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Molina Healthcare Inc (MOH -4.17%)
Q3Â 2018 Earnings Conference Call
Nov. 01, 2018, 7:30 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good day and welcome to the Molina Healthcare Third Quarter 2018 Earnings Conference Call. All participants will be in listen-only mode. (Operator Instructions) After today's presentation, there will be an opportunity to ask questions. (Operator Instructions) Please note this event is being recorded.
I would now like to turn the conference over to Ryan Kubota, AVP of Investor Relations. Please go ahead.
Ryan Kubota -- Assistant Vice President of Investor Relations
Thank you, operator. Hello, everyone, and thank you for joining us. The purpose of this call is to discuss Molina Healthcare's financial results for the third quarter ended September 30th 2018. The company issued its earnings release reporting third quarter 2018 results last night after the market closed, and this release is now posted for viewing on the company website.
On the call with me today are Joe Zubretsky, our President and Chief Executive Officer; and Tom Tran our Chief Financial Officer. After the completion of our prepared remarks, we will open the call to take your questions. (Operator Instructions)
Our comments today will contain forward-looking statements under the safe harbor provisions of the Private Securities Litigation Reform Act. All of our forward-looking statements are based on our current expectations and assumptions, which are subject to numerous risk factors that could cause our actual results to differ materially.
A description of such risk factors can be found in our earnings release and in our reports filed with the Securities and Exchange Commission, including our Form 10-K annual report, our Form 10-Q quarterly reports and our Form 8-K current reports. These reports can be accessed under the Investor Relations tab of our company website or on the SEC's website.
All forward-looking statements made during today's call represent our judgment as of November 1st, 2018, and we disclaim any obligation to update such statements except as required by the securities laws.
This call is being recorded, and a 30-day replay of the conference call will be available at our company's website, molinahealthcare.com.
I would now like to turn the call over to our Chief Executive Officer, Joe Zubretsky.
Joseph Zubretsky -- President and Chief Executive Officer
Thank you, Ryan, and thank you all for joining us this morning. Last night, we reported third quarter earnings of $2.90 per diluted share and $7.60 per diluted share for the nine months ending September 30th 2018. For the quarter net non-run rate charges were $30 million or $0.35 per diluted share. These charges resulted primarily from a mandated retroactive adjustment for a minimum loss ratio floor and risk corridor on the 2016 California Medicaid Expansion business, partially offset by the gain on the sale of MMS. This adjustment is described in our earnings release.
For the nine months ending September 30th 2018 net non-run rate benefits were $54 million or $0.59 per diluted share. Therefore from a pure performance perspective after considering these non-run rate items we achieved fully diluted earnings per share of $3.25 for the third quarter and $7.01 for the nine months ending September 30th 2018.
I also note that the quarter included $0.34 in tax benefits, mainly to adjust our year-to-date effective tax rate to a lower projected tax rate and recognition of our improved outlook for full year earnings. The nine months results, however fully reflect our projected full year tax rate. We are very pleased with the continued improvement in the performance of our business and our financial results reflect the significant progress we are making in executing our margin recovery and sustainability plan.
Now for a deeper look into the underlying operating leverage and metrics. First, with respect to revenues. Premium revenue decreased by approximately 4% from the second quarter of 2018 and approximately 2.7% after removing the impact of the retroactive California risk corridor adjustment. The decrease is largely attributable to the expected seasonal decline in Marketplace membership, the Washington Medicaid pharmacy carve-out effective July 1st, and the effective rate changes for July 1st. Our Medicaid and Medicare volumes remained strong.
Second with respect to our control of medical costs and the resulting medical care ratio, we continue to produce sequential MCR improvement. Our pure performance medical care ratio excluding the retroactive California risk corridor adjustment was 86.4% in the third quarter, a 60 basis point improvement over the second quarter MCR of 87% on a pure performance basis after adjusting for the benefit of the 2017 Marketplace risk adjustment and cost-sharing reduction. Medical cost across all the health plans and product lines were largely stable and in many places improved when compared to prior quarters. Our medical cost baseline continues to develop favorably and we have managed cost trends to below our forecasted trend rate.
