 which, if implemented by a state, set new minimum
capitalization requirements for insurance companies, HMOs, and other entities bearing risk for
health care coverage. The requirements take the form of risk-based capital, or RBC, rules.
Michigan, Nevada, New Mexico, Ohio, Texas, Utah, and Washington have adopted these rules, although
the rules as adopted may vary somewhat from state to state. California has not yet adopted NAIC
risk-based capital requirements for HMOs and has not formally given notice of its intention to do
so. Such requirements, if adopted by California, may increase the minimum capital required for that
state.
12
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
As of September 30, 2007, our HMOs had aggregate statutory capital and surplus of
approximately $279,000, compared to the required minimum aggregate statutory capital and surplus of
approximately $152,000. All of our HMOs were in compliance with the minimum capital requirements at
September 30, 2007. We have the ability and commitment to provide additional capital to each of our
HMOs when necessary to ensure that they continue to meet statutory and regulatory capital
requirements.
7. Related Party Transactions
Effective March 1, 2006, we assumed an office lease from Millworks Capital Ventures with a
remaining term of 52 months (through July 2010). Millworks Capital Ventures is owned by John C.
Molina, our chief financial officer, and his wife. The monthly base lease payment is approximately
$18 and is subject to an annual increase. Based on a market report prepared by an independent
realtor, we believe the terms and conditions of the assumed lease are at fair market value. We are
currently using the office space under the lease for an office expansion. Payment made under this
lease totaled $57 and $56 for the three months ended September 30, 2007 and 2006, respectively.
Payment made under this lease totaled $188 and $113 for the nine months ended September 30, 2007
and 2006, respectively.
We are a party to a fee-for-service agreement with Pacific Hospital of Long Beach. Pacific
Hospital is owned by Abrazos Healthcare, Inc., the shares of which are held as community property
by Dr. Martha Bernadett, our Executive Vice President, Research and Development, and her husband.
We believe that the claims submitted to us by Pacific Hospital were reimbursed at prevailing market
rates. Effective June 1, 2006, the Company entered into an additional agreement with Pacific
Hospital as part of a capitation arrangement. Under this arrangement, Pacific Hospital receives a
fixed fee per member per month from us based on member type. Amounts paid under the terms of both
agreements were $1,226 and $73 for the three months ended September 30, 2007 and 2006,
respectively. Amounts paid under the terms of both agreements were $3,410 and $316 for the nine
months ended September 30, 2007 and 2006, respectively.
Other assets at September 30, 2007 included an equity investment of approximately $3,500 in a
vision services provider that provides medical services to the Companys members. Payments to the
vision services provider were $3,350 and $2,209 for the three months ended September 30, 2007 and
2006, respectively. Payments to the vision services provider were $9,224 and $5,670 for the nine
months ended September 30, 2007 and 2006, respectively.
8. Subsequent Events
Issuance of Senior Convertible Notes
On October 11, 2007, we completed our offering of $200 million aggregate principal amount of
3.75% Convertible Senior Notes due 2014 (the Notes). The sale of the Notes resulted in net
proceeds to us in the amount of $193,400. The Notes are convertible into cash and, under certain
circumstances, shares of our common stock at an initial conversion rate of 21.3067 shares of common
stock per one thousand dollar principal amount of notes, subject to adjustment. This conversion
rate is equivalent to an initial conversion price of approximately $46.93 per share.
During the month of October 2007, we used a portion of the net proceeds from our sale of the
Notes to pay off in full the $20,000 owed under our credit facility at September 2007. We intend to
use the remaining net proceeds to fund future acquisitions and expansion and for general corporate
purposes, including working capital.
Acquisition of Mercy CarePlus
On September 6, 2007, we entered into a definitive Purchase Agreement to acquire Mercy
CarePlus (Mercy), a Medicaid managed care organization based in St. Louis, Missouri. The purchase
price for the acquisition of all of Mercys outstanding limited liability company units is
approximately $80,000 ($74,000, net of retained cash), and is subject to certain adjustments. The
acquisition closed on November 1, 2007, and was funded with the net proceeds from our sale of the
Notes.
13
Item 2. Managements Discussion and Analysis of Financial Condition and Results of Operations.
Forward Looking Statements
This quarterly report on Form 10-Q contains forward-looking statements within the meaning of
Section 27A of the Securities Act of 1933, or Securities Act, and Section 21E of the Securities
Exchange Act of 1934, or Securities Exchange Act. All statements, other than statements of
historical facts, that we include in this quarterly report may be deemed to be forward-looking
statements for purposes of the Securities Act and the Securities Exchange Act. We use the words
anticipate(s), believe(s), estimate(s), expect(s), intend(s), may, plan(s),
project(s), will, would and similar expressions to identify forward-looking statements,
although not all forward-looking statements contain these identifying words. We cannot guarantee
that we actually will achieve the plans, intentions, or expectations disclosed in our
forward-looking statements and, accordingly, you should not place undue reliance on our
forward-looking statements. There are a number of important factors that could cause actual results
or events to differ materially from the forward-looking statements
that we make. You should
read these factors and the other cautionary statements as being applicable to all related
forward-looking statements wherever they appear in this quarterly
report. We caution you that we do not undertake any obligation to update
forward-looking statements made by us. Forward-looking statements involve known and unknown risks
and uncertainties that may cause our actual results in future periods to differ materially from
those projected or contemplated as a result of, but not limited
to, the following factors:
|
|
|
the continuing achievement of savings from a decrease in the overall medical care ratio
of our health plans, including the individual medical care ratios of our Ohio and Texas
health plans; |
|
|
|
|
risks related to our lack of experience with members in Ohio, Texas, and Missouri; |
|
|
|
|
an increase in enrollment in our dual eligible population consistent with our
expectations; |
|
|
|
|
our ability to reduce administrative costs in the event enrollment or revenue is lower
than expected; |
|
|
|
|
increased administrative costs in support of the Companys efforts to expand Medicare
membership; |
|
|
|
|
our ability to accurately estimate incurred but not reported medical costs; |
|
|
|
|
the securing of adequate premium rate increases under the government contracts of our
health plans; |
|
|
|
|
the potential termination or expiration without renewal of the government contracts of
our health plans; |
|
|
|
|
our dependence upon a relatively small number of government contracts and subcontracts
for our revenue; |
|
|
|
|
limitations in our ability to control our medical costs and other operating expenses; |
|
|
|
|
the payment of savings sharing income by the State of Utah to our Utah plan consistent
with our expectations; |
|
|
|
|
the negative impact of the DRG rate rebasing in Washington being greater than expected,
and the possibility that our new rates in Washington for 2008 will not fully offset the rate rebasing; |
|
|
|
|
the potential for disagreement with the State of New Mexico over the proper
interpretation of our Salud! Medicaid managed care contract; |
|
|
|
|
risks related to our new Medicare Advantage plans with prescription drug coverage, or
MAPD plans, including our lack of operating experience with such plans, compliance issues,
and confusion regarding the new plans among Medicare beneficiaries, providers, pharmacists,
and regulators; |
14
|
|
|
the successful and cost-effective integration of Mercy CarePlus, including risks related
to our lack of a prior operating history in Missouri; |
|
|
|
|
the availability of adequate financing to fund and/or capitalize our acquisitions and
start-up activities; |
|
|
|
|
membership eligibility processes and methodologies; |
|
|
|
|
unexpected changes in demographics, member utilization patterns, healthcare practices, or
healthcare technologies; |
|
|
|
|
high dollar claims related to catastrophic illness or conditions; |
|
|
|
|
risks related to the continued solvency of our major providers and provider groups; |
|
|
|
|
changes in federal or state laws or regulations or in their interpretation; |
|
|
|
|
failure to maintain effective, efficient, and secure information systems and claims
processing technology; |
|
|
|
|
the unfavorable resolution of pending litigation or arbitration; |
|
|
|
|
risks associated with the potential perception among regulators, governmental
representatives, and the public of abuses occurring within the Medicaid or Medicare managed
care sectors and the association or general attribution of such negative perceptions to the
Company; |
|
|
|
|
funding decreases in the Medicaid, SCHIP, or Medicare programs or the failure to timely
renew the SCHIP program; |
|
|
|
|
risks associated with the Notes; |
|
|
|
|
epidemics such as the avian flu; and |
|
|
|
|
changes to government laws and regulations or in the interpretation and enforcement of
those laws and regulations, including the recently enacted citizenship certification
requirements. |
Investors should refer to our annual report on Form 10-K for the year ended December 31, 2006,
to our quarterly reports on Form 10-Q, and to our prospectus supplement filed on October 5, 2007,
for a discussion of certain risk factors which could materially affect our business, financial
condition, or future results. Given these risks and uncertainties, we can give no assurances that
any results or events projected or contemplated by our forward-looking statements will in fact
occur and we caution investors not to place undue reliance on these statements.
This document and the following discussion of our financial condition and results of
operations should be read in conjunction with the accompanying consolidated financial statements
and the notes to those statements appearing elsewhere in this report and the audited financial
statements and Managements Discussion and Analysis appearing in our Report on Form 10-K for the
year ended December 31, 2006.
