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MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS ("MD&A")
Edgar Glimpses
FORWARD-LOOKING STATEMENTS
This quarterly report on Form 10-Q contains forward-looking statements regarding
our business, financial condition, and results of operations within the meaning
of Section 27A of the Securities Act of 1933, or Securities Act, and Section 21E
of the Securities Exchange Act of 1934, or Securities Exchange Act. Many of the
forward-looking statements are located under the heading "Management's
Discussion and Analysis of Financial Condition and Results of Operations."
Forward-looking statements provide current expectations of future events based
on certain assumptions and include any statement that does not directly relate
to any historical or current fact. Forward-looking statements can also be
identified by words such as "guidance," "future," "anticipates," "believes,"
"estimates," "expects," "growth," "intends," "plans," "predicts," "projects,"
"will," "would," "could," "can," "may," and similar terms. Readers are cautioned
not to place undue reliance on any forward-looking statements, as
forward-looking statements are not guarantees of future performance and the
Company's actual results may differ significantly due to numerous known and
unknown risks and uncertainties. Those known risks and uncertainties include,
but are not limited to, the risk factors identified in the section titled "Risk
Factors" in our 2020 Annual Report on Form 10-K, including without limitation
the following:
•the impact of the COVID-19 pandemic and its associated or indirect effects on
our business, operations, and financial results, including without limitation
the duration of the Public Health Emergency Declaration ("PHE") and associated
suspension in redeterminations, and the potential impact on our workforce or
contractors of federal or state vaccine mandates;
•significant budget pressures on state governments from diminished tax revenues
incidental to the COVID-19 pandemic and their efforts to reduce rates or limit
rate increases, to impose profit caps or risk corridors, or to recoup previously
paid premium amounts on a retroactive basis;
•the numerous political, judicial, and market-based uncertainties associated
with the Affordable Care Act (the "ACA");
•the market dynamics surrounding the ACA Marketplaces, including issues
impacting enrollment, risk adjustment estimates and results, the potential for
disproportionate enrollment of higher acuity members, and the discontinuation of
premium tax credits;
•the outcome of the legal proceedings in Kentucky with regard to the Medicaid
contract award to our Kentucky health plan and our acquisition of certain assets
of Passport;
•the success of our efforts to retain existing or awarded government contracts,
and the success of any bid submissions in response to requests for proposal,
including our contracts in California and Texas ;
•subsequent adjustments to reported premium revenue based upon subsequent
developments or new information, including changes to estimated amounts payable
or receivable related to Marketplace risk adjustment;
•our ability to consummate, integrate, and realize benefits from acquisitions,
including the completed acquisitions of Magellan Complete Care, Passport, and
Affinity, and the announced acquisitions of AgeWell New York and the Medicaid
assets of Cigna in Texas ;
•effective management of our medical costs;
•our ability to predict with a reasonable degree of accuracy utilization rates,
including utilization rates associated with COVID-19;
•cyber-attacks, ransomware attacks, or other privacy or data security incidents
resulting in an inadvertent unauthorized disclosure of protected information;
•the ability to manage our operations, including maintaining and creating
adequate internal systems and controls relating to authorizations, approvals,
provider payments, and the overall success of our care management initiatives;
•our receipt of adequate premium rates to support increasing pharmacy costs,
including costs associated with specialty drugs and costs resulting from
formulary changes that allow the option of higher-priced non-generic drugs;
•our ability to operate profitably in an environment where the trend in premium
rate increases lags behind the trend in increasing medical costs;
•the interpretation and implementation of federal or state medical cost
expenditure floors, administrative cost and profit ceilings, premium
stabilization programs, profit-sharing arrangements, and risk adjustment
provisions and requirements;
•our estimates of amounts owed for such cost expenditure floors, administrative
cost and profit ceilings, premium stabilization programs, profit-sharing
arrangements, and risk adjustment provisions and requirements;
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•the Medicaid expansion medical cost corridor, and any other retroactive
adjustment to revenue where methodologies and procedures are subject to
interpretation or dependent upon information about the health status of
participants other than Molina members;
•the interpretation and implementation of at-risk premium rules and state
contract performance requirements regarding the achievement of certain quality
measures, and our ability to recognize revenue amounts associated therewith;
•the success and renewal of our Medicare-Medicaid Plan ("MMP") programs in
California , Illinois , Michigan , Ohio , South Carolina , and Texas ;
•the accurate estimation of incurred but not reported or paid medical costs
across our health plans;
•efforts by states to recoup previously paid and recognized premium amounts;
•changes in our annual effective tax rate, due to federal and/or state
legislation, or changes in our mix of earnings and other factors;
•complications, member confusion, eligibility redeterminations, or enrollment
backlogs related to the renewal of Medicaid coverage;
•fraud, waste and abuse matters, government audits or reviews, comment letters,
or potential investigations, and any fine, sanction, enrollment freeze,
corrective action plan, monitoring program, or premium recovery that may result
therefrom;
•our exit from Puerto Rico , including the payment in full of our outstanding
accounts receivable, the effective run-out of claims, the return of our capital,
and the outcome of the claims filed against our Puerto Rico health plan and us
by the Puerto Rico Health Insurance Administration , or ASES;
•changes with respect to our provider contracts and the loss of providers;
•approval by state regulators of dividends and distributions by our health plan
subsidiaries;
•changes in funding under our contracts as a result of regulatory changes,
programmatic adjustments, or other reforms;
•high dollar claims related to catastrophic illness;
•the resolution, favorable or unfavorable, of litigation, arbitration, or
administrative proceedings;
•the relatively small number of states in which we operate health plans,
including the greater scale and revenues of our California , Ohio , Texas , and
Washington health plans;
•the failure to comply with the financial or other covenants in the Credit
Agreement or the indentures governing our outstanding notes;
•the availability of adequate financing on acceptable terms to fund and
capitalize our expansion and growth, repay our outstanding indebtedness at
maturity, and meet our general liquidity needs;
•the sufficiency of funds on hand to pay the amounts due upon maturity of our
outstanding notes;
•the failure of a state in which we operate to renew its federal Medicaid
waiver;
•changes generally affecting the managed care industry;
•increases in government surcharges, taxes, and assessments;
•the unexpected loss of the leadership of one or more of our senior executives;
and
•increasing competition and consolidation in the Medicaid industry.
