About Molina Healthcare, Inc.

Molina Healthcare is dedicated to helping low-income Americans receive health and behavioral health coverage as well as primary care services. The company's Health Plan segment arranges for the delivery of health services to some 4.2 million people who receive their care through Medicaid, Medicare, and other government-funded programs in about a dozen states and Puerto Rico. It also operates health clinics in six states. Molina's Medicaid Solutions segment provides business process outsourcing (BPO) solutions to Medicaid agencies in five states for their Medicaid Management Information Systems (MMIS), the tool used to support administration of state health care entitlement programs. The family of founder C. David Molina controls the company through holdings and trusts.

Operations

Molina operates through two primary segments: Health Plan and Molina Medicaid Solutions. Altogether, the company's operations provide plans or services to 4.2 million individuals in about a dozen states. Molina's Health Plans segment accounts for more than 95% of revenues. The company's health plans provide medical services through state networks of contracted hospitals and physicians that accept Molina health plan coverage.

The Medicaid Management segment helps state agencies administer their Medicaid programs with such offerings as IT development and business processing.

Other operations include Pathways, which provides behavioral health and social services.

Geographic Reach

Molina's health plans primarily operate in Washington, California, South Carolina, Texas, Ohio, and Michigan, as well as in New Mexico and Florida. The direct delivery line of business consists of about 30 primary care community clinics in California, Florida, New Mexico, Utah, Virginia, and Washington.

The Medicaid Solutions segment provides IT services in Idaho, Louisiana, Maine, New Jersey, West Virginia, and the US Virgin Islands; it also administers a drug rebate program in Florida.

Molina's Health Plans segment leases around 90 facilities, while the Medicaid solutions segment leases a dozen facilities.

Sales and Marketing

Molina's client base includes independent physicians, physician groups, hospitals, and ancillary care providers, as well as its own clinics.

Financial Performance

Molina has seen steady revenue increases over the last few years. In 2016, revenue rose 25% to $17.8 billion as all revenue streams saw growth. Leading these gains was the largest area of business, premiums. These increased 24% to $16.4 billion thanks to a 27% increase in membership. Additionally, services revenue more than doubled to $539 million; this was primarily due the Pathways behavioral health subsidiary, which was acquired in late 2016.

Net income, which had been rising rapidly, took a fall in 2016, declining 25% to $52 million on higher operating expenses. Molina's medical care costs, costs of services, and general expenses all increased that year. As a result, cash flow from operations fell 40% to $673 million.

Strategy

One of Molina's immediate initiatives is advocating for the improvement of the insurance marketplace under regulatory guidelines. The company says that it is owed more than $142 million in risk corridor payments from the federal government and it has yet to recognize revenue from these payments. (The risk corridor program, established as part of the Affordable Care Act, aimed to protect insurers participating in exchanges from higher-than-expected claims through 2016.) In a mid-2017 win, a federal claims court ruled that the government owes Molina $52 million in risk corridor payments.That ruling followed a string of upsets, from quarterly losses and company layoffs to the withdrawal from Utah's and Wisconsin's exchanges and the firing of the company's CEO and CFO (both sons of Molina's founder).

A key Molina strategy for growth is to expand membership, especially in its existing markets, by acquiring the Medicaid contracts of other businesses. It made several of these purchases in 2016, adding more than 220,000 Medicaid members to its books. It has also secured a number of state contracts, including deals made in 2017 to provide Medicaid coverage in Illinois and Mississippi. That year the company was also granted a contract for north-central Washington's new integrated managed care program. In addition, Molina enters new markets through both organic measures and through acquisitions, targeting large markets with competitive provider communities.

The company is also working on cutting costs to improve efficiency. It underwent restructuring efforts in 2017 as mentioned above, but has also improved its care management systems and processes. It is increasingly utilizing hospitalists (dedicated physicians working in hospitals) and coordinating care efforts among teams of providers to both save money and improve health outcomes.

Molina's newest subsidiary, Pathways (acquired in late 2016), provides behavioral health managed care, which the company believes will see a growth in demand over the next few years. For example, substance abuse and mental illness are expected to be the leading causes of disability within five years. Additionally, Medicaid members have twice as much a chance of suffering from a mental illness than the members of the general population. As a Medicaid specialist, Molina stands to benefit from the growing need for coordinated care for these individuals.

