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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

Please note, this event is being recorded.

turn the conference over to your host today, Jeffrey Geier. Please go ahead.

Good morning, and welcome to Molina Healthcare's fourth quarter and full year twenty twenty four earnings call. Joining me today are Molina's President and CEO, Joe Zabreski and our CFO, Mark Skine. A press release announcing our fourth quarter and full year twenty twenty four 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, 02/06/2025, 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 fourth quarter and full year twenty twenty four earnings release. During the call, we will be making certain forward looking statements, including, but not limited to, statements regarding our 2025 guidance, the estimated amount of our embedded earnings power and future earnings realization, expected Medicaid rate adjustments and updates, our projected MCR, our recent RFP awards, our acquisitions and M and A activity, revenue growth related to RFPs and M and A activity and our long term growth strategy. 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 K annual report filed with the SEC as well as our risk factors listed in our Form 10 Q and Form eight K 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 Zabrzky. Joe?

Thank you, Jeff, and good morning. Today, I will discuss several topics. Our reported financial results for the fourth quarter and full year 2024, our growth initiatives and related increases to embedded earnings, and our full year 2025 premium revenue and earnings guidance. Let me start with our fourth quarter performance. Last night, we reported adjusted earnings per share of $5.05 on $10,000,000,000 of premium revenue.

Our fourth quarter results and performance metrics did not meet our expectations, but we did demonstrate a continued ability to maintain operating discipline while navigating industry wide headwinds. Our 90.2% consolidated MCR was higher than expected due to medical cost pressure in our Medicaid and Medicare segments. In Medicaid, our fourth quarter twenty twenty four guidance assumed a moderate increase in trend, often elevated cost baseline from the third quarter. However, the medical cost pressure experienced in the fourth quarter was higher than anticipated with risk corridors providing no material benefit. Medicare continued to experience higher medical costs consistent with prior quarters and marketplace performed very well despite the late in year medical cost seasonality we typically experience.

For the full year 2024, we reported adjusted earnings per share of $22.65 representing 8.5% year over year growth. Our full year premium revenue of $38,600,000,000 represents 19% year over year growth and our pre tax margin of 4.3% was well within our long term target range. While our fourth quarter performance resulted in our full year results falling below our guidance, We have a solid earnings jump off point heading into 2025 and continue to be very bullish on the growth opportunities within all of our businesses as evidenced by our increased embedded earnings. In Medicaid, our flagship business representing nearly 80% of revenue, we reported a 90.3% MCR for the full year or 89.8% when adjusting for the impact of higher MCRs on new stores and the prior year California retro items. With respect to observed medical cost trend in 2024, it was certainly a tale of two halves.

In the first half of the year, medical costs trended slightly higher than our initial expectations, primarily due to the acuity shift caused by redeterminations. However, MCRs remained lower in the first half of the year because the acuity shift impact was moderated by our medical cost management, risk corridor protection and rate increases. In the second half of the year, we experienced higher than expected utilization among the continuing population. The second half rate increases and risk corridors were not sufficient to completely offset the higher medical cost pressure that continued into the fourth quarter. In Medicare, the full year MCR was 89.1%.

The business performed as well as we could have expected given some of the dynamics the industry has experienced. In marketplace, the MCR was 75.4% for the full year and significantly outperformed our long term target range. This was the second consecutive year marketplace outperformed its long term target margins. This outperformance allowed us to reinvest excess margin into 2025 pricing to drive higher growth and sustain mid single digit pre tax margins. Our G and A ratio performance has been excellent at 6.7% for the full year.

We continue to have the discipline to harvest fixed cost leverage, manage our internal resources effectively, increase productivity and negotiate attractive vendor contracts. Turning now to our growth initiatives. 2024 was an extraordinary year for securing future growth on top of the reported 19% premium revenue growth. Starting with recent acquisitions. On February 1, we closed our acquisition of ConnectiCare from EmblemHealth and this year expect $1,200,000,000 of revenue mostly in marketplace.

