Molina Healthcare

Analyst: Paula Wade

Report Summary

Still controlled and run by the family who founded the company, Molina Healthcare has focused entirely on Medicaid and those dually eligible for Medicaid and Medicare. It administers benefits to 1.5 million lives in 10 states. Medicaid, which has been the fastest-growing segment of the healthcare industry for the past four years, is set to expand by an estimated 16 million beginning in 2014, when eligibility is opened to adults earning less than 133 percent of the poverty level. Beyond the sheer numeric expansion of Medicaid, its exponential cost expansion is driving more states to seek managed care contracts to help rein in costs. Molina's recent purchase of the Medicaid IT administration business of Unisys Corp. expands its ability to compete, particularly in those states where HMO-style Medicaid management isn't being used.

HealthLeaders-InterStudy's National Health Plan Analyzer Series profiles the nation's top 14 healthcare companies, with data and analysis of each national health plan's finances, its strength in various markets, its products in the commercial, Medicaid, Medicare, government employee and ancillary segments, its competitive standing, mergers and acquisitions, pharmacy administration, history, and its prospects for the near future.

Questions Answered in This Report

Molina began as a group of primary-care clinics that started a California Medicaid plan, and the founder's son, a physician, still runs the company. How has its history and corporate culture shaped its direction and growth?

There's no longer an incentive for states to "carve out" their Medicaid pharmacy business and administer it separately to maximize rebates. What states have done carve-outs, and is Molina trying to win back that business from its client states with carve-outs?

Medicare plans are scrambling to improve their CMS star quality ratings now that reimbursement bonuses are tied to the results. How has Molina fared in the star ratings, and what is it doing to improve?

Primary Research

Analysis of financial documents, regulatory filings, public information and analysis of years of data from HealthLeaders-InterStudy, CMS and others.