In the past, Molina's growth strategy also consisted of opening additional primary care clinics in existing and new territories. The addition of more clinics helped Molina diversify its operations by expanding its involvement in the direct delivery of primary care. However, in what may be the beginning of a general move away from primary care, the company announced the closure of a Michigan specialty clinic in mid-2017.

Mergers and Acquisitions

In 2015 Molina Healthcare of Michigan acquired certain assets of HealthPlus of Michigan for $47 million, expanding its operations in that state. The deal included assets of HealthPlus' Medicaid and MIChild (for uninsured children) businesses. Later that year, Molina Healthcare of Florida bought assets of Preferred Medical Plan's Medicaid business in Florida for $8 million, while Molina Healthcare of Illinois entered the Chicago market with the acquisition of certain assets of Accountable Care Chicago (aka MyCare Chicago). The Illinois unit also purchased certain Cook County-based Medicaid assets of accountable care entity Better Health Network for $18 million.

Also in 2015 the company acquired Providence Human Services (which provides behavioral and mental health services in more than 20 states) and Providence Community Services from The Providence Service Corporation for some $200 million. Those companies now operate under the Pathways brand.

In 2016 Molina Healthcare bought Total Care Medicaid, a plan serving some 39,000 members in upstate New York, from Universal American for $41.3 million. Other deals that year included the purchases of Loyola Physician Partners ($15 million, adding 21,000 Medicaid members in Illinois) and HAP Midwest Health Plan (adding some 81,000 Medicaid and MIChild members).

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Molina Healthcare, Inc.

200 Oceangate Ste 100
Long Beach, CA 90802-4317
Phone: 1 (562) 435-3666
Fax: 1 (562) 437-7235

Stats

  • Employer Type: Public
  • Stock Symbol: MOH
  • Stock Exchange: NYSE
  • President, CEO, and Director: Joseph M. Zubretsky
  • Chairman: Dale B. Wolf
  • President, CEO, and Director: Joseph M. Zubretsky
  • 2016 Employees: 21,000

Major Office Locations

  • Long Beach, CA

Other Locations

  • Citrus Heights, CA
  • Corona, CA
  • Fontana, CA
  • Lakewood, CA
  • Ontario, CA
  • Pomona, CA
  • Rialto, CA
  • Sacramento, CA
  • San Bernardino, CA
  • San Diego, CA
  • Wilmington, CA
  • Woodland, CA
  • Washington, DC
  • Fort Pierce, FL
  • Sarasota, FL
  • Augusta, GA
  • Columbus, GA
  • Richmond Hill, GA
  • Savannah, GA
  • Thomasville, GA
  • Toccoa, GA
  • Chicago, IL
  • Springfield, IL
  • Baton Rouge, LA
  • Metairie, LA
  • Slidell, LA
  • Portland, ME
  • Detroit, MI
  • Troy, MI
  • Charlotte, NC
  • Columbus, NC
  • Durham, NC
  • Spindale, NC
  • Trenton, NJ
  • Albuquerque, NM
  • Las Cruces, NM
  • Pahrump, NV
  • Columbus, OH
  • Independence, OH
  • Altoona, PA
  • Auburn, PA
  • Clearfield, PA
  • Erie, PA
  • Franklin, PA
  • Hazleton, PA
  • Jim Thorpe, PA
  • Lehighton, PA
  • Minersville, PA
  • Pottsville, PA
  • Somerset, PA
  • Stroudsburg, PA
  • Summit Hill, PA
  • Tamaqua, PA
  • Temple, PA
  • North Charleston, SC
  • Houston, TX
  • Orem, UT
  • Abingdon, VA
  • Bedford, VA
  • Belle Haven, VA
  • Charlottesville, VA
  • Christiansburg, VA
  • Clintwood, VA
  • Culpeper, VA
  • Danville, VA
  • Fairfax, VA
  • Fredericksburg, VA
  • Hampton, VA
  • Herndon, VA
  • Lexington, VA
  • Lynchburg, VA
  • North Chesterfield, VA
  • Norton, VA
  • Roanoke, VA
  • Verona, VA
  • Virginia Beach, VA
  • Everett, WA
  • Milwaukee, WI
  • Kearneysville, WV
  • Moorefield, WV
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