With respect to new contract wins, in Georgia, the state announced its intent to award us a Medicaid managed care services contract. This was a significant win with an estimated $2,000,000,000 in annual premium revenue based on expected market share. We also had significant new contract wins in our dual eligible and integrated product businesses. We successfully procured dual contracts that will expand our footprint in Ohio, Michigan, Massachusetts and Idaho. The incremental revenue from these new contracts is over $3,000,000,000 an increase from the prior estimate of $1,800,000,000 we had shared at our November Investor Day.

Twenty twenty four was also a year in which we successfully defended RFPs in key states. We retained traditional Medicaid contracts in our Michigan, Florida and Wisconsin businesses. These contracts represent over $2,000,000,000 of renewed premium revenue. While we are disappointed in the Virginia contract loss, this award is under protest and the current contract will extend well into 2025. We are very pleased with the execution of our 2024 growth initiatives.

And in that context, we further note, when all of the aforementioned contracts are enforced, we are well on our way to meeting our target of $46,000,000,000 of premium revenue in 2026 and at least $52,000,000,000 in 2027. With our current footprint contributing its average annual growth and now fully considering all of our recent growth successes, the path to achieve these growth milestones recent activity has allowed us to increase our embedded earnings to $7.75 for 2026 and beyond after harvesting $1.5 of embedded earnings in our 2025 guidance. Having embedded earnings of at least 20% to 25 of run rate EPS is an attractive benchmark to support future EPS growth. Now at approximately 30%, we are very well positioned to meet our long term targets. In short, we are solidly on track to achieve the growth outlook we projected at our recent Investor Day.

Turning now to our 2025 guidance. We project 2025 premium revenue of approximately $42,000,000,000 and adjusted earnings per share of at least $24.5 which is approximately 8% year over year growth highlighted by an 88.7 consolidated MCR and a 4.1% pre tax margin. Similar to the situation we encountered in 2023, this $24.5 EPS guidance is burdened with $1 of contract implementation costs related to yet another significant future revenue growth cycle we secured this year. These are complex programs with a new contract in Georgia and fully integrated duals product launches in at least four states. These are not speculative investments, but investments that have near term and certain realizable value.

Mark will take you through the detailed earnings guidance build in a few minutes, but let me offer some high level segment commentary. First in Medicaid, Medicaid is projected to be nearly back to performing within our target ranges with an 89.9% MCR. For 2025, we project a continuing elevated medical cost trend during the year. Our 2025 Medicaid rates, most of which are known, are expected to be sufficient to capture this elevated trend. Whichever 2024 MCR you observe, Q4 at 90.2%, second half at 89.9%, full year at 89.8% or our 2025 guidance at 89.9%, our flagship business is hovering around the 90% mark, nearly 100 basis points off our long term MCR target.

The business is expected to produce an excellent pre tax margin of 4.3. When the broader market receives the rates it needs to bring itself back into balance, we expect to be operating well within our long term ranges and we believe that will be in the very near future. Next in Medicare, we would characterize 2025 as a year of transition and some early growing pains as the business transforms to serve the increasingly integrated in high growth dual eligible population. We expect our 2025 Medicare MCR to be slightly above our target range for three reasons. First, utilization pressure from the second half of twenty twenty four is expected to continue into 2025.

Second, recent rates have not kept pace with trend. And finally, while our long term outlook for Bright's earnings accretion is unchanged, we expect that it will be slightly below breakeven in 2025. Finally, in marketplace, we are projecting to grow premium at 60% in total, half of which is organic. Two consecutive years of exceeding target margins have allowed us to reinvest several hundred basis points of excess margin into pricing in order to grow. Our product is competitively positioned for this year and we are very pleased with our early enrollment results.

We expect the business to produce an MCR in the middle of our target range and a solid pre tax margin of 6% in 2025, while continuing to sustain mid single digit pre tax margins over the long term. Our businesses are positioned to produce an earnings per share outlook of $25.5 in 2025. This is a meaningful measure of underlying performance and represents 13% growth on full year 2024 results. When we include the new contract implementation costs of one dollars our adjusted EPS guidance for 2025 is at least $24.5 per share. This is a solid foundation off of which to grow and realize the embedded earnings power of the opportunities we have already secured.

