8-K
Molina Healthcare, Inc. (MOH)
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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FORM 8-K
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Current Report
Pursuant to Section 13 OR 15(d) of the Securities Exchange Act of 1934
Date of Report (Date of earliest event reported): May 16, 2023 (May 15, 2023)
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MOLINA HEALTHCARE, INC.
(Exact name of registrant as specified in its charter)
| Delaware | 001-31719 | 13-4204626 |
|---|---|---|
| (State or other jurisdiction of<br><br> <br>incorporation) | (Commission File Number) | (IRS Employer Identification No.) |
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| 200 Oceangate, Suite 100,<br> Long Beach, California<br> 90802 |
|---|
| (Address of principal executive offices) (Zip Code) |
Registrant’s telephone number, including area code: (562) 435-3666
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:
☐ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)
☐ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)
☐ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))
☐ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))
Securities registered pursuant to Section 12(b) of the Act:
| Title of each class | Trading Symbol(s) | Name of each exchange on which registered |
|---|---|---|
| Common Stock, $0.001 Par Value | MOH | New York Stock Exchange |
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter).
| Emerging growth company | ☐ |
|---|---|
| If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any<br> new or revised financial accounting standards provided pursuant to Section13(a) of the Exchange Act. | ☐ |
Item 5.02. Departure of Directors or Certain Officers; Election of Directors; Appointment of Certain Officers; Compensatory Arrangements of Certain Officers.
Effective as of May 15, 2023, Jim Woys and Mark Keim were each promoted to the position of senior executive vice president of Molina Healthcare, Inc. (the “Company”). Mr. Woys assumed the role of the Company’s chief operating officer, and Mr. Keim will continue as the Company’s chief financial officer with expanded operational and growth-related responsibilities.
Biographical and other information about Messrs. Woys and Keim required by Item 5.02(c) of Form 8-K is included in the Company’s proxy statement on Schedule 14A for its 2023 annual stockholders’ meeting filed with the Securities and Exchange Commission on March 20, 2023, and such information is hereby incorporated by reference into this Item 5.02. There were no changes to the compensation of Messrs. Woys and Keim incidental to their promotions.
A copy of the press release announcing the promotions of Messrs. Woys and Keim is included as Exhibit 99.1 to this report. The information in the website cited in the press release is not part of this report.
Item 7.01. Regulation FD Disclosure.
On May 15, 2023, the Company presented and webcast certain slides as part of the Company’s presentation at its Investor Day Conference, a copy of which slides is included as Exhibit 99.2 to this report. The Company’s presentation included forward looking statements regarding, without limitation, the Company’s growth strategy and long-term outlook, the realization of embedded earnings, the achievement of future premium targets, the expected sustaining of the Company’s profit margins, future RFPs, the Company’s mergers and acquisitions pipeline, future Medicaid rates and carve-ins, the Company’s 2023 guidance, Medicaid redeterminations or reverifications, and the Company’s general business plans. Listeners and readers are cautioned not to place undue reliance on any of the Company’s forward-looking statements, as forward-looking statements are not guarantees of future performance and the Company’s actual results may differ materially due to numerous known and unknown risks and uncertainties. Those risks and uncertainties include, but are not limited to, the risk factors identified in the section titled “Risk Factors” in the Company’s 2022 Annual Report on Form 10-K.
An audio and slide replay of the live webcast of the Company’s Investor Day presentation will be available for 30 days from the date of the presentation at the Company’s website, www.molinahealthcare.com. The information contained in such websites is not part of this report.
Note: The information in Item 7.01 of this Form 8-K and the exhibits attached hereto shall not be deemed to be “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or otherwise subject to the liabilities of that section, nor shall it be deemed incorporated by reference in any filing under the Securities Act of 1933, as amended, or the Exchange Act, except as expressly set forth by specific reference in such a filing.
Item 9.01. Financial Statements and Exhibits.