15
Overview
Our financial performance for the three and nine months ended September 30, 2007 as compared
to our financial performance for the three and nine months ended September 30, 2006 may be briefly
summarized, respectively in each case, as follows (dollars in thousands, except per share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, |
|
Nine Months Ended September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
|
|
(Amounts in thousands, except per share data) |
Earnings per diluted share |
|
$ |
0.62 |
|
|
$ |
0.44 |
|
|
$ |
1.43 |
|
|
$ |
1.21 |
|
Premium revenue |
|
$ |
628,402 |
|
|
$ |
512,080 |
|
|
$ |
1,791,764 |
|
|
$ |
1,441,197 |
|
Operating income |
|
$ |
28,815 |
|
|
$ |
20,458 |
|
|
$ |
67,694 |
|
|
$ |
56,353 |
|
Net income |
|
$ |
17,513 |
|
|
$ |
12,341 |
|
|
$ |
40,419 |
|
|
$ |
34,083 |
|
Medical care ratio |
|
|
83.7 |
% |
|
|
84.1 |
% |
|
|
84.8 |
% |
|
|
84.4 |
% |
G&A expenses as a
percentage of total
revenue |
|
|
11.7 |
% |
|
|
11.7 |
% |
|
|
11.3 |
% |
|
|
11.5 |
% |
Total ending membership |
|
|
|
|
|
|
|
|
|
|
1,070,000 |
|
|
|
1,015,000 |
|
Revenue
Premium revenue is fixed in advance of the periods covered and is not generally subject to
significant accounting estimates. For the nine months ended September 30, 2007, we received
approximately 91.5% of our premium revenue as a fixed amount per member per month, or PMPM,
pursuant to our contracts with state Medicaid agencies and other managed care organizations for
whom we operate as a subcontractor. These premium revenues are recognized in the month that members
are entitled to receive health care services. The state Medicaid programs periodically adjust
premium rates. The amount of these premiums may vary substantially between states and among various
government programs. PMPM premiums for members of the State Childrens Health Insurance Program, or
SCHIP, are generally among the Companys lowest, with rates as low as approximately $75 PMPM in
California and Utah. Premium revenues for Medicaid members are generally higher. Among the
Temporary Aid for Needy Families (TANF) Medicaid population the Medicaid group that includes
most mothers and children PMPM premiums range between approximately $90 in California to a high
of approximately $200 in Ohio. Among our Medicaid Aged, Blind and Disabled (ABD) membership, PMPM
premiums range from approximately $320 in California to over $1,000 in New Mexico and Ohio.
Medicare revenue is approximately $1,200 PMPM. Approximately 3.7% of our premium revenue in the
nine months ended September 30, 2007 was realized under a Medicaid cost-plus reimbursement
agreement that our Utah plan has with that state. We also received approximately 4.8% of our
premium revenue for the nine months ended September 30, 2007 in the form of birth income a
one-time payment for the delivery of a child from the Medicaid programs in Michigan, Ohio,
Texas, and Washington. Such payments are recognized as revenue in the month the birth occurs.
Premium revenue realized under Medicare was approximately $32.1 million for the nine months ended
September 30, 2007.
Certain components of premium revenue are subject to accounting estimates. Chief among these
are (i) that portion of premium revenue paid to our New Mexico
health plan by the State of New Mexico that
exceeds certain specified floor amounts that are required to be expended on defined medical care
costs, and (ii) the additional premium revenue our Utah health plan is entitled to receive from the State
of Utah as an incentive payment for saving the State of Utah money in relation to fee-for-service
Medicaid.
Our contract with the State of New Mexico requires that we spend a minimum percentage of
premium revenue on certain explicitly defined medical care costs. During the third quarter of 2007,
we recorded an adjustment in the amount of $2.2 million to reduce the estimated liability
associated with this requirement for the two-year period ended June 30, 2007. At September 30,
2007, we have recorded a liability of approximately $13.8 million under our interpretation of the
existing terms of this contract provision. Any change to the terms of this provision, including
revisions to the definitions of premium revenue or medical care costs, the period of time over
which the minimum percentage is measured or the manner of its measurement, or the percentage of
revenue required to be spent on the defined medical care costs, may trigger a change in this
amount.
We have estimated the amount that we believe we will recover under our savings sharing
agreement with the State of Utah based on the information we have to date and our interpretation of
our contract with the state. The state may not agree with our interpretation or our application of
the contract language, and it may also not agree with the
16
manner in which we have processed and analyzed our member claims and encounter records. Thus,
the ultimate amount of savings sharing revenue that we realize may be subject to negotiation with
the state. During the third quarter of 2007, we recorded an adjustment to reduce this receivable by
$1.7 million. Our Utah health plan continues to work with the state in an effort to assure an
appropriate determination of amounts due under the savings share agreement. At September 30, 2007,
we had recorded approximately $3.0 million in receivables associated with the Utah savings sharing
plan. When additional information is known, or agreement is reached with the state regarding the
appropriate savings sharing payment amount, we will adjust the amount of savings sharing revenue
recorded in our financial statements.
Historically,
membership growth has been the primary reason for our increasing
revenues, although more recently our revenues have also grown due
to the more care intensive benefits associated with our ABD and dual
eligible members. We have increased
our membership (excluding the Indiana health plan) through both internal growth and acquisitions.
The following table sets forth the approximate total number of members by state as of the dates
indicated.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of |
|
As of |
|
As of |
|
|
September 30, |
|
December 31, |
|
September 30, |
Market |
|
2007 |
|
2006 |
|
2006 |
California |
|
|
288,000 |
|
|
|
300,000 |
|
|
|
302,000 |
|
Michigan |
|
|
211,000 |
|
|
|
228,000 |
|
|
|
227,000 |
|
New Mexico |
|
|
69,000 |
|
|
|
65,000 |
|
|
|
62,000 |
|
Ohio |
|
|
138,000 |
|
|
|
76,000 |
|
|
|
33,000 |
|
Texas |
|
|
30,000 |
|
|
|
19,000 |
|
|
|
3,000 |
(2) |
Utah |
|
|
50,000 |
|
|
|
52,000 |
|
|
|
54,000 |
|
Washington |
|
|
284,000 |
|
|
|
281,000 |
|
|
|
280,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal |
|
|
1,070,000 |
|
|
|
1,021,000 |
|
|
|
961,000 |
|
Indiana |
|
|
N/A |
(1) |
|
|
56,000 |
|
|
|
54,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
1,070,000 |
|
|
|
1,077,000 |
|
|
|
1,015,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
The Companys Indiana health plan ceased serving members effective January 1, 2007. |
|
(2) |
|
The Companys Texas health plan commenced operations in September 2006. |
The ending membership for our Medicare Advantage Special Needs plans by state is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30, 2007 |
|
December 31, 2006 |
|
September 30, 2006 |
California |
|
|
875 |
|
|
|
549 |
|
|
|
455 |
|
Michigan |
|
|
814 |
|
|
|
152 |
|
|
|
138 |
|
Nevada |
|
|
178 |
|
|
|
|
|
|
|
|
|
Utah |
|
|
1,802 |
|
|
|
1,452 |
|
|
|
1,426 |
|
Washington |
|
|
446 |
|
|
|
235 |
|
|
|
153 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
4,115 |
|
|
|
2,388 |
|
|
|
2,172 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The ending membership for our Aged, Blind and Disabled (ABD) population by state is as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30, 2007 |
|
December 31, 2006 |
|
September 30, 2006 |
California |
|
|
10,912 |
|
|
|
10,717 |
|
|
|
10,368 |
|
Michigan |
|
|
31,488 |
|
|
|
22,540 |
(1) |
|
|
22,553 |
(1) |
New Mexico |
|
|
6,844 |
|
|
|
6,697 |
|
|
|
6,674 |
|
Ohio |
|
|
14,965 |
|
|
|
|
|
|
|
|
|
Texas |
|
|
16,515 |
|
|
|
|
|
|
|
|
|
Utah |
|
|
7,056 |
|
|
|
6,827 |
|
|
|
6,763 |
|
Washington |
|
|
2,715 |
|
|
|
2,713 |
|
|
|
2,727 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
90,495 |
|
|
|
49,494 |
|
|
|
49,085 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
Does not include the ABD membership of Cape Health Plan. |
17
The following table details total member months (defined as the aggregation of each months
ending membership for the period) by state for the periods indicated:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
|
September 30, |
|
% of Increase |
|
|
2007 |
|
2006 |
|
(Decrease) |
California |
|
|
859,000 |
|
|
|
911,000 |
|
|
|
(5.7 |
)% |
Michigan |
|
|
640,000 |
|
|
|
681,000 |
|
|
|
(6.0 |
)% |
New Mexico |
|
|
200,000 |
|
|
|
181,000 |
|
|
|
10.5 |
% |
Ohio |
|
|
416,000 |
|
|
|
95,000 |
|
|
|
337.9 |
% |
Texas |
|
|
90,000 |
|
|
|
3,000 |
(2) |
|
|
N/A |
|
Utah |
|
|
142,000 |
|
|
|
167,000 |
|
|
|
(15.0 |
)% |
Washington |
|
|
854,000 |
|
|
|
846,000 |
|
|
|
0.9 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal |
|
|
3,201,000 |
|
|
|
2,884,000 |
|
|
|
11.0 |
% |
Indiana |
|
|
N/A |
(1) |
|
|
150,000 |
|
|
|
N/A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
3,201,000 |
|
|
|
3,034,000 |
|
|
|
5.5 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended |
|
|
|
|
September 30, |
|
% of Increase |
|
|
2007 |
|
2006 |
|
(Decrease) |
California |
|
|
2,619,000 |
|
|
|
2,785,000 |
|
|
|
(6.0 |
)% |
Michigan |
|
|
1,967,000 |
|
|
|
1,677,000 |
|
|
|
17.3 |
% |
New Mexico |
|
|
589,000 |
|
|
|
535,000 |
|
|
|
10.1 |
% |
Ohio |
|
|
1,155,000 |
|
|
|
229,000 |
|
|
|
404.4 |
% |
Texas |
|
|
247,000 |
|
|
|
3,000 |
(2) |
|
|
N/A |
|
Utah |
|
|
438,000 |
|
|
|
527,000 |
|
|
|
(16.9 |
)% |
Washington |
|
|
2,570,000 |
|
|
|
2,572,000 |
|
|
|
(0.1 |
)% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal |
|
|
9,585,000 |
|
|
|
8,328,000 |
|
|
|
15.1 |
% |
Indiana |
|
|
N/A |
(1) |
|
|
328,000 |
|
|
|
N/A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
9,585,000 |
|
|
|
8,656,000 |
|
|
|
10.7 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
The Companys Indiana health plan ceased serving members effective January 1, 2007. |
|
(2) |
|
The Companys Texas health plan commenced operations in September 2006. |
Expenses
Our operating expenses include expenses related to the provision of medical care services and
general and administrative, or G&A, costs. Our results of operations are impacted by our ability to
manage effectively expenses related to health care services and to estimate accurately costs
incurred.