Each of the terms "Molina Healthcare, Inc. " "Molina Healthcare ," "Company,"
"we," "our," and "us," as used herein, refers collectively to Molina Healthcare,
Inc. and its wholly owned subsidiaries, unless otherwise stated. The Company
assumes no obligation to revise or update any forward-looking statements for any
reason, except as required by law.
Readers should refer to the section entitled "Risk Factors" in our 2020 Annual
Report on Form 10-K, for a discussion of certain risk factors that could
materially affect our business, financial condition, cash flows, or results of
operations. Given these risks and uncertainties, we can give no assurance that
any results or events projected or contemplated by our forward-looking
statements will in fact occur.
This Quarterly Report on Form 10-Q 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
Management's Discussion and Analysis appearing in our 2020 Annual Report on Form
10-K.
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OVERVIEW
Molina Healthcare, Inc. , a FORTUNE 500 company, provides managed healthcare
services under the Medicaid and Medicare programs, and through the state
insurance marketplaces (the "Marketplace"). We served approximately 4.8 million
members as of September 30, 2021 .
THIRD QUARTER 2021 HIGHLIGHTS
We reported net income of $143 million , or $2.46 per diluted share, for the
third quarter of 2021, which reflected the following:
•Membership increase of 0.8 million, or 20%, compared with September 30, 2020 ,
and a 142,000 sequential increase compared to June 30, 2021 ;
•Premium revenue of $6.8 billion , which increased 43% compared with the third
quarter of 2020, reflecting increased organic membership in all lines of
business, along with the impact of acquisitions;
•Consolidated medical care ratio ("MCR") was 88.9%, compared with 85.9% for the
third quarter of 2020, and increased due to the net effect of COVID, which
increased the MCR by 110 basis points in the third quarter of 2021, but was
slightly positive in the third quarter of 2020;
•General and administrative expense ("G&A") ratio of 7.5%, which increased
compared with 7.3% in the third quarter of 2020, reflecting appropriate
investments to support our business growth and increased acquisition-related
expenses, partially offset by the benefits of revenue growth and continued
discipline in cost management; and
•After-tax margin of 2.0%, which met our expectations.
We note the following factors impacting the 2021 third quarter financial
results:
•We estimate that the net effect of COVID decreased net income by approximately
$1.00 per diluted share in the third quarter of 2021. The net effect of COVID
was slightly positive in the third quarter of 2020.
•The net effect of COVID reflects higher COVID inpatient costs, lower
COVID-related utilization curtailment and the impact of the COVID risk-sharing
corridors, and impacted all our segments.
•We experienced higher than expected membership increases in Marketplace. This
improvement resulted from several factors, including strong product design and
competitive pricing, better than expected natural attrition rates, and the
extended open enrollment period, as described in further detail below in "Trends
and Uncertainties."
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CONSOLIDATED FINANCIAL SUMMARY
Three Months Ended September 30, Nine Months Ended September 30,
2021 2020 2021 2020
(In millions, except per-share amounts)
Premium revenue $ 6,800 $ 4,768 $ 19,689 $ 13,444
Less: medical care costs 6,049 4,098 17,342 11,412
Medical margin 751 670 2,347 2,032
MCR (1) 88.9 % 85.9 % 88.1 % 84.9 %
Other revenues:
Premium tax revenue 204 170 576 477
Health insurer fees reimbursed - 69 - 206
Investment income 20 10 39 48
Other revenue 16 4 58 13
General and administrative expenses 532 368 1,489 1,030
G&A ratio (2) 7.5 % 7.3 % 7.3 % 7.3 %
Premium tax expenses 204 170 576 477
Health insurer fees - 70 - 209
Depreciation and amortization 32 23 96 64
Other 2 3 30 9
Operating income 221 289 829 987
Interest expense 30 27 90 72
Other expense, net - - - 5
Income before income tax expense 191 262 739 910
Income tax expense 48 77 183 271
Net income $ 143 $ 185 $ 556 $ 639
Net income per share - Diluted $ 2.46 $ 3.10 $ 9.51 $ 10.65
Diluted weighted average shares outstanding 58.5 59.6 58.5 60.0
Other Key Statistics
Ending membership 4.8 4.0 4.8 4.0
Effective income tax rate 24.8 % 29.5 % 24.7 % 29.8 %
After-tax margin (3) 2.0 % 3.7 % 2.7 % 4.5 %
________________________
(1) MCR represents medical care costs as a percentage of premium revenue.
(2) G&A ratio represents general and administrative expenses as a percentage of
total revenue.
(3) After-tax margin represents net income as a percentage of total revenue.
CONSOLIDATED RESULTS
NET INCOME AND OPERATING INCOME
Net income in the third quarter of 2021 amounted to $143 million , or $2.46 per
diluted share, compared with $185 million , or $3.10 per diluted share, in the
third quarter of 2020. We estimate that the net effect of COVID decreased net
income by approximately $1.00 per diluted share in the third quarter of 2021. In
the third quarter of 2020, the net effect of COVID had a slightly positive
impact on earnings.
Operating income of $221 million in the third quarter of 2021, was lower
compared with $289 million in the third quarter of 2020.
Net income in the nine months ended September 30, 2021 amounted to $556 million ,
or $9.51 per diluted share, compared with $639 million , or $10.65 per diluted
share, in the nine months ended September 30, 2020 . Operating
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income of $829 million in the nine months ended September 30, 2021 , was lower
compared with $987 million in the nine months ended September 30, 2020 .
The decrease in operating income for both periods was mainly due to the increase
in MCR, due primarily to the net effect of COVID, partially offset by membership
growth and higher premium revenues.
The year-over-year comparison between 2020 and 2021 is significantly impacted by
the positive net effect of COVID that characterized the relatively early phases
of the pandemic in the second and third quarters of 2020.
Net income per share in the third quarter and nine months ended September 30,
2021 was favorably impacted by the reduction in common shares outstanding as a
result of our share repurchases in late 2020 and early 2021. See further
discussion in "Liquidity and Financial Condition," below.
PREMIUM REVENUE
Premium revenue increased $2.0 billion , or 43%, in the third quarter of 2021,
when compared with the third quarter of 2020, and increased $6.2 billion , or
46%, in the nine months ended September 30, 2021 , when compared with the nine
months ended September 30, 2020 .
Membership increased by 805,000 compared with September 30, 2020 , which mainly
reflected organic increases in the Medicaid and Marketplace segments and the
impact from the Magellan Complete Care and other acquisitions that closed in the
second half of 2020. The increase in premium revenue was net of COVID-related
risk corridors that have been enacted in several states beginning in the second
quarter of 2020.