Now that we have credible nine-month data with good visibility into the underlying medical economics, we can attribute the improvement to many of the early actions the company has taken to improve its performance. Most notably, we have recontracted high-cost providers in our networks. We have added additional resources to front line utilization management and improved execution of utilization controls and care management protocols. This has resulted in lower rate of hospital admissions, ER visits and short in-patient stays, as well as reduced length of stay for hospital admissions.
We have improved claim payment integrity processes by enhancing our software platforms to ensure we pay for services appropriately reducing errors and duplicate claims and executing better and coordination of benefit recoveries. And we have achieved better performance in retaining at-risk revenue by improved risk borrowing and quality measurement. All in all, we have enhanced our ability to manage and forecast medical cost, all while ensuring our members receive the high-quality service they deserve, at the right time, at the right price and in the right setting.
I turn now to our control of administrative costs. We have continued to improve our administrative cost structure and to lower our G&A ratio through a number of our ongoing initiatives. We have reduced our administrative expense sequentially in each of the last three quarters through the following actions: first, we have managed our headcount to align with activity and transaction volumes. Since the beginning of the year, we have reduced our headcount by more than 600 physicians or over 5% of our workforce. Second, we have continued to streamline our management ranks and manage bands of control. Third, we have eliminated spending on certain IT projects that in our view were not creating value. Fourth, we continue to steadily reduce our excess real estate capacity. And fifth, we have negotiated lower unit costs in many of our labor and non-labor contracts. We will continue to scrutinize all aspects of our administrative cost structure.
However, we anticipate that administrative expense in the fourth quarter will increase due to the seasonality of some marketing programs and the commencement of many of our expense information initiatives that will produce benefits in 2019 and beyond. We also made significant progress in the quarter related to out capital structure and free cash flow to the parent. In the quarter we continue to deleverage and reduce the share count volatility associated with our convertible notes. We closed on the sale of MMS, delivering approximately $230 million of cash to the parent, and we recently announced the sale of pathways, a non-core asset for a nominal purchase price.
The transaction closed in October and we estimate that we will record a loss on the sale of approximately $0.60 per diluted share in the fourth quarter. Our capital structure is stable, cash flows to the parent entity are strong, and our credit metrics are sound. This positions us well for beginning the conversation about a potential credit rating upgrade, which could lower our future cost of debt.
I turn now to the performance of our product lines. Our Medicaid product performed well, compared to the second quarter. On a pure performance basis, our Medicaid MCR with 89%, compared to 89.8% in the second quarter. Our ABD an expansion products drove the improvement, while we experienced slightly higher medical cost in our TANF product, which still have much room for improvement. Medicare generally performed in line with our expectations, but deteriorated sequentially with a combined medical care ratio of 87.3%, compared to 85% in the second quarter.
On a nine month basis, the total medical care ratio is in line with our expectations at 85.7%. The sequentially elevated MCR was in the integrated MMP plans and largely attributable to certain revenue transfers between the Medicare and Medicaid lines of business, which had no impact on our consolidated results.
Our FIDE SNP (ph) product continues to perform very well. In serving the Dual Eligible population is a key area for our future growth. Both our MMP and FIDE SNP products benefited from our improved collection of risk core data and our ability to retain quality with hold. Our marketplace business has continued to perform well, achieving a pure performance medical care ratio of 65.3%, compared to 68.4% in the second quarter after removing the impact of the non-run rate items. This 310 basis point improvement was driven by lower medical costs and higher revenue from better risk to our performance and better than expected membership retention.
We have not yet observed the seasonal in year utilization increase we experienced in prior years. Marketplace is now performing at an after tax margin of approximately 9% to 10% for the full year, well ahead of our pricing expectations, while only triggering the minimum MLR in one market. The pricing actions that we took in 2018 increased our average rates by nearly 60%. Based on our performance year-to-date, we are pleased at how well our forecast is expected cost trends and membership mix aligned with the rate increases we delivered.