(d) Exhibits:
| Exhibit<br><br> No. | Description |
|---|---|
| 99.1 | Press release of Molina<br> Healthcare, Inc. issued May 16, 2023 announcing promotion of two senior executives |
| 99.2 | Slide presentation given at the Investor Day Conference of Molina Healthcare, Inc. on May 15, 2023 |
| 104 | Cover page information from Molina Healthcare, Inc.’s<br> Current Report on Form 8-K filed on May 16, 2023 formatted in iXBRL (Inline Extensible Business Reporting Language) |
SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
| MOLINA HEALTHCARE, INC. | ||
|---|---|---|
| Date: May 16, 2023 | By: | /s/ Jeff D. Barlow |
| Jeff D. Barlow,<br><br> <br>Chief Legal Officer and Secretary | ||
| Exhibit 99.1 | ||
| --- |
Molina Healthcare Announces Promotions of Two Senior Executives
LONG BEACH, Calif.--(BUSINESS WIRE)--May 16, 2023--Molina Healthcare, Inc. (NYSE: MOH) (“Molina”) today announced that Jim Woys and Mark Keim have each been promoted to the position of senior executive vice president, effective May 15th. With this promotion, Woys also assumes the role of chief operating officer. Keim will continue as chief financial officer with expanded operational and growth-related responsibilities.
Woys has served as Molina’s executive vice president – health plan services, since May 2018. Keim had served as Molina’s executive vice president – transformation, since January 2018, and became chief financial officer in February 2021.
"Jim and Mark have been instrumental leaders of Molina’s growth and performance over the past five years," said Joe Zubretsky, president and chief executive officer of Molina. "I look forward to working with them and our deep and talented leadership team to drive the next wave of value creation for all of our stakeholders."
About Molina Healthcare
Molina Healthcare, Inc., a FORTUNE 500 company (currently ranked 125), provides managed healthcare services under the Medicaid and Medicare programs and through the state insurance marketplaces. Molina Healthcare served approximately 5.3 million members as of March 31, 2023, located across 19 states. For more information about Molina Healthcare, please visit molinahealthcare.com.
Contacts
Investor Contact: Joseph Krocheski, Joseph.Krocheski@molinahealthcare.com, 562-951-8382
**Media Contact:** Caroline Zubieta, Caroline.Zubieta@molinahealthcare.com, 562-951-1588
| Exhibit 99.2 |
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Investor Day 2023Sustaining Profitable Growth:The Next Wave May 15, 2023
Sustaining Profitable Growth: The Next Wave Topic Speaker Welcome and Introduction Joe Krocheski Sustaining Profitable Growth Joe Zubretsky Compelling Financial Profile Mark Keim Executive Q&A Joe Zubretsky Mark Keim
Cautionary Statement Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995: This presentation and the accompanying oral remarks include forward-looking statements regarding, without limitation, the Company’s growth strategy and long-term outlook, the realization of embedded earnings, the achievement of our future premium targets, the sustaining of our profit margins, future RFPs, our M&A and acquisitions pipeline, future Medicaid rates and carve-ins, our 2023 guidance, Medicaid redeterminations or reverifications, and the Company’s general business plans. The Company intends such forward-looking statements to be covered by the safe harbor provisions for forward looking statements contained in the Private Securities Litigation Reform Act of 1995. Readers and listeners 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 materially due to numerous known and unknown risks and uncertainties. Those risks and uncertainties are discussed under Item 1A in the section entitled “Risk Factors” in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022, and also in the Company’s quarterly reports, current reports, and other reports and filings with the Securities and Exchange Commission, or SEC. These reports can be accessed under the investor relations tab of the Company’s website or on the SEC’s website at www.sec.gov. All forward looking statements in this presentation represent management’s judgment as of May 15, 2023, and, except as otherwise required by law, the Company disclaims any obligation to update any forward-looking statements to conform the statement to actual results or changes in its expectations..