Turning now to the political and legislative landscape. The facts are the Republicans control Congress with a very narrow majority and have a White House, Two budget reconciliation bills are likely to be passed in 2025 and political parties in the state legislatures and the governor's offices did not change materially in the last cycle and the states will weigh in heavily on any policy changes. The question and it is a question that has been posed and remains is whether cuts to Medicaid funding will be part of these legislative packages. We continue to believe that any changes to the Medicaid program as we know it today will be marginal. Neither side of the aisle wants to see an increase in the number of uninsured, a reduction in benefits for those relying on government assistance or the related impact to providers.

While our fourth quarter results fell short of our expectations, I am pleased with our team's ability to manage through the many industry wide headwinds in all of 2024. Our revenue growth has exceeded our long term targets. We have produced a consolidated pre tax margin within our long term target range and embedded earnings has reached a new high. The 2025 earnings profile is solid and perhaps industry leading in managed Medicaid. All of this allows us to remain very confident in our ability to achieve the long term targets that we shared with you at our November Investor Day.

Finally, I want to thank our 18,500 dedicated associates who work tirelessly on behalf of our members and our stakeholders. Their day to day efforts, particularly in the face of difficulty, danger and natural disasters are in a word heroic. 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 some additional details on our fourth quarter and the full year performance, the balance sheet and our 2025 guidance. Beginning with our fourth quarter and full year 2024 results. For the quarter, we reported approximately $10,500,000,000 in total revenue and $10,000,000,000 of premium revenue with adjusted EPS of $5.05 On a consolidated basis, our fourth quarter MCR was 90.2% and our full year MCR was 89.1% reflecting higher than expected medical costs in the second half of the year in both Medicaid and Medicare. In Medicaid, our fourth quarter MCR was 90.2%.

Consistent with the third quarter, the Medicaid MCR reflected higher utilization, particularly for LTSS, pharmacy and behavioral health services. We previously expected 50 basis points of trend in the fourth quarter of what we considered to be an inflated baseline in the third quarter. However, fourth quarter net trend was approximately 1.2% and we saw no material benefit from risk corridors. For the full year, the reported Medicaid MCR was 90.3, which restates the 89.8 when adjusting for the prior year California retro item and the impact of new store businesses. Given the unprecedented challenges of rates and trends in the year, we demonstrated strong operating performance with that MCR just 80 basis points above our long term range.

In Medicare, our fourth quarter MCR was 93.8% and our full year MCR was 89.1%, both above our long term range. Higher medical costs in the quarter reflected continued higher utilization of LTSS and pharmacy as well as higher outpatient utilization within our D SNP population. The fourth quarter also reflects the seasonal impact of CMS annual facility fee schedule increases and the revenue recognition of certain risk adjustment items. As Joe mentioned, we remain confident in our twenty twenty five bids and believe our pricing strategy was conservative enough to protect against higher medical cost trend that occurred in the second half of twenty twenty four and is expected to continue in 2025. In marketplace, our fourth quarter MCR was 83.3, reflecting normal late in year seasonality.

Our full year marketplace MCR was 75.4 and well below our long term target range for the second consecutive year. This allowed us to reinvest excess margin into pricing to achieve significant growth for 2025. Our adjusted G and A ratio for the quarter was 6.3 and our full year adjusted G and A ratio was 6.7. This was the second consecutive quarter we benefited from renegotiated vendor contracts and several one time items. We're very pleased with the disciplined cost management, productivity and leverage we continue to demonstrate.

Turning to the balance sheet. Our capital foundation remains strong. In the quarter, we harvested approximately $327,000,000 of subsidiary dividends. Our parent company cash balance was approximately $445,000,000 at the end of the quarter, a portion of which was used to fund the ConnectiCare acquisition, which just closed earlier this week. During the quarter, we repurchased 1,700,000.0 shares at a total cost of $500,000,000 dollars In November, we closed a bond offering of $750,000,000 of senior notes due in 02/1933.

Debt at the end of the quarter was 1.7x trailing twelve month EBITDA with our debt to cap ratio at about 41%. 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 48, consistent with the third quarter and well within our normal range. We remain confident in the strength of our reserves. Our operating cash flow for the full year 2024 was $644,000,000 This was lower than 2023 and primarily reflects the impact of risk corridor payments made in 2024.

