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 June 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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One Golden Shore Drive,
Long Beach, California
(Address of principal executive offices)
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90802
(Zip Code) |
(562) 435-3666
(Registrants telephone number, including area code)
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 $0.001 per share,
outstanding as of August 3, 2007, was 28,291,647.
MOLINA HEALTHCARE, INC.
Index
2
PART I FINANCIAL INFORMATION
Item 1: Financial Statements.
MOLINA HEALTHCARE, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
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June 30, |
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December 31, |
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2007 |
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2006 |
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(Amounts in thousands, except share data) |
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(Unaudited) |
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ASSETS
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Current assets: |
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Cash and cash equivalents |
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$ |
471,502 |
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$ |
403,650 |
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Investments |
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78,492 |
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81,481 |
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Receivables |
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106,309 |
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110,835 |
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Income tax receivable |
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2,515 |
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7,960 |
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Deferred income taxes |
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2,708 |
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313 |
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Prepaid expenses and other current assets |
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10,616 |
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9,263 |
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Total current assets |
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672,142 |
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613,502 |
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Property and equipment, net |
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45,503 |
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41,903 |
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Goodwill and intangible assets, net |
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137,274 |
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143,139 |
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Restricted investments |
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23,480 |
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20,154 |
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Receivable for ceded life and annuity contracts |
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31,400 |
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32,923 |
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Other assets |
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12,926 |
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12,854 |
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Total assets |
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$ |
922,725 |
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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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$ |
303,239 |
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$ |
290,048 |
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Deferred revenue |
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44,325 |
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18,120 |
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Accounts payable and accrued liabilities |
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51,815 |
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46,725 |
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Total current liabilities |
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399,379 |
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354,893 |
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Long-term debt |
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30,000 |
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45,000 |
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Deferred income taxes |
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3,576 |
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6,700 |
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Liability for ceded life and annuity contracts |
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31,400 |
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32,923 |
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Other long-term liabilities |
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9,723 |
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4,793 |
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Total liabilities |
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474,078 |
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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: 28,284,263 shares at June 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, $0.001 par value; 20,000,000
shares authorized, no shares issued and
outstanding |
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Additional paid-in capital |
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179,815 |
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173,990 |
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Accumulated other comprehensive loss |
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(141 |
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(337 |
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Retained earnings |
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289,335 |
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266,875 |
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Treasury stock (1,201,174 shares, at cost) |
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(20,390 |
) |
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(20,390 |
) |
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Total stockholders equity |
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448,647 |
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420,166 |
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Total liabilities and stockholders equity |
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$ |
922,725 |
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$ |
864,475 |
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See accompanying notes.
3
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
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Three months ended |
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Six months ended |
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June 30, |
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June 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)
(Unaudited) |
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Revenue: |
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Premium revenue |
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$ |
607,127 |
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$ |
479,823 |
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$ |
1,163,362 |
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$ |
929,117 |
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Investment income |
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6,761 |
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4,811 |
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13,429 |
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8,893 |
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Total revenue |
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613,888 |
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484,634 |
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1,176,791 |
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938,010 |
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Expenses: |
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Medical care costs: |
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Medical services |
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117,317 |
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86,020 |
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228,208 |
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160,878 |
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Hospital and specialty services |
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336,587 |
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267,689 |
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644,729 |
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530,559 |
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Pharmacy |
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62,961 |
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48,006 |
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120,405 |
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93,525 |
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Total medical care costs |
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516,865 |
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401,715 |
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993,342 |
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784,962 |
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General and administrative expenses |
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67,208 |
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56,308 |
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130,596 |
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107,521 |
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Depreciation and amortization |
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6,749 |
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4,870 |
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13,192 |
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9,632 |
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Impairment charge on purchased software |
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782 |
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782 |
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Total expenses |
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591,604 |
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462,893 |
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1,137,912 |
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902,115 |
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Operating income |
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22,284 |
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21,741 |
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38,879 |
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35,895 |
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Other expense: |
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Interest expense |
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(725 |
) |
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(577 |
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(1,850 |
) |
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(991 |
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Total other expense |
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(725 |
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(577 |
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(1,850 |
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(991 |
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Income before income taxes |
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21,559 |
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21,164 |
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37,029 |
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34,904 |
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Income tax expense |
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8,245 |
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8,012 |
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14,123 |
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13,162 |
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Net income |
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$ |
13,314 |
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$ |
13,152 |
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$ |
22,906 |
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$ |
21,742 |
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Net income per share: |
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Basic |
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$ |
0.47 |
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$ |
0.47 |
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$ |
0.81 |
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$ |
0.78 |
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Diluted |
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$ |
0.47 |
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$ |
0.47 |
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$ |
0.81 |
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$ |
0.77 |
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Weighted average shares outstanding: |
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Basic |
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28,233 |
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27,947 |
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28,192 |
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27,901 |
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Diluted |
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28,343 |
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28,270 |
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28,309 |
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28,207 |
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See accompanying notes.
4
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
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Six Months Ended |
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June 30, |
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2007 |
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2006 |
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(Dollars in thousands) |
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(Unaudited) |
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Operating activities |
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Net income |
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$ |
22,906 |
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$ |
21,742 |
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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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13,192 |
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9,632 |
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Amortization of capitalized credit facility fees |
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475 |
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429 |
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Deferred income taxes |
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(4,763 |
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(2,483 |
) |
Stock-based compensation |
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3,644 |
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2,747 |
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Changes in operating assets and liabilities: |
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Receivables |
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4,526 |
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(6,208 |
) |
Prepaid expenses and other current assets |
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(1,353 |
) |
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3,098 |
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Medical claims and benefits payable |
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13,191 |
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9,919 |
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Deferred revenue |
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26,205 |
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Accounts payable and accrued liabilities |
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4,736 |
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(2,922 |
) |
Income taxes |
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5,232 |
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2,634 |
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Net cash provided by operating activities |
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87,991 |
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38,588 |
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Investing activities |
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Purchases of equipment |
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(10,440 |
) |
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(7,333 |
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Purchases of investments |
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(42,816 |
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(57,737 |
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Sales and maturities of investments |
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46,117 |
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66,476 |
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(Increase) decrease in restricted cash |
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(3,326 |
) |
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|
940 |
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Net cash acquired in purchase transactions |
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5,820 |
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Increase in other long-term liabilities |
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4,484 |
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|
106 |
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Increase in other assets |
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(864 |
) |
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(1,070 |
) |
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Net cash (used in) provided by investing activities |
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(6,845 |
) |
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7,202 |
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Financing activities |
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Borrowings under credit facility |
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20.000 |
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Repayment of amounts borrowed under credit facility |
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(15,000 |
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(5,000 |
) |
Payment of credit facility fees |
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(475 |
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Repurchase and retirement of common stock |
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(117 |
) |
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Tax benefit from exercise of employee stock options recorded as additional
paid-in capital |
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642 |
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653 |
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Proceeds from exercise of stock options and employee stock purchases |
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1,656 |
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1,472 |
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Net cash (used in) provided by financing activities |
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(13,294 |
) |
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17,125 |
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Net increase in cash and cash equivalents |
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67,852 |
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|
62,915 |
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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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$ |
471,502 |
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$ |
312,118 |
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Supplemental cash flow information |
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Cash paid during the period for: |
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Income taxes |
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$ |
9,715 |
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$ |
12,411 |
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Interest |
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$ |
2,041 |
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$ |
1,055 |
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Schedule of non-cash investing and financing activities: |
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Change in unrealized loss (gain) on investments |
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$ |
312 |
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$ |
(128 |
) |
Deferred taxes |
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(116 |
) |
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43 |
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Change in net unrealized loss (gain) on investments |
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$ |
196 |
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$ |
(85 |
) |
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Value of stock issued for employee compensation earned in previous year |
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$ |
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|
$ |
2,178 |
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Details of acquisitions: |
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Fair value of assets acquired |
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$ |
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$ |
86,003 |
|
Less cash acquired in purchase transaction |
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(49,820 |
) |
Deferred taxes |
|
|
|
|
|
|
(42,003 |
) |
|
|
|
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|
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Change in net unrealized loss (gain) on investments |
|
$ |
|
|
|
$ |
(5,820 |
) |
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|
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|
|
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|
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|
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Cumulative effect of adoption of Financial Interpretation No. 48, Accounting for
Uncertainty in Income Taxes |
|
$ |
446 |
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Deferred tax asset related to business purchase |
|
$ |
873 |
|
|
$ |
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|
|
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Accrual for capital expenditures |
|
$ |
354 |
|
|
$ |
|
|
|
|
|
|
|
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|
See accompanying notes.