Sustaining Profitable Growth Joe Zubretsky President and Chief Executive Officer
Our Historical Performance Our trailing three-year performance has exceeded our long-term targets What We Delivered 2020 to 2023G 20% Premium revenue CAGR $4B of growth in current footprint $3B realized new RFP wins $7B realized from acquisitions 4.5% average adjusted pre-tax margin 24% Adjusted EPS CAGR 59% Bronze Silver What We Said We Would Do 13% - 15% premium revenue growth, driven by: Organic growth in our current footprint Strategic initiatives Accretive acquisitions 4% - 5% Adjusted pre-tax margins 15% - 18% EPS growth
Our Performance Outlook Continued execution of growth strategy with updated premium revenue target of $46 billion in 2026 while sustaining margin profile How We Will Do It Maintain our balanced approach to growth Realize $4.5B of premium from recent RFP wins Harvest $4.50 of new store embedded EPS Sustain our industry leading margin profile Execute the Molina Playbook 59% Bronze Silver What We Will Do – The Next 3 Years 13% - 15% premium revenue growth, driven by: Organic growth in our current footprint Strategic initiatives Accretive acquisitions 4% - 5% Adjusted pre-tax margins 15% - 18% EPS growth
Sustaining Profitable Growth Our Value Creating Franchise Retrospective Performance Excellence Our Performance Outlook The Growth Model Current Environment
Our Value Creating Franchise
Franchise Leading pure-play, government-sponsored managed care franchise with depth, breadth and scale 125Ranking $32B Premium Revenue 2023G 5.1MMembers YE 2023 22States 2024 3Products Medicaid, Medicare and Marketplace
Balanced Portfolio 6-10% >10% 5% or less Percent of Total Premium Revenue $32B 2023G Premium 13% Medicare 5% Marketplace 82% Medicaid Synergistic Medicare and Marketplace Segments Complement Medicaid Well Diversified 22 State Portfolio Increasingly geographically diversified portfolio of complementary product segments, with Medicaid as the flagship 2024 Start
Portfolio Synergies Synergistic product segments provide member continuity and leverage common capabilities Federal Poverty Level 400 - 250 - 138 - 100 - 150 - MAPD Duals Medicaid Marketplace (low subsidy) Marketplace Target (max subsidies) MAPD Target (low-income) <65 >65 Continuity for “age ins” Mobility as income levels change Age
Retrospective
Premium Revenue Growth Our trailing three-year growth has exceeded our long-term targets 8% - 10% 5% 13% - 15% 10% 10% 20% 2020 - 2023G Achieved 2021 IR Day LT Target
Organic Premium Revenue Growth We have delivered total organic growth at the high end of our long-term target 2021 IR Day LT Target 2020 - 2023G Achieved 8% - 10% 5% - 8% 11% - 13% 8% - 10% 10% 2% 12% 12% Weighted Total Marketplace Medicare Medicaid
Molina Wins Proven success retaining existing contracts and delivering new store growth with RFP wins and accretive acquisitions New Procurements Reprocurements Announced M&A CA MS OH WA KY NV IA NE TX ABD IN LTSS $3B Premium Realized 2021-2023G $4.5B Premium To Be Realized 2024-25 $7B Premium Realized 2021-2023G IA
Premium Revenue Growth 20% trailing 3-year CAGR was well balanced between organic growth and M&A 2020 Current Footprint Strategic Initiatives M&A 2023G $18 $32 In $ Billions Organic
Adjusted EPS Growth Trailing 24% EPS CAGR driven by current footprint and realization of new store embedded earnings >$20.25 $17.92 $10.67 $13.54 New Store Realized ($1.00) ($1.50) ($1.00) New Store Additions $1.00 $4.00 $0.50 Ending Balance $2.50 $2.50 $5.00 $4.50 Realized New Store Organic growth in current footprint
Current Environment
Government Managed Care Market Our addressable markets exceed $1 trillion in annual spend with attractive and durable growth $443B 58M Members Members Spend $460B 31M Spend Members 16M $105B Sources: CBO, CMS and NHE Spend 8% Projected Long-term CAGR 9% Projected Long-term CAGR 5% Projected Long-term CAGR Marketplace Managed Medicare Managed Medicaid 2023 2023
Molina Market Share Opportunity Large enough for scale and relevance yet with significant local market share growth opportunity in all segments Average State Market Share National Market Share ~10% - 25% ~10% ~4% ~10% - 30% ~3% ~5% - 20% Medicaid #4 Nationally ~6% #7 Nationally ~3% ~2% Sources: Health Management Associates, State-reported data, CMS and Decision Resources Group Molina Top Competitors Top 15 Nationally Medicare Marketplace