Recall that earlier this year, we made several large corridor settlements related to prior years. Now some additional details on our 2025 guidance, beginning with membership. In Medicaid, we expect new membership growth from recent contract wins and growth in our current footprint to add over 100,000 members. We expect twenty twenty five year end membership of approximately 5,000,000 members. In Medicare, we expect to begin 2025 with approximately 217,000 members based on strong open enrollment in our D SNP product, somewhat offset by our exit from MAPD in 13 states for 2025.

The acquisition of ConnectiCare adds 39,000 members. Combined with organic growth in our Medicare business, we expect to end 2025 with approximately 250,000 Medicare members. In marketplace, based on very strong open enrollment, we begin 2025 with approximately 546,000 members, representing 35% growth in our legacy business. To that, we add the acquisition of ConnectiCare with approximately 66,000 members. Effectuation rates among renewing members were in line with prior years, while the effectuation rates on our new members are stronger than in recent years.

We expect smaller levels of SEP growth throughout the year compared to 2024 and forecast the year to end with approximately 580,000 members, almost 50% growth year over year. Our 2025 premium revenue guidance is approximately $42,000,000,000 representing approximately 9% growth from 2024. Our expected premium revenue growth is comprised of several items: $2,100,000,000 from growth in our current footprint, $1,200,000,000 from the acquisition of Kineticare and $600,000,000 of revenue tied to recent RFP wins. Partially offsetting these growth drivers are minor headwinds due to the annualized impact of last year's Medicaid redeterminations and reduction in our Medicare MAPD footprint. Our 2025 guidance assumes the extension of our Virginia Medicaid contract well into 2025, while we expect the start of Texas Star Chip contract to be delayed to 2026.

Moving on to earnings guidance. We expect 2025 full year adjusted earnings of at least $24.5 per share. Our EPS guidance reflects approximately $1.5 for the underlying organic growth in our legacy footprint, realization of $1.5 of new store embedded earnings and $0.9 benefit from lower average share count in 2025. These items are partially offset by approximately $1 due to higher interest expense driven by the bond offering we completed in November as well as lower net investment income. These components put our earnings outlook at $25.5 a share, an increase of 13% over twenty twenty four full year.

When we include the contract implementation cost of $1 for the recent Georgia and Medicare dual contract wins, our adjusted EPS guidance for 2025 is at least 24.5 I will note that these implementation costs are just 1% of the more than $5,000,000,000 in revenue we expect to see from the Georgia new contract win and the duals wins in four states. Turning to our 2025 MCR guidance. We expect consolidated MCR of 88.7%, Medicaid MCR at 89.9, 90 basis points above the high end of our long term range due to known and estimated rate increases just keeping pace with expected trend. This is almost in line with the 2024 normalized MCR of 89.8, which excludes the impact from new store businesses and the California retro item. We expect full year rate increases of 4.5% with 75% of our full year premium already known at approximately 5% and the remaining 25% estimated at 2.5%.

Our Medicaid NCR guidance includes trend assumption of approximately 4.5% and no impact from risk corridors as they remain constant over the two year period. Favorable second half rates versus our conservative estimates, any off cycle rate adjustments and further moderation in trend present upsides to our 2025 guidance. We expect Medicare MCR of 89%. The MCR reflects our conservative approach to 2025 bids and the expectation that utilization experience in the second half of twenty twenty four will continue into 2025. In marketplace, we expect MCR of 79% squarely within our long term target MCR range of 78% to 80%.

Moving on to select P and L guidance metrics, we expect adjusted G and A ratio of 7%, which reflects 20 basis points of new business implementation costs and 20 basis points due to a higher mix of marketplace membership, partially offset by leverage and increased scale of our business. Normalizing for these items, our guidance G and A ratio falls to 6.6, again demonstrating continued operating leverage year over year. In other guidance metrics, we expect effective tax rate of 25.3%, adjusted pretax margin of 4.1% within our long term range, weighted average share count of 55,600,000 shares, and we expect quarterly earnings to be evenly distributed throughout the year. Turning to embedded earnings. At our recent Investor Day, we had $6 of new store embedded earnings.

To this, we add $1.25 for the Georgia Medicaid RFP win, $1 for our additional duals contract wins in four states and the contract implementation costs of $1 leaving us with $9.25 from acquisitions and new contracts. Our 2025 guidance includes the realization of $1.5 to yield embedded earnings of approximately $7.75 going into 2026, giving us high confidence in our 13% to 15% long term growth rate. This concludes our prepared remarks. Operator, we're now ready to take questions.