5
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Dollar amounts in thousands, except share data)
(Unaudited)
June 30, 2007
1. The Reporting Entity
Molina Healthcare, Inc. (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 very small
number of our members 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 subsidiaries licensed as health maintenance organizations, or HMOs,
in the states of California, Indiana (through December 31, 2006), Michigan, New Mexico, Ohio,
Texas, Utah, and Washington. We serve a very small number (less than ten) of dual eligible members
in Nevada from our Utah health plan.
Our Texas HMO began serving members in September 2006. The Medicaid contract of our Indiana
HMO expired without renewal on December 31, 2006, and that health plan is currently winding up its
operations.
On May 18, 2006, we completed our acquisition of HCLB, Inc., the parent company of Cape Health
Plan, Inc. which is a Michigan-licensed HMO based in Southfield, Michigan (Cape). At the time of
the acquisition, Cape served approximately 90,000 Medicaid members primarily in Southeast Michigan.
The acquisition was deemed effective May 15, 2006 for accounting purposes. Accordingly, the results
of operations for Cape Health Plan are included in the consolidated financial statements for the
periods following May 15, 2006. Effective December 31, 2006, we merged Cape Health Plan into Molina
Healthcare of Michigan, Inc.
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 June 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 six months ended June 30, 2007 and 2006 are summarized below:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Six Months |
|
|
|
June 30, |
|
|
Ended June 30, |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
Stock options (including shares issued under our employee stock purchase plan) |
|
$ |
567 |
|
|
$ |
572 |
|
|
$ |
1,086 |
|
|
$ |
1,081 |
|
Stock grants |
|
|
534 |
|
|
|
373 |
|
|
|
1,173 |
|
|
|
630 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total stock-based compensation expense, net of tax |
|
$ |
1,101 |
|
|
$ |
945 |
|
|
$ |
2,259 |
|
|
$ |
1,711 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Stock option activity during the six months ended June 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 |
|
|
242,250 |
|
|
|
31.38 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(111,923 |
) |
|
|
8.95 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(51,484 |
) |
|
|
29.94 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding as of June 30, 2007 |
|
|
868,808 |
|
|
$ |
29.26 |
|
|
$ |
2,798 |
|
|
|
8.09 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable as of June 30, 2007 |
|
|
387,078 |
|
|
$ |
25.93 |
|
|
$ |
2,447 |
|
|
|
6.91 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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 June 30, |
|
Six Months Ended June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Risk-free interest rate |
|
|
4.70 |
% |
|
|
5.00 |
% |
|
|
4.52 |
% |
|
|
4.54 |
% |
Expected volatility |
|
|
48.74 |
% |
|
|
51.6 |
% |
|
|
48.77 |
% |
|
|
53.1 |
% |
Expected option life (in years) |
|
|
6.12 |
|
|
|
6.00 |
|
|
|
6.12 |
|
|
|
6.00 |
|
Expected dividend yield |
|
None |
|
None |
|
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 second quarter of 2007.
The weighted-average fair value of options granted during the three and six months ended June
30, 2007 were $16.96 and $16.54, respectively. The weighted-average fair value of options granted
during the three and six months ended June 30, 2006 were $16.55 and $12.87, respectively.
The total intrinsic value of stock options exercised during the three and six months ended
June 30, 2007 amounted to $1,043 and $2,558, respectively. The total intrinsic value of stock
options exercised during the three and six months ended June 30, 2006 amounted to $614 and $1,869,
respectively.
The total fair value of restricted shares granted during the three and six months ended June
30, 2007 was $1,919 and $6,548, respectively. The total fair value of restricted shares granted
during the three and six months ended June 30, 2006 were $1,452 and $1,659, respectively.
The total fair value of restricted shares vested during the three and six months ended June
30, 2007 was $375 and $986, respectively. The total fair value of restricted shares vested during
the three and six months ended June 30, 2006 was $470 and $581, respectively.
7
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
Non-vested restricted stock and restricted stock unit activity for the six months ended June
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 |
|
|
207,600 |
|
|
|
31.54 |
|
Vested |
|
|
(32,049 |
) |
|
|
35.77 |
|
Forfeited |
|
|
(13,510 |
) |
|
|
33.70 |
|
|
|
|
|
|
|
|
|
Non-vested balance as of June 30, 2007 |
|
|
263,799 |
|
|
$ |
33.84 |
|
|
|
|
|
|
|
|
As of June 30, 2007, there was $14,361 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 June 30, |
|
|
Six Months Ended June 30, |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
|
|
|
Shares outstanding at the beginning of the period |
|
|
28,199,000 |
|
|
|
27,935,000 |
|
|
|
28,119,000 |
|
|
|
27,792,000 |
|
Weighted average number of shares issued for stock options,
stock grants, and employee stock purchases |
|
|
34,000 |
|
|
|
12,000 |
|
|
|
74,000 |
|
|
|
109,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for basic earnings per share |
|
|
28,233,000 |
|
|
|
27,947,000 |
|
|
|
28,193,000 |
|
|
|
27,901,000 |
|
Dilutive effect of employee stock options and restricted stock |
|
|
110,000 |
|
|
|
323,000 |
|
|
|
116,000 |
|
|
|
306,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for diluted earnings per share |
|
|
28,343,000 |
|
|
|
28,270,000 |
|
|
|
28,309,000 |
|
|
|
28,207,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets Impairment Charge
During the second quarter of 2007, an impairment charge of $782 was recorded related to
commercial software no longer used for operations. No such charge occurred in the second quarter of
2006.
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 to financial reports for interim and
annual reporting periods beginning after December 15, 2006. The Company adopted EITF 06-3 on
January 1, 2007. The Company collects premium taxes from various states on premium revenue, which
are accounted for on a gross basis. Premium taxes included in premium revenue totaled $20.1 million
and $14.4 million for the three months ended June 30, 2007 and 2006, respectively. Premium taxes
included in premium revenue totaled $39.2 million and $27.2 million for the six months ended June
30, 2007 and 2006, respectively. Premium taxes are included in General and administrative
expense 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
8
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
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 on 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
June 30, 2007, the Company had $4,112 of total gross unrecognized tax benefits of which $1,275 (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 June 30, 2007 and December 31, 2006, the Company had
accrued cumulative $524 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 audit, the Company reduced its FIN 48 liability by
$213 which included interest of $33.
The Company was previously audited in a state jurisdiction for certain refund claims filed
based on additional state tax credits identified for years between 1998 and 2001. The Company has
previously reserved for the estimated amount of reduction. During the three months ended June 30,
2007, the Company settled the 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.
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, state, and local income tax
examination by tax authorities for tax years before 2002.
Other recent accounting pronouncements issued by the FASB (including its Emerging Issues Task
Force), 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.
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:
|
|
|
|
|
|
|
|
|
|
|
June 30, |
|
|
December 31, |
|
|
|
2007 |
|
|
2006 |
|
California HMO |
|
$ |
19,702 |
|
|
$ |
32,404 |
|
Utah HMO |
|
|
40,248 |
|
|
|
46,570 |
|
Ohio HMO |
|
|
28,837 |
|
|
|
11,611 |
|
Washington HMO |
|
|
8,426 |
|
|
|
7,447 |
|
Others |
|
|
9,096 |
|
|
|
12,803 |
|
|
|
|
|
|
|
|
Total receivables |
|
$ |
106,309 |
|
|
$ |
110,835 |
|
|
|
|
|
|
|
|
9
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
As of June 30, 2007, the receivable for our California HMO included a retroactive rate
increase adjustment of $2.9 million for our San Diego County members. Excluding this transaction,
substantially all receivables due our
California HMO at June 30, 2007 and December 31, 2006 were collected in July 2007 and January
of 2007, respectively.