Political and Regulatory Environment The political and regulatory environment strongly favors the social safety net of government- sponsored healthcare Medicaid Commitment to continuity of coverage during redetermination Continuing penetration of managed care through carve-ins and expansion Medicare Recent rate and program changes don’t materially alter long-term growth Bipartisan program support insulates from drastic change Marketplace “Family glitch” fix and extension of enhanced subsidies Rules to help transition redetermined Medicaid members to Marketplace Governors Legislatures Medicaid and Insurance Regulators State Level White House Congress HHS and CMS Federal Level
The Growth Model Medicaid / Medicare / Marketplace / Accretive M&A
Total Growth Long-Term Premium Revenue Growth - Unchanged Strong organic growth opportunities complemented by a disciplined acquisition strategy 8% - 10% 5% 13% - 15% Organic Growth Weighted Total Medicare Marketplace 8% - 10% 5% with Optionality 11% - 13% 8% - 10% Medicaid
The Growth Model Our growth model is well balanced between organic drivers and accretive M&A ~5% Bolt-ons in Core Products Lines 4% Member Growth and Rate 4% - 6% New Contracts Market Share Penetration Carve-ins 13% - 15% Industry Leading Profitable Growth Current Footprint Strategic Initiatives ~2/3 Organic ~1/3 Accretive M&A
Medicaid
Strategic Initiatives Organic Premium Revenue Opportunity Medicaid Long-Term Organic Growth Long-term organic growth rate of 8% - 10% driven by current footprint and strategic initiatives 1 Increase market share 2 Pursue LTSS carve-in and expansion opportunities 3 Win new RFP States 4% - 6% 8% - 10% ~4%
Increase Market Share Focus on fundamental operating tactics to drive significant market share opportunity Service Area Market Shares 11-15% 6-10% 5% or less >15% Engage providers to drive membership loyalty Improve quality scores to drive auto assignment Increase voluntary enrollment through community presence and awareness Maximize retention in redetermination Retain existing contracts 1% Increase in Service Area Market Share ~$2B 2026 Revenue Opportunity Actions
Win New RFP States New State procurement opportunities total ~$60 billion in annual premium revenue by 2026 Annual Contract Value 2024 2025 2026 GA ~$30B ~$20B ~$10B TX STAR Kids IN ABD AZ LTSS Contract Inception Year NH NM FL PA KS RI NC OR CO HI
2026 total premium revenue RFP opportunity ~$60B Pursue subset of opportunities ~40% ~30% Projected competitive win rate ~50% ~92% Projected market share ~20% ~30% 2026 Molina premium revenue opportunity ~$2.5B Sizing the New State RFP Opportunity Significant RFP opportunities and proven track record provide confidence in additional revenue growth from new State contracts Outlook Since 2021 IR Day
Molina’s Winning RFP Formula Our RFP success is built on execution of proven strategy and track record of operational excellence Target Selection Criteria 1 Size and duration of contract 2 Strength of incumbents 3 Number of awardees 4 Access to high-quality low-cost network 5 Rational rate environment Winning Formula Strong proposal writing team 2 Effective ground game that starts two years before RFP 1 Demonstrated track record of program success and leading capabilities 3 Experienced implementation team 4
~$26B in Opportunities Pursue LTSS Carve-in and Expansion Opportunities Numerous LTSS carve-in opportunities and potential expansion as States leverage managed care efficiency Pursue announced carve-in programs Leverage Molina’s leading LTSS capabilities and growing platform Advocate for expansion and additional carve-in programs Sources: CMS and Company estimates TX OH MS NE NV LTSS Carve-In Opportunities TX WI MS SC FL Expansion Opportunities Actions ~8% Service Area Market Share ~$2B 2026 Revenue Opportunity
Medicare
Molina Medicare Product Portfolio Several products within our growing Medicare segment serve high acuity, low-income populations Current Molina Medicare States Product States 2023G Members (K) 2023G Premium (B) ‘20-23G Premium CAGR MMP 5 64 $2.1 6% HIDE/FIDE 8 41 $1.1 54% D-SNP 9 42 $0.7 18% Low Income MAPD 17 28 $0.3 94% Total 18 175 $4.2 19%
