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Molina Healthcare provides managed health care services through the Medicare and Medicaid programs and state insurance marketplaces to low-income Americans. Founded in 1980, the company now serves over 5 million people across 21 states.

Q2 2026

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Q4 2024

Molina Healthcare (MOH): Company Profile, Stock Price, News, Rankings

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Molina Healthcare

molina healthcare

Good day, and welcome to the Molina Healthcare Second Quarter twenty twenty five Earnings Conference Call. All participants will be in listen only mode. After today's presentation, there will be an opportunity to ask questions. Please note this event is being recorded. I would now like to turn the conference over to Jeff Guyer, Vice President of Investor Relations. Please go ahead.

Good morning and welcome to Molina Healthcare's second quarter twenty twenty five earnings call. Joining me today are Molina's President and CEO, Joe Zabretsky and our CFO, Mark Keim. A press release announcing our second quarter twenty twenty five earnings was distributed after the market closed yesterday and is available on our Investor Relations website. Shortly after the conclusion of this call, a replay will be available for thirty days. The numbers to access the replay are in the earnings release.

For those of you who listen to the rebroadcast of this presentation, we remind you that all of the remarks are made as of today, Thursday, 07/24/2025, and have not been updated subsequent to the initial earnings call. On this call, we will refer to certain non GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in the second quarter twenty twenty five earnings release. During the call, we will be making certain forward looking statements, including, but not limited to, statements regarding our 2025 guidance and 2025 guidance elements, the medical cost trend and our projected MCRs, Medicaid rate adjustments and updates our 2026 Marketplace pricing and rate filings our RFP awards and our M and A activity revenue growth related to RFPs and M and A activity the recently enacted Big Beautiful Bill and expected Medicaid, Medicare and Marketplace program changes and the estimated amount of our embedded earnings power. Listeners are cautioned that all of our forward looking statements are subject to certain risks and uncertainties that could cause our actual results to differ materially from our current expectations.

We advise listeners to review the risk factors discussed in our Form 10 ks annual report filed with the SEC as well as our risk factors listed in our Form 10 Q and Form eight ks filings with the SEC. After the completion of our prepared remarks, we will open the call to take your questions. I will now turn the call over to our Chief Executive Officer, Joe Zabretsky. Joe?

Thank you, Jeff, and good morning. Today, I will discuss several topics. Our reported financial results for the second quarter, an update on our full year 2025 guidance, our growth initiatives and strategy for sustaining profitable growth, and some commentary on the potential impacts of the recently passed budget bill. Let me start with our second quarter performance, which greatly informs our discussion on 2025 guidance. Last night, we reported adjusted earnings per share of $5.48 on $10,900,000,000 of premium revenue.

Our 90.4% consolidated MCR reflects a very challenging medical cost trend environment, but moderated by our consistently effective medical cost management. We produced a 3.3% adjusted pre tax margin. Year to date, our consolidated MCR is 89.8%, and our adjusted pre tax margin is 3.6%. In Medicaid, the business produced an MCR of 91.3%, which is above our long term target range. We continue to experience medical cost pressure in behavioral, pharmacy, and inpatient and outpatient care.

Let me expand on what we are seeing in our Medicaid business. Behavioral health costs have increased nationally, reflecting both supply side and demand side drivers, and imposed limitations on utilization management in certain states. High cost drugs remain a source of pressure, driven by higher script volumes, and the introduction of a variety of expensive therapies beyond GLP-1s for conditions such as cancer and HIV. Higher inpatient utilization in the quarter was driven by a higher volume of admissions for complex health episodes, many of which originated from increased ER visits. And the increase in outpatient utilization in the quarter was driven by primary care visits and preventive screenings, many of which led to subsequent treatment in specialist settings.

This is the fourth consecutive quarter we have observed some combination of these trends. The magnitude and persistence of these medical cost increases are unprecedented. To briefly recap how these trends have emerged over time. Starting in the third quarter of twenty twenty four, while an increasing trend emerged from the end of the redetermination process, rates and Molina's risk corridor positions at the time were sufficient to offset that increasing trend. By the fourth quarter of twenty twenty four, the increasing medical cost trend moved beyond the 2024 midyear rate updates, and corridors had largely become depleted.