I turn out to the performance of our local health plan. The majority of our health plans have continued to perform well, as a result of our new operating model, which mandates local execution and decision making with stringent enterprise oversight and performance management. Michigan, Texas and Washington continued to perform well across most lines of business. Michigan saw an improvement from slightly higher premium revenue and continued in-patient cost improvement, as the health plan is focused on reducing short-term in-patient stays. Texas is with than 50% of our Marketplace revenue improved sequentially, while much of the improvement was due to lower medical costs and improved revenue retention in Marketplace. The Medicaid and Medicare lines of business combined also performed slightly better-than-expected. We remain positive on our prospects with the reprocurement of the STAR and the STAR+ contracts.
Washington has continued to reduce the in-patient cost pressures in the Medicaid product that were identified earlier in the year to a more intense utilization management approach. Also as you will recall Washington carved-out the Medicaid pharmacy benefit in the third quarter and our results now reflect the corresponding premium and medical cost declines associated with that carve-out. In the quarter, we also made significant progress on many future value-creating initiatives.
Most notably our Mississippi health plan went live on October 1st, as a new entrant into a market with two existing health plans. As a start-up plan, we will receive all of the auto assignment membership until our health plan reaches 20% of the total membership in the program. We currently expect to end the year with approximately 20,000 members and the projection for 2019 could be as high as 90,000 members by the end of the year.
Our new islandwide contract in Puerto Rico is expected to go live with approximately 290,000 members, a slight decline from our prior two region membership roles, but with significant potential for additional membership. We remain confident that we will be able to earn and sustain a return in excess of our cost of capital.
And finally the court has not yet issued a ruling on our protest in New Mexico. Pending the court's decision, we are managing the run-off of the New Mexico Medicaid plan and transitioning the membership. We will remain in the Marketplace and Medicare business in New Mexico in 2019.
I turn now to our revised guidance. Our revised GAAP guidance for the year is $8.80 to $9 earnings per diluted share or an increase of $1.65 at the midpoint from our previous guidance. On a pure performance basis our revised guidance is a $2.60 per share increase. Our GAAP guidance in our pure performance guidance are expected to be nearly identical as the non-run rate benefit for the first nine months will be offset by the loss on the sale of the Pathways business. Tom will elaborate on guidance in a few minutes.
Assuming the achievement of our full year guidance, we step back and look at our businesses for the full year 2018 through the lens of our margin recovery plan. Our Medicaid business is a solid franchise has a diversified footprint, great product depth and with an after-tax margin between 2% and 2.5% is now performing very well, although there is still significant room for improvement.
Our Medicare business with annual revenue of approximately $2 billion is favorably positioned in the Dual's market and is performing well having now achieved after-tax margins between 3% and 3.5%. In our Marketplace business after years of corrective pricing actions in instability is not only stable, but is now producing after-tax margins of 9% to 10%. Measured off of any starting point we could choose Marketplace is a significant part of this overall margin recovery story. On a consolidated basis, we expect to achieve an after-tax margin of 3.2%, which for the first year of this turnaround is a result we are very pleased with.
I will close with some preliminary thoughts on 2019, as we head into the fourth quarter. While it is too early to provide detail on 2019 earnings. I can provide the following observations, as we see them today. At the midpoint of $8.90 pure performance guidance EPS for 2018, we have a very solid earnings baseline and within a range margins that are sustainable and have less potential for volatility. In short, the quality of earnings in 2018 is high.
Against this backdrop of a solid 2018 earnings baseline we are currently in the process of developing our 2019 financial plan in evaluating all of the factors that will impact our 2019 earnings trajectory, including the continuation of the positive momentum we have in managed medical cost trend, the continued adequacy of our Medicaid rates, the competitiveness of our Medicare and Marketplace rates, once our competitors rates are known. How much of the significant profit improvement plans we previously communicated will manifest in 2019 earnings, and while we are effectively managing the total and partial run-off of the New Mexico and Florida Medicaid contracts, the potential for some level of stranded fixed cost still exists.
Over the long-term management is committed to increasing both operating earnings and earnings per diluted share above the levels of our 2018 full year guidance. We are currently developing our 2019 financial plan. This plan will fully consider the solid 2018 earnings baseline and these other factors, all