Organic Premium Revenue Opportunity Strategic Initiatives Medicare Long-Term Growth Long-term organic growth rate of 11% - 13% driven by current footprint and strategic initiatives 2 Increase HIDE / FIDE share and penetration of Medicaid footprint 1 Increase D-SNP and low income MAPD market share 4% - 6% 11% - 13% ~7% 3 Maximize MMP conversion into HIDE/FIDE
Increase D-SNP and Low-Income MAPD Market Shares Execution of fundamental operating tactics drives significant market share opportunity Capture age-ins Expand direct sales channels Deepen targeted broker relationships Strengthen key provider relationships Improve retention through member engagement D-SNP and MAPD Service Area Market Share >5% 2-5% 1% or less Actions ~$1B 2026 Revenue Opportunity 1% Increase in Service Area Market Share
Increase HIDE / FIDE Share and Penetration of Medicaid Footprint Penetrating remaining footprint and increasing share in current Molina States provides meaningful growth lever Targeted introduction of HIDE / FIDE in Medicaid footprint Expand direct sales channels Deepen targeted broker relationships Develop key provider relationships Actions ~$1B 2026 Revenue Opportunity 1% Market Share Current Molina States with HIDE or FIDE Programs Current Molina HIDE or FIDE States with scale
Maximize MMP Conversion into HIDE / FIDE We will transition MMP members to HIDE or FIDE products in remaining MMP States by 2026 CMS sunsetting MMP demonstrations by 2026 Existing MMP members to be transitioned to alternative integrated HIDE / FIDE products Molina partnering with States to seamlessly transition members to these integrated Molina products Market Dynamics Molina MMP Footprint CA Conversion Complete
Marketplace
Strong Market Growth Several market dynamics are driving continued growth Source: CMS, Urban Institute and HHS Market Dynamics Enhanced subsidies were extended through 2025 Year-round Special Enrollment Period under 150% FPL was made permanent The “Family glitch” was fixed, expanding access Member transitions from Medicaid as redetermination resumes Market Growth 2020 12.0M 11.4M 2023 55% 56% 2021 2022 14.5M 16.3M 59% Bronze Silver Gold 54%
Marketplace Risk Pool Significant challenges to the stability of the Marketplace risk pool in recent years led to our reallocation of capital to attractive Medicaid and Medicare segments Changes that impacted who could enroll and when were often made after pricing was filed Regulatory Changes New players entered with aggressive pricing strategies, then exited after incurring significant losses Competitor Rotation Membership churn increased due to multiple regulatory changes, creating pricing and risk adjustment challenges Membership Churn
Strategic Initiatives Molina Market Shares Marketplace Option Value Continued Marketplace presence within Medicaid footprint provides option value for significant revenue growth once risk pools have stabilized ~$2.5B Revenue Opportunity Return to 2018 Market Share 2022 ~5% ~2% 2018 4 Exercise option upon market stabilization 3 Prioritize margin discipline 1 Focus on highly subsidized population 2 Maintain presence in Medicaid footprint
Accretive M&A
Our M&A Platform M&A is a key element of our long-term premium growth outlook 3 M&A generally as accretive as new procurement economics 4 Previously announced purchase prices are highly capital efficient 1 Ample excess cash flow internally funds acquisitions 2 We buy long-dated revenue streams 6 Expert integration teams ensure accretion targets are achieved 5 Underperforming properties yield “sweat equity” accretion
Acquisition Pipeline Acquisition pipeline remains robust with many remaining opportunities Strategic Fit and Synergies Large franchise opportunities Bolt on plans Turnaround opportunities ~300 Government Health Plans Near-Term Target List 1 Numerous acquisition opportunities remain 4 2026 revenue target assumes additional ~$4.5 billion of acquired revenue 3 Capitated risk, not services or vertical integration 2 Turnarounds provide attractive economics
2023 2022 2021 2020 M&A Track Record Seven transactions sequenced for manageable integration Announced Closed Confidential YourCare Health Plan YourCare Health Plan Cigna Texas Medicaid Magellan Complete Care Passport Health Plan Affinity Health Plan AgeWell New York My Choice Wisconsin Passport Health Plan Magellan Complete Care Affinity Health Plan AgeWell New York My Choice Wisconsin Estimated Mid-2023 Cigna Texas Medicaid 2019