Moving into the first quarter of twenty twenty five, the January first rate cycle captured much of the continued trend pressure. And now, in the second quarter of twenty twenty five, we experienced yet another increase in trend, which moved beyond the rate updates received in the first quarter, and risk corridor protection at this point is very limited and isolated. We are confident our cost control protocols and procedures continue to be effective, albeit applied to much higher intake volumes. Cost data indicates a higher prevalence of allowable and appropriate diagnoses and medical procedures. In Medicare, we reported a second quarter MCR of ninety percent, which is above our long term target range, as utilization was higher in the more acute populations, particularly for long term services and supports and high cost drugs.

In marketplace, the second quarter NCR of 85.4% was much higher than expected, including the new store NCR related to Connecticut. We continue to experience much higher utilization relative to risk adjustment revenue, the latter which has now been validated by external sources. Our adjusted G and A ratio at 6.1% reflects lower incentive compensation as a result of our revised view of performance, as well as continued productivity enhancements. Turning now to our 2025 guidance. Full year 2025 premium revenue guidance remains unchanged at approximately $42,000,000,000 Our full year 2025 adjusted earnings per share guidance is now expected to be no less than $19 per share, a floor, if you will, which is $5.5 below our initial guidance of $24.5 and $3 lower than the midpoint of what was recently communicated on July 7.

Providing some color. This further revision results from new information gained in our June close process and implications for trend assumptions for the second half of the year, particularly related to Marketplace. We used this most recent experience data to forecast the balance of the year, which resulted in a more conservative view and a view within a wider range of probable outcomes than is normal for this point in the year. This revised guidance of a $19 floor produces a consolidated MCR and pretax margin of 90.23.1%, respectively. Our full year guidance now includes 140 basis points of consolidated MCR pressure compared to our initial guidance at $24.5 which is disproportionately attributed to Marketplace.

Marketplace is 10% of our revenue and accounts for nearly half of this 140 basis point MCR revision. We consider the $19 guidance to be a floor, as we believe the cost trend could moderate from this conservative indication and produce earnings upside. A reminder that 35 basis points of MCR in the second half equates to $1 of upside earnings per share potential. Now some color on the segments. In Medicaid, our guidance assumes a full year MCR of 90.9%, which produces a pre tax margin of 3.6.

While this Medicaid MCR result is above the high end of our long term target range, we do evaluate it in the context of this unprecedented and challenging trend environment. We received adjustments and new off cycle rate updates in a few states that will benefit the second half of twenty twenty five. Then, with approximately 55% of our Medicaid premium renewing on January 1, our rate cycle is well timed for early twenty twenty six. There is little question that most state programs are significantly underfunded as a result of medical cost inflection. We have very strong rate advocacy efforts, working with our state partners to restore rates to appropriate levels.

States are listening and have been responsive. With that in mind, our own analysis, validated by fact based external reports, has us operating with Medicaid MCRs 200 to 300 basis points lower than the broader market. When rates and trends reach equilibrium for the broader market, we should be back to operating within our long term target range. In Medicare, our full year guidance includes an MCR of 90% and a low single digit pre tax margin. We continue to effectively manage the elevated utilization through our cost control protocols.

We consider this higher cost trend in our bids for 2026 and remain strategically focused on our dual eligibles population. In Marketplace, at this time in the cycle, the focus is not only on the second half of twenty twenty five, but also on the positions taken in rate filings for 2026. With respect to full year 2025, we expect to produce an MCR of 85% and a pre tax margin in the low single digits. This result includes the pressure from the prior year items we recognized in the first half and the new store impact of Connecticut. We conservatively forecasted medical cost trend in our risk adjustment revenue, the latter which has now been validated by external sources, as it is clear that the market wide risk pool is higher acuity.

Medical cost trend relative to risk adjustment continues to produce a higher than expected MCR, and we have considered this higher cost baseline and trend in our rate filings for 2026. More on that later, as rates for 2026 will also be affected by the expiration of the enhanced subsidies and program integrity policies. Our small, silver and stable approach to this line of business, where we target mid single digit margins, even at the expense of growth, was deliberate and well considered. This line of business has significant inherent volatility in a constantly shifting risk pool. We have limited this segment to just 10% of our portfolio, and we always approach it cautiously.