Expenses related to medical care services are captured in the following four categories:
Fee-for-service: Most specialists and hospitals, as well as many primary care physicians, are
paid on a capitation basis. Physician providers paid on a fee-for-service basis are paid
according to a fee schedule set by the state or by our contracts with these providers. We pay
hospitals in a variety of ways, including per diem amounts, diagnostic-related groups or DRGs,
percent of billed charges, case rates, and capitation. We also have stop-loss agreements with the
hospitals with which we contract. Under all fee-for-service arrangements, we retain the financial
responsibility for medical care provided. Expenses related to fee-for-service contracts are
recorded in the period in which the related services are dispensed. The costs of drugs
administered in a physician or hospital setting that are not billed through our pharmacy benefit
managers are included in fee-for-service costs.
Capitation: Many of our primary care physicians and a small portion of our specialists and
hospitals are paid on a capitation basis. Under capitation contracts, we typically pay a fixed
per member per month (PMPM) payment to the provider without regard to the frequency, extent, or
nature of the medical services actually furnished. Under capitated contracts, we remain liable
for the provision of certain health care services. Certain of our capitated contracts also
contain incentive programs based on service delivery, quality of care, utilization management,
and other criteria. Capitation payments are fixed in advance of the periods covered and are not
subject to significant accounting estimates. These payments are expensed in the period the
providers are
18
obligated to provide services. The financial risk for pharmacy services for a small portion
of our membership is delegated to capitated providers.
Pharmacy: Pharmacy costs include all drug, injectibles, and immunization costs paid through our
pharmacy benefit managers. As noted above, drugs and injectibles not paid through our pharmacy
benefit managers are included in fee-for-service costs, except in those limited instances where
we capitate drug and injectible costs.
Other: Other medical care costs include medically-related administrative costs, certain
provider incentive costs, reinsurance cost, and other health care expense. Medically-related
administrative costs include, for example, expenses relating to health education, quality
assurance, case management, disease management, 24-hour on-call nurses, and a portion of
information technology costs. Salary and benefit costs are a substantial portion of these
expenses. For the three months ended September 30, 2007 and 2006, medically-related
administrative costs were approximately $17.1 million and $13.8 million, respectively. For the
nine months ended September 30, 2007 and 2006, medically-related administrative costs were
approximately $47.9 million and $37.9 million, respectively.
The following table provides detail of our consolidated medical care costs for the periods
indicated (dollars in thousands except PMPM amounts):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Three Months Ended |
|
|
|
September 30, 2007 |
|
|
September 30, 2006 |
|
|
|
|
|
|
|
|
|
|
|
% of Total |
|
|
|
|
|
|
|
|
|
|
% of Total |
|
|
|
|
|
|
|
|
|
|
|
Medical |
|
|
|
|
|
|
|
|
|
|
Medical |
|
|
|
Amount |
|
|
PMPM |
|
|
Care Costs |
|
|
Amount |
|
|
PMPM |
|
|
Care Costs |
|
Medical care costs: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fee-for-service costs |
|
$ |
339,841 |
|
|
$ |
106.15 |
|
|
|
64.6 |
% |
|
$ |
284,648 |
|
|
$ |
93.81 |
|
|
|
66.1 |
% |
Capitation |
|
|
95,879 |
|
|
|
29.95 |
|
|
|
18.2 |
% |
|
|
68,144 |
|
|
|
22.46 |
|
|
|
15.8 |
% |
Pharmacy |
|
|
67,844 |
|
|
|
21.19 |
|
|
|
12.9 |
% |
|
|
51,697 |
|
|
|
17.04 |
|
|
|
12.0 |
% |
Other |
|
|
22,338 |
|
|
|
6.98 |
|
|
|
4.3 |
% |
|
|
26,381 |
|
|
|
8.69 |
|
|
|
6.1 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total medical
care costs |
|
$ |
525,902 |
|
|
$ |
164.27 |
|
|
|
100.0 |
% |
|
$ |
430,870 |
|
|
$ |
142.00 |
|
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended |
|
|
Nine Months Ended |
|
|
|
September 30, 2007 |
|
|
September 30, 2006 |
|
|
|
|
|
|
|
|
|
|
|
% of Total |
|
|
|
|
|
|
|
|
|
|
% of Total |
|
|
|
|
|
|
|
|
|
|
|
Medical |
|
|
|
|
|
|
|
|
|
|
Medical |
|
|
|
Amount |
|
|
PMPM |
|
|
Care Costs |
|
|
Amount |
|
|
PMPM |
|
|
Care Costs |
|
Medical care costs: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fee-for-service costs |
|
$ |
984,375 |
|
|
$ |
102.70 |
|
|
|
64.8 |
% |
|
$ |
814,928 |
|
|
$ |
94.14 |
|
|
|
67.0 |
% |
Capitation |
|
|
276,742 |
|
|
|
28.87 |
|
|
|
18.2 |
% |
|
|
187,997 |
|
|
|
21.72 |
|
|
|
15.5 |
% |
Pharmacy |
|
|
194,354 |
|
|
|
20.28 |
|
|
|
12.8 |
% |
|
|
148,858 |
|
|
|
17.19 |
|
|
|
12.2 |
% |
Other |
|
|
63,773 |
|
|
|
6.65 |
|
|
|
4.2 |
% |
|
|
64,049 |
|
|
|
7.40 |
|
|
|
5.3 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total medical
care costs |
|
$ |
1,519,244 |
|
|
$ |
158.50 |
|
|
|
100.0 |
% |
|
$ |
1,215,832 |
|
|
$ |
140.45 |
|
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Our medical care costs include amounts that have actually been paid by us through the
reporting date as well as estimated liabilities for medical care costs incurred but not paid by us
as of the reporting date. Such medical care cost liabilities include, among other items, capitation
payments owed providers, unpaid pharmacy invoices, and various medically related administrative
costs that have been incurred but not paid. We also record reserves for estimated referral claims
related to medical groups under contract with us that are financially troubled or insolvent and
that may not be able to honor their obligations for the payment of medical services provided by
other providers. In these instances, we may be required to honor these obligations for legal or
business reasons. Based on our current assessment of providers under contract with us, such losses
are not expected to be material. In applying this policy, we use judgment to determine the
appropriate assumptions for determining the required estimates.
19
The most important part in estimating our medical care costs, however, is our estimate of
fee-for-service costs which have been incurred but not paid by us. Fee-for-service costs and their
related medical claims and benefits payable are based upon actual historical experience and
estimates of fee-for-service costs incurred but not reported, or IBNR. We estimate our IBNR costs
monthly using actuarial methods based on a number of factors. Such factors include, but are not
limited to, claims receipt and payment experience, changes in membership, provider billing
practices, health care service utilization trends, cost trends, product mix, seasonality, prior
authorization of medical services, benefit changes, provider contract changes, changes to Medicaid
fee schedules, and the incidence of high dollar claims. We continually review and update the
estimation methods and the resulting reserves. Many of our medical contracts are complex in nature
and may be subject to differing interpretations regarding amounts due for the provision of various
services. Such differing interpretations may not come to light until a substantial period of time
has passed following the contract implementation, leading to potential misstatement of some costs
in the period in which they are first recorded. Estimates are adjusted monthly as more information
becomes available. Any adjustments to reserves are reflected in current operations. We employ our
own actuaries and engage the service of independent actuaries as needed. We believe that our
process for estimating IBNR is adequate, but all estimates are subject to uncertainties and, on
occasion in the past, our actual medical care costs have exceeded such estimates. If our estimated
IBNR is less than our actual medical care costs in the future, our results of operations would be
negatively impacted. Additionally, if we are unable to accurately estimate IBNR, our ability to
take timely corrective actions may be affected, further exacerbating the extent of the negative
impact on our results of operations.
G&A costs are largely comprised of wage and benefit costs related to our employee base,
premium taxes, and other administrative expenses. Some G&A services are provided locally, while
others are delivered to our health plans from a centralized location. The major centralized
functions are claims processing, information systems, finance and accounting services, and legal
and regulatory services. Locally-provided functions include marketing (to the extent permitted by
law and regulation), plan administration, and provider relations. Included in G&A expenses are
premium taxes for each of our health plans in California, Michigan, Nevada, New Mexico, Ohio,
Texas, and Washington.