Performance Excellence
Performance Excellence – The What We commit to excellent performance across many dimensions 4 Deliver high-quality healthcare and member experience 3 Target 4% - 5% enterprise pretax margins 1 Maintain target segment MCRs 2 Drive G&A ratio below 7% 5 Maintain pristine compliance
Performance Excellence – The How Molina achieves and sustains growth and margins while providing quality healthcare 4 Build Industry-Leading Team and Winning Culture 3 Execute the Molina Playbook 1 Focus on the Fundamentals of Managed Care 2 Deliver Value Added Products and Services
Performance Excellence - Execution Larry Anderson Human Resources Deb Bacon Medicare & Marketplace Jeff Barlow Legal Jason Dees Medical Affairs Amir Desai Information Technology Carolyn Ingram Marketing Mark Keim Finance and Strategy Ron Kurtz Chief of Staff Dave Reynolds Regional Health Plans Marc Russo Medicaid Health Plans Suzette Valentine Integration and Innovation Jim Woys Health Plan Services Joe Zubretsky President & CEO The Roster Operating Model Management Process Organization Design Talent Leadership Values Decision Rights “The Molina Manifesto” Proven leadership team and execution of Molina Playbook drive sustainable value creation The Playbook
Our Performance Outlook
Our Performance Outlook Continued execution of growth strategy with updated premium revenue target of $46 billion in 2026 while sustaining margin profile How We Will Do It Maintain our balanced approach to growth Realize $4.5B of premium from recent RFP wins Harvest $4.50 of new store embedded EPS Sustain our industry leading margin profile Execute the Molina Playbook 59% Bronze Silver What We Will Do – The Next 3 Years 13% - 15% premium revenue growth, driven by: Organic growth in our current footprint Strategic initiatives Accretive acquisitions 4% - 5% Adjusted pre-tax margins 15% - 18% EPS growth
Compelling Financial Profile Mark Keim Chief Financial Officer
Compelling Financial Profile Strong Capital Foundation and Discipline Long-Term Margin Targets Value Creation Model 2023 Guidance and Revenue Outlook
Long-Term Margin Targets
Medical Care Ratio 87.5% - 88.5% <7% 4% - 5% Pre-Tax Margin Long-Term Margin Targets We will grow premium at 13% - 15% and maintain our current margin profile Weighted Total At current portfolio mix Medicare Marketplace 87.5% - 88.5% 78% - 80% 87% - 88% 88% - 89% Medicaid
Medicaid Rate Environment Core rates are expected to remain actuarially sound with many COVID-era risk sharing corridors now expired Medical Cost Mechanisms COVID-era corridors eliminated in all but three States Remaining COVID-era corridors constrain current EPS by ~$2.00 Continuation of legacy minimum MLRs and experience rebate mechanisms Prospective rate setting, consistent with pre-pandemic methodology Rates reflect “actuarially sound” trend projection Expect off-cycle rate adjustments if redetermination shifts trend Core Rates
Medicaid Margin Sustainability Rate setting on total market population allows Molina to continually drive MLR outperformance Example Market MLRs 25% 25% 25% 25% Molina Outperformance Market Risk Pool Cost trend included in rates as CMS requires rate setting to be actuarially sound State actuarial processes set rates on total program population, not individual MCO’s Molina’s sustainable, best in class margins driven by continually outperforming total State populations All plans must satisfy quality requirements
Redetermination Trend Impact Numerous factors are expected to mitigate potential trend impact from redetermination MCR Drivers Cohort analysis indicates minimal exposure Mix effect of lower PMPM members disenrolling reduces impact Gradual disenrollment dilutes any potential 2023 impact ahead of normal rate cycle adjustments Experience rebates and minimum MLRs serve as a buffer Off-cycle and normal course rate adjustments address any cost trends for 2024 88.0% 87.4% 88.0% 88.5% 88.7% Reported Medicaid MCRs
Redetermination Cohort Analysis Cohort analysis indicates minimal exposure in Expansion and TANF / CHIP 40% Unchanged Up Slightly Medicaid Revenue Mix Members with greater than 1-year duration Members with less than 25% MCR Unchanged Members with coordination of benefits Negligible Potential Trend Impact ABD 30% Up Slightly Up Slightly Up Slightly Minimal Expansion 30% Up Slightly Unchanged Up Slightly Minimal TANF / CHIP