MEDICAL CARE RATIO
The consolidated MCR in the third quarter of 2021 was 88.9%, compared with 85.9%
in the third quarter of 2020. The net effect of COVID increased the consolidated
MCR by approximately 110 basis points in the third quarter of 2021, and reflects
higher COVID inpatient costs, lower COVID-related utilization curtailment and
the impact of the risk-sharing corridors, and impacted all our segments. In the
prior year the net effect of COVID had a slightly favorable impact to the
consolidated MCR.
The consolidated MCR in the nine months ended September 30, 2021 was 88.1%,
compared with 84.9% in the nine months ended September 30, 2020 . Similar to the
quarter-to-date consolidated MCR, the increase is due to the net effect of
COVID; however, the impacts were varied by segment.
The prior year reserve development in the third quarter and nine months ended
September 30, 2021 was modestly favorable, but its impact on earnings was mostly
absorbed by the COVID-related risk corridors.
PREMIUM TAX REVENUE AND EXPENSES
The premium tax ratio (premium tax expense as a percentage of premium revenue
plus premium tax revenue) was 2.9% and 3.4% for the third quarter of 2021 and
2020, respectively, and 2.8% and 3.4% for the nine months ended September 30,
2021 and 2020, respectively. The current year ratio decrease was mainly due to
changes in business mix resulting from the Magellan Complete Care and other
acquisitions closed in the second half of 2020.
INVESTMENT INCOME
Investment income increased to $20 million in the third quarter of 2021,
compared with $10 million in the third quarter of 2020, due to higher invested
assets and increased realized gains. Investment income decreased to $39 million
in the nine months ended September 30, 2021 , compared with $48 million in the
nine months ended September 30, 2020 . The year-over-year decrease was due to the
continued low interest rate environment and a temporarily higher allocation in
shorter-term invested assets during the COVID-19 pandemic, which was rescinded
effective for the second quarter of 2021.
OTHER REVENUE
Other revenue increased to $16 million in the third quarter of 2021, compared
with $4 million in the third quarter of 2020, and increased to $58 million in
the nine months ended September 30, 2021 , compared with $13 million in the nine
months ended September 30, 2020 . Beginning in the first quarter of 2021, other
revenue includes service revenue associated with the long-term services and
supports consultative services we now provide in Wisconsin , as a result of our
Magellan Complete Care acquisition.
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G&A EXPENSES
The G&A expense ratio increased to 7.5% in the third quarter of 2021, compared
with 7.3% in the third quarter of 2020. The G&A expense ratio was 7.3% in the
nine months ended September 30, 2021 , consistent with the nine months ended
September 30, 2020 . The year over year comparisons for both periods are impacted
by appropriate investments to support our business growth and increased
acquisition-related expenses, partially offset by continued discipline in cost
management and increased revenues.
HEALTH INSURER FEES ("HIF")
There were no HIF fees incurred or reimbursed in 2021, because the HIF was
repealed effective for years after 2020.
DEPRECIATION AND AMORTIZATION
Depreciation and amortization increased to $32 million in the third quarter of
2021, compared with $23 million in the third quarter of 2020, and increased to
$96 million in the nine months ended September 30, 2021 , compared with $64
million in the nine months ended September 30, 2020 . The increases in both
periods were due primarily to amortization associated with acquisitions
completed in the second half of 2020.
Refer to Notes to Consolidated Financial Statements, Note 10, "Segments," for
further information.
OTHER OPERATING EXPENSES
Other operating expenses decreased to $2 million in the third quarter of 2021,
compared with $3 million in the third quarter of 2020, and increased to $30
million in the nine months ended September 30, 2021 , compared with $9 million in
the nine months ended September 30, 2020 . Beginning in the first quarter of
2021, other operating expenses include service costs associated with the
long-term services and supports consultative services we now provide in
Wisconsin , as noted above.
INTEREST EXPENSE
Interest expense increased to $30 million in the third quarter of 2021, compared
with $27 million in the third quarter of 2020, and to $90 million in the nine
months ended September 30, 2021 , compared with $72 million in the nine months
ended September 30, 2020 , mainly due to the $650 million principal amount of
3.875% Notes issued in the fourth quarter of 2020.
See further details of our financing transactions in Notes to Consolidated
Financial Statements, Note 8, "Debt," and below in "Liquidity and Financial
Condition."
INCOME TAXES
Income tax expense amounted to $48 million in the third quarter of 2021, or
24.8% of pretax income, compared with income tax expense of $77 million , or
29.5% of pretax income in the third quarter of 2020. Income tax expense amounted
to $183 million in the nine months ended September 30, 2021 , or 24.7% of pretax
income, compared with income tax expense of $271 million , or 29.8% of pretax
income in the nine months ended September 30, 2020 . The effective tax rate is
lower in 2021 mainly because the nondeductible HIF was repealed for years after
2020.
TRENDS AND UNCERTAINTIES
COVID-19 PANDEMIC
As the COVID-19 pandemic continues to evolve, its ongoing impact to our
business, results of operations, financial condition, and cash flows is
uncertain and difficult to predict. Specific trends and uncertainties related to
our Medicaid, Medicare, and Marketplace segments follow.
Federal Economic Stabilization and Other Programs
In addition to various programs enacted in 2020 and described in our 2020 Annual
Report on Form 10-K, the $1.9 trillion American Rescue Plan Act of 2021 was
enacted on March 11, 2021 . This legislation includes several components to
assist in COVID-19 vaccine testing and deployment, as well as provisions
relating to the opening of schools; direct immediate relief to working families;
and additional support for communities struggling in the wake of the pandemic.
Among its specific provisions:
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•$350 billion in state and local funding;
•Funding for Medicaid and CHIP COVID-19 vaccines and treatment to be matched at
100% of the federal medical assistance percentage ("FMAP");
•Incentives for states that have not expanded Medicaid to do so;
•State flexibility to extend Medicaid eligibility to women for 12 months
postpartum;
•A temporary 10% FMAP increase for states to improve Medicaid home- and
community-based services for one year; and
•An increase to the ACA Marketplace premium subsidies for 2021 and 2022.
In addition, the Biden Administration has extended the COVID-19 related PHE. The
Biden Administration has indicated the PHE will likely remain in place
throughout 2021, and that states will receive 60 days' notice before the end of
the PHE to prepare for the end of emergency authorities and the resumption of
pre-PHE rules. This extension of the PHE will continue the suspension in state
Medicaid eligibility redeterminations.