In summary, with respect to our full year guidance, we provide it with full confidence, quantification and detail in this season of great uncertainty. Turning now to our growth initiatives. We remain on track to achieving our premium revenue target of $46,000,000,000 in 2026, and with a modest estimate of future growth initiatives, at least $52,000,000,000 for 2027. Our outlook considers growth in our current footprint and recent Medicaid and Medicare dual RFP wins. These wins should more than offset the marketplace headwind due to the expiration of enhanced subsidies.

This outlook is before considering any impacts of membership declines due to the budget bill, which we continue to evaluate in size and believe the ultimate impact of which is likely to manifest beyond 2028. With respect to M and A activity, our acquisition pipeline still contains many actionable opportunities, and we remain opportunistic in deploying capital to accretive acquisitions. This current challenging operating environment has been a catalyst for many smaller and less diverse health plans to consider their strategic options, creating more opportunities. Our embedded earnings, which accounts for the estimated accretion related to new contract wins and recent acquisitions, remains at $8.65 per share. For all of these reasons, we remain confident in our long term growth targets.

Turning now to the political and legislative landscape and the related long term outlook for our businesses. In Medicaid, we believe changes to the Medicaid program related to the recently passed budget bill will be modest and gradual. We evaluate its impacts in two broad categories, direct and indirect. By direct impact, we mean any impact specific to our actual membership and the potential for a related risk pool acuity shift. Note that for the expansion population, work requirements commence in 2027 or later by approval.

Biannual reverifications also commence in 2027 or later by approval as well. We continue to estimate that the ultimate impact will be in the range of 15% to 20% on the 1,300,000 members in our expansion population, as many of these members will automatically qualify as a result of exclusions, and two thirds already work in some capacity. By indirect impacts to the program, we are referring to funding reductions not expressly linked to certain populations. For instance, it is more difficult to predict how states will react to the reductions in federal funding resulting from limitations on directed payments and provider taxes. States could limit eligibility, reduce benefits, or keep their programs intact by funding it with additional state revenues.

We anticipate that whatever a state elects to do will follow prevailing state specific political tendencies. We believe these changes will be implemented over the course of the two year period of 2027 and 2028, and possibly into 2029, and therefore, allow the market time to react appropriately, so any impact would be gradual and not abrupt. Finally, in marketplace, we continue to expect the enhanced subsidies will not be extended beyond this year. External sources estimate a significant industry impact to 2026 enrollment. In addition to taking a conservative view of the current medical cost baseline and forward trend, we are attempting to conservatively capture the potential related acuity shift in the risk pool in our 2026 rate filings.

Most of our states have confirmed that they will allow market participants a second pass rate filing, which will give us a last look based on the most current information available, thus mitigating any mispricing risk. Regardless, our strategy of keeping this business small, stable and oriented towards silver cured products has served us well. In summary, we are disappointed with our second quarter results and guidance revision, even in the backdrop of this difficult environment of accelerating medical cost trend. In Medicaid, where health plan participants are essentially rate takers, we believe this dislocation between rates and trend is temporary, and will normalize over time, just as it has in past years of the program. And in marketplace, where there has been significantly increased utilization relative to risk adjustment, our rate filing process will address this incongruity and restore the product to target margins.

I do step back and take stock. In doing so, I am encouraged by a number of observations that deserve emphasis. Even in this broadly challenging environment, we have the confidence and clarity to provide a specific earnings per share guidance floor with upside potential. We continue to grow premium this year at 919% over the past few years. Our consolidated MCR outlook is 90.2% in an extended period of accelerating trend.

When combined with our G and A efficiencies harvested over the past number of years, we are still projecting a full year 3.1% pretax margin, which is just 90 basis points off the lower end of our long term range. And finally, with margins normalizing, as we are heading towards $46,000,000,000 and $52,000,000,000 of premium revenue in 2026 and 2027, we are very well positioned to reestablish our profitable growth trajectory. At Molina, we power through short term industry wide challenges and strive to deliver superior sector performance. We have built a durable government sponsored healthcare franchise. This franchise has been designed to deliver results with the same consistency and commitment to operating excellence that has been our hallmark.

With that, I will turn the call over to Mark for some additional color on the financials. Mark?