20
Results of Operations
The following table sets forth selected consolidated operating ratios. All ratios with the
exception of the medical care ratio are shown as a percentage of total revenue. The medical care
ratio is shown as a percentage of premium revenue because there is a direct relationship between
the premium revenue earned and the cost of health care.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, |
|
Nine Months Ended September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Premium revenue |
|
|
98.8 |
% |
|
|
99.0 |
% |
|
|
98.8 |
% |
|
|
99.0 |
% |
Investment income |
|
|
1.2 |
% |
|
|
1.0 |
% |
|
|
1.2 |
% |
|
|
1.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenue |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medical care ratio |
|
|
83.7 |
% |
|
|
84.1 |
% |
|
|
84.8 |
% |
|
|
84.4 |
% |
General and
administrative
expense ratio,
excluding premium
taxes |
|
|
8.4 |
% |
|
|
8.6 |
% |
|
|
8.0 |
% |
|
|
8.5 |
% |
Premium taxes
included in general
and administrative
expenses |
|
|
3.3 |
% |
|
|
3.1 |
% |
|
|
3.3 |
% |
|
|
3.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total general and
administrative
expense ratio |
|
|
11.7 |
% |
|
|
11.7 |
% |
|
|
11.3 |
% |
|
|
11.5 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and
amortization
expense ratio |
|
|
1.1 |
% |
|
|
1.1 |
% |
|
|
1.1 |
% |
|
|
1.0 |
% |
Effective tax rate |
|
|
38.1 |
% |
|
|
37.7 |
% |
|
|
38.1 |
% |
|
|
37.7 |
% |
Operating income |
|
|
4.5 |
% |
|
|
4.0 |
% |
|
|
3.7 |
% |
|
|
3.9 |
% |
Net income |
|
|
2.8 |
% |
|
|
2.4 |
% |
|
|
2.2 |
% |
|
|
2.3 |
% |
Three Months Ended September 30, 2007 Compared to Three Months Ended September 30, 2006
Net Income
Net income for the quarter ended September 30, 2007, increased to $17.5 million, or $0.62 per
diluted share, compared to net income of $12.3 million, or $0.44 per diluted share, for the quarter
ended September 30, 2006.
The following tables summarize premium revenue, medical care costs, medical care ratio, and
premium taxes by health plan for the three months ended September 30, 2007 and September 30, 2006
(PMPM amounts are in whole dollars while other dollar amounts are in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, 2007 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
93,154 |
|
|
$ |
108.39 |
|
|
$ |
76,443 |
|
|
$ |
88.95 |
|
|
|
82.1 |
% |
|
$ |
2,382 |
|
Michigan |
|
|
119,752 |
|
|
|
187.19 |
|
|
|
100,378 |
|
|
|
156.90 |
|
|
|
83.8 |
% |
|
|
7,069 |
|
New Mexico |
|
|
72,543 |
|
|
|
361.23 |
|
|
|
56,984 |
|
|
|
283.76 |
|
|
|
78.6 |
% |
|
|
2,828 |
|
Ohio |
|
|
125,452 |
|
|
|
302.02 |
|
|
|
111,387 |
|
|
|
268.16 |
|
|
|
88.8 |
% |
|
|
5,645 |
|
Texas |
|
|
24,997 |
|
|
|
279.39 |
|
|
|
19,041 |
|
|
|
212.82 |
|
|
|
76.2 |
% |
|
|
450 |
|
Utah |
|
|
27,513 |
|
|
|
193.52 |
|
|
|
26,534 |
|
|
|
186.63 |
|
|
|
96.4 |
% |
|
|
|
|
Washington |
|
|
164,367 |
|
|
|
192.43 |
|
|
|
130,216 |
|
|
|
152.45 |
|
|
|
79.2 |
% |
|
|
2,748 |
|
Other |
|
|
624 |
|
|
|
|
|
|
|
4,919 |
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated |
|
$ |
628,402 |
|
|
$ |
196.29 |
|
|
$ |
525,902 |
|
|
$ |
164.27 |
|
|
|
83.7 |
% |
|
$ |
21,129 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, 2006 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
93,590 |
|
|
$ |
102.71 |
|
|
$ |
85,283 |
|
|
$ |
93.59 |
|
|
|
91.1 |
% |
|
$ |
2,934 |
|
Michigan |
|
|
122,209 |
|
|
|
179.25 |
|
|
|
95,049 |
|
|
|
139.42 |
|
|
|
77.8 |
% |
|
|
7,505 |
|
New Mexico |
|
|
58,648 |
|
|
|
324.51 |
|
|
|
50,533 |
|
|
|
279.61 |
|
|
|
86.2 |
% |
|
|
2,164 |
|
Ohio |
|
|
20,977 |
|
|
|
219.76 |
|
|
|
20,466 |
|
|
|
214.41 |
|
|
|
97.6 |
% |
|
|
968 |
|
Texas |
|
|
280 |
|
|
|
108.86 |
|
|
|
361 |
|
|
|
140.69 |
|
|
|
129.2 |
% |
|
|
24 |
|
Utah |
|
|
39,268 |
|
|
|
234.81 |
|
|
|
35,961 |
|
|
|
215.03 |
|
|
|
91.6 |
% |
|
|
|
|
Washington |
|
|
152,481 |
|
|
|
180.40 |
|
|
|
112,372 |
|
|
|
132.95 |
|
|
|
73.7 |
% |
|
|
2,587 |
|
Indiana |
|
|
24,626 |
|
|
|
164.15 |
|
|
|
25,384 |
|
|
|
169.20 |
|
|
|
103.1 |
% |
|
|
|
|
Other |
|
|
1 |
|
|
|
|
|
|
|
5,461 |
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated |
|
$ |
512,080 |
|
|
$ |
168.77 |
|
|
$ |
430,870 |
|
|
$ |
142.00 |
|
|
|
84.1 |
% |
|
$ |
16,184 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21
Premium Revenue
Premium revenue for the third quarter of 2007 was $628.4 million, an increase of $116.3
million, or 22.7%, over premium revenue of $512.1 million for the third quarter of 2006. Among the
factors increasing premium revenue between the third quarter of 2007 and the third quarter of 2006
were:
|
|
|
Increased enrollment at our Ohio and Texas health plans. The Ohio health plan
contributed $125.5 million in premium revenue in the third quarter of 2007, an increase of
$104.5 million from a year ago. The Texas health plan, which commenced operations in
September 2006, contributed $25.0 million in premium revenue in the third quarter of 2007
and less than $0.3 million in September 2006. |
|
|
|
|
Increased revenue of approximately $14.0 million at our New Mexico health plan due to: |
|
|
|
A rate increase of approximately 5% effective July 1, 2007; |
|
|
|
|
Increased enrollment; and |
|
|
|
|
A one time out-of-period increase to revenue of approximately $2.2 million.
This adjustment was made to reduce the amount we estimated was owed back to the
state for the two-year period ending June 30, 2007, based upon direct medical costs
incurred during that period. |
The following items served to decrease premium revenue for the third quarter of 2007 compared
to the third quarter of 2006:
|
|
|
Termination of operations at our Indiana health plan effective January 1, 2007. The
Indiana health plan contributed no premium revenue in the third quarter of 2007 compared to
$24.6 million in premium revenue in the third quarter of 2006. |
|
|
|
|
Reduced revenue of approximately $11.8 million at our Utah health plan due to: |
|
|
|
Lower enrollment; |
|
|
|
|
Lower medical costs, which reduced revenue under our Utah health plans
cost-plus reimbursement contract; and |
|
|
|
|
An out-of-period reduction of approximately $1.7 million to the amount
receivable under a savings sharing agreement with the state. The amount of the
receivable for this item has been reduced from approximately $4.7 million at June
30, 2007, to $3.0 million at September 30, 2007. Our Utah health plan continues to
work with the state in an effort to assure an appropriate determination of amounts
due under the savings sharing agreement. |
22
Investment Income
Investment income during the third quarter of 2007 totaled $7.6 million as compared to $5.4
million in the third quarter of 2006, an increase of $2.2 million, as a result of higher invested
balances and higher rates of return.
Medical Care Costs
Medical care costs as a percentage of premium revenue (the medical care ratio) decreased to
83.7% in the third quarter of 2007 from 84.1% in the third quarter of 2006, an improvement of 40
basis points year-over-year. Sequentially, the medical care ratio decreased from 85.1% for the
quarter ended June 30, 2007, an improvement of 140 basis points. We believe that our medical care
ratio is normally at its lowest during the third quarter of any given fiscal year as a result of
seasonality in medical care utilization.