Also, President Biden's January 2021 executive order providing for a three-month
Marketplace special enrollment period from February 15, 2021 to May 15, 2021 ,
was extended through August 15, 2021 . This SEP has now ended in all of our
states except for California , where the state-run exchange intends to keep it in
place for the remainder of the 2021 benefit year, which ends on December 31,
2021 .
Due to the uncertainty as to the duration and breadth of the pandemic, we are
unable to reasonably estimate the ultimate impact of the economic stabilization
and other programs to our business, financial condition, and operating results.
Operations
Enrollment and Premium Revenue
Excluding acquisitions and our exit from Puerto Rico , we have added over 700,000
new Medicaid members since March 31, 2020 , when we first began to report on the
impacts of the pandemic. We believe this membership increase was mainly due to
the suspension of redeterminations for Medicaid eligibility. We expect Medicaid
enrollment to continue to benefit from the extension of the PHE period, and the
associated pause on membership redeterminations, at least through mid-January
2022 .
Marketplace revenue growth is now expected to be over 90% in 2021, and we expect
to end 2021 with approximately 680,000 members.
The current rate environment is stable and rational. We continue to believe that
the risk-sharing corridors previously introduced are related to the declared PHE
and will likely be eliminated as the COVID pandemic subsides. However, the risk
corridors continue to contribute an added level of variability to our results of
operations. In the third quarter and the nine months ended September 30, 2021 ,
we recognized approximately $17 million and $183 million , respectively, for the
impact of risk corridors enacted in several states beginning in the second
quarter of 2020, in response to the lower utilization of medical services
resulting from COVID-19.
It is possible that certain states could change the structure of existing risk
corridors, implement new risk corridors in the future or discontinue existing
risk corridors. Due to these uncertainties, the ultimate outcomes could differ
materially from our estimates as a result of changes in facts or further
developments, which could have an adverse effect on our consolidated financial
position, results of operations, or cash flows.
Medical Care Costs
We expect continued uncertainty regarding utilization trends as the pandemic
continues. The speed and extent to which utilization rebounds will be greatly
impacted by the economy and consumer behavior, provider capacity, and the
potential resurgence of COVID-19 infection rates. We believe that some portion
of the utilization curtailment experienced in the nine months ended September
30, 2021 is likely the result of service deferrals, and so these services will
likely be provided to members over the remainder of the year.
Capital and Financial Resources
We continue to monitor and assess the estimated operating and financial impact
of the COVID-19 pandemic, and as it evolves, we continue to process, assemble,
and assess member utilization information. We believe that our cash resources,
borrowing capacity available under the Credit Agreement, and cash flow generated
from operations will continue to be sufficient to withstand the financial impact
of the pandemic, and will enable us to continue to support our operations,
regulatory requirements, debt repayment obligations, and capital expenditures
for the foreseeable future. Refer to "Liquidity and Financial Condition" below
for further discussion of our capital and financial resources.
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AFFORDABLE CARE ACT
In December 2018 , in a case brought by the state of Texas and nineteen other
states, a federal judge in Texas held that the individual mandate of the ACA is
unconstitutional. He further held that since the individual mandate is
inseverable from the entire body of the ACA, the entire ACA is unconstitutional.
The effect of his ruling was stayed pending the appeal of the ruling to the
Fifth Circuit Court of Appeals . In December 2019 , a three-judge panel of the
Fifth Circuit Court of Appeal , in a two to one decision, affirmed the District
Court's ruling that the individual mandate is unconstitutional, but remanded the
case back to the District Court for further consideration of the severability
issue. The intervenor defendant states led by California subsequently appealed
the case to the U.S. Supreme Court , which heard oral arguments in the case on
November 10, 2020 . In June 2021 , the Supreme Court held in a 7-2 opinion that
the states and individuals that brought the lawsuit challenging the ACA's
individual mandate did not have standing to challenge the law. Although the
Supreme Court did not reach the merits of the challenge, it vacated the District
Court's judgment and remanded the case with instructions to dismiss-effectively
ending the case.
OTHER RECENT DEVELOPMENTS
New York Acquisition-Medicaid. On October 25, 2021 , we closed on our acquisition
of substantially all of the assets of Affinity Health Plan, Inc. , a Medicaid
health plan in New York . The net purchase price for the transaction is
approximately $380 million , net of certain tax benefits and allocation of
required regulatory capital, which we funded with cash on hand.
New York Acquisition-Medicaid. On October 7, 2021 , we announced a definitive
agreement to acquire the Medicaid Managed Long Term Care business of AgeWell New
York. As of August 31, 2021 , AgeWell served approximately 13,000 managed
long-term services and supports members, with full-year 2020 premium revenue of
approximately $700 million . The purchase price for the transaction is
approximately $110 million , net of certain tax benefits and target allocation of
required regulatory capital, which we intend to fund with cash on hand. The
transaction is subject to applicable federal and state regulatory approvals and
the satisfaction of other customary closing conditions. We currently expect the
transaction to close by the third quarter of 2022.
Nevada Procurement-Medicaid. On August 17, 2021 , we announced that our Nevada
health plan subsidiary was selected as an awardee in Clark and Washoe Counties.
This new contract is expected to commence on January 1, 2022 , and will offer
health coverage to TANF, CHIP and Medicaid Expansion beneficiaries. The four
year contract with a possible two year extension was ratified in September 2021 .
California Procurement-Medicaid. The state currently expects a final RFP to be
released in February 2022 .
Texas Acquisition-Medicaid and Medicare. On April 22, 2021 , we announced a
definitive agreement to acquire Cigna Corporation's Texas Medicaid and
Medicare-Medicaid Plan ("MMP") contracts, along with certain operating assets.
As of December 31, 2020 , Cigna served approximately 48,000 members in the Texas
ABD program, also known as "STAR+PLUS," in the Hidalgo , Tarrant and Northeast
service areas, and approximately 2,000 MMP members in the Hidalgo service area,
with full year 2020 premium revenue of approximately $1.0 billion . The purchase
price for the transaction is approximately $60 million , which we intend to fund
with cash on hand. The transaction is subject to the receipt of applicable
federal and state regulatory approvals and the satisfaction of other customary
closing conditions. We currently expect the transaction to close in January
2022 .
