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 4.5 million people who receive their care through Medicaid, Medicare, and other government-funded programs in about a dozen states and Puerto Rico. Its Medicaid Solutions segment provides business process outsourcing (BPO) solutions to Medicaid agencies in six 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.
Until 2018, Molina operated through two primary segments: Health Plan and Molina Medicaid Solutions. Altogether, the company's operations provide plans or services to 4.5 million individuals in 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 health plans are each licensed as health maintenance organizations (HMOs).
The Medicaid segment helped state agencies administer their Medicaid programs with such offerings as IT development and business processing. Molina sold that business to DXC Technology in 2018.
Molina's health plans primarily operate in Washington, California, South Carolina, Texas, Ohio, and Michigan, as well as in New Mexico and Florida.
Molina's Health Plans segment leases around 70 facilities, while the Medicaid solutions segment leases a dozen facilities.
Sales and Marketing
Molina's primary customers include state Medicaid agencies and the federal government.
Molina has seen steady revenue increases over the last few years. In 2017, revenue rose 25% to $19.8 billion as premium revenue increased (largely as a result of a 10% increase in membership) and investment income saw growth. Premium revenue growth was led by California, Florida, Texas, and Washington. However, a decline in service revenue and the absence of reimbursed health insurer fees partially offset those gains.
As a participant in the Affordable Care Act marketplace, the company has been struggling to be profitable. It has initiated a restructuring effort that included a management shakeup in 2017. That year it fell into the black in 2017 with a net loss of $512 million. One factor contributing to that loss was the federal government's move to stop funding cost-sharing reduction (CRS) payments. As such, medical care costs increased and the company had $470 million in impairment losses. It also had $234 million in restructuring and separation costs.
Operating cash flow totaled $804 million that year, a 19% increase from that of 2016.
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 $128 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). Restructuring expenses led the company to incur $234 million in related losses in 2017.
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 and a deal in 2018 to provide Children's Health Insurance Program (CHIP) services in Texas. In addition, Molina enters new markets through both organic measures and through acquisitions, targeting large markets with competitive provider communities.But in 2017, the company lost certain Medicaid contracts in New Mexico, Florida, and Illinois, which ultimately contributed to a $470 million impairment loss. Molina is working to regain contracts lost in New Mexico and Florida.
The company is also working on cutting costs to improve efficiency. In addition to its restructuring efforts mentioned above, it 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 former Pathways subsidiary (acquired in late 2016) provided home- and community-based behavioral health services, which the company believed would see a growth in demand over the next few years. However, after reporting $173 million impairment loss primarily related to the Pathways business, the company sold the unit to investment firm Atar Capital in 2018.
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. Recently, though, the company has been quietly exiting the primary care business. It has closed down several clinics and sold several others.
With these exits and divestitures, Molina is increasingly focused on its core health plan operations.
Mergers and Acquisitions
In 2016 Molina Healthcare bought Total Care Medicaid, a plan serving some 39,000 members in upstate New York, from
200 OCEANGATE STE 100
Long Beach, CA 90802-4317
Phone: 1 (562) 435-3666
Employer Type: Publicly Owned
Stock Symbol: MOH
Stock Exchange: , NYSE
COO: Terry P. Bayer
Chairman: Dale B. Wolf
President, CEO, and Director: Joseph M. Zubretsky
Employees (This Location): 2,800
Employees (All Locations): 11,000
Long Beach, CA
Citrus Heights, CA
Grand Rapids, CA
Long Beach, CA
San Bernardino, CA
San Diego, CA
Fort Pierce, FL
Baton Rouge, LA
Saint Louis, MO
Las Cruces, NM
Jim Thorpe, PA
Summit Hill, PA
North Charleston, SC
Belle Haven, VA
North Chesterfield, VA
Virginia Beach, VA