The most significant developments regarding medical care costs in the third quarter of 2007
were:
|
|
|
An improvement in the medical care ratios of our Ohio and Texas health plans. The
medical care ratio of the Ohio health plan declined to 88.8% in the third quarter of 2007
from 97.6% in the third quarter of 2006 and 91.1% in the second quarter of 2007. The
medical care ratio of our Texas health plan declined to 76.2% in the third quarter of 2007
from 91.3% in the second quarter of 2007. Our Texas health plan did not have significant
premium revenue or medical expense in the third quarter of 2006. We believe that the
medical care costs of our Ohio and Texas health plans are developing as anticipated,
although the medical care costs of our Texas plan have been somewhat better than
anticipated. Nevertheless, the limited claims payment experience for the many members who
have been added during 2007 adds a degree of uncertainty to the medical care cost estimates
in both Ohio and Texas that is not found with our more mature health plans. |
|
|
|
|
An improvement in the medical care ratio of our New Mexico health plan as a result of a
1.5% increase to per member per month medical care costs compared to the third quarter of
2006 and the increases to premium revenue discussed above. |
|
|
|
|
An improvement in the medical care ratio of our California health plan as a result of a
5% decrease to per member per month medical care costs compared to the third quarter of
2006, and increases to premium revenue that took effect during the first half of 2007,
particularly in San Diego County. |
|
|
|
|
Increases in the medical care ratios of our Washington and Michigan health plans when
compared to the third quarter of 2006. We believe that the medical care ratios experienced
by our Washington and Michigan health plans in the third quarter of 2006 were not
reasonably sustainable on a long-term basis. |
|
|
|
|
The termination of operations in Indiana. Our Indiana health plan had a medical care
ratio of 103.1% in the third quarter of 2006. |
Days in claims payable were 54 days at September 30, 2007, June 30, 2007, and September 30,
2006.
General and Administrative Expenses
General and administrative expenses were $74.2 million, or 11.7% of total revenue, for the
third quarter of 2007 as compared to $60.5 million, or 11.7% of total revenue, for the third
quarter of 2006.
Core G&A expenses (defined as G&A expenses less premium taxes) decreased to 8.4% of revenue in
the third quarter of 2007 compared to 8.6% in the third quarter of 2006, but increased from 7.7% in
the second quarter of 2007. The decline in Core G&A as a percentage of total revenue year-over-year
is primarily due to higher premium revenue. Core G&A on a per member per month basis increased 14%
in the third quarter of 2007 when compared to the third quarter of 2006, while premium revenue per
member per month increased by 16%.
23
The increase in Core G&A in comparison to the second quarter of 2007 is primarily the result
of increases to bonus accruals as a result of our improved financial performance in 2007 as well as
our continued investment in the administrative infrastructure necessary to support our Medicare
product line. Absent the additional bonus expense recorded in the third quarter of 2007, our Core
G&A Ratio would have been 7.8% compared to 7.7% in the second quarter of 2007.
Depreciation and Amortization
Depreciation and amortization expense for the third quarter of 2007 increased by $1.5 million
compared to the third quarter of 2006. Depreciation expense increased by $1.2 million in the third
quarter of 2007 due to investments in infrastructure. Amortization expense increased by $0.3
million in the third quarter of 2007.
Interest Expense
Interest expense in the third quarter of 2007 was flat when compared to the third quarter of
2006.
Income Taxes
Income taxes were recognized in the third quarter of 2007 based upon an effective tax rate of
38.1% as compared to an effective tax rate of 37.7% in the third quarter of 2006. The increase in
the effective tax rate in the third quarter of 2007 was due to an increase in that portion of our
net income earned by subsidiaries that are subject to state income tax, coupled with the dilution
of economic development credits in California due to a larger pretax income in the third quarter of
2007.
Nine Months Ended September 30, 2007 Compared to Nine Months Ended September 30, 2006
The following summarizes premium revenue, medical care costs, medical care ratio, and premium
taxes by health plan for the nine months ended September 30, 2007 and September 30, 2006 (PMPM
amounts are in whole dollars while other dollar amounts are in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended September 30, 2007 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
280,796 |
|
|
$ |
107.22 |
|
|
$ |
228,952 |
|
|
$ |
87.42 |
|
|
|
81.5 |
% |
|
$ |
8,614 |
|
Michigan |
|
|
364,945 |
|
|
|
185.54 |
|
|
|
306,163 |
|
|
|
155.66 |
|
|
|
83.9 |
% |
|
|
21,942 |
|
New Mexico |
|
|
191,073 |
|
|
|
324.23 |
|
|
|
159,152 |
|
|
|
270.07 |
|
|
|
83.3 |
% |
|
|
6,438 |
|
Ohio |
|
|
311,853 |
|
|
|
270.08 |
|
|
|
282,164 |
|
|
|
244.37 |
|
|
|
90.5 |
% |
|
|
14,033 |
|
Texas |
|
|
64,406 |
|
|
|
260.88 |
|
|
|
55,163 |
|
|
|
223.44 |
|
|
|
85.6 |
% |
|
|
1,140 |
|
Utah |
|
|
88,473 |
|
|
|
201.87 |
|
|
|
81,535 |
|
|
|
186.04 |
|
|
|
92.2 |
% |
|
|
|
|
Washington |
|
|
489,254 |
|
|
|
190.36 |
|
|
|
392,201 |
|
|
|
152.60 |
|
|
|
80.2 |
% |
|
|
8,117 |
|
Other |
|
|
964 |
|
|
|
|
|
|
|
13,914 |
|
|
|
|
|
|
|
|
|
|
|
21 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated |
|
$ |
1,791,764 |
|
|
$ |
186.93 |
|
|
$ |
1,519,244 |
|
|
$ |
158.50 |
|
|
|
84.8 |
% |
|
$ |
60,305 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended September 30, 2006 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
279,161 |
|
|
$ |
100.23 |
|
|
$ |
245,599 |
|
|
$ |
88.18 |
|
|
|
88.0 |
% |
|
$ |
8,918 |
|
Michigan |
|
|
301,739 |
|
|
|
179.88 |
|
|
|
234,950 |
|
|
|
140.06 |
|
|
|
77.9 |
% |
|
|
18,259 |
|
New Mexico |
|
|
168,088 |
|
|
|
314.30 |
|
|
|
141,657 |
|
|
|
264.88 |
|
|
|
84.3 |
% |
|
|
6,039 |
|
Ohio |
|
|
49,555 |
|
|
|
216.18 |
|
|
|
46,199 |
|
|
|
201.54 |
|
|
|
93.2 |
% |
|
|
2,237 |
|
Texas |
|
|
280 |
|
|
|
108.86 |
|
|
|
381 |
|
|
|
148.47 |
|
|
|
136.4 |
% |
|
|
24 |
|
Utah |
|
|
126,741 |
|
|
|
240.30 |
|
|
|
115,828 |
|
|
|
219.61 |
|
|
|
91.4 |
% |
|
|
|
|
Washington |
|
|
460,733 |
|
|
|
179.17 |
|
|
|
362,800 |
|
|
|
141.08 |
|
|
|
78.7 |
% |
|
|
7,937 |
|
Indiana |
|
|
54,873 |
|
|
|
167.16 |
|
|
|
52,980 |
|
|
|
161.40 |
|
|
|
96.6 |
% |
|
|
|
|
Other |
|
|
27 |
|
|
|
|
|
|
|
15,438 |
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated |
|
$ |
1,441,197 |
|
|
$ |
166.49 |
|
|
$ |
1,215,832 |
|
|
$ |
140.45 |
|
|
|
84.4 |
% |
|
$ |
43,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24
Net Income
Net income for the nine months ended September 30, 2007, increased to $40.4 million, or $1.43
per diluted share, compared to net income of $34.1 million, or $1.21 per diluted share, for the
nine months ended September 30, 2006.
Premium Revenue
Premium revenue for the nine months ended September 30, 2007, was $1,791.8 million, an
increase of $350.6 million, or 24.3%, over premium revenue of $1,441.2 million for the nine months
ended September 30, 2006. The increase in premium revenue for the nine months ended September 30,
2007, was driven by increased membership in our Ohio and Texas health plans and by our acquisition
of Cape Health Plan in Michigan effective May 15, 2006.
The Ohio health plan contributed $311.9 million in premium revenue in the nine months ended
September 30, 2007, an increase of $262.3 million from a year ago.
The Texas health plan, which commenced operations in September 2006, contributed $64.4 million
in premium revenue in the nine months ended September 30, 2007.
The premium revenue from the Companys Michigan health plan increased $63.2 million due
primarily to the acquisition of Cape Health Plan.
The
premium revenue from the Utah health plan decreased $38.3 million
primarily due to lower enrollment associated with the overall lower Medicaid enrollment throughout the State of Utah.
The Indiana health plan, where the Company ceased serving members effective January 1, 2007,
contributed no premium revenue in the nine months ended September 30, 2007, compared to $54.9
million in premium revenue in the same nine-month period of 2006.
Investment Income
Investment income during the nine months ended September 30, 2007, totaled $21.1 million as
compared to $14.3 million for the same nine month period of 2006, an increase of $6.8 million, as a
result of higher invested balances and higher rates of return.
Medical Care Costs
Medical care costs as a percentage of premium revenue (the medical care ratio) increased to
84.8% in the nine months ended September 30, 2007, from 84.4 % in the same nine-month period of
2006, a deterioration of 40 basis points, principally as a result of the higher medical care costs
of our Ohio and Texas health plans.
The medical care ratios reported by the Ohio and Texas health plans for the nine months ended
September 30, 2007, were 90.5% and 85.6%, respectively. The Company has previously disclosed its
expectation that Ohio and Texas would experience medical care ratios higher than those historically
experienced by the Company as a whole. Additionally, as noted above, the limited claims payment
experience for the many members who have been added during 2007 adds a degree of uncertainty to the
Ohio and Texas expense estimates that is not found in the Companys more mature health plans.
Excluding the Companys Ohio, Texas and Indiana health plans, the Companys medical care ratio
would have been 83.6% for the nine months ended September 30, 2007, as compared to 83.5% for the
same nine-month period of 2006.
Our health plans in California and New Mexico reported lower medical care ratios in the nine
months ended September 30, 2007, when compared to the same nine-month period of 2006, while our
Michigan and Washington health plans reported an increase in their medical care ratio.
