MMIT Payer Portrait: Molina Healthcare

Founded by a physician in 1980 as a primary care clinic for low-income Californians, Molina Healthcare is now the fourth-largest Medicaid insurer in the U.S., serving more than 4.1 million lives. In addition to its public-sector products, Molina also offers Affordable Care Act exchange plans in 12 states. After receiving a contract extension in 2019, CVS Caremark will continue to serve as the insurer’s pharmacy benefits manager through 2021, and no plans for a possible successor have been announced.

While the other top Medicaid payers have made major moves in recent years (Centene Corp.’s purchase of WellCare and UnitedHealthcare’s continued membership growth key among them) Molina suffered setbacks, comparatively. In 2017, it lost one of its largest state contracts in New Mexico and saw service area reductions in Florida and Texas. But a string of deals have helped Molina bounce back, most notably, a major contract win in Kentucky and subsequent acquisition of Passport Health Plan, and a completed purchase of Magellan Complete Care, which holds Medicaid contracts in three states. Molina in April was also selected for Ohio’s upcoming Medicaid managed care transformation.

Analysts have said they expect this activity to continue, with Molina potentially positioning itself as the “next great aggregator” of smaller Medicaid plans, according to a July 16, 2020, article in AIS’s RADAR on Medicare Advantage. In September 2020, the company unveiled plans to purchase Affinity Health Plan, a New York insurer that will boost Molina’s individual commercial products in addition to Medicaid, and in April 2021 Cigna Corp. revealed Molina will purchase its last remaining Medicaid asset, its STAR+PLUS plan in Texas, in a $60 million deal. The acquisition is expected to close in the second half of 2021, subject to regulatory approval.

NOTE: Molina Healthcare, Passport Health Plan and Magellan Complete Care are represented as separate entities in DHP, linked by a Parent ID.

SOURCE: DHP, AIS’s Directory of Health Plans; MMIT Analytics. Learn more about subscribing to AIS Health’s publications here: https://bit.ly/3xypXM4.

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