Our agreement with the state of Utah calls for the reimbursement of our Utah HMO 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 HMO 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.
The receivable due our Ohio HMO includes approximately $8,300 of accrued delivery payments due
from the state of Ohio and approximately $20,000 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 June 30, 2007 this receivable was
comprised of approximately $12,300 paid on behalf of the provider group, which is to be deducted
from capitation payments in the months of July and August. An additional $7,700 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. Monthly
gross capitation paid to the provider group is approximately $8,000.
4. Other Assets
Other assets include an investment in a vision services provider (see 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 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 00.75% 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
HMO subsidiaries.
10
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
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 June 30, 2007, we were in
compliance with all financial covenants in the credit agreement.
During the first quarter of 2007, we repaid $15,000 of our borrowings under the credit
facility. At June 30, 2007 and December 31, 2006, the amounts outstanding under the credit facility
were $30,000 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, a shareholder derivative complaint was filed 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 purports 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 July 11, 2007, the plaintiff filed an amended complaint. The Company intends to
file a demurrer with respect to the amended complaint. Discovery in the Derivative Action is stayed
pending the courts final ruling on the Companys demurrer. No prediction can be made at this time
as to the outcome of the Derivative Action.
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 has resulted in her severe and permanent
disability. 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. In a series of rulings on the HMO defendants
summary judgment motions, the court has dismissed all money damage claims against the Companys New
Mexico HMO. The only claims that remain are declaratory and injunctive relief claims. The New
Mexico HMO has filed a motion for summary judgment with respect to those remaining claims. The
hearing on the motion is set for August 15, 2007. 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
11
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
indemnification escrow account was established and funded
with $6,000 in order to indemnify our New Mexico
HMO 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, 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 $240,700 at June 30, 2007
and $236,800 at December 31, 2006. The National Association of Insurance Commissioners, or 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. Indiana,
Michigan, 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.
As of June 30, 2007, our HMOs had aggregate statutory capital and surplus of approximately
$259,700, compared to the required minimum aggregate statutory capital and surplus of approximately
$149,900. All of our HMOs were in compliance with the minimum capital requirements at June 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. 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 $56 and
$57 for the three months ended June 30, 2007 and 2006, respectively. Payment made under this lease
totaled $131 and $57 for the six months ended June 30, 2007 and 2006, respectively.
12
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
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 from us based
on member type. Amounts paid under the terms of both agreements were $1,070 and $107 for the three
months ended June 30, 2007 and 2006, respectively. Amounts paid under the terms of both agreements
were $2,184 and $243 for the six months ended June 30, 2007 and 2006, respectively
Other assets at June 30, 2007 included an equity investment of approximately $1,400 in a
vision services provider that provides medical services to the Companys members. Payments to the
vision services provider were $3,075 and $1,998 for the three months ended June 30, 2007 and 2006,
respectively. Payments to the vision services provider were $5,874 and $3,461 for the six months
ended June 30, 2007 and 2006, respectively.
13
Item 2. Managements Discussion and Analysis of Financial Condition and Results of Operations.
Forward Looking Statements
The information made available below and elsewhere in this quarterly report on Form 10-Q
contains forward-looking statements that involve numerous risks and uncertainties. These
forward-looking statements are often accompanied by words such as believe(s), anticipate(s),
plan(s), expect(s), estimate(s), intend(s), seek(s), goal, may, will, and similar
words and expressions. These statements include, without limitation, statements about our
anticipated future financial performance, our growth strategy, our expected activities and business
plans, our market opportunity, competition, future acquisitions and investments, and the adequacy
of our available cash resources. These statements are intended to take advantage of the safe
harbor provisions of the Private Securities Litigation Reform Act of 1995. 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 in the forward-looking
statements as a result of, but not limited to, the following factors:
|
|
|
the continuing achievement of a decrease in the medical care ratio of our start-up
health plans in Ohio and Texas and risks related to our lack of experience with members in those states; |
|
|
|
|
the continuing achievement of projected savings from a decrease in the medical care
ratio of our California health plan; |
|
|
|
|
an increase in enrollment in our Ohio and Texas health plans and in our dual eligible
population consistent with our expectations; |
|
|
|
|
potential increases to the medical costs of our Washington health plan in connection
with the rebasing of DRG rates in that state anticipated to take effect on August 1, 2007; |
|
|
|
|
the finalization of a contract amendment between our New Mexico health plan and the
state 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; |
|
|
|
|
risks related to the continued solvency of our major providers and provider groups; |
|
|
|
|
our ability to accurately estimate incurred but not reported medical costs; |
|
|
|
|
the securing of adequate premium rate increases, particularly in the states of
California, Michigan, and New Mexico; |
|
|
|
|
costs associated with the non-renewal and run-out of the Medicaid contract of our Indiana health plan; |
|
|
|
|
the successful renewal and continuation of the government contracts of our health plans; |
|
|
|
|
limitations in our ability to control our medical costs and other operating expenses; |
|
|
|
|
our dependence upon a relatively small number of government contracts and subcontracts for our revenue; |
|
|
|
|
increased administrative costs in support of the Companys efforts to expand Medicare membership; |
|
|
|
|
the payment of savings sharing income by the state of Utah to our Utah plan consistent
with our expectations; |
|
|
|
|
the availability of adequate financing to fund and/or capitalize our acquisitions and start-up activities; |
|
|
|
|
the successful and cost-effective integration of our acquisitions; |
|
|
|
|
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; |
|
|
|
|
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 favorable resolution of pending litigation or arbitration; |
|
|
|
|
funding decreases in the Medicaid, SCHIP, or Medicare programs or the failure to timely
renew the SCHIP program; |
|
|
|
|
epidemics such as the avian flu; |
|
|
|
|
changes to government laws and regulations or in the interpretation and enforcement of
those laws and regulations, including the recently enacted citizenship certification
requirements; |
14
|
|
|
the superior financial resources of our competitors, particularly those which also
provide commercial health insurance; |
|
|
|
|
restrictions and covenants in our credit facility that may impede our ability to make or
finance acquisitions and declare dividends; |
|
|
|
|
our dependence upon key employees; |
|
|
|
|
our increased exposure to malpractice and other litigation risks as a result of the
operation of our primary care clinics in California; and |
|
|
|
|
the existence of state regulations that impair our ability to dividend cash from our subsidiaries. |
Investors should refer to our annual report on Form 10-K for the year ended December 31, 2006,
and also to our quarterly report on Form 10-Q for the quarter ended March 31, 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.
Overview
Our financial performance for the quarter and six months ended June 30, 2007 as compared to
our financial performance for the quarter and six months ended June 30, 2006 may be briefly
summarized, respectively in each case, as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Earnings per diluted share |
|
$ |
0.47 |
|
|
$ |
0.47 |
|
|
$ |
0.81 |
|
|
$ |
0.77 |
|
Premium revenue |
|
$ |
607,127 |
|
|
$ |
479,823 |
|
|
$ |
1,163,362 |
|
|
$ |
929,117 |
|
Operating income |
|
$ |
22,284 |
|
|
$ |
21,741 |
|
|
$ |
38,879 |
|
|
$ |
35,895 |
|
Net income |
|
$ |
13,314 |
|
|
$ |
13,152 |
|
|
$ |
22,906 |
|
|
$ |
21,742 |
|
Medical care ratio |
|
|
85.1 |
% |
|
|
83.7 |
% |
|
|
85.4 |
% |
|
|
84.5 |
% |
G&A expenses as a percentage
of total revenue |
|
|
10.9 |
% |
|
|
11.6 |
% |
|
|
11.1 |
% |
|
|
11.5 |
% |
Total ending membership |
|
|
|
|
|
|
|
|
|
|
1,076,000 |
|
|
|
1,008,000 |
|
Revenue
Premium revenue is fixed in advance of the periods covered and is not generally subject to
significant accounting estimates. For the six months ended June 30, 2007, we received approximately
91.3% 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
15
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. Medicare revenue is approximately $1,200 PMPM.