The California health plans medical care ratio declined to 81.5% for the nine months ended
September 30, 2007, compared to 88.0% for the same nine-month period of 2006 due to increased
premium revenue and the success of provider re-contracting efforts and stable medical care
utilization.
25
The New Mexico health plan reported a decrease in its medical care ratio to 83.3% in the nine
months ended September 30, 2007, compared to 84.3% in the same nine-month period of 2006. The New
Mexico health plan recorded a $6.9 million decrease to premium revenue during the nine months ended
September 30, 2007, in order to comply with contractual terms that require it to spend a specified
minimum percentage of premium revenue on direct medical care costs. Absent this accrual, the New
Mexico health plans medical care ratio in the nine months ended September 30, 2007, would have
been 80.4%, an improvement of 390 basis points year-over-year.
The Michigan health plan reported an increase in its medical care ratio to 83.9% for the nine
months ended September 30, 2007, compared to 77.9% for the nine months ended September 30, 2006.
The higher medical care ratio is due to higher fee-for-service and capitated costs.
The Washington health plan reported an increase in its medical care ratio to 80.2% in the nine
months ended September 30, 2007, compared to 78.7% in the same nine-month period of 2006,
principally due to higher fee-for-service costs.
General and Administrative Expenses
General and administrative expenses were $204.8 million, or 11.3% of total revenue, for the
nine months ended September 30, 2007, as compared to $168.0 million, or 11.5% of total revenue, for
the same nine-month period of 2006.
Core G&A expenses decreased to 8.0% of total revenue for the nine months ended September 30,
2007, compared to 8.5% in the same nine-month period of 2006. The decline in Core G&A as a
percentage of total revenue is due to higher premium revenue than commensurate G&A expenses. Core
G&A on a per member per month basis increased 4.7% in the nine months ended September 30, 2007,
when compared to the same nine-month period of 2006, while premium revenue per member per month
increased by 12.3%.
Depreciation and Amortization
Depreciation and amortization expense increased by $5.0 million for the nine months ended
September 30, 2007 compared to the same nine-month period of 2006. Depreciation expense increased
by $2.9 million in the nine months ended September 30, 2007, due to investments in infrastructure.
Amortization expense increased by $2.1 million in same period, primarily due to the Cape Health
Plan acquisition in Michigan and amortization expense related to software used in operations.
Impairment Charge on Purchased Software
During the second quarter of 2007, an impairment charge of $782,000 was recorded related to
purchased software no longer used for operations. No such charge occurred during the nine months
ended September 30, 2006.
Interest Expense
Interest expense for the nine months ended September 30, 2007 increased by $0.7 million
compared to the nine months ended September 30, 2006 principally due to increased borrowings.
Income Taxes
Income taxes were recognized in the nine months ended September 30, 2007 based upon an
effective tax rate of 38.1% as compared to an effective tax rate of 37.7% in the same period of
2006. The increase in the effective tax rate in 2007 was due to an increase in that portion of our
net income earned by subsidiaries that are subject to state income tax, coupled with the dilution
of economic development credits in California due to a larger pretax income for the nine months
ended September 30, 2007.
26
Liquidity and Capital Resources
We
generate cash both from premium revenues and from interest income on
invested balances. Our primary uses of cash include
the payment of expenses related to medical care services and G&A expenses. We generally receive
premium revenue in advance of payment of claims for related health care services.
Our investment policies are designed to provide liquidity, preserve capital, and maximize
total return on invested assets. At September 30, 2007, we invested a substantial portion of our
cash in a portfolio of highly liquid money market securities. At September 30, 2007, our
unrestricted investments (all of which were classified as current assets) consisted solely of
investment grade debt securities. Our investment policies require that all of our investments have
final maturities of ten years or less (excluding auction rate securities and variable rate
securities, for which interest rates are periodically reset) and that the average maturity be four
years or less. Two professional portfolio managers operating under documented investment guidelines
manage our investments. The average annualized portfolio yield for the nine months ended September
30, 2007 and 2006 was approximately 5.2% and 4.8%, respectively.
The states in which we operate prescribe the types of instruments in which our subsidiaries
may invest their funds. Our restricted investments are invested principally in certificates of
deposit and treasury securities.
Cash provided by operating activities for the nine months ended September 30, 2007, was $113.3
million, as compared to $67.2 million for the same period in 2006, an increase of $46.1 million.
The primary sources of cash provided by operating activities were increased net income, increased
deferred revenue at the Ohio health plan, the timing of payments for medical claims and benefits
payable, and an increase in accounts payable and accrued liabilities. Medical claims liabilities of
our Indiana health plan, which had no membership effective January 1, 2007, declined by $20.6
million between December 31, 2006 and September 30, 2007. Absent the Indiana claims run-out,
medical claims liabilities increased by $39.2 million during the nine months ended September 30,
2007, primarily as a result of enrollment growth at our Ohio and Texas health plans.
At September 30, 2007, we had working capital of $278.1 million compared to $258.6 million at
December 31, 2006. At September 30, 2007 and December 31, 2006, cash and cash equivalents were
$447.6 million and $403.7 million, respectively. At September 30, 2007 and December 31, 2006,
investments (all classified as current assets) were $108.2 million and $81.5 million, respectively.
At September 30, 2007, the parent company (Molina Healthcare, Inc.) had cash and investments of
approximately $24.0 million. We believe that our cash resources and internally generated funds will
be sufficient to support our operations, regulatory requirements, and capital expenditures for at
least the next 12 months.
Subsequent to quarter end, the Company issued $200 million in senior
convertible Notes, resulting in net proceeds to the Company in the amount of $193.4 million. A portion of the proceeds from the issuance of the Notes was used to pay off the
$20.0 million total outstanding balance under the Companys $180 million credit facility at
September 30, 2007, leaving the Companys credit facility with a zero balance as of October 17, 2007. We also used $80.0 million
of net proceeds in connection with our acquisition of Mercy CarePlus in Missouri. At November 6,
2007, the remaining net proceeds from the sale of the Notes is approximately $93.4 million.
Regulatory Capital and Dividend Restrictions
Our principal operations are conducted through our eight HMO subsidiaries operating in
California, Michigan, Nevada, New Mexico, Ohio, Texas, Utah, and Washington. The HMOs are subject
to state laws that, among other things, require the maintenance of minimum levels of statutory
capital, as defined by each state, and may restrict the timing, payment, and amount of dividends
and other distributions that may be paid to Molina Healthcare, Inc. as the sole stockholder of each
of our HMOs.
The National Association of Insurance Commissioners, or NAIC, has established model rules
which, if adopted by a particular state, set minimum capitalization requirements for HMOs and other
insurance entities bearing risk for health care coverage. The requirements take the form of
risk-based capital, or RBC, rules. These rules, which vary slightly from state to state, have been
adopted in Michigan, Nevada, New Mexico, Ohio, Texas, Utah, and Washington. California has not
adopted RBC rules and has not given notice of any intention to do so. The RBC rules, if adopted by
California, may increase the minimum capital required by that state.
27
At September 30, 2007, our HMOs had aggregate statutory capital and surplus of approximately
$279.0 million, compared to the required minimum aggregate statutory capital and surplus of
approximately $152.0 million. All of our HMOs were in compliance with the minimum capital
requirements at September 30, 2007. We have the ability and commitment to provide additional
working capital to each of our HMOs when necessary to ensure that capital and surplus continue to
meet regulatory requirements. Barring any change in regulatory requirements, we believe that we
will continue to be in compliance with these requirements through 2007.
Contractual Obligations
In our Annual Report on Form 10-K for the year ended December 31, 2006, we reported on our
contractual obligations as of that date. There have been no material changes to our contractual
obligations since that report other than the repayment of $25 million on our credit facility during
the nine months ended September 30, 2007.
On October 11, 2007, we completed our offering of $200 million aggregate principal amount of convertible senior Notes due 2014. A portion of the proceeds was used to pay off the $20 million owed on our credit facility
at September 2007. We also used $80 million of net proceeds to fund our acquisition of Mercy
CarePlus in Missouri. The remaining proceeds of approximately $93.4 million will be used for future
acquisitions and for general corporate purposes including working capital.
Critical Accounting Policies
When we prepare our consolidated financial statements, we use estimates and assumptions that
may affect reported amounts and disclosures. The determination of our liability for claims and
medical benefits payable is particularly important to the determination of our financial position
and results of operations and requires the application of significant judgment by our management
and, as a result, is subject to an inherent degree of uncertainty.
Our medical care costs include amounts that have actually been paid by us through the
reporting date as well as estimated liabilities for medical care costs incurred but not paid by us
as of the reporting date. Such medical care cost liabilities include, among other items, capitation
payments owed providers, unpaid pharmacy invoices, and various medically related administrative
costs that have been incurred but not paid. We also record reserves for estimated referral claims
related to medical groups under contract with us that are financially troubled or insolvent and
that may not be able to honor their obligations for the payment of medical services provided by
other providers. In these instances, we may be required to honor these obligations for legal or
business reasons. Based on our current assessment of providers under contract with us, such losses
are not expected to be significant. In applying this policy, we use judgment to determine the
appropriate assumptions for determining the required estimates.