Yes. Thank you. We will now begin the question and answer session. And this morning's first question comes from Andrew Mok with Barclays.

Hi, good morning. At the Investor Day, I think you gave us an illustration of what's needed to deliver on 89% Medicaid MLR in 2025. Can you give us a little bit more color on the components within that between rates, trend and corridors that came in better or worse than expectations resulting in Medicaid MLR 90 basis points above that? Thanks.

Sure. Andrew, I'll frame it and then I'll turn it to Mark. The MLR guide for 2025 in Medicaid is basically flat with 2024. We have good visibility into rates. We're projecting a 4.5% rate increase and a 4.5% trend of the 2024 baseline.

That rate increase, 75% of it is known at 5%, twenty five % of it is estimated at 2.5% blending to 4.5%. On the trend number, we fully considered the second half pressure as we trended into 2025. All the pressures we saw in the second half of the year continuing into the fourth quarter, we included in our outlook for medical costs in 2025. That puts us only 90 basis points above the high end of our long term range, which we feel really good that we're maybe a rate action or two, not a rate cycle, but a rate action or two away from being at the top end of our long term range at 89. Mark, any color?

Yes. I'll just do a quick reconciliation of where we are now versus what we said at IR Day. At IR Day, we were jumping off the second half of the year and we wound up 60 basis points higher in the second half of the year for the results of the fourth quarter. Per Joe's comment, we also thought that that the combination of rates, corridors and trends would give us about 20 bps. They wound up being pretty much breakeven, so we got about zero out of that.

So about 60 basis points worse on the jump off point and pretty much didn't get the rate versus trend of benefit of 20 bps that I was looking for at Investor Day.

Got it. And then in the prepared remarks, I think you said risk corridors didn't provide a material benefit. Can you help us understand cited about 100 basis points remaining at the third quarter call. Thanks.

It's a matter of geography. As we've always said, we're almost low to give a number of how deep we are in the corridors because while it is a hedge, it's an imperfect hedge. If you have underperformance, it depends where that underperformance happens, whether you get the benefit of the corridor. And in the fourth quarter of this year, while we had forecasted, I believe 50 basis points of trend pressure absorbed by the corridors, it didn't pan out that way. Mark, anything to add?

No, that's exactly right. We're in 21 states. And the benefit of the corridor is not evenly distributed across 21 states. So what really matters is where does the trend pressure show up versus where is corridor protection remaining and that can either help you significantly or it can leave you no benefit, which is more or less what happened in the fourth quarter.

Thank you. And the next question comes from Stephen Baxter with Wells Fargo.

Hi, thanks. I appreciate the color on the full year Medicaid MLR and the components impacting it. I was hoping you could give us also the fourth quarter breakdown, if there's any lingering impact from new store, any impact from retros either positive or negative? And then to the extent maybe there was any negative development in the quarter to potentially spike out in Medicaid, just trying to understand the jump off point a little bit more clearly to think about the achievability of guidance? Thank you.

On the Medicaid MCR in the fourth quarter, it actually was merely a case, not to oversimplify it, of fourth quarter dates of service trending at 1.2% versus a forecast of 50 basis points. There was no one time items. There were no retros anticipated or received. It was from an accounting perspective very, very clean. Trend outpaced our estimate, quarters protection provided no benefit.

The typical suspects, higher utilization among the stayers population, particularly for LTSS, pharmacy and BH. BH inpatient was up and look at on the pharmacy side, it's not only GLP-1s that are causing the pressure, but other high cost therapies. The trend pressure in the fourth quarter was the same as we experienced in the third quarter and was not muted, benefited or detrimented by any one time items or artifacts.

Okay. And then just as a follow-up, would you be able to share the IBNR balance at the end of the year just to help us evaluate the reserve picture? Thank you.

Absolutely. On medical claims payable, you might have seen we were at $4,600,000,000 The DCP, which is an imperfect measure, but I know why you guys use it, was $48,000,000,000 Just to put that in context, over the last three years, DCP averaged 49. At the low was forty seven one quarter at the high was fifty one one quarter but averaged 49. The biggest driver of volatility around DCP and IV and R is how fast cash goes out the door, right? Because the actuaries have a very consistent process of accruing liability.