Approximately 3.8% of our premium revenue in the six months ended June 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 six months ended June 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. Other revenues from savings sharing and fee-for-service clinic income contributed the
remaining 0.1% of our premium revenue.
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 HMO by the State of New Mexico that
may be returned if specified minimum amounts are not expended on certain defined medical care
costs, and (ii) the additional premium revenue our Utah HMO 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. At June 30, 2007, we have
recorded a payable to the state of approximately $14.6 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 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 of the contract
language, and the ultimate amount of savings sharing revenue that we realize may be subject to
negotiation with the state. At June 30, 2007, we have recorded approximately $4.7 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.
Membership growth has been the primary reason for our increasing revenues. We have increased
our membership 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 |
|
|
June 30, |
|
December 31, |
|
June 30, |
Market |
|
2007 |
|
2006 |
|
2006 |
California |
|
|
291,000 |
|
|
|
300,000 |
|
|
|
307,000 |
|
Michigan |
|
|
217,000 |
|
|
|
228,000 |
|
|
|
232,000 |
|
New Mexico |
|
|
66,000 |
|
|
|
65,000 |
|
|
|
59,000 |
|
Ohio |
|
|
138,000 |
|
|
|
76,000 |
|
|
|
30,000 |
|
Texas |
|
|
30,000 |
|
|
|
19,000 |
|
|
|
N/A |
(2) |
Utah |
|
|
47,000 |
|
|
|
52,000 |
|
|
|
57,000 |
|
Washington |
|
|
287,000 |
|
|
|
281,000 |
|
|
|
286,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal |
|
|
1,076,000 |
|
|
|
1,021,000 |
|
|
|
971,000 |
|
Indiana |
|
|
N/A |
(1) |
|
|
56,000 |
|
|
|
37,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
1,076,000 |
|
|
|
1,077,000 |
|
|
|
1,008,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
The Companys Indiana health plan ceased serving members effective January 1, 2007. |
|
(2) |
|
The Companys Texas health plan commenced operations in September 2006. |
16
The ending membership for our Medicare Advantage Special Needs plans by state is as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
June 30, 2007 |
|
December 31, 2006 |
|
June 30, 2006 |
California |
|
|
724 |
|
|
|
549 |
|
|
|
234 |
|
Michigan |
|
|
459 |
|
|
|
152 |
|
|
|
50 |
|
Nevada |
|
|
9 |
|
|
|
|
|
|
|
|
|
Utah |
|
|
1,646 |
|
|
|
1,452 |
|
|
|
1,385 |
|
Washington |
|
|
413 |
|
|
|
235 |
|
|
|
111 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
3,251 |
|
|
|
2,388 |
|
|
|
1,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The ending membership for our Aged, Blind and Disabled (ABD) population by state is
as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
June 30, 2007 |
|
December 31, 2006 |
|
June 30, 2006 |
California |
|
|
10,728 |
|
|
|
10,717 |
|
|
|
10,261 |
|
Michigan |
|
|
31,940 |
|
|
|
22,540 |
(1) |
|
|
22,737 |
(1) |
New Mexico |
|
|
6,822 |
|
|
|
6,697 |
|
|
|
6,649 |
|
Ohio |
|
|
15,117 |
|
|
|
|
|
|
|
|
|
Texas |
|
|
16,603 |
|
|
|
|
|
|
|
|
|
Utah |
|
|
6,876 |
|
|
|
6,827 |
|
|
|
6,961 |
|
Washington |
|
|
2,693 |
|
|
|
2,713 |
|
|
|
2,679 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
90,779 |
|
|
|
49,494 |
|
|
|
49,287 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(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 |
|
|
|
|
June 30, |
|
% of Increase |
|
|
2007 |
|
2006 |
|
(Decrease) |
California |
|
|
874,000 |
|
|
|
927,000 |
|
|
|
(5.7 |
)% |
Michigan |
|
|
658,000 |
|
|
|
565,000 |
|
|
|
16.5 |
% |
New Mexico |
|
|
197,000 |
|
|
|
176,000 |
|
|
|
11.9 |
% |
Ohio |
|
|
399,000 |
|
|
|
86,000 |
|
|
|
364.0 |
% |
Texas |
|
|
91,000 |
|
|
|
N/A |
(2) |
|
|
N/A |
|
Utah |
|
|
145,000 |
|
|
|
179,000 |
|
|
|
(19.0 |
)% |
Washington |
|
|
860,000 |
|
|
|
858,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal |
|
|
3,224,000 |
|
|
|
2,791,000 |
|
|
|
15.5 |
% |
Indiana |
|
|
N/A |
(1) |
|
|
99,000 |
|
|
|
N/A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
3,224,000 |
|
|
|
2,890,000 |
|
|
|
11.6 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended |
|
|
|
|
June 30, |
|
% of Increase |
|
|
2007 |
|
2006 |
|
(Decrease) |
California |
|
|
1,760,000 |
|
|
|
1,874,000 |
|
|
|
(6.1 |
)% |
Michigan |
|
|
1,327,000 |
|
|
|
996,000 |
|
|
|
33.2 |
% |
New Mexico |
|
|
389,000 |
|
|
|
354,000 |
|
|
|
9.9 |
% |
Ohio |
|
|
739,000 |
|
|
|
134,000 |
|
|
|
451.5 |
% |
Texas |
|
|
157,000 |
|
|
|
N/A |
(2) |
|
|
N/A |
|
Utah |
|
|
296,000 |
|
|
|
360,000 |
|
|
|
(17.8 |
)% |
Washington |
|
|
1,716,000 |
|
|
|
1,726,000 |
|
|
|
(0.6 |
)% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal |
|
|
6,384,000 |
|
|
|
5,444,000 |
|
|
|
17.3 |
% |
Indiana |
|
|
N/A |
(1) |
|
|
178,000 |
|
|
|
N/A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
6,384,000 |
|
|
|
5,622,000 |
|
|
|
13.6 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(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 include two components: direct medical expenses and
medically-related administrative costs. Direct medical expenses include, for example, payments to
physicians, hospitals, and providers of ancillary medical services, such as pharmacy, laboratory,
and radiology services. 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 six months ended June 30, 2007 and 2006,
medically-related administrative costs, included in Medical services in our Condensed
Consolidated Statements of Income, were approximately $30.8 million and $24.1 million.
respectively. Approximately one-third of medically related administrative costs are reported as
expenses of our corporate parent, Molina Healthcare, Inc.
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 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
18
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 obligated to
provide services. The financial risk for pharmacy services for a small portion of our membership is
delegated to capitated providers. All capitation expenses are recorded as Medical services in our
Condensed Consolidated Statements of Income.
Those primary care physicians and specialists not paid on a capitation basis are paid on a
fee-for-service basis. In addition, specialists and hospitals are paid for the most part on a
fee-for-service 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, on the basis of 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.
Although we pass on the financial risk for pharmacy service for a small portion of our membership
to capitated providers, the majority of our pharmacy costs are paid on a fee for service basis. For
the six months ended June 30, 2007, 81.2% of our direct medical expenses were related to fees paid
to providers on a fee-for-service basis, with the balance paid on a capitation basis.
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. Medical care costs and medical
claims and benefits payable are based upon actual historical experience and estimates of medical
expenses 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. 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
19
are premium taxes for the California HMO, the Michigan HMO, the New Mexico HMO, the Ohio HMO,
the Texas HMO (beginning September 2006), and the Washington HMO.