Ohio Procurement-Medicaid. On April 13, 2021 , we announced that our Ohio health
plan subsidiary was selected as an awardee in all three regions across the state
pursuant to the Medicaid managed care request for award issued on September 30,
2020 , by the Ohio Department of Medicaid . This new contract is expected to begin
July 1, 2022 , and will offer health care coverage to Medicaid beneficiaries
through the state of Ohio's Covered Family and Children, Expansion, and ABD
programs.
For a discussion of additional segment trends, uncertainties and other
developments, refer to our 2020 Annual Report on Form 10-K, "Item 1.
Business-Our Business," and "-Legislative and Political Environment."
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REPORTABLE SEGMENTS
As of September 30, 2021 , we served approximately 4.8 million members eligible
for Medicaid, Medicare, and other government-sponsored healthcare programs for
low-income families and individuals, including Marketplace members, most of whom
receive government premium subsidies.
In the first quarter of 2021, we realigned our reportable operating segments to
reflect recent changes in our internal operating and reporting structure, which
is now organized by government program. These reportable segments consist of:
1) Medicaid; 2) Medicare; 3) Marketplace; and 4) Other.
The Medicaid, Medicare, and Marketplace segments represent the government-funded
or sponsored programs under which we offer managed healthcare services. The
Other segment, which is insignificant to our consolidated results of operations,
includes certain corporate amounts not associated with or allocated to the
Medicaid, Medicare, or Marketplace segments. Additionally, the Other segment
includes service revenues and service costs associated with the long-term
services and supports consultative services we now provide in Wisconsin , as a
result of the Magellan Complete Care acquisition on December 31, 2020 .
HOW WE ASSESS PERFORMANCE
We derive our revenues primarily from health insurance premiums. Our primary
customers are state Medicaid agencies and the federal government.
The key metrics used to assess the performance of our Medicaid, Medicare, and
Marketplace segments are premium revenue, medical margin and medical care ratio
("MCR"). MCR represents the amount of medical care costs as a percentage of
premium revenue. Therefore, the underlying medical margin, or the amount earned
by the Medicaid, Medicare, and Marketplace segments after medical costs are
deducted from premium revenue, represents the most important measure of earnings
reviewed by management, and is used by our chief executive officer to review
results, assess performance, and allocate resources. The key metric used to
assess the performance of our Other segment is service margin. The service
margin is equal to service revenue minus cost of service revenue.
Management's discussion and analysis of the change in medical margin is
discussed below under "Segment Financial Performance." For more information, see
Notes to Consolidated Financial Statements, Note 10, "Segments."
SEGMENT MEMBERSHIP
The following table sets forth our membership by segment as of the dates
indicated:
September 30, December 31, September 30,
2021 (1) 2020 2020
Medicaid 3,981,000 3,599,000 3,595,000
Medicare 138,000 115,000 113,000
Marketplace 719,000 318,000 325,000
Total 4,838,000 4,032,000 4,033,000
____________________
(1)Approximately 200,000 members, from the Magellan Complete Care acquisition that closed onDecember 31, 2020 , are included in the totals as ofSeptember 30, 2021 , but not in prior periods. Molina Healthcare, Inc. September 30, 2021 Form 10-Q | 29 -------------------------------------------------------------------------------- Table of Contents SEGMENT FINANCIAL PERFORMANCE The following tables summarize premium revenue, medical margin, and MCR by segment for the periods indicated (dollars in millions): Three Months Ended September 30, 2021 2020 Premium Medical Premium Medical Revenue Margin MCR Revenue Margin MCR Medicaid$ 5,146 $ 532 89.6 %$ 3,754 $ 509 86.4 % Medicare 875 151 82.8 632 91 85.6 Marketplace 779 68 91.3 382 70 81.6 Total$ 6,800 $ 751 88.9 %$ 4,768 $ 670 85.9 % Nine Months Ended September 30, 2021 2020 Premium Medical Premium Medical Revenue Margin MCR Revenue Margin MCR Medicaid$ 15,020 $ 1,687 88.8 %$ 10,415 $ 1,427 86.3 % Medicare 2,488 329 86.8 1,896 333 82.4 Marketplace 2,181 331 84.8 1,133 272 76.0 Total$ 19,689 $ 2,347 88.1 %$ 13,444 $ 2,032 84.9 %
Medicaid
Medicaid premium revenue increased$1,392 million in the third quarter of 2021, when compared with the third quarter of 2020. Medicaid premium revenue increased$4,605 million in the nine months endedSeptember 30, 2021 , when compared with the nine months endedSeptember 30, 2020 . The increase in both periods was mainly due to membership growth and the impact from the Magellan Complete Care and other acquisitions closed in the second half of 2020. Excluding the acquisitions, the membership growth was across several states and was mainly driven by the extension of the PHE period and the associated suspension of membership redeterminations due to COVID-19. The overall increase was partially offset by the impact of state risk corridors stemming from COVID-19. As described above in "Trends and Uncertainties," we recognized approximately$17 million and$183 million in the third quarter and nine months endedSeptember 30, 2021 , respectively, for the impact of risk corridors enacted in several states beginning in the second quarter of 2020, in response to the lower utilization of medical services resulting from COVID-19. The medical margin in our Medicaid program increased$23 million in the third quarter of 2021 when compared with the third quarter of 2020. The increase in margin was driven by increased premium revenues, partially offset by the MCR increase discussed below. The medical margin in our Medicaid program increased$260 million in the nine months endedSeptember 30, 2021 when compared with the nine months endedSeptember 30, 2020 . The increase was driven by increased premium revenues and margin associated with the membership growth discussed above, partially offset by the MCR increase discussed below. The Medicaid MCR increased to 89.6% in the third quarter of 2021, from 86.4% in the third quarter of 2020, and increased to 88.8% in the nine months endedSeptember 30, 2021 , from 86.3% in the nine months endedSeptember 30, 2020 . The increase for both periods is mainly driven by the net effect of COVID and changes in business mix. The net effect of COVID increased the MCR for the current year and reflects an increase in COVID-related inpatient costs, lower COVID-related utilization curtailment and the impact of the COVID-related risk corridors enacted in several states as previously disclosed. In the prior year the net effect of COVID decreased the MCR. Medicare Medicare premium revenue increased$243 million in the third quarter of 2021 compared to the third quarter of 2020 and increased$592 million in the nine months endedSeptember 30, 2021 compared to the nine months endedSeptember 30, 2020 . The increase was primarily due to the impact of the Magellan Complete Care acquisition, including higher membership and higher premium revenue PMPM.Molina Healthcare, Inc. September 30, 2021 Form 10-Q | 30 -------------------------------------------------------------------------------- Table of Contents The medical margin for Medicare increased$60 million in the third quarter of 2021 and decreased$4 million in the nine months endedSeptember 30, 2021 , when compared to the same periods in 2020. The year-over-year changes in margin are driven by an increase in premium revenue and