Who Is Molina Healthcare?
Molina Healthcare specializes in managed healthcare for:
- Low-income families.
- Pregnant women and other individuals who receive their care through a Medicaid health plan.
- The State Children’s Health Insurance Program (SCHIP).
- Medicare Advantage health plans aimed at low-income seniors.
- Dual Medicare/Medicaid plans.
- Prescription drugs for people in all of these categories.
All of Molina’s plans have low premiums and low out-of-pocket costs.
The company started in this segment of the health insurance business in 1980 in California after emergency room doctor C. David Molina was concerned about the number of patients who came to the emergency room for routine care. He opened a clinic to serve these patients.
Dr. Molina’s idea took root and by December 2020, Molina Healthcare Inc. was a Fortune 500 company — using New York Stock Exchange ticker MOH — serving about 4 million people.
These plans are administered by state governments under federal rules. Molina contracts to provide this managed care in:1
- New Mexico
- New York
- Puerto Rico
- South Carolina
The company also contracts with a network of providers, including independent physicians and physician groups, hospitals, other kinds of healthcare services, and pharmacies. It also runs clinics that provide healthcare directly to Medicaid members, and it has a 24-hour nurse advice line.
Managed Care and Clinics
Molina Healthcare has contracts with a dozen states to manage medical care, and in some areas, it runs its own clinics.
Overall, it participates in the following Medicaid programs:
- Temporary Assistance for Needy Families (TANF). This program covers low-income families with children.
- Medicaid Aged, Blind, or Disabled (ABD). ABD programs cover low-income persons with chronic physical disabilities or behavioral health impairments.
- Children’s Health Insurance Program (CHIP). CHIP is a joint federal and state matching program that provides health care coverage to children whose families earn too much to qualify for Medicaid coverage.
- Medicaid Expansion. In states that have elected to participate, Medicaid Expansion provides eligibility to nearly all low-income individuals under age 65 with incomes at or below 138% of the federal poverty line.2
Molina offers comprehensive care and manages access and costs. To accurately assess patients’ needs and provide a variety of services, Molina sometimes sends case managers into its customers’ homes.
Molina — and other companies managing care profitably through government programs — offer this care at reasonable prices because the rates at which they can reimburse healthcare providers are set by the states and are lower than those paid by private insurers. 3
Little Wiggle Room
The company operates in a highly regulated space with numerous rules and little wiggle room.
How Do You Enroll in Coverage with Molina Healthcare?
To receive healthcare through Molina, you must have income low enough to qualify for government assistance in the state in which you live. Most Molina plans are health management organizations (HMOs) that serve family and individuals, as well as y.
The company also offers Medicare Advantage plans and plans aimed at people who are eligible for both Medicare and Medicaid. These plans serve seniors and the disabled with low incomes.
Molina offers some Healthcare Marketplace plans that have low deductibles and low out-of-pocket costs. These are for people transitioning from Medicaid to private insurance and allows them to keep their previous Molina healthcare providers as they make the switch.4
Use this calculator from Healthcare.gov to see if you might be eligible for one of the programs that Molina manages.
One way to find a Molina healthcare state plan is to find your state and read what suits your needs. Once you find your state, you’ll see online links and telephone numbers. You also can call the Molina home office in California at (562) 435-3666. You can enroll in Molina through an independent, licensed insurance agent, too.
Molina specializes in closely managing healthcare. You’ll never file a claim because Molina handles that administrative detail. If you are receiving care directly from one of Molina’s clinics, no direct billing is involved.
One challenge customers encounter, which isn’t Molina’s fault, but does have an impact on clients’ ability to remain Molina customers, is the demand from governments that Medicaid customers reaffirm their eligibility, usually annually.5 These “redeterminations” ask for proof of income and expenses. They can be complex, and customers who don’t provide information on time or in the format demanded can quickly find themselves without insurance.
What Is Molina’s Financial Status?
Many Molina Healthcare customers don’t have a choice — their state has chosen Molina to manage their government-funded health plan. Nevertheless, Molina is a public company with financials that show that it is likely capable of continuing to pay its healthcare expenses. 6
Investors appreciate Molina. Wall Street calculates its return on capital employed as 21%, which it says is about twice as high as the healthcare industry average of 10%. That’s not only good news for investors because it shows how efficient a company is in turning income into profits, it could also be reassuring to patients. It shows the company’s ability to operate efficiently using the government’s payments, which are lower than they are in private healthcare. 7
Two years ago in its most recent rating session, financial rating service Moody’s raised Molina Healthcare’s insurance financial strength ratings to Ba1 from Ba2. This reflected the performance of its subsidiaries, which include Molina Healthcare of California, Molina Healthcare of Michigan Inc., Molina Healthcare of New Mexico Inc., Molina Healthcare of Ohio Inc., Molina Healthcare of Texas Inc., and Molina Healthcare of Washington Inc. 8 9
Molina Healthcare operates a highly regulated and fiscally challenging business. Most of its customers rely on Molina because they have no other choice. They are limited to narrow caregiver networks and clinics, and the management of treatments and costs is tight because state and federal authorities hold the purse strings.
If you have a complaint, Molina has an internal process for resolving it. You can also call (800) 580-2811.
- Find out if you are qualified for a low-cost Molina policy.
- Gather required paperwork before contacting Molina.
- Understand the network available to you, and try to avoid using any doctors or other providers out of it.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.