Results of Operations
The following table sets forth selected 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 June 30, |
|
Six Months Ended June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Premium revenue |
|
|
98.9 |
% |
|
|
99.0 |
% |
|
|
98.9 |
% |
|
|
99.1 |
% |
Investment income |
|
|
1.1 |
% |
|
|
1.0 |
% |
|
|
1.1 |
% |
|
|
0.9 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenue |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medical care ratio |
|
|
85.1 |
% |
|
|
83.7 |
% |
|
|
85.4 |
% |
|
|
84.5 |
% |
General and administrative expense ratio, excluding premium
taxes |
|
|
7.7 |
% |
|
|
8.6 |
% |
|
|
7.8 |
% |
|
|
8.6 |
% |
Premium taxes included in general and administrative expenses |
|
|
3.2 |
% |
|
|
3.0 |
% |
|
|
3.3 |
% |
|
|
2.9 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total general and administrative expense ratio |
|
|
10.9 |
% |
|
|
11.6 |
% |
|
|
11.1 |
% |
|
|
11.5 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization expense ratio |
|
|
1.1 |
% |
|
|
1.0 |
% |
|
|
1.1 |
% |
|
|
1.0 |
% |
Effective tax rate |
|
|
38.2 |
% |
|
|
37.9 |
% |
|
|
38.1 |
% |
|
|
37.7 |
% |
Operating income |
|
|
3.6 |
% |
|
|
4.5 |
% |
|
|
3.3 |
% |
|
|
3.8 |
% |
Net income |
|
|
2.2 |
% |
|
|
2.7 |
% |
|
|
1.9 |
% |
|
|
2.3 |
% |
Three Months Ended June 30, 2007 Compared to Three Months Ended June 30, 2006
Net Income
Net income for the quarter ended June 30, 2007, increased to $13.3 million, or $0.47 per
diluted share, compared with net income of $13.2 million, or $0.47 per diluted share, for the
quarter ended June 30, 2006.
Net of certain out-of-period items, earnings for the quarter increased to $0.45 per share
from $0.36 per share for the second quarter of 2006. The out-of-period items affecting
comparability between quarters are as follows:
|
|
|
In the second quarter of 2006, we had recorded a benefit of approximately $5.0 million
(or $0.11 per diluted share, net of taxes) as a result of positive prior period claims
development related to our claims liability at December 31, 2005. |
|
|
|
|
In the second quarter of 2007, we recorded a benefit (net of premium taxes and related
medical costs) of approximately $1.9 million (or $0.04 per diluted share, net of taxes)
due to the receipt of a premium increase in San Diego County, California, retroactive to
July 1, 2006. |
|
|
|
|
In the second quarter of 2007, we recorded a charge of approximately $0.8 million (or
$0.02 per diluted share, net of taxes) related to the impairment of certain purchased
software. |
Our improved second quarter performance was primarily the result of four factors:
20
|
|
|
A 26.5% increase in premium revenue. |
|
|
|
|
An improvement to the combined medical cost performance at our legacy health plans in
California, Michigan, New Mexico, Utah, and Washington. Excluding the retroactive premium
rate increase in San Diego County and the out-of-period claims benefit in 2006, the
combined medical care ratio of these five legacy plans declined by 40 basis points, from
84.2% in the second quarter of 2006 to 83.8% in the second quarter of 2007. |
|
|
|
|
An improvement of 90 basis points in the percentage of revenue spent on general and
administrative expenses other than premium taxes. |
|
|
|
|
An increase to investment income. |
The following summarizes premium revenue, medical care costs, medical care ratio, and premium
taxes by health plan for the three months ended June 30, 2007 and June 30, 2006 (PMPM amounts are
in whole dollars):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2007 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
94,710 |
|
|
$ |
108.43 |
|
|
$ |
76,185 |
|
|
$ |
87.22 |
|
|
|
80.4 |
% |
|
$ |
3,202 |
|
Michigan |
|
|
121,427 |
|
|
|
184.43 |
|
|
|
101,184 |
|
|
|
153.68 |
|
|
|
83.3 |
% |
|
|
7,364 |
|
New Mexico |
|
|
61,337 |
|
|
|
312.44 |
|
|
|
52,949 |
|
|
|
269.71 |
|
|
|
86.3 |
% |
|
|
1,394 |
|
Ohio |
|
|
111,457 |
|
|
|
279.18 |
|
|
|
101,515 |
|
|
|
254.28 |
|
|
|
91.1 |
% |
|
|
5,016 |
|
Texas |
|
|
24,953 |
|
|
|
273.48 |
|
|
|
22,774 |
|
|
|
249.59 |
|
|
|
91.3 |
% |
|
|
433 |
|
Utah |
|
|
30,033 |
|
|
|
206.15 |
|
|
|
26,535 |
|
|
|
182.14 |
|
|
|
88.4 |
% |
|
|
|
|
Washington |
|
|
162,905 |
|
|
|
189.45 |
|
|
|
130,726 |
|
|
|
152.02 |
|
|
|
80.2 |
% |
|
|
2,685 |
|
Other |
|
|
305 |
|
|
|
|
|
|
|
4,997 |
|
|
|
|
|
|
|
|
|
|
|
(19 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
607,127 |
|
|
$ |
188.30 |
|
|
$ |
516,865 |
|
|
$ |
160.30 |
|
|
|
85.1 |
% |
|
$ |
20,075 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2006 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
92,032 |
|
|
$ |
99.34 |
|
|
$ |
82,254 |
|
|
$ |
88.79 |
|
|
|
89.4 |
% |
|
$ |
2,957 |
|
Michigan |
|
|
101,822 |
|
|
|
180.32 |
|
|
|
79,999 |
|
|
|
141.67 |
|
|
|
78.6 |
% |
|
|
6,013 |
|
New Mexico |
|
|
53,860 |
|
|
|
305.87 |
|
|
|
43,486 |
|
|
|
246.96 |
|
|
|
80.7 |
% |
|
|
1,998 |
|
Ohio |
|
|
18,467 |
|
|
|
214.96 |
|
|
|
16,696 |
|
|
|
194.35 |
|
|
|
90.4 |
% |
|
|
813 |
|
Utah |
|
|
43,626 |
|
|
|
243.58 |
|
|
|
40,062 |
|
|
|
223.67 |
|
|
|
91.8 |
% |
|
|
|
|
Washington |
|
|
153,344 |
|
|
|
178.64 |
|
|
|
118,284 |
|
|
|
137.80 |
|
|
|
77.1 |
% |
|
|
2,646 |
|
Indiana |
|
|
16,696 |
|
|
|
167.50 |
|
|
|
15,564 |
|
|
|
156.15 |
|
|
|
93.2 |
% |
|
|
|
|
Other |
|
|
(24 |
) |
|
|
|
|
|
|
5,370 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
479,823 |
|
|
$ |
166.01 |
|
|
$ |
401,715 |
|
|
$ |
138.99 |
|
|
|
83.7 |
% |
|
$ |
14,427 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Premium Revenue
Premium revenue for the second quarter of 2007 was $607.1 million, an increase of $127.3
million, or 26.5%, over premium revenue of $479.8 million for the second quarter of 2006. The
increase in premium revenue in the second quarter of 2007 was driven by increased membership in our
Ohio and Texas start-up health plans and by the acquisition of Cape Health Plan in Michigan
effective May 15, 2006.
The Ohio health plan contributed $111.5 million in premium revenue in the second quarter of
2007, an increase of $93.0 million from a year ago.
21
The Texas health plan, which commenced operations in September 2006, contributed $25.0 million
in premium revenue in the second quarter of 2007.
The premium revenue from our Michigan health plan increased $19.6 million due primarily to the
acquisition of Cape Health Plan.
The Indiana health plan, where we ceased serving members effective January 1, 2007,
contributed no premium revenue in the second quarter of 2007 compared with $16.7 million in premium
revenue in the second quarter of 2006.
As noted above, our California health plan benefited from a rate increase for its Medicaid
membership in San Diego County retroactive to July 1, 2006. This increase of approximately 4.8%
added approximately $2.9 million to premium revenue in the second quarter, of which approximately
$2.2 million related to the last half of 2006 and the first quarter of 2007.
Investment Income
Investment income during the second quarter of 2007 totaled $6.7 million as compared to $4.8
million in the second quarter of 2006, an increase of $1.9 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
85.1% in the second quarter of 2007 from 83.7% in the second quarter of 2006. Excluding the impact
of the $5.0 million benefit for favorable out-of-period claims development in the second quarter of
2006, our medical care ratio increased 37 basis points year-over-year. Excluding the collective
impact of the 2006 out-of-period claims development, the retroactive premium rate increase in San
Diego County, our discontinued Indiana health plan and the Ohio and Texas start-up health plans,
our medical care ratio would have been 83.8% for the second quarter of 2007 as compared with 84.2%
for the second quarter of 2006, an improvement of 40 basis points year-over-year.