The most important part in estimating our medical care costs, however, is our estimate for
fee-for-service claims which have been incurred but not paid by us. These fee-for-service costs
that have been incurred but are not paid at the reporting date are collectively referred to as
medical costs that are Incurred But Not Reported, or IBNR. We estimate our IBNR monthly using
actuarial methods based on a number of factors. Such factors include, but are not limited to,
claims receipt and payment experience, changes in membership, provider billing practices, health
care service utilization trends, cost trends, product mix, seasonality, prior authorization of
medical services, benefit changes, provider contract changes, changes to Medicaid fee schedules and
the incidence of high dollar claims. The estimation methods and the resulting reserves are
frequently reviewed and updated, and adjustments, if necessary, are reflected in the period known.
While we believe our current estimates are adequate, we have in the past been required to make
a significant adjustment to these estimates and it is possible that we will be required to make
significant adjustments or revisions to these estimates in the future.
The most significant estimates involved in determining our IBNR liability concern the
determination of claims payment completion factors and trended per member per month cost estimates.
For the fifth month of service prior to the reporting date and earlier, we estimate our
outstanding claims liability based upon actual claims paid, adjusted for estimated completion
factors. Completion factors seek to measure the cumulative percentage of claims expense that will
have been paid for a given month of service as of the reporting date based on historical payment
patterns.
28
The following table reflects the change in our estimate of claims liability as of September
30, 2007 that would have resulted had we changed our completion factors for the fifth through the
twelfth months preceding September 30, 2007 by the percentages indicated. A reduction in the
completion factor results in an increase in medical claims liabilities. Our Utah HMO is excluded
from these calculations, as the majority of the Utah business is conducted under a cost
reimbursement contract. Dollar amounts are in thousands.
|
|
|
|
|
|
|
Increase (Decrease) in |
(Decrease) Increase in |
|
Medical Claims and |
Estimated Completion Factors |
|
Benefits Payable |
(3)% |
|
$ |
20,793 |
|
(2)% |
|
|
13,862 |
|
(1)% |
|
|
6,931 |
|
1% |
|
|
(6,931 |
) |
2% |
|
|
(13,862 |
) |
3% |
|
|
(20,793 |
) |
For the four months of service immediately prior to the reporting date, actual claims paid are
not a reliable measure of our ultimate liability, given the inherent delay between the
patient/physician encounter and the actual submission of a claim for payment. For these months of
service, we estimate our claims liability based upon trended per member per month (PMPM) cost
estimates. These estimates are designed to reflect recent trends in payments and expense,
utilization patterns, authorized services, and other relevant factors. The following table reflects
the change in our estimate of claims liability as of September 30, 2007 that would have resulted
had we altered our trend factors by the percentages indicated. An increase in the PMPM costs
results in an increase in medical claims liabilities. Our Utah HMO is excluded from these
calculations, as the majority of the Utah business is conducted under a cost reimbursement
contract. Dollar amounts are in thousands.
|
|
|
|
|
(Decrease) Increase in |
|
(Decrease) Increase in |
Trended per Member |
|
Medical Claims and |
per Month Cost Estimates |
|
Benefits Payable |
(3)% |
|
$ |
(11,391 |
) |
(2)% |
|
|
(7,594 |
) |
(1)% |
|
|
(3,797 |
) |
1% |
|
|
3,797 |
|
2% |
|
|
7,594 |
|
3% |
|
|
11,391 |
|
Assuming a hypothetical 1% change in completion factors from those used in our calculation of
IBNR at September 30, 2007, net income for the nine months ended September 30, 2007 would increase
or decrease by approximately $4.3 million, or $0.15 per diluted share, net of tax. Assuming a
hypothetical 1% change in PMPM cost estimates from those used in our calculation of IBNR at
September 30, 2007, net income for the nine months ended September 30, 2007 would increase or
decrease by approximately $2.4 million, or $0.08 per diluted share, net of tax.
The following table shows the components of the change in medical claims and benefits payable
for the nine months ended September 30, 2007 and 2006. Dollar amounts are in thousands.
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended September 30, |
|
|
|
2007 |
|
|
2006 |
|
Balances at beginning of period |
|
$ |
290,048 |
|
|
$ |
217,354 |
|
Medical claims and benefits payable from business acquired |
|
|
|
|
|
|
22,536 |
|
Components of medical care costs related to: |
|
|
|
|
|
|
|
|
Current year |
|
|
1,568,949 |
|
|
|
1,254,174 |
|
Prior years |
|
|
(49,705 |
) |
|
|
(38,342 |
) |
|
|
|
|
|
|
|
Total medical care costs |
|
|
1,519,244 |
|
|
|
1,215,832 |
|
Payments for medical care costs related to: |
|
|
|
|
|
|
|
|
Current year |
|
|
1,278,321 |
|
|
|
1,017,923 |
|
Prior years |
|
|
222,249 |
|
|
|
180,872 |
|
|
|
|
|
|
|
|
Total paid |
|
|
1,500,570 |
|
|
|
1,198,795 |
|
|
|
|
|
|
|
|
Balances at end of period |
|
$ |
308,722 |
|
|
$ |
256,927 |
|
|
|
|
|
|
|
|
Days in claims payable |
|
|
54 |
|
|
|
54 |
|
Number of members at end of period |
|
|
1,070,000 |
|
|
|
1,015,000 |
|
Number of claims in inventory at end of period (1) |
|
|
179,186 |
|
|
|
246,435 |
|
Billed charges of claims in inventory at end of period (in thousands) (1) |
|
$ |
231,753 |
|
|
$ |
234,494 |
|
Claims in inventory per member at end of period (1) |
|
|
0.17 |
|
|
|
0.26 |
|
|
|
|
(1) |
|
2006 claims data excludes information for Cape Health Plan membership of
approximately 85,000 members. Cape membership was processed on a separate claims platform
through December 31, 2006. |
29
Our claims liability includes an allowance for adverse claims development based on historical
experience and other factors including, but not limited to, variation in claims payment patterns,
changes in utilization and cost trends, known outbreaks of disease, and large claims. Accordingly,
any benefit recognized in medical care costs resulting from favorable development of an estimated
liability at the start of the period (captured as a component of medical care costs related to
prior years) may be offset by the addition of an allowance for adverse claims development when
estimating the liability at the end of the period (captured as a component of medical care costs
related to current year).
Inflation
We use various strategies to mitigate the negative effects of health care cost inflation.
Specifically, our health plans try to control medical and hospital costs through contracts with
independent providers of health care services. Through these contracted providers, our health plans
emphasize preventive health care and appropriate use of specialty and hospital services. There can
be no assurance, however, that our strategies to mitigate health care cost inflation will be
successful. Competitive pressures, new health care and pharmaceutical product introductions,
demands from health care providers and customers, applicable regulations, or other factors may
affect our ability to control health care costs.
Compliance Costs
Our health plans are regulated by both state and federal government agencies. Regulation of
managed care products and health care services is an evolving area of law that varies from
jurisdiction to jurisdiction. Regulatory agencies generally have discretion to issue regulations
and interpret and enforce laws and rules. Changes in applicable laws and rules occur frequently.
Compliance with such laws and rules may lead to additional costs related to the implementation of
additional systems, procedures and programs that we have not yet identified.
Item 3. Quantitative and Qualitative Disclosures About Market Risk.
Concentrations of Credit Risk
Financial instruments that potentially subject us to concentrations of credit risk consist
primarily of cash and cash equivalents, investments, receivables, and restricted investments. We
invest a substantial portion of our cash in the CADRE Liquid Asset Fund and CADRE Reserve Fund
(CADRE Funds), a portfolio of highly liquid money market securities. Two professional portfolio
managers operating under documented investment guidelines manage our investments. Restricted
investments are invested principally in certificates of deposit and treasury securities.
Concentration of credit risk with respect to accounts receivable is limited due to payors
consisting principally of the governments of each state in which our HMO subsidiaries operate.
As of September 30, 2007, we had cash and cash equivalents of $447.6 million, unrestricted
investments of $108.2 million, and restricted investments of $27.8 million. Cash equivalents
consist of highly liquid securities with original maturities of up to three months. At September
30, 2007, our investments (all of which were classified as current assets) consisted solely of
investment grade debt securities. Our investment policies require that all of our investments have
final maturities of ten years or less (excluding auction rate securities and variable rate
securities, for which interest rates are periodically reset) and that the average maturity be four
years or less. The restricted investments consist of interest-bearing deposits required by the
respective states in which we operate. These investments are subject to interest rate risk and will
decrease in value if market rates increase. All non-restricted investments are maintained at fair
market value on the condensed consolidated balance sheet. Declines in interest rates over time will
reduce our investment income.
30
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures: Our management, with the participation of
our Chief Executive Officer and our Chief Financial Officer, has concluded, based upon its
evaluation as of the end of the period covered by this report, that the Companys disclosure
controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange
Act of 1934 (the Exchange Act)) are effective to ensure that information required to be disclosed
in the reports that we file or submit under the Exchange Act is recorded, processed, summarized,
and reported within the time periods specified in the Securities and Exchange Commissions rules
and forms.
Changes in Internal Control Over Financial Reporting: There has been no change in our internal
control over financial reporting during the three months ended September 30, 2007 that has
materially affected, or is reasonably likely to materially affect, our internal controls over
financial reporting.
31
PART II OTHER INFORMATION
Item 1. Legal Proceedings
The health care industry is subject to numerous laws and regulations of federal, state, and
local governments. Compliance with these laws and regulations can be subject to government review
and interpretation, as well as regulatory actions unknown and unasserted at this time. Violations
of these laws and regulations can result in significant fines and penalties, exclusion from
participating in publicly-funded programs, and the repayment of previously billed and collected
revenues.