Disenrollment Timing and Rate Cycle Mid-year disenrollments come in advance of rate cycles, providing ample time for data-driven rate setting Confidential Redetermination Timeline 2023 Apr May Jun Jul Sep Oct 2024 Jan May 1 3 9 4 CMS Completion Deadline 52% 14% 10% 14% 10% MOH States Beginning Disenrollment Premium Revenue by New Fiscal Year / Rate Cycle
Operating Focus State-of-the-art medical economics platform Utilization management High-acuity care management Centers of Excellence for BH, Rx and LTSS Core technology, automation and quality Value based contracting Medical Cost Management Numerous capabilities drive medical cost efficiencies with focus on high-acuity populations Risk Adjustment Care Management Analytics Network Pharmacy Utilization Management Quality Payment Integrity Operating Focus
Member and provider experience New business development M&A integration Medical economics and data analytics Population health Automation and process redesign Digitization Centralization to Center of Excellence Transparency and discipline Outsourcing commodity services Expense Management Leveraging the Base Building Capabilities G&A Expense Management Continued expense management and operating leverage drive lower G&A ratio while building capabilities for continued outperformance 50% Variable 50%Fixed + -
G&A Leverage Geography New States leverage corporate cost structure while significant growth in legacy States doubles the operating leverage through corporate and local cost structures Full Year 2021E New State Growth Legacy State Growth Example G&A Ratios 3.5% 3.5% Stand-Alone Health Plan 1.75% 3.5% Pro Forma Corporate Costs Local Costs 7.0% 5.3% Corporate Cost Leverage Stand-Alone Health Plan Pro Forma Corporate Costs Local Costs 7.0% 3.5% Corporate Cost Leverage Local Cost Leverage 3.5% 3.5% 1.75% 1.75%
2023 Guidance and Revenue Outlook
Embedded Earnings Power 2023 Guidance and 2024 Building Blocks Adjusted EPS of at least $20.25 forms solid jump off for next year. 2024 EPS building blocks include current footprint, New Store growth, absence of implementation costs and redetermination Full Year 2021E Affirming Guidance New Store Growth New Contract Wins (CA, IA, NE, IN) >$4.00 Acquisitions (AgeWell & My Choice WI) $0.50 Total New Store Growth >$4.50 New Store Implementation Costs $0.75 Redetermination ($0.65) COVID-Era Corridors ~$2.00 Premium Revenue $32B Total Revenue $33B Adjusted EPS At least $20.25 MCR % 87.8% G&A % 7.1% Pre-tax Margin % 4.8%
Medicaid Redetermination We expect 2023 premium revenue impact of ~$0.5 billion and an additional ~$1.1 billion in 2024 Timing Duration Eligibility Redeterminations restarted in February, with first terminations effective April. States share timelines CMS requires States to complete by May 2024 Precedent and cohort analysis suggest retention of many members gained through pause in redetermination 800,000 Members gained organically since beginning of pandemic 400,000 Estimated 50% of members retained FY 2022 FY 2023 Implied Premium Revenue ~$3B ~$3.5B FY 2024 ~$1.9B 12 months
2023G Current Footprint RFP Wins Acquisitions Redeterminations Rx Carve-outs 2024 Outlook $32 Initial 2024 Premium Revenue Outlook Known building blocks provide line of sight to 13% premium revenue growth in 2024 before additional strategic initiatives >$36 Iowa - $0.9B Indiana - $0.5B Nebraska - $0.6B California - $2.0B My Choice Wisconsin full year ($1.1) In $ Billions ($0.3)
2023G Current Footprint Announced Identified M&A 2026 Before Regulatory Headwinds Redetermination and Rx Carve-outs 2026 Target $47.5 2026 Premium Revenue Target Premium revenue target drives 14% CAGR before absorbing regulatory headwinds with high visibility to significant portion of revenue drivers Strategic Initiatives Iowa - $0.9 Indiana - $1.0 Nebraska - $0.6 California - $2.0 $46 $32 In $ Billions ($1.4)