The medical care ratios reported by the Ohio and Texas health plans for the second quarter of
2007 were 91.1% and 91.3%, respectively. Medical care ratios for both Ohio and Texas in the second
quarter of 2007 improved sequentially. We continue to monitor the development of medical care
costs in both these states. While we believe our claims reserves in Ohio and Texas are
appropriate, the limited claims payment experience for the many members who have been added during
2007 adds a degree of uncertainty to these estimates that is not found in our more mature health
plans.
Our California health plan continued to make progress in managing its medical care costs
during the second quarter of 2007. Absent the out-of-period revenue related to the San Diego rate
increase, the California health plan reported a medical care ratio of 82.2% in the second quarter
of 2007 compared with 89.4% a year earlier. The improved medical cost performance in California is
primarily due to the success of provider re-contracting efforts and stable medical care
utilization.
Our Washington health plan reported an increase in its medical care ratio to 80.2% for the
second quarter of 2007 compared with 77.1% for the second quarter of 2006, primarily due to higher
specialty fee for service costs.
The Michigan health plan reported an increase in its medical care ratio to 83.3% for the
second quarter of 2007 compared with 78.6% for the second quarter of 2006. The higher medical care
ratio is due to higher capitation and specialty fee-for-service costs. We have increased
capitation payments to primary care physicians in Michigan in an effort to increase enrollment.
The New Mexico health plan reported an increase in its medical care ratio to 86.3% in the
second quarter of 2007 compared with 80.7% in the second quarter of 2006. The New Mexico health
plan recorded a $3.2 million decrease to premium revenue during the second quarter of 2007 in order
to comply with contractual terms that require the plan to spend a specified minimum percentage of
premium revenue on direct medical care costs. No such
22
adjustments were made to revenue during the first half of 2006. Absent this accrual, the New
Mexico health plans medical care ratio in the second quarter of 2007 would have been 82.1%, an
increase of 140 basis points as compared with the second quarter of 2006. The remaining increase
in the medical care ratio is partially due to increased enrollment in that states uninsured adult
program (the State Coverage Initiative), where we have experienced a higher medical care ratio than
in our Medicaid population.
Days in claims payable were 54 days at June 30, 2007, March 31, 2007, and June 30, 2006.
General and Administrative Expenses
General and administrative expenses were $67.2 million, or 10.9% of total revenue, for the
second quarter of 2007 as compared with $56.3 million, or 11.6% of total revenue, for the second
quarter of 2006.
Core G&A expenses (defined as G&A expenses less premium taxes) increased $5.3 million
year-over-year, but decreased as a percentage of revenue by 0.9%, from 8.6% in the second quarter
of 2006 to 7.7% in the second quarter of 2007, and from 7.9% in the first quarter of 2007. The
decline in Core G&A as a percentage of total revenue is primarily due to higher premium revenue
rather than to a decline in absolute G&A expenses. Core G&A on a per member per month basis
increased slightly (less than 1%) in the second quarter of 2007 when compared with the second
quarter of 2006, while premium revenue per member per month increased by over 13%.
Depreciation and Amortization
Depreciation and amortization expense increased by $1.9 million compared to the second quarter
of 2006. Depreciation expense increased by $1.1 million in the second quarter of 2007 due to
investments in infrastructure. Amortization expense increased by $0.8 million in the second quarter
of 2007, 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
commercial software no longer used for operations. No such charge occurred in the second quarter of
2006.
Interest Expense
Interest expense in the second quarter of 2007 increased by $0.1 million compared to the
second quarter of 2006, principally due to increased borrowings in the second quarter of 2007.
Income Taxes
Income taxes were recognized in the second quarter of 2007 based upon an effective tax rate of
38.2% as compared to an effective tax rate of 37.9% in the second quarter of 2006. The increase in
the effective tax rate in the second 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 second quarter
of 2007.
23
Six Months Ended June 30, 2007 Compared to Six Months Ended June 30, 2006
The following summarizes premium revenue, medical care costs, medical care ratio, and premium
taxes by health plan for the six months ended June 30, 2007 and June 30, 2006 (PMPM amounts are in
whole dollars):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2007 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
187,642 |
|
|
$ |
106.64 |
|
|
$ |
152,509 |
|
|
$ |
86.68 |
|
|
|
81.3 |
% |
|
$ |
6,232 |
|
Michigan |
|
|
245,193 |
|
|
|
184.75 |
|
|
|
205,785 |
|
|
|
155.05 |
|
|
|
83.9 |
% |
|
|
14,873 |
|
New Mexico |
|
|
118,530 |
|
|
|
305.11 |
|
|
|
102,168 |
|
|
|
262.99 |
|
|
|
86.2 |
% |
|
|
3,610 |
|
Ohio |
|
|
186,401 |
|
|
|
252.13 |
|
|
|
170,777 |
|
|
|
231.00 |
|
|
|
91.6 |
% |
|
|
8,388 |
|
Texas |
|
|
39,409 |
|
|
|
250.35 |
|
|
|
36,122 |
|
|
|
229.47 |
|
|
|
91.7 |
% |
|
|
690 |
|
Utah |
|
|
60,960 |
|
|
|
205.88 |
|
|
|
55,001 |
|
|
|
185.76 |
|
|
|
90.2 |
% |
|
|
|
|
Washington |
|
|
324,887 |
|
|
|
189.33 |
|
|
|
261,985 |
|
|
|
152.67 |
|
|
|
80.6 |
% |
|
|
5,369 |
|
Other |
|
|
340 |
|
|
|
|
|
|
|
8,995 |
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
1,163,362 |
|
|
$ |
182.23 |
|
|
$ |
993,342 |
|
|
$ |
155.60 |
|
|
|
85.4 |
% |
|
$ |
39,176 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2006 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
185,571 |
|
|
$ |
99.03 |
|
|
$ |
160,316 |
|
|
$ |
85.55 |
|
|
|
86.4 |
% |
|
$ |
5,984 |
|
Michigan |
|
|
179,530 |
|
|
|
180.31 |
|
|
|
139,901 |
|
|
|
140.51 |
|
|
|
77.9 |
% |
|
|
10,754 |
|
New Mexico |
|
|
109,440 |
|
|
|
309.09 |
|
|
|
91,124 |
|
|
|
257.36 |
|
|
|
83.3 |
% |
|
|
3,875 |
|
Ohio |
|
|
28,578 |
|
|
|
213.62 |
|
|
|
25,733 |
|
|
|
192.36 |
|
|
|
90.1 |
% |
|
|
1,269 |
|
Utah |
|
|
87,473 |
|
|
|
242.85 |
|
|
|
79,867 |
|
|
|
221.73 |
|
|
|
91.3 |
% |
|
|
|
|
Washington |
|
|
308,252 |
|
|
|
178.56 |
|
|
|
250,428 |
|
|
|
145.07 |
|
|
|
81.2 |
% |
|
|
5,350 |
|
Indiana |
|
|
30,247 |
|
|
|
169.70 |
|
|
|
27,596 |
|
|
|
154.83 |
|
|
|
91.2 |
% |
|
|
|
|
Other |
|
|
26 |
|
|
|
|
|
|
|
9,997 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
929,117 |
|
|
$ |
165.26 |
|
|
$ |
784,962 |
|
|
$ |
139.62 |
|
|
|
84.5 |
% |
|
$ |
27,232 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net Income
Net income for the six months ended June 30, 2007 was $22.9 million, or $0.81 per diluted
share, compared to net income of $21.7 million, or $0.77 per diluted share, for the six months
ended June 30, 2006. As discussed above in the comparison of quarterly results, net income for 2007
was affected by the retroactive premium rate increase in San Diego County and the impairment of
certain purchased software. Net income for 2006 was affected by the positive prior period claims
development related to our claims liability at December 31, 2005.