changes in the MCR. The Medicare MCR decreased to 82.8% in the third quarter of 2021, from 85.6% in the third quarter of 2020, mainly due to a favorable impact from the net effect of COVID, including utilization curtailment and corridor related adjustments. The Medicare MCR increased to 86.8% in the nine months endedSeptember 30, 2021 , compared to 82.4% in the nine months endedSeptember 30, 2020 , primarily driven by the net effect of COVID, including higher direct COVID medical costs, and the temporary industry-wide challenge of risk scores that do not fully reflect the acuity of our membership. COVID-related utilization curtailment drove a lower MCR for the nine months endedSeptember 30, 2020 . Marketplace Marketplace premium revenue increased$397 million in the third quarter of 2021 compared to the third quarter of 2020 and increased$1,048 million in the nine months endedSeptember 30, 2021 compared to the nine months endedSeptember 30, 2020 . The increase was mainly due to higher membership, partially offset by a decrease in premium revenue PMPM. Our Marketplace membership as ofSeptember 30, 2021 , amounted to 719,000 members, representing growth of 81,000 members sequentially compared toJune 30, 2021 , and substantially exceeding our expectations. This improvement resulted from several factors, including strong product design and competitive pricing, better than expected natural attrition rates, and the extended open enrollment period. The decrease in premium revenue PMPM was mainly driven by changes in business mix, with an increase of members in the bronze metal tier. The Marketplace medical margin decreased$2 million in the third quarter of 2021 when compared with the third quarter of 2020, due to the increase in the MCR, partially offset by the impact of increased premium revenue. The Marketplace medical margin increased$59 million in the nine months endedSeptember 30, 2021 when compared with the nine months endedSeptember 30, 2020 , primarily due to the increase in membership and premiums, mostly offset by an increase in the MCR compared to 2020. The Marketplace MCR increased to 91.3% in the third quarter of 2021, compared to 81.6% in the third quarter of 2020, and increased to 84.8% in the nine months endedSeptember 30, 2021 , compared to 76.0% in the nine months endedSeptember 30, 2020 . The increase for both periods resulted mainly from higher direct COVID medical costs, due to continued COVID utilization pressure in many of our Marketplace geographies, and non-COVID utilization by members enrolled through the special enrollment period. Other The Other segment includes service revenues and costs associated with the long-term services and supports consultative services we now provide inWisconsin , and also includes certain corporate amounts not allocated to the Medicaid, Medicare, or Marketplace segments. Such amounts were immaterial to our consolidated results of operations for the third quarter and nine months endedSeptember 30, 2021 and 2020. LIQUIDITY AND FINANCIAL CONDITION LIQUIDITY We manage our cash, investments, and capital structure to meet the short- and long-term obligations of our business while maintaining liquidity and financial flexibility. We forecast, analyze, and monitor our cash flows to enable prudent investment management and financing within the confines of our financial strategy. We maintain liquidity at two levels: 1) the regulated health plan subsidiaries; and 2) the parent company. Our regulated subsidiaries generate significant cash flows from premium revenue, which is generally received a short time before related healthcare services are paid. Premium revenue is our primary source of liquidity. Thus, any decline in the receipt of premium revenue, and our profitability, could have a negative impact on our liquidity. In the first half of 2021, we did not experience noticeable delays to, or changes in, the timing or level of premium receipts as a result of the COVID-19 pandemic, but there can be no assurances that we will not experience such delays in the future. See further discussion below in "Future Sources and Uses of Liquidity-Future Uses-Potential Impact of COVID-19 Pandemic." A majority of the assets held by our regulated health plan subsidiaries is in the form of cash, cash equivalents, and investments. When available and as permitted by applicable regulations, cash in excess of the capital needs of our regulated health plan subsidiaries is generally paid in the form of dividends to our parent company to be used forMolina Healthcare, Inc. September 30, 2021 Form 10-Q | 31 -------------------------------------------------------------------------------- Table of Contents general corporate purposes. In the third quarter and nine months endedSeptember 30, 2021 , the parent company received$127 million and$346 million , respectively, in dividends and return of capital from the regulated health plan subsidiaries. See further discussion of dividends below in "Future Sources and Uses of Liquidity-Future Sources." The parent company may also contribute capital to the regulated health plan subsidiaries to satisfy minimum statutory net worth requirements, including funding for newer health plans. In the third quarter and nine months endedSeptember 30, 2021 , the parent company contributed capital of$23 million and$110 million , respectively, to the regulated health plan subsidiaries. Cash, cash equivalents and investments at the parent company amounted to$703 million and$644 million as ofSeptember 30, 2021 , andDecember 31, 2020 , respectively. The increase as ofSeptember 30, 2021 , was mainly due to the dividends received from the regulated health plan subsidiaries in the nine months endedSeptember 30, 2021 , partially offset by the capital contributed to regulated health plan subsidiaries and our share repurchase program. In the first quarter of 2021, we purchased an aggregate of approximately 577,000 shares for$122 million , and we also paid$6 million to settle shares purchased in lateDecember 2020 . Investments After considering expected cash flows from operating activities, we generally invest cash of regulated subsidiaries that exceeds our expected short-term obligations in longer term, investment-grade, and marketable debt securities to improve our overall investment return. These investments are made pursuant to board-approved investment policies which conform to applicable state laws and regulations. Our investment policies are designed to provide liquidity, preserve capital, and maximize total return on invested assets, all in a manner consistent with state requirements that prescribe the types of instruments in which our subsidiaries may invest. These investment policies require that our investments have final maturities of less than 10 years, or less than 10 years average life for structured securities. Professional portfolio managers operating under documented guidelines manage our investments and a portion of our cash equivalents. Our portfolio managers must obtain our prior approval before selling investments where the loss position of those investments exceeds certain levels. We believe that the risks of the COVID-19 pandemic, as they relate to our investments, are minimal. The overall rating of our portfolio remains strong and is rated AA. Our investment policy has directives in conjunction with state guidelines to minimize risks and exposures in volatile markets. Additionally, our portfolio managers assist us in navigating the current volatility in the capital markets. Our restricted investments are invested principally in cash, cash equivalents, andU.S. Treasury securities; we have the ability to hold such restricted investments until maturity. All of our unrestricted investments are classified as current assets. Cash Flow Activities Our cash flows are summarized as follows: Nine