Thanks, Joe, and good morning, everyone. Today, I'll discuss additional details of our second quarter performance, the balance sheet and our 2025 guidance. Beginning with our second quarter results. For the quarter, we reported approximately $11,000,000,000 in total revenue and $10,900,000,000 of premium revenue with adjusted EPS of $5.48 Our second quarter consolidated MCR was 90.4 reflecting a very challenging medical cost trend environment for each of our segments, but moderated by our consistently effective medical cost management. In Medicaid, our second quarter MCR was 91.3 higher than our expectations.

We continue to experience medical cost pressure in behavioral, pharmacy and the inpatient and outpatient care settings that Joe summarized. The combination of these trends exceeded rate updates received in the first half of the year. In Medicare, our second quarter MCR was 90, also higher than our expectations. We experienced higher utilization among our high acuity dual populations, particularly for LTSS and high cost pharmacy drugs. We remain confident in our cost controls.

In Marketplace, our second quarter reported MCR was 85.4%. Similar to first quarter, the MCR includes approximately 150 basis points of higher new store MCR in Connecticut and 150 basis points for member reconciliation from previous years. Excluding these items, the normalized MCR of approximately 82.4% was higher than we expected. Utilization among our renewing membership and new membership was elevated compared to previous guidance. While risk adjustment might normally offset higher observed trend, our market indicators clearly suggest that the overall market risk pool is also significantly elevated, reducing the value of the natural hedging effect of risk adjustment.

Initial Wakeleys just received in late June clearly confirm that national marketplace risk pools are trending higher. Our adjusted G and A ratio for the quarter was 6.1, significantly below normal levels, reflecting reduced incentive compensation tied to lower expected performance in our normal operating discipline. Turning to the balance sheet. Our capital foundation remains strong. In the quarter, we harvested approximately $260,000,000 of subsidiary dividends and our parent company cash balance was approximately $100,000,000 at the end of the quarter.

Our operating cash flow for the first six months of twenty twenty five was an outflow of $100,000,000 due to the timing of government receivables and risk corridor settlement activity that offset the normal positive items. Debt at the end of the quarter was reduced by approximately $200,000,000 through cash flow at the parent and now stands at just 1.9 times trailing twelve month EBITDA. Our debt to cap ratio is about 43%. We continue to have ample cash and access to capital to fuel our growth initiatives. Days and claims payable at the end of the quarter was 43, significantly lower than prior quarters, driven by several items.

Recall, the DCP calculation compares the fee for service components of our IBNR balance to the average daily medical claims expense. By quarter end, larger than normal cash payments significantly reduced the IBNR balances driven by faster processing and adjudication of claims as well as several large discrete cash settlements of age liabilities. Normalizing for these items, our DCP is more in line with historical averages. As some of these items are sustaining, we guide to lower DCPs in the mid-40s in future periods. We remain confident in the strength of our actuarial process and our reserve position.

Next, a few comments on our 2025 guidance. We continue to expect full year premium revenue to be approximately $42,000,000,000 Our adjusted earnings guidance is no less than $19 per share. Within our guidance, the full year consolidated MCR increases to 90.2%, up 140 basis points from our initial guidance at twenty four point five As Joe mentioned, the higher MCR is disproportionately driven by Marketplace. Marketplace is just 10 of our premium revenue, yet accounts for almost half of the consolidated increase in MCR. In Medicaid, we are raising the full year MCR guidance from 89.9% to 90.9% as trend is now expected to exceed rates.

With the observed trend in Q2 and our expectations for higher trend over the rest of the year, we are updating our full year over year trend outlook from 5% to 6%. Updated rates in several states increased our full year over year rate only modestly from 5% to a little higher than 5%. We have several known on cycle rates timed for Q3 and Q4, recognizing higher experience trends. We continue to see a willingness from states to discuss off cycle and retro rate adjustments as data develops, but we do not include speculative off cycle rate updates in our guidance. In the second half of the year, ongoing medical cost pressure will exceed known rate updates.

As such, we expect our Medicaid MCR of 90.8% in the first half to increase to ninety one percent in the second half of the year. Even at these MCR guidance levels higher than our long term target range, our Medicaid segment full year pre tax guidance margin is approximately 3.5%, demonstrating the underlying strength of this segment even in this challenging operating environment. In Medicare, we are increasing our full year MCR guidance from 89 to 90, reflecting among our high acuity duals membership. We expect our Medicare first half MCR of 89.2 to increase to 90.9 in the second half of the year, driven by our outlook on trends, normal medical cost seasonality and the new inpatient facility fee schedule in the fourth quarter. The Medicare segment full year pre tax guidance margin is approximately 1.5%.