Premium Revenue
Premium revenue for the six months ended June 30, 2007, was $1,163.4 million, an increase of
$234.3 million, or 25.2%, over premium revenue of $929.1 million for the six months ended June 30,
2006. The increase in premium revenue for the first half of 2007 was driven by increased
membership in our Ohio and Texas start-up health plans and by the acquisition of Cape Health Plan
in Michigan effective May 15, 2006.
The Ohio health plan contributed $186.4 million in premium revenue in the first half of 2007,
an increase of $157.8 million from a year ago.
The Texas health plan, which commenced operations in September 2006, contributed $39.4 million
in premium revenue in the first half of 2007.
The premium revenue from our Michigan health plan increased $65.7 million due primarily to the
acquisition of Cape Health Plan.
The Indiana health plan, where we ceased serving members effective January 1, 2007,
contributed no premium revenue in the first half of 2007 compared with $30.2 million in premium
revenue in the first half of 2006.
24
Investment Income
Investment income during the six months ended June 30, 2007, totaled $13.4 million as compared
to $8.9 million for the same six-month period of 2006, an increase of $4.5 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 increased to 85.4% in the first half of
2007 from 84.5% in the first half of 2006.
The medical care ratios reported by the Ohio and Texas health plans for the first half of 2007
were 91.6% and 91.7%, respectively. We have previously disclosed our expectation that Ohio and
Texas would experience medical care ratios higher than those historically experienced by our
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 our more mature health plans.
As discussed earlier, the medical care costs in the second quarter of 2006 included $5.0
million of positive reserve development. Excluding our Ohio, Texas and Indiana health plans, the
retroactive premium rate increase in San Diego County and the positive reserve adjustment, our
medical care ratio would have been 84.1% for the first half of 2007 as compared with 84.6% for the
first half of 2006. We attribute the improvement of 50 basis points year-over-year to our various
medical care cost control initiatives.
Our health plans in California and Washington reported lower medical care ratios in the first
half of 2007 when compared with the same period in 2006, while our Michigan health plan reported an
increase in its medical care ratio.
The California health plans medical care ratio declined to 81.3% for the six months ended
June 30, 2007, compared with 86.4% for the same six-month period of 2006. Absent the out-of-period
revenue related to the San Diego rate increase, the California health plan reported a medical care
ratio of 82.2% in the first half of 2007, an improvement of 420 basis points year-over-year.
The Washington health plan reported a decrease in its medical care ratio to 80.6% in the first
half of 2007 compared with 81.2% in the first half of 2006, principally due to lower hospital and
specialty costs.
The Michigan health plan reported an increase in its medical care ratio to 83.9% for the six
months ended June 30, 2007, compared with 77.9% for the six months ended June 30, 2006. The higher
medical care ratio is due to higher capitation and specialty fee for service costs.
The New Mexico health plan reported an increase in its medical care ratio to 86.2% in the
first half of 2007 compared with 83.3% in the first half of 2006. The New Mexico health plan
recorded a $7.8 million decrease to premium revenue during the first half of 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. No such adjustments were made to revenue during the first
half of 2006. Absent this accrual, the New Mexico health plans medical care ratio in the first
half of 2007 would have been 80.9%, an improvement of 240 basis points year-over-year.
General and Administrative Expenses
General and administrative expenses were $130.6 million, or 11.1% of total revenue, for the
first half of 2007 as compared with $107.5 million, or 11.5% of total revenue, for the first half
of 2006.
Core G&A expenses decreased to 7.8% of total revenue for the six months ended June 30, 2007,
compared with 8.6% in the same 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 slightly (less than 1%) in the first half of 2007 when compared with the
first half of 2006, while premium revenue per member per month increased by over 10%.
25
Depreciation and Amortization
Depreciation and amortization expense increased by $3.6 million for the first half of 2007
compared to the first half of 2006. Depreciation expense increased by $1.8 million in the six
months ended June 30, 2007, due to investments in infrastructure. Amortization expense increased by
$1.8 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
commercial software no longer used for operations. No such charge occurred in the second quarter of
2006.
Interest Expense
Interest expense for the six months ended June 30, 2007 increased by $0.9 million compared to
the six months ended June 30, 2006 principally due to increased borrowings.
Income Taxes
Income taxes were recognized in the first half of 2007 based upon an effective tax rate of
38.1% as compared to an effective tax rate of 37.7% in the first half 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 in the first half of 2007.
Liquidity and Capital Resources
We generate cash from premium revenue and investment income. 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 June 30, 2007, we invested a substantial portion of our cash in
a portfolio of highly liquid money market securities. At June 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 six months ended June 30, 2007 and
2006 was approximately 5.1% and 4.7%, 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 six months ended June 30, 2007, was $88.0
million. For the same period in 2006, cash provided by operating activities was $38.6 million.
Net income, increased deferred revenue at the Companys Ohio health plan and the timing of payments
for medical claims and benefits payable were the primary sources of cash provided by operating
activities. Medical claims liabilities of the Indiana health plan, which had no membership
effective January 1, 2007, declined by $18.2 million between December 31, 2006 and June 30, 2007.
Absent the Indiana claims run-out, medical claims liabilities increased by $31.4 million during the
six months ended June 30, 2007, as a result of enrollment growth at the Companys Ohio and Texas
health plans.
During the first half of 2007, the Company repaid $15.0 million owed under its $200 million
credit facility. At June 30, 2007, the Company owed $30.0 million under the facility. See Note 5
to the Notes to Condensed Financial Statements included in Item 1 above for additional information
regarding our credit facility.
26
At June 30, 2007, we had working capital of $272.8 million compared to $258.6 million at
December 31, 2006. At June 30, 2007 and December 31, 2006, cash and cash equivalents were $471.5
million and $403.7 million, respectively. At June 30, 2007 and December 31, 2006, investments (all
classified as current assets) were $78.5 million and $81.5 million, respectively. At June 30, 2007,
the parent company (Molina Healthcare, Inc.) had cash and investments of approximately $31.9
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.
In November 2005, we filed a shelf registration statement on Form S-3 with the Securities and
Exchange Commission covering the issuance of up to $300 million of securities, including common
stock and debt securities. No securities have been issued under the shelf registration statement.
We may publicly offer securities from time to time at prices and terms to be determined at the time
of the offering.
Regulatory Capital and Dividend Restrictions
Our principal operations are conducted through our seven HMO subsidiaries operating in
California, Michigan, 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 Indiana, Michigan, 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.
At June 30, 2007, our HMOs had aggregate statutory capital and surplus of approximately $259.7
million, compared to the required minimum aggregate statutory capital and surplus of approximately
$149.9 million. All of our HMOs were in compliance with the minimum capital requirements at June
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 $15 million on our credit facility during
the first quarter of 2007.
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
27
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.
The following table reflects the change in our estimate of claims liability as of June 30,
2007 that would have resulted had we changed our completion factors for the fifth through the
twelfth months preceding June 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)% |
|
$ |
19,275 |
|
(2)% |
|
|
12,850 |
|
(1)% |
|
|
6,425 |
|
1% |
|
|
(6,425 |
) |
2% |
|
|
(12,850 |
) |
3% |
|
|
(19,275 |
) |
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 June 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.
28
|
|
|
|
|
(Decrease) Increase in |
|
(Decrease) Increase in |
Trended per Member |
|
Medical Claims and |
per Month Cost Estimates |
|
Benefits Payable |
(3)% |
|
$ |
(10,695 |
) |
(2)% |
|
|
(7,130 |
) |
(1)% |
|
|
(3,565 |
) |
1% |
|
|
3,565 |
|
2% |
|
|
7,130 |
|
3% |
|
|
10,695 |
|
Assuming a hypothetical 1% change in completion factors from those used in our calculation of
IBNR at June 30, 2007, net income for the six months ended June 30, 2007 would increase or decrease
by approximately $4.0 million, or $0.14 per diluted share, net of tax. Assuming a hypothetical 1%
change in PMPM cost estimates from those used in our calculation of IBNR at June 30, 2007, net
income for the six months ended June 30, 2007 would increase or decrease by approximately $2.2
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 six months ended June 30, 2007 and 2006. Dollar amounts are in thousands.