Months Ended
2021 2020 Change
(In millions)
Net cash provided by operating activities $ 1,522 $ 599 $ 923
Net cash (used in) provided by investing activities (1,106) 98 (1,204)
Net cash (used in) provided by financing activities (204) 61 (265)
Net increase (decrease) in cash, cash equivalents,
and restricted cash and cash equivalents
$ 212
Operating Activities We typically receive capitation payments monthly, in advance of payments for medical claims; however, government payors may adjust their payment schedules, positively or negatively impacting our reported cash flows from operating activities in any given period. For example, government payors may delay our premium payments, or they may prepay the following month's premium payment. Net cash provided by operations for the nine months endedSeptember 30, 2021 was$1,522 million , compared with$599 million in the nine months endedSeptember 30, 2020 . The$923 million increase in cash flow was due to the growth in operations and the net impact of timing differences in government receivables and payables.Molina Healthcare, Inc. September 30, 2021 Form 10-Q | 32 -------------------------------------------------------------------------------- Table of Contents Investing Activities Net cash used in investing activities was$1,106 million in the nine months endedSeptember 30, 2021 , compared with$98 million provided by investing activities in the nine months endedSeptember 30, 2020 , a decrease in cash flow of$1,204 million . This decrease in cash flow was primarily due to increased purchases of investments in the nine months endedSeptember 30, 2021 . Financing Activities Net cash used in financing activities was$204 million in the nine months endedSeptember 30, 2021 , compared with$61 million provided by financing activities in the nine months endedSeptember 30, 2020 , a decrease in cash flow of$265 million . In the nine months endedSeptember 30, 2021 , financing cash outflows included common stock purchases of$128 million and$52 million for common stock withheld to settle employee tax obligations. Additionally, we paid$23 million to settle contingent consideration liabilities relating to our Kentucky Passport acquisition that closed in 2020,$20 million of which has been presented as a financing cash outflow. In the nine months endedSeptember 30, 2020 , financing cash inflows included$380 million borrowed under the term loan facility and net proceeds of$189 million related to the repayment of the term loan facility and issuance of senior notes. This was offset by financing cash outflows related to common stock purchases of$453 million , common stock withheld to settle employee tax obligations of$8 million , and other financing outflows of$47 million . FINANCIAL CONDITION We believe that our cash resources, borrowing capacity available under the Credit Agreement as discussed further below in "Future Sources and Uses of Liquidity-Future Sources," and internally generated funds will be sufficient to support our operations, regulatory requirements, debt repayment obligations and capital expenditures for at least the next 12 months. On a consolidated basis, atSeptember 30, 2021 , our working capital was$3.3 billion , compared with$2.9 billion atDecember 31, 2020 . AtSeptember 30, 2021 , our cash and investments amounted to$7.4 billion , compared with$6.2 billion atDecember 31, 2020 .Regulatory Capital and Dividend Restrictions Each of our regulated, wholly owned subsidiaries must maintain a minimum amount of statutory capital determined by statute or regulations. Such statutes, regulations and capital requirements also restrict the timing, payment and amount of dividends and other distributions, loans or advances that may be paid to us as the sole stockholder. To the extent our subsidiaries must comply with these regulations, they may not have the financial flexibility to transfer funds to us. Based upon current statutes and regulations, the minimum capital and surplus requirement for these subsidiaries was estimated to be approximately$1.9 billion atSeptember 30, 2021 , compared with$1.5 billion atDecember 31, 2020 . The aggregate capital and surplus of our wholly owned subsidiaries was in excess of these minimum capital requirements as of both dates. Under applicable regulatory requirements, the amount of dividends that may be paid by our wholly owned subsidiaries without prior approval by regulatory authorities as ofSeptember 30, 2021 , was approximately$182 million in the aggregate. The subsidiaries may pay dividends over this amount, but only after approval is granted by the regulatory authorities. Based on our cash and investments balances as ofSeptember 30, 2021 , management believes that our regulated wholly owned subsidiaries remain well capitalized and exceed their regulatory minimum requirements. We have the ability, and have committed to provide, additional capital to each of our health plans as necessary to ensure compliance with statutory capital and surplus requirements. Debt Ratings Each of our high-yield senior notes is rated "BB-" byStandard & Poor's , and "Ba3" byMoody's Investor Service, Inc. A downgrade in our ratings could adversely affect our borrowing capacity and increase our borrowing costs. Financial Covenants The Credit Agreement contains customary non-financial and financial covenants, including a net leverage ratio and an interest coverage ratio. Such ratios are computed as defined by the terms of the Credit Agreement. In addition, the indentures governing each of our outstanding high-yield senior notes contain cross-default provisions that are triggered upon default by us or any of our subsidiaries on any indebtedness in excess of the amount specified in the applicable indenture. As ofSeptember 30, 2021 , we were in compliance with all financial and non-financial covenants under the Credit Agreement and other long-term debt.Molina Healthcare, Inc. September 30, 2021 Form 10-Q | 33 --------------------------------------------------------------------------------
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FUTURE SOURCES AND USES OF LIQUIDITY Future Sources Our regulated subsidiaries generate significant cash flows from premium revenue, which is generally received a short time before related healthcare services are paid. Premium revenue is our primary source of liquidity. Thus, any decline in the receipt of premium revenue, and our profitability, could have a negative impact on our liquidity. Potential Impact of COVID-19 Pandemic. Excluding acquisitions and our exit fromPuerto Rico , we have added over 700,000 new Medicaid members sinceMarch 31, 2020 , when we first began to report on the impacts of the pandemic. We believe this membership increase was mainly due to the suspension of redeterminations for Medicaid eligibility. We expect Medicaid enrollment to continue to benefit from the extension of the PHE period, and the associated pause on membership redeterminations, at least throughmid-January 2022 . Dividends from Subsidiaries. When available and as permitted by applicable regulations, cash in excess of the capital needs of our regulated health plans is generally paid in the form of dividends to our unregulated parent company to be used for general corporate purposes. As a result of the COVID-19 pandemic, state regulators could restrict the ability of our regulated health plan subsidiaries to pay dividends to the parent company, which would reduce the liquidity of the parent company. Credit Agreement Borrowing Capacity. As ofSeptember 30, 2021 , we had available borrowing capacity of$1 billion under the revolving