Looking forward to 2026, we believe the final rate notice and our product designs, which we filed in May captured this higher 2025 jumping off point for our 2026 bids. In marketplace, we are increasing our full year MCR guidance from 80 to 85. The full year marketplace MCR now includes approximately 200 basis points attributable to the combination of prior year member reconciliations and the new store impact of Connecticut. Excluding these items, the normalized full year Marketplace MCR is approximately 83. We expect the normalized Marketplace MCR of 80 in the first half of the year to increase to approximately 86 in the second half of the year, reflecting higher observed trends and normal seasonal patterns for Marketplace.

While we are disappointed with these results for Marketplace, I will note that even with an expected full year reported MLR of approximately 85%, we would achieve low single digit pretax margins in this business. The Marketplace segment full year pretax guidance margin is approximately 1% or 3% normalized for the items I have detailed. We believe we can capture this trend pressure in our 2026 marketplace pricing with additional conservative assumptions included for the expiration of enhanced subsidies, new program integrity policies and the related potential acuity shift in the market risk pool. Given our relatively low exposure to marketplace at just 10% of our current portfolio revenue mix, we can remain focused on producing mid single digit pretax margins. We will prioritize margin and let membership fall where it may.

We now expect the full year G and A ratio to be approximately 6.6, better than previously guided by 30 basis points, reflecting the very low second quarter expense and continued efficiencies in our operations. Our full year EPS guidance is now expected to be no less than $19 per share, lower than our first quarter guidance by 5.5 Guidance now includes $8 for our updated full year MCR outlook, partially offset by two fifty from the improved G and A ratio and slightly higher investment income given the fewer Fed rate cuts now expected. Our consolidated guidance pre tax margin is expected to be approximately 3.1% despite the significant dislocation of rates and trends. With 55% of our revenue renewing on January 1, our rate cycle is well timed for 2026. This concludes our prepared remarks. Operator, we are now ready to take questions.

The first question comes from Andrew Mok from Barclays. Please go ahead.

Hi, good morning. You noted that the back half Medicaid MLR is higher than the first half, but it looks like there's some modest improvement from the 2Q MLR. How do you get confidence that Medicaid margins will improve from here when the spot rate for reimbursement seems to be inadequate in an inflationary trend environment and newer redeterminations and integrity measures look like they may impact both membership and risk pool on a go forward basis? Thanks.

Yes. Good morning, Andrew. It's Mark. In the first half, we reported a 90.8 and my guidance implies a 91 for the second half of the year. Essentially, what we have is trend slightly outstripping the rates that we know about, which is why we have a little upward pressure on that.

Now the good news is our previous guidance already had a bunch of rate manifesting in Q3 and Q4. We didn't get much more. I originally thought second half would be better than this. So we are factoring in that observed trend. On the other issue you mentioned, there's the news flying around about the duplicative members in marketplace and or Medicaid.

If you look, I think they're saying it's about 2.8% of the combined Medicaid and marketplace pool, which we think there's a lot of errors in the numbers. And I think it's also going to take a long time to play out. I don't see that as being a meaningful membership headwind this year. So to me, it's all about the relationship of rates and trends. And we already had a lot of rates back in for us.

This trend keeps coming and we're going to model it like it is.

Great. Maybe just a follow-up on the ACA. As you look to refile the rates, is there a number you have in mind for the required premium increases next year to properly account for all the trend and risk pool issues across both '25 and '26 and reset to a normalized margin? Thanks.

Andrew, we're not going to disclose our rate filings state by state. But I will tell you, the rate models very clearly, first, have to catch up with the underperformance this year to get it back to mid single digit target margins. Second, a healthy dose of medical cost trend. Bear in mind, we've increased our assumption this year on medical cost trend year over year from seven percent to eleven percent, and you can rest assured we're putting a healthy dose of trend into rates. And then thirdly, the acuity shift that's going to occur next year due to the expiration of the APTCs.

Again, modeled conservatively, a healthy dose of conservatism put into rates. But we're not going go state by state, but we've captured all the elements that need to be captured. And we don't expect the business to grow next year. The market will shrink, and we're not looking to grow. We're looking to get back to mid single digit target margins, having rated up for all the elements that are going to impact next year.