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, |
|
|
|
2007 |
|
|
2006 |
|
Balances at beginning of period |
|
$ |
290,048 |
|
|
$ |
217,354 |
|
Medical claims and benefits payable from business acquired |
|
|
|
|
|
|
22,516 |
|
Components of medical care costs related to: |
|
|
|
|
|
|
|
|
Current year |
|
|
1,036,378 |
|
|
|
819,466 |
|
Prior years |
|
|
(43,036 |
) |
|
|
(34,504 |
) |
|
|
|
|
|
|
|
Total medical care costs |
|
|
993,342 |
|
|
|
784,962 |
|
Payments for medical care costs related to: |
|
|
|
|
|
|
|
|
Current year |
|
|
764,638 |
|
|
|
603,585 |
|
Prior years |
|
|
215,513 |
|
|
|
171,458 |
|
|
|
|
|
|
|
|
Total paid |
|
|
980,151 |
|
|
|
775,043 |
|
|
|
|
|
|
|
|
Balances at end of period |
|
$ |
303,239 |
|
|
$ |
249,789 |
|
|
|
|
|
|
|
|
Days in claims payable |
|
|
54 |
|
|
|
54 |
|
Number of members at end of period |
|
|
1,076,000 |
|
|
|
1,008,000 |
|
Number of claims in inventory at end of period (1) |
|
|
254,794 |
|
|
|
279,052 |
|
Billed charges of claims in inventory at end of period (1) |
|
$ |
260,108 |
|
|
$ |
259,015 |
|
Claims in inventory per member at end of period (1) |
|
|
0.24 |
|
|
|
0.30 |
|
|
|
|
(1) |
|
2006 claims data excludes information for Cape Health Plan membership of
approximately 88,000 members. Cape membership was processed on a separate claims platform
through December 31, 2006. |
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). During the second quarter of 2006, the Company
recognized a net benefit in medical care costs of approximately $5.0 million due to favorable
development of its medical claims liability at December 31, 2005.
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.
29
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 Affinity 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 June 30, 2007, we had cash and cash equivalents of $471.5 million, unrestricted
investments of $78.5 million, and restricted investments of $23.5 million. Cash equivalents consist
of highly liquid securities with original maturities of up to three months. At June 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.
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 June 30, 2007 that has
materially affected, or is reasonably likely to materially affect, our internal controls over
financial reporting.
30
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, a shareholder derivative complaint was filed 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 purports 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 July 11, 2007, the plaintiff filed an amended complaint. The Company intends to
file a demurrer with respect to the amended complaint. Discovery in the Derivative Action is stayed
pending the courts final ruling on the Companys demurrer. No prediction can be made at this time
as to the outcome of the Derivative Action.
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 has resulted in her severe and permanent
disability. 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. In a series of rulings on the HMO defendants
summary judgment motions, the court has dismissed all money damage claims against the Companys New
Mexico HMO. The only claims that remain are declaratory and injunctive relief claims. The New
Mexico HMO has filed a motion for summary judgment with respect to those remaining claims. The
hearing on the motion is set for August 15, 2007. 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 $6,000 in order to indemnify our New Mexico HMO 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.
Item 1A. Risk Factors
In addition to the other 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. The risks described in our Annual Report on Form 10-K and in our
Quarterly Reports on Form 10-Q are not 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.
31
Item 4. Submission of Matters to a Vote of Security Holders
At our 2007 Annual Meeting of Stockholders held on May 9, 2007, our stockholders elected three
Class II directors as follows:
|
|
|
|
|
|
|
|
|
Director |
|
Votes For |
|
Votes Withheld |
Charles Z. Fedak |
|
|
25,545,708 |
|
|
|
707,454 |
|
John C. Molina |
|
|
25,612,278 |
|
|
|
640,884 |
|
Sally K. Richardson |
|
|
26,125,799 |
|
|
|
127,363 |
|
The
three directors terms as Class II directors shall continue until the 2010 Annual Meeting
of Stockholders. There were no additional matters voted upon at the Annual Meeting.
Item 5. Other Information.
Effective as of July 1, 2007,
Molina Healthcare of Ohio, Inc., a subsidiary of the Company, entered into contracts with the Ohio Department of Job
and Family Services with respect to both the Covered Families and Children (CFC) Medicaid program, and the Aged,
Blind or Disabled (ABD) Medicaid program. The contracts extend through June 30, 2008. As of June 30, 2007, there
were approximately 123,000 CFC Medicaid members, and approximately 15,000 ABD Medicaid members, covered under the
contracts. Revenues under the contracts represented approximately 12.7% and 3.2%, respectively, of our
total revenues through the first six months of the 2007 fiscal year. Copies of the contracts are attached hereto as Exhibits 10.1 and 10.2, respectively.
Effective as of
April 12, 2007, Molina Healthcare of California Partner Plan, Inc., a subsidiary of the Company and affiliate
of Molina Healthcare of California, entered into a contract renewal with the California Department of Health
Services with respect to the San Diego Geographic Managed Care program. The contract renewal extends through
December 31, 2008 the same general terms and conditions of the parties
previous contract covering Medi-Cal (California Medicaid) members in San Diego County, California.
The amendment also increases various capitation rates on a retroactive basis starting from January 1, 2006,
and provides for further capitation rate increases effective as of July 1, 2006, and July 1, 2007. As of June 30, 2007,
there were approximately 42,000 Medi-Cal members covered under the contract, and revenues under the
contract represented approximately 2.8% of the Companys total revenues through the
first six months of the 2007 fiscal year. A copy of the contract is attached hereto as Exhibit 10.4. Pursuant to California
Government Code Section 6254(q) which requires provider contracts entered into by the California
Medical Assistance Commission to remain confidential for one year and for rate terms to remain
confidential for four years, confidential treatment has been requested for the bulk of this
document.
Effective as of July 1, 2007, Molina Healthcare of Utah, Inc., a subsidiary of the Company, entered into a contract extension with the Utah Department of Health with respect to its Medicaid members. The contract extends through December 31, 2007 the same terms and conditions of the parties previous contract. The parties have agreed to negotiate a new savings sharing provision which shall be retroactive to the commencement
of the Utah state fiscal year 2008 (July 1, 2007 through June 30, 2008).
As of June 30, 2007, there were approximately 47,000 Medicaid members covered
under the contract, and revenues under the contract represented approximately 5.2% of the
Companys total revenues through the first six months of the 2007 fiscal year. A copy of the contract is attached hereto as Exhibit 10.5.
The Company does not believe that its business is substantially dependent on any one of the contracts described above.
Item 6. Exhibits
A list of exhbits 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.
32
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)
|
|
|
/s/ JOSEPH M. MOLINA, M.D.
|
|
|
Joseph M. Molina, M.D. |
|
|
Chairman of the Board,
Chief Executive Officer and President
(Principal Executive Officer) |
|
|
Dated: August 7, 2007
|
|
|
|
|
|
|
|
|
/s/ JOHN C. MOLINA, J.D.
|
|
|
John C. Molina, J.D. |
|
|
Chief Financial Officer and Treasurer
(Principal Financial Officer) |
|
|
Dated: August 7, 2007
33
EXHIBIT INDEX
|
|
|
Exhibit No. |
|
Title |
10.1
|
|
Ohio Medical Assistance Provider Agreement for Managed
Care Plan CFC Eligible Population effective July 1, 2007. |
|
|
|
10.2
|
|
Ohio Medical Assistance Provider Agreement for Managed
Care Plan ABD Eligible Population effective July 1, 2007. |
|
|
|
10.3
|
|
Contract between Molina Healthcare of California Partner
Plan, Inc. and California Department of Health Services
regarding San Diego Geographic Managed Care Program.** |
|
|
|
10.4
|
|
Contract between Molina Healthcare of California Partner
Plan, Inc. and the California Department of Health
Services regarding Sacramento Geographic Managed Care
Program.** |
|
|
|
10.5
|
|
Contract between Molina Healthcare of Utah, Inc. and the
Utah Department of Health effective July 1, 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. |
|
|
|
** |
|
In accordance with the requirements of California
Government Code Section 6254(q), confidential treatment
has been requested for this Exhibit pursuant to Rule 406
promulgated under the Securities Act. |
34