Derivative Action. On August 8, 2005, plaintiff Perry Jarrell filed a shareholder derivative
complaint in the Superior Court of the State of California for the County of Los Angeles, Case No.
BC 337912 (the Derivative Action). The Derivative Action purported to allege claims on behalf of
Molina Healthcare, Inc. against certain current and former officers and directors for breach of
fiduciary duty, breach of the duty of loyalty, gross negligence, and violation of California
Corporations Code Section 25402, arising out of the Companys announcement of its guidance for the
2005 fiscal year. On February 7, 2006, the Superior Court ordered that the Derivative Action be
stayed pending the outcome of the securities class action lawsuit that had been filed against the
Company in late July 2005 in the United States District Court for the Central District of
California, Case No. CV 05-5460 GPS (SHx), which lawsuit also arose out of the Companys
announcement of its guidance for the 2005 fiscal year (the Federal Class Action). In November
2006, the Federal Class Action was dismissed with prejudice and without liability. As a result of
the final disposition of the Federal Class Action, on June 21, 2007, the Los Angeles Superior Court
held a hearing on the Companys demurrer to the derivative complaint. The Superior Court sustained
the Companys demurrer, but granted the plaintiff leave to amend its complaint. On October 12,
2007, the Superior Court held a hearing on the Companys demurrer to the plaintiffs amended
derivative complaint. At that hearing, the Superior Court sustained the Companys demurrer with
prejudice and without leave to amend.
Malpractice Action. On February 1, 2007, a complaint was filed in the Superior Court of the
State of California for the County of Riverside by plaintiff Staci Robyn Ward through her guardian
ad litem, Case No. 465374. The complaint purports to allege claims for medical malpractice against
Molina Medical Centers and certain other defendants. The plaintiff alleges that the defendants
failed to properly diagnose her medical condition which resulted in her severe and permanent
disability. On July 22, 2007, the plaintiff passed away. The proceeding is in the early stages, and
no prediction can be made as to the outcome.
Starko. Our New Mexico HMO is named as a defendant in a class action lawsuit brought by New
Mexico pharmacies and pharmacists, Starko, Inc., et al. v. NMHSD, et al., No. CV-97-06599, Second
Judicial District Court, State of New Mexico. The lawsuit was originally filed in August 1997
against the New Mexico Human Services Department (NMHSD). In February 2001, the plaintiffs named
health maintenance organizations participating in the New Mexico Medicaid program as defendants,
including Cimarron Health Plan, the predecessor of our New Mexico HMO. The plaintiffs assert that
NMHSD and the defendant HMOs failed to pay pharmacy dispensing fees under an alleged New Mexico
statutory mandate. Discovery is currently underway. On July 10, 2007, the court dismissed all
damages claims against Molina Healthcare of New Mexico, leaving only a pending action for
injunctive and declaratory relief. On August 15, 2007, the court held a hearing on the motion of
Molina Healthcare of New Mexico to dismiss the plaintiffs claims for injunctive and declaratory
relief. At that hearing, the court dismissed all remaining claims against Molina Healthcare of New
Mexico. The plaintiffs have filed a Notice of Appeal of the courts dismissal orders. It is not
currently possible to assess the amount or range of potential loss or probability of a favorable or
unfavorable outcome. Under the terms of the stock purchase agreement pursuant to which the Company
acquired Health Care Horizons, Inc., the parent company to our New Mexico HMO, an indemnification
escrow account was established and funded with approximately $6
million in order to indemnify our New Mexico HMO
against the costs of such litigation and any eventual liability or settlement costs. Currently,
approximately approximately $4.1 million remains in the indemnification escrow fund.
We are involved in other legal actions in the normal course of business, some of which seek
monetary damages, including claims for punitive damages, which are not covered by insurance. These
actions, when finally concluded and determined, are not likely, in our opinion, to have a material
adverse effect on our consolidated financial position, results of operations, or cash flows.
32
Item 1A. Risk Factors
Set forth below are additional risk factors not previously disclosed in our annual report on
Form 10-K for the year ended December 31, 2006. In addition to these risk factors and the other
cautionary language and information set forth in this report, you should carefully consider the
risk factors discussed in Part I, Item 1A Risk Factors, in our annual report on Form 10-K for
the year ended December 31, 2006, and also the risk factors and cautionary language in our
quarterly reports on Form 10-Q, our current reports on Form 8-K, and our prospectus supplement
filed on October 5, 2007. The risks described in these reports and filings are not necessarily the
only risks facing our Company. Additional risks and uncertainties not currently known to us or that
we currently deem to be immaterial may also materially adversely affect our business, financial
condition, and/or operating results.
High profile qui tam matters and
negative publicity regarding Medicaid managed care and Medicare Advantage may lead to programmatic
changes, intensified regulatory scrutiny, and guilt by
association.
Certain of our competitors have
recently been involved in high profile qui tam or whistleblower actions which have resulted
in significant volatility in the price of their stock. Because of the limited number of health
care companies competing in our market space, these whistleblower actions and investigations,
and the resulting negative publicity, could become associated with or imputed to the Company,
regardless of the Company's actual regulatory compliance. Such an association, as well as any
perception of a recurring pattern of abuse among the health plan participants in these
government programs and the diminished reputation of the managed care sector as a whole,
could result in public distrust, political pressure for programmatic changes, intensified
scrutiny by regulators, increased stock volatility due to speculative trading, and heightened
barriers to new managed care markets and contracts, all of which could have a material adverse
effect on our business, financial condition, or results of
operations.
The State of Utah may be unwilling
to pay our Utah plan a savings sharing incentive amount that is at minimum equal to the amount
recorded in our financial statements.
We have
estimated the amount that we believe our Utah plan has earned and will recover under its savings
sharing agreement with the State of Utah based on the information we have to date and our
interpretation of our Utah plan's contract with the state. The state may not agree with our
claims processing methodology or with our interpretation of the contract language, and the
amount of savings sharing revenue that we realize may be subject to negotiation with the state.
At September 30, 2007, we have recorded $3.0 million in receivables associated with the Utah
savings sharing plan. In the event the amount recovered is less than the amount previously
recorded or if we are required to pay an amount to the State, the adjustment to our financial
statements could have a significant impact on our results of
operations.
Funding under our contracts is
subject to regulatory and programmatic adjustments and reforms for which we may not be
appropriately compensated.
The
federal government and the governments of the states in which we operate frequently consider
legislative and regulatory proposals regarding Medicaid reform and programmatic changes.
Such proposals involve, among other things, changes in reimbursement or payment levels based
on certain parameters or member characteristics, changes in eligibility for Medicaid, and
changes in benefits covered such as pharmacy, behavioral health or vision. Any of these
changes could be made retroactively effective. If our cost increases resulting from these
changes are not matched by commensurate increases in our revenue, we would be unable to make
offsetting adjustments, such as supplemental premiums or changes in our benefit plans, as would
a commercial health plan. For example, as part of its periodic rebasing of diagnostic-related
group (DRG) rates to adjust for changes in hospital cost experience, effective August 1, 2007,
the state of Washington recalibrated the relative weights used in its DRG reimbursement system
for in-patient hospital claims. The changes were intended to be budget neutral, but corresponding
increases were not made to the amounts paid to managed care organizations such as our Washington
health plan. As a result, the Washington DRG rebasing is expected to increase our Washington
plans medical care costs for the remainder of 2007 without a compensating increase in payments
to the Washington plan. We expect to receive a compensating rate increase effective January 1, 2008, but such rate increase may not occur or may be less than we expect. Any other such regulatory or programmatic reforms at either the federal
or state level could have a material adverse effect on our business, financial condition, or
results of operations.
Item 5. Other Information.
None.
Item 6. Exhibits
A list of exhibits required to be filed as part of this Quarterly Report on Form 10-Q is set
forth in the Index to Exhibits, which immediately precedes such exhibits, and is incorporated
herein by this reference.
33
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly
caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
|
|
|
|
|
|
MOLINA HEALTHCARE, INC.
(Registrant)
|
|
Dated: November 8, 2007 |
/s/ JOSEPH M. MOLINA, M.D.
|
|
|
Joseph M. Molina, M.D. |
|
|
Chairman of the Board,
Chief Executive Officer and President
(Principal Executive Officer) |
|
|
|
|
|
|
|
|
|
|
Dated: November 8, 2007 |
/s/ JOHN C. MOLINA, J.D.
|
|
|
John C. Molina, J.D. |
|
|
Chief Financial Officer and Treasurer
(Principal Financial Officer) |
|
|
34
EXHIBIT INDEX
|
|
|
|
|
Exhibit No. |
|
Title |
|
3.1 |
|
|
Certificate of Incorporation (filed as Exhibit 3.2 to registrants
Registration Statement on Form S-1 filed December 30, 2002). |
|
|
|
|
|
|
3.2 |
|
|
Amended and Restated Bylaws (filed as Exhibit 3.4 to registrants
Form S-1/A filed March 11, 2003). |
|
|
|
|
|
|
4.1 |
|
|
Indenture dated as of October 11, 2007 (filed as Exhibit 4.1 to registrants Form 8-K filed October 5, 2007). |
|
|
|
|
|
|
4.2 |
|
|
First Supplemental Indenture dated as of October 11, 2007 (filed as Exhibit 4.2 to registrants Form 8-K filed October 5, 2007). |
|
|
|
|
|
|
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. |
35