The next question comes from the line of Josh Raskin from Nephron Research. Please go ahead.

Yes, thanks. I guess the question on the marketplace would be in light of the trends developing even worse just the last couple of weeks, how much adjustment to your marketplace pricing can actually be done at this point to the states and the Fed exchange? Do they allow significant adjustments at this point? And maybe when's the last time you could submit pricing changes for 2026?

Yes. Hey, Josh, good morning. Yes, the states are adding a lot of flexibility this year. In past years, it was pretty hard and fast when the deadlines are. This year, every state is a little bit different.

But there's either new deadlines, even through August, or there's soft kind of rolling discussions about where we are. Now some states also parse things a little bit differently. Can you change your trend assumption year to year just on core utilization? That might be harder than can you change your assumption for acuity shift as more data evolves. So it's a little bit about what components of pricing are changing.

States view the components differently on where the flexibility is, but that's an ongoing discussion. And you have to appreciate that states need to be a little bit accommodating here, because the last thing they want is folks to drop out. They need to be accommodating on pricing because it's part of a sustaining market.

Yes, that makes sense. But I guess I'm just sort of thinking about your comments last quarter and the quarter before where you about a more stable marketplace membership. You talked about higher retention this year. So I guess I'm just still struggling with what do you think is the root cause of this pickup in utilization and now, I guess, market wide?

It is market wide. And as demonstrated by the Wakeley analysis that the risk pool has deteriorated by 8% year over year. The acuity of the entire marketplace risk pool is higher by 8% year over year, which means on a relative basis, risk adjustment is not going to keep up with the elevated trend. As I said, we've increased our trend assumption from 7% that went into pricing to 11% in our forecast. And as I said, all we can do is put a healthy dose of trend into next year's rates, catch up adjustment, acuity adjustment, and we feel confident that we'll get back to mid single digit margins at the expense of growth.

But there's no other explanation except that the marketplace risk pool nationally is higher acuity. Wakeley's estimate, 8% higher this year than last.

The next question comes from Steven Baxter from Wells Fargo. Please go ahead.

Hi. Thanks. Just another couple on the exchanges. I guess, I know you're not going to give specific rate increases or requests by state, but I guess just big picture, like how are you thinking about market wide enrollment decline in 2026? Obviously, that's a key component of forecasting acuity correctly.

And I guess, is it fair to say that the acuity shift that you're putting into pricing is going to be multiples of the acuity shifts we're seeing this year? And ultimately, if you do have states that don't let you take the rate increases that you want, like how do you plan to respond? Thanks.

Mark? Yes. So a couple of things. We're hesitant to talk about specific acuity adjustments or memberships just because this is a competitive market. And you can imagine that that's something everyone needs to do independently.

The other thing though, is it varies so much by state. There are national averages for trend for acuity shift from the subsidies from acuity shift from program integrity. But the dynamic state by state are so different. One of the things you have to look at is some of these states didn't grow their marketplace meaningfully from pre pandemic. So they're not in a different place.

But it also really matters what is the distribution of metallic cohorts? What is the distribution of federal poverty level cohorts and then finally what states expanded, which ones didn't. All those things mean that some states will have very material declines in marketplace, Other ones will be quite subtle because things aren't that meaningfully different under the new rules. So look, we have to go about this and price state by state very specifically. In some cases, the numbers are big and in some cases not so much.

And related to the acuity shift, which is the wildcard for next year, it'll be interesting to see how all the market participants react to that. We have very intricate models trying to assess what the elasticity of demand is around a dollar differential in price, looking at whether we're number one, two, three, or four in that market and where the competitors were last year, is a bronze product available in that market. So a lot of factors go into it. As I said, all you can do is lean on the assumptions, approach it conservatively when it comes to the acuity adjustment, and the the our state based partners are absolutely willing to give us a second pass rate filing to use the latest information, which should mitigate any of this pricing risk.

The next question comes from Justin Lake from Wolfe Research. Please go ahead.

Thanks. Good morning. First question is around run rate earnings. It looks like your back half is around $7.50. I think you've talked about and even seen historically about even split, give or take, of first half or second half.

So you look like you're one rating at about $15 a share in the back half of the year. Curious if that's a reasonable way to think about it in your mind. And if so, how does that bias us to think about your ability to grow earnings year over year into 2026?