credit facility of our Credit Agreement. In addition, the Credit Agreement provides for a$15 million swingline sub-facility and a$100 million letter of credit sub-facility, as well as incremental term loans available to finance certain acquisitions up to$500 million , plus an unlimited amount of such term loans as long as our consolidated net leverage ratio is not greater than a defined maximum. See further discussion in the Notes to Consolidated Financial Statements, Note 8, "Debt." Future Uses Common Stock Purchases. InSeptember 2021 , our board of directors authorized the purchase of up to$500 million , in the aggregate, of our common stock. This new program immediately supersedes the stock purchase program previously approved by our board of directors inSeptember 2020 . This new program will be funded with cash on hand and extends throughDecember 31, 2022 . The exact timing and amount of any repurchase is determined by management based on market conditions and share price, in addition to other factors, and subject to the restrictions relating to volume, price, and timing under applicable law. As ofOctober 28, 2021 ,$500 million remained available to purchase our common stock under this program throughDecember 31, 2022 . Acquisitions. OnOctober 25, 2021 , we closed on our acquisition of substantially all of the assets ofAffinity Health Plan, Inc. , a Medicaid health plan inNew York . The net purchase price for the transaction is approximately$380 million , net of certain tax benefits and allocation of required regulatory capital, which we funded with cash on hand. OnOctober 7, 2021 , we announced a definitive agreement to acquire the Medicaid Managed Long Term Care business of AgeWell New York. As ofAugust 31, 2021 , AgeWell served approximately 13,000 managed long-term services and supports members, with full-year 2020 premium revenue of approximately$700 million . The purchase price for the transaction is approximately$110 million , net of certain tax benefits and target allocation of required regulatory capital, which we intend to fund with cash on hand. The transaction is subject to applicable federal and state regulatory approvals and the satisfaction of other customary closing conditions. We currently expect the transaction to close by the third quarter of 2022. OnApril 22, 2021 , we announced a definitive agreement to acquire Cigna Corporation's Texas Medicaid and Medicare-Medicaid Plan ("MMP") contracts, along with certain operating assets. As ofDecember 31, 2020 , Cigna served approximately 48,000 members in the Texas ABD program, also known as "STAR+PLUS," in theHidalgo ,Tarrant and Northeast service areas, and approximately 2,000 MMP members in theHidalgo service area, with full year 2020 premium revenue of approximately$1.0 billion . The purchase price for the transaction is approximately$60 million , which we intend to fund with cash on hand. The transaction is subject to the receipt of applicable federal and state regulatory approvals and the satisfaction of other customary closing conditions. We currently expect the transaction to close inJanuary 2022 . Potential Impact of COVID-19 Pandemic. As described above in "Trends and Uncertainties," we have been subject to Medicaid risk corridors as a result of the pandemic. Beginning in 2020, throughSeptember 30, 2021 , various states enacted temporary risk corridors in response to the reduced demand for medical services stemming from COVID-19, which have resulted in a reduction of our medical margin. In some cases, these risk corridors wereMolina Healthcare, Inc. September 30, 2021 Form 10-Q | 34 -------------------------------------------------------------------------------- Table of Contents retroactive to earlier periods in 2020, or as early as the beginning of the states' fiscal years in 2019. Beginning in the second quarter of 2020, we have recognized retroactive risk corridors that we believe to be probable, and where the ultimate premium amount is reasonably estimable. For the three and nine months endedSeptember 30, 2021 , we recognized approximately$17 million and$183 million , respectively, related to such risk corridors, primarily in the Medicaid segment. It is possible that certain states could change the structure of existing risk corridors, implement new risk corridors in the future or discontinue existing risk corridors. Due to these uncertainties, the ultimate outcomes could differ materially from our estimates as a result of changes in facts or further developments, which could have an adverse effect on our consolidated financial position, results of operations, or cash flows. Regulatory Capital Requirements and Dividend Restrictions. We have the ability, and have committed to provide, additional capital to each of our health plans as necessary to ensure compliance with statutory capital and surplus requirements. CONTRACTUAL OBLIGATIONS A summary of future obligations under our various contractual obligations and commitments as ofDecember 31, 2020 , was disclosed in our 2020 Annual Report on Form 10-K. There were no significant changes to our contractual obligations and commitments outside the ordinary course of business during the nine months endedSeptember 30, 2021 . CRITICAL ACCOUNTING ESTIMATES When we prepare our consolidated financial statements, we use estimates and assumptions that may affect reported amounts and disclosures; actual results could differ from these estimates. Our critical accounting estimates relate to: •Medical claims and benefits payable. Refer to Notes to Consolidated Financial Statements, Note 7, "Medical Claims and Benefits Payable," for a table that presents the components of the change in medical claims and benefits payable, and for additional information regarding the factors used to determine our changes in estimates for all periods presented in the accompanying consolidated financial statements. Other than the discussion as noted above, in the nine months endedSeptember 30, 2021 there have been no significant changes to our disclosure reported in "Critical Accounting Estimates" in our 2020 Annual Report on Form 10-K. •Contractual provisions that may adjust or limit revenue or profit. For a discussion of this topic, including amounts recorded in our consolidated financial statements, refer to Notes to Consolidated Financial Statements, Note 2, "Significant Accounting Policies." •Quality incentives. In the nine months endedSeptember 30, 2021 , there have been no significant changes to our disclosure reported in "Critical Accounting Estimates" in our 2020 Annual Report on Form 10-K. •Business combinations, goodwill, and intangible assets, net. In the first quarter of 2021, we realigned our reportable operating segments to reflect recent changes in our internal operating and reporting structure, which is now organized by government program. The revised reporting structure reflects the reporting and review process used by our chief executive officer (who is our chief operating decision maker) to assess performance and allocate resources, and is consistent with how we currently manage the business and view the markets we serve. These reportable segments consist of: 1) Medicaid; 2) Medicare; 3) Marketplace; and 4) Other. Such reportable operating segments also now constitute our reporting units in the annual assessment of goodwill impairment. Refer to Notes to Consolidated Financial Statements, Note 10, "Segments," for a presentation of goodwill, and intangibles assets, net, by reportable segment, and "Critical Accounting Estimates," in our 2020 Annual Report on Form 10-K, for further information.Molina Healthcare, Inc. September 30, 2021 Form 10-Q | 35
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