Having said that, cash payments are a little bit lumpy. So we're at 48%. That's the same sequentially quarter over quarter, well within the middle of our range. I think that's a good proxy for the IVR.

Thank you. And the next question comes from Josh Raskin with F and R.

Hi, thanks. Good morning. It seems like the marketplace MLR was worse in the fourth quarter. I'm not hearing much commentary around that. So maybe what the specific drivers were there relative to what you guys had put up at Investor Day?

And then just back on the Medicare Advantage, maybe if you could give us a little bit more of the specifics on the Medicare Advantage pressures in 4Q, especially in the acquired book from Bright and maybe what changes you made in 2025 to give you confidence in the bids?

I'll turn it to Mark for the marketplace commentary in Q4. Mark?

Absolutely. Hey, good morning, Josh. Look, nothing more on marketplace than normal seasonality. As you know, because of deductibles, co pays, things like that, marketplace is fairly seasonable and tends to be running hotter later in the year. Look, we were at 83.3% maybe it's a little bit higher than we thought too.

But on a full year basis coming in at a 75% we feel pretty good about the year. Just chalk it up to a little seasonal noise.

And the only thing I'll add to that is when you're coming in at 75% for the full year, we now have two consecutive years of being able to invest what we call excess margins, margins that came in at 10% pretax into the growth of the product. We're now one or two priced silver in 50% of our geographies. As Mark said, we ended the year with 400,000, we're going to start the year with 600,000, end the year with 580,000 members. It's a great story. And we believe that given the dampening effect of special enrollment during the year unlike last year, that it's a very stable book of business and we have high confidence in the 6% pretax margin and the 79% MCR we're projecting for next year for 2025.

Yes, absolutely. We reported a 93.8 on Medicare. Part of that is just the industry wide trend that everybody is seeing. Joe mentioned the drivers of trend in Medicare, LTSS both skilled nursing facility and in home, a variety of pharmaceuticals. And then the inpatient and outpatient both have a number of drivers in them.

Again, that's not unique to Molina. I think we're seeing that just about everywhere. Part of the story too which compounds the MLR is on the revenue side. We wound up adjusting some of our risk adjustment ultimates. The way risk adjustment works is obviously you do a lot of provider in office risk adjustment.

We also do a lot of in home assessments, the combination of those. We adjusted our ultimate and took down some of the revenue a little bit. That's kind of a one time item. The knock on question, Josh, which I would expect you to ask is how does that tee you up for next year? And I think, look, rates aren't great for next year.

We're pretty conservative on trend based on what we saw Q3, Q4. So what you're seeing is not a strong move in MLR year over year, just reflecting a lot of that. You'll see us pretty much a little bit over the top end of our range for guidance, but nevertheless we feel we're pretty conservative on trend just given what we saw Q3, Q4.

The only other comment I'd add on Medicare is the Bright business. While we have full confidence in the 1,300 basis point turnaround to get to the full dollar of accretion, we're not going to be quite at breakeven this year, it will be slightly lower, which is putting a little bit of pressure on the margins. But at 89% MCR for next year, a 2.2% pretax margin on nearly $6,000,000,000 of revenue, keys us up nicely to take advantage of the growth aspects of the duals and the integrated products. So we're quite bullish on our prospects here at Medicare and with the early twenty twenty six rate notice, I think we're queued up for margin expansion in 2026 and beyond.

Thank you. And the next question comes from Sarah James with Cantor Fitzgerald.

Thank you. It sounds like you're assuming 4.5% cost trends in 25% down from the 6% you were experiencing in 3Q. What was 4Q cost trend and what's driving your assumptions of cost trend lowering in 2025?

Let me do full year over year and then I'll kick it to Mark, because it can get quite complicated depending on which period you're comparing. In 2024 in Medicaid, our cost trend was 6.5%, half of which was the acuity shift due to redetermination and half of which is what we call core utilization, higher utilization of the continuing population. Comparing that to the 4.5% trend in 2025, the acuity shift doesn't recur. So we're actually projecting a 4.5 core utilization trend in 2025 compared to a 3.25% core utilization trend in 2023, which is 125 basis points higher. Now depending what period you compare, but we think that is a very clean and clear way of looking at it.