Well, I think that is the run rate math. Bear in mind that over half our Medicaid revenue has a oneone renewal cycle. We're advocating very hard for adequate rates for oneone, Making sure our state partners use the most reasonable and recent baseline. We're advocating for July '24 to July 25 as the baseline, which is really important. Takes a lot of risk out of what you the jumping off point that you trend off of.

So we're optimistic about the one one rate cycle for '26. Of course, we have a third of embedded earnings that are going to emerge in 2026, including the $1 of implementation cost that just disappears. But too early to make a call in 2026, but that is the back half math, about $15 a share. But we feel good about the pricing cycle for marketplace, feel pretty good about the rate cycle for 01/01/1926 in Medicaid. And then, of course, we have embedded earnings.

But far too early to make a call in 2026, we'll have to wait to the third or the fourth quarter to do that. Mark, anything to add?

Justin, your math is good, roughly $7.50 in the second half, but you can't just double it for next year for all the reasons Joe mentioned. Again, the rate cycle is just critical for January 1, the industry needs these rates more than Molina does at the moment. The industry is very underfunded. We need money just to get back to target margins. So we should see a lot of progress on the rate cycle for January 1.

And then lastly, as Joe mentioned, we're carrying that $865,000,000 of embedded earnings. We had previously guided to seeing about a third of it next year. We'll update that as we see the rate cycle and everything else coming forward. But as Joe mentioned, if the guidance is a third of that for next year, a dollar of its guaranteed, it's just the reversal of the implementation fees we carry this year. So too soon to give guidance for next year, but I think those are the building blocks in the setup for next year.

Last comment make the back half is when we closed out the second quarter, it became obvious to us that quarterly trend in Medicaid had again accelerated. Trending in first quarter off the fourth was 1.2%. That's just a quarterly trend. When we closed out June, it was 1.6%, just a quarterly trend. Of course, you have a decision to make, how conservative do you want to be for the back half?

We repeated that 1.6% Medicaid trend in each of Q3 and Q4. So whether it proves to be conservative or not, or enough remains to be seen, but we used the last data point, which is the highest quarterly trend we've observed in the last four and projected it forward.

Thanks. And then just a couple of quick numbers questions. First, the SG and A benefit for the year from lower comp, executive comp that probably comes back next year. If it's possible to put a number on that, that'd be helpful. If I missed it, I apologize, but I heard Steve ask what you think the exchanges decline by next year in terms of membership. I didn't hear an answer there. Thanks.

So a couple of things there. Our original G and A guidance was 6.9% way back to the beginning of the year. We're currently guiding to 6.6% and a meaningful part of that is the one time or the management compensation that came second quarter. Now if you're going to how do I think about the setup for next year, yes, that management compensation piece comes back next year as potentially a G and A headwind. The good news is it's offset by that implementation cost that's in our G and A that go away for next year, right?

So those two offset, which if I were modeling a G and A number for next year, it would be a little better than 6.9%, call it 6.8 and we'll see how that evolves. I think that's the zip code. Now on marketplace membership, we're not here to give projections on the market and specifically not on our own member base. Some pundits out there have kicked around numbers of a roughly 30% decline. You can make an argument for why it's more, you can make an argument for why it's less.

We need to take our own views internally. And why that's critical is linked to the membership decline is the acuity shift. So we're working through that right now, as you can imagine.

And given that it's only 10% of the portfolio, we have far more optionality and flexibility than many others in the market. We'd like to keep it at 10%, but if it becomes lower in order to get to mid single digit margins, that's the way it's going to be.

The next question comes from A. J. Rice from UBS. Please go ahead.

Think about second half of this year versus potentially first half of next year. I know you got 55% of your rate or your book resets and rates. If I think about where you're at on margin for first half of this year versus and then second half, assume when you came into the year, you assumed a step up in performance in the second half of this year. That doesn't seem like it's materialized. I'm trying to understand how much of a hole you have when you compare first half of this year against your jumping off point for first half next year.

Are you dependent on those rate updates to even get back to where you had in the first half of the year? Or would that be a step forward to getting to your target margins, if you understand what I'm trying to ask?

Yes, I think I do, AJ. It's a matter of degree. So clearly, we're disappointed in our outlook for the second half of the year. Rates that should have been good enough to carry us through the year per expectations are now woefully short of how trend is emerging, which is why we have a significantly lower second half of the year than first. Now for the setup of next year, as Joe mentioned, 55% of the revenue on January 1, we clearly need the rate cycle to help us get back to our normal target margins.

The question is how much will we see and how does it manifest? I'm also somewhat encouraged that there will be some off cycles along the way that juice that 55% of revenue a little further, but we're just not going to project those for right now. Does that help?

Yes. I think I'm just trying to figure out I don't think you were target margins in the first half of the year. So just how much of a hole are you starting on the year to year comparison before you take into the rate updates? Or they move you forward, you just might not get to full target margins in the first half of twenty six, but

They definitely move us forward. It's a matter to what degree we get them. If the industry is funded to where it needs to be, we'll be well back into the target margins even paying into corridors again. So it's just a matter of how quickly do states move back to what is actuarially appropriate.

Okay. Just the other thing I wanted to ask you about is I appreciate the comments about the budget bill. I think there's, and the 15 to 20% of the expansion population that could be at risk under the work rules. Any comments about how that might affect, the underlying acuity or risk pool and whether we're gonna be dealing with another Medicaid redetermination type of phenomenon there. And you didn't mention the the issue of the undocumented immigrants that are getting covered in some of the states, and some I know you have exposure to.

How meaningful an issue is that if they eliminate federal funding for that Medicaid population?

First, with respect to the risk pool, we believe this will happen in a gradual manner. A state would be well served not to have a shot loss. They can't be dealt with either administratively or from an acuity perspective. We have looked at all of our cohorts by age, duration, geography, etcetera, for our expansion population, and the MCR skewers, the the way it's skewed, are not significant. Now you start with the premise that if people need insurance, they're gonna keep it, and people, who leave don't need it.

So there'll be a little bit of a shift there, but the the skews by cohort are not so significant. And the fact that we believe it will happen gradually gives us comfort that it can ease into the rate cycle without a seismic shift, the way the three year pause on the redetermination process caused the risk pool to shift initially.

And just so there's no confusion, A. J, the 15% to 20% we're talking about is of the expansion population, not the Medicaid book. So this is a dramatically lower impact and potential decline than the broader redebt that we experienced over the last couple of years.

On the second question about undocumented immigrants, we have about five states where they are in the program, but it's very, very minor. The one state where there's a significant number where we are a player is California. We have we are working, to continue to figure out how they're going to handle that, cover them or not. Obviously, the FMAP match reduction, if they do decide to cover them, disappeared in the in the final budget bill. So that's not a factor.

But the only state that's material to us, to the program is California. We're monitoring that closely, but no answers at this point.

The next question comes from Kevin Fischbeck from Bank of America. Please go ahead.

Great, thanks. Just wanted to see if you guys have a better understanding of why trend is so elevated across all of these products. I know you've already mentioned kind of the buckets that they're elevated in, but is there something driving that this year that would give you confidence or optimism that these trends will start to moderate in future years? It's just not clear to me why we're so persistently high and therefore it's hard to forecast how much margin improvement we should be forecasting.

Interesting question. You know, we have really we have our arms around the what. I think the industry generally doesn't have their arms around the why. I mean, you go cost component by cost component for behavioral. The prevalence of behavioral conditions is up, so the prevalence is higher.

The stigma around getting services has begun to disappear in older populations that existed and younger populations doesn't. States have encouraged us to widen our networks. People did not go for services during the pandemic, and now they are. So there's some pent up demand, but I could go cost category by cost category. And, you know, it's a supply and demand side equation.

The supply side is finding interesting ways to code, to bundle codes, etcetera, using AI, etcetera. So there's a myriad of reasons why the demand is higher and the supply is more rich. But it's happening nationally and it's not just Medicaid, it's not just Medicare, it's in commercial populations, self insured populations, it's across the board.

Okay, and then maybe it's just the second question would just be on timing because I think that, you know, these rate cycles go through and they're still always on a lag. I mean, do you believe that, you know, when you get these rate updates, you'll be at in that target margin range next year? Does it take more rate cycles? It just seems like the risk pool is continuing to shift underneath everything and that you'll get the rate cycle to reflect last year's cost, but this year's cost will be high, this year's cost will still see risk pool shifts. So like do you ever catch up?

Molina Healthcare (MOH) Q2 2025 Earnings Call Transcript

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