2026 Strategic Initiative Opportunity Targeted 2026 premium revenue requires execution of less than 25% of identified strategic initiatives $2.5 $2.0 $6.5 $11 2026 Premium Revenue Opportunity Gap to 2026 Premium Revenue Target $2.0 Increase market share $2.5 Win new RFP States $2.0 Pursue carve-in and expansion opportunities $1.0 Increase D-SNP and MAPD market share $1.0 Increase HIDE/FIDE share and penetrate Medicaid footprint - Maximize MMP conversion into HIDE/FIDE $2.5 Optionality $2.5 Marketplace Medicare Medicaid In $ Billions
Strong Capital Foundation and Discipline
Strong Capital Foundation Strong balance sheet provides foundation for stability and growth 1Q23 Credit Stats Reserve Strength Acquisition Capacity 2023 Parent Company Cash ~$500M Debt Capacity ~$2.0B Total Deployable Capital ~$2.5B Reserves at 3/31/23 $3.8B Days in Claims Payable 48 Days Net Debt to EBITDA Ratio 1.5x Net Debt / Capitalization ~39% Revolver Capacity $1B Recurring Parent Cash Flow 2023 Dividends to Parent >$800M Dividend to Net Income Conversion 80% - 100%
Capital Deployment Discipline Capital is deployed to highest return opportunities EPS Accretion Long-Term Target Capital Allocation Organic growth is the highest priority Most efficient use of capital to grow All lines of business are high growth Re-invest in Business 25% Robust pipeline Disciplined approach Strategic fit and operational synergies Accretive Acquisitions 50% Share repurchases Return to Shareholders 25%
Value Creation Model
Total Growth Long-Term Premium Revenue Growth - Unchanged Strong organic growth opportunities complemented by a disciplined acquisition strategy 8% - 10% 5% 13% - 15% Organic Growth Weighted Total Medicare Marketplace 8% - 10% 5% with Optionality 11% - 13% 8% - 10% Medicaid
Long-Term EPS Growth Strong revenue and earnings growth off 2023 outlook, enhanced by operating leverage and share repurchases Premium Revenue Growth 13% - 15% Hedge to Margins / Operating Leverage 0% - 1% Net Income Growth 13% - 16% Share Repurchases ~2% EPS Growth 15% - 18%
Strong market growth trends Numerous strategic initiatives Capitalized at <10% of revenue Low volatility Organic Acquisitions Enterprise Value Creation Model Highly efficient capital generation and deployment model creates significant value Numerous pipeline opportunities Announced acquisitions at attractive valuations, averaging 22% of revenue Turnaround opportunities drive strong EPS accretion Cost structure yields significant operating leverage High conversion of net income to cash flow Attractive capital redeployment opportunities 8% - 10% revenue growth ~60% levered ROE ~5% revenue growth ~20% levered ROE 13% - 15% revenue growth 15% - 18% EPS growth
Investment Thesis Strong growth, sustained margins and disciplined capital management form the core of shareholder return Pure play government sponsored healthcare Legacy and new market opportunities Double digit revenue growth Attractive margins and operating leverage High return capital deployment Proven management team
Executive Q&A
Reconciliation of Non-GAAP Financial Measures Adjustments represent additions and deductions to GAAP net income as indicated in the table below, which include the non-cash impact of amortization of acquired intangible assets, acquisition-related expenses, and the impact of certain expenses and other items that management believes are not indicative of longer-term business trends and operations. Managements opinions on business trends and operations can change, so the adjustments included in the table will not be consistent from period to period. 2020 2021 2022 2023G (1) Net income per diluted share $ 11.23 $ 11.25 $ 13.55 $ 19.02 Adjustments: Amortization of intangible assets 0.26 0.83 1.32 1.55 Acquisition-related expenses 0.37 1.59 0.83 0.08 Impairment (2) - - 3.56 - Loss on debt repayment 0.26 0.43 - - Marketplace risk corridor judgment (2.14) - - - Other (3) 0.51 0.16 - - Subtotal, adjustments (0.74) 3.01 5.71 1.63 Income tax effect 0.18 (0.72) (1.34) (0.40) Adjustments, net of tax (0.56) 2.29 4.37 1.23 Adjusted net income per diluted share $ 10.67 $ 13.54 $ 17.92 $ 20.25 (1) 2023 Guidance updated on April 26, 2023 (2) Resulting from the Company's plan to reduce its leased real estate footprint (3) 2020 includes charitable contribution, premium deficiency reserves, and restructuring costs. 2021 includes change in premium deficiency reserves, loss on sale of property, and restructuring costs. 2022 includes gain on lease termination and disposal of fixed assets