We considered every nuance of utilization trend in the third and fourth quarters to inform that trend, property by property, DRG by DRG, and we're very confident in that projection. Mark, anything to add?

I would just repeat that Joe, because it's a big point. Last year was 6.5% trend, half of it was directly because of mix of redetermination. So the other half was just hot users, the stairs. So 3.25% I call it. This year we're projecting 4.5% trend which is directly comparable to that 3.25% number last year.

So you can see we've got pretty strong trend baked into our 2025 outlook. Now I think that's prudent based on where we are. But if the second half of last year was the new normal, that's assuming a pretty strong trend above what we've seen in other kind of normal years. So pretty strong trend at 4.5%. And as we've also mentioned, offsetting that trend of 4.5% in 2025 is roughly 4.5% of rates.

Now when we think about rates, we parse known versus estimated. 75% of our rates are known for 2025 at 5%, twenty five % we're still estimating, but we feel conservative at those rates at 2.5%. So they weighted average to 4.5. I know most of them and I'm pretty conservative on what I'm estimating. But the high level news for 2025 is 4.5% trend assumption, 4.5% rate mostly known, some assumed.

That's helpful. Maybe just one more clarification, since you know 75 of the rate and you have a pretty good view of where margins lay, does that mean that you could get into your long term goals for Medicaid margins for the whole of 2025 or would it be more exiting 2025?

We would need we conservatively estimated the 25% of rates we don't know at 2.5% and the 75% we do know came in at 5%. Is it conservative? Perhaps. So there could be some upside if we get rate increases north of the 2.5 that we estimated. By the way, we never forecast retros and our rate advocacy process, which is really robust, advocating for actual early sound rates in all of our contracts could provide some retro activity in 2025 on 2024, but we never forecast that.

That would be additional upside if we achieve that.

Thank you. And the next question comes from Justin Lake with Wolfe Research.

Thanks. Good morning. I'll ask another question on trends, because you guys have done such a good job of kind of laying it out for us at the Investor Day and today. If I look at the Investor Day deck, you're saying in the third quarter sequentially you had a 2.6% increase in trend. Fourth quarter, now you're saying 1.2%, right?

So just annualizing that back half into the first half of next year, if I'm doing the math in my head correctly, should be like a 2% trend kind of just catch up as you annualize. So I'm just trying to think, Joe, like maybe you could talk to us in a similar way that you did as you did at the Investor Day and today, like just like what are you really expecting for quarterly trends? If you think about those little kind of green bars you put at the Investor Day deck for trend, what would you like I would think they might only be 50 basis points a quarter to get the 4.5% because you still got to annualize the back half of this year. Am I thinking about that incorrectly?

As I said, when sir asked your question, it gets really complicated depending on what period you want to use. Obviously, if you use just the second half, the 4.5% trend number is a lower number for 2025 than it is for 2024 to oversimplify the case. I'll turn it to Mark. We do have a lot of analysis on the quarterly progression of this. Mark?

Hey, Justin. So last year, we mentioned 6.5% trend across the year, full year. But at Investor Day, to your point, we also jumped off a second half of the year view just because we said, gee, maybe the second half is the new normal. So let's baseline off that. If you look at our guidance full year over year, we said 4.5% of rates, 4.5% of trend.

If you jump off of second half in the framework like we did at Investor Day, it would be more like 2% rates, 2% trend. And now that 2%, you can start to think more like in quarterly increments and you're probably closer to your 50 bps a quarter that you're thinking about.

Perfect. Thanks. And then just a couple of quick numbers questions here. You talked about some one time benefit in SG and A. Can you give us some more color on that?

And then Joe, you said you're not rates away, you said you're rate actions away in one or two places. Can you tell us like can you give us any specificity? It sounds like it's a couple of states that you need some rate updates from. Are those larger states or are there smaller states where you need big rates or larger states where you're just waiting for some true ups there?

First thing I would say is the 2.5% that we projected on rates that we don't know about is perhaps conservative. But let me frame it this way. The rate action versus cycle comment was merely to reflect we're operating no matter which way you cut this, second half Q4 full year or 2025 guidance, we're operating 100 basis points above the high end of our long term range, 100. Based on analysis that we've done, external reports, regulatory filings, we believe that many market participants are operating at 200, three hundred, maybe even 400 basis points above an acceptable MCR range. That might take a rate cycle, but when you're 100 basis points above the long term range, maybe a rate action or two will get you there.

That's my point. I don't think this has to cycle through one or two times in order to get there. 90 basis points is $4 a share on $32,000,000,000 of revenue. So if we can get back to the top end of our range, when the market gets the rates it needs to get back into balance, we will comfortably be operating in the high 80s, paying into the quarters like we were before all this happened and that's exactly where we want to be, high 80s and paying into the corridors to provide that 200 basis points of protection.

Thank you. And the next question comes from A. J. Rice with UBS.

Hi, everybody. First, I just wanted to ask about quarterly progression across '25, if there's anything you can do to help us think about that. Obviously, you got the dollar of startup costs. I assume that's more backend loaded. You've got the rate updates, which we've been talking about on Medicaid and maybe you would have a positive progression there contributing to EPS.

And then you've got more public exchange business, which is going to exacerbate the fourth quarter, it sounds like. Any way you can give us a little bit of flavor for how you think quarterly earnings layout over the course of the year?

Sure. I'll turn it to Mark. When you have the items appropriately captured that factor into the seasonality projection of the business. Mark, color?

Hey, A. J, good morning. Yes, so normally we're a little bit front end loaded with EPS. And what I'm saying this year is we'll be fifty-fifty very evenly distributed quarter to quarter. So what's different?

The first big driver is you've got a specific accounting of where we are on rates within the year quarter to quarter. We talked about how we know 75% of them, but we also know specifically when they come in. We also have a specific view on that trend number of 4.5%, how it's seasonalizes. So you've got that as one of the bigger drivers. Next, you've got just a little bit of carryover from new stores last year.

It's not as big a phenomenon as it was last year, so we're not going to call significant attention to it, but you still got a little bit of that going on. So that more or less levels MLR quarter to quarter in the year. Now the other thing that's going on is G and A. I heard your statement, but believe it or not, we're front end loaded on G and A this year with a lot of the initiatives we have. We have a bunch of Go Readys, 01/01/2026.

And a lot of the IT spend, a lot of the upfront investment comes in early, which front ends our G and A. So those things are a little bit different this year. I take your point on more marketplace, which is typically a little bit back end loaded on MLR. Yes, that's true. But you put our three businesses together, we've got a pretty even outlook on our margins and therefore our EPS.

Okay. All right. That's helpful. And then I just wanted to ask, I know you guys mentioned in the prepared remarks about keeping an eye on what's going on in Washington. Obviously, there's a lot of chatter about potential Medicaid reform.

Is it a situation where at this point you're having some discussions with the states about how they might respond to some of these scenarios and maybe relying on history, does it tend to push the states to put more of the people that they haven't put in managed Medicaid into managed Medicaid? Is there enough flexibility in the benefit design that if there's pressure on Medicaid funding that they tweak benefits and how does that impact your business? Any thoughts you can give us along those lines?

I can't. I can't give you any answers, but I can give you our thinking. And you're absolutely right about the way you're focused on it. Look, the market really focuses on the how. If you come up with a per capita cap scheme, FMAP match for reduction, FMAP match reduction on expansion, block rents, whatever the mechanism is, the CBO can score it.

That's not the issue. The issue is what are you going to reduce in terms of where the money goes. You've got 25,000,000 people in marketplace, 92% subsidized, 20,000,000 people in expansion, 100% subsidized at ninety percent and twenty five million uninsured population, 9.5% of the eligibles. Tell me which number you want to see changed. Neither side of the aisle wants to see more uninsured, below 10% of eligibles for the first time in decades.

Reduction in benefits, reduction in enrollment, reduction in payments to providers or none of the above and I either have to as a state decrease my education budget or raise taxes. None of those solutions is politically tenable. That's what to focus on. The way to cut a cost is actually really and financially determinable. Where that would go is where the political tension exists.

Molina Healthcare (MOH) Q4 2024 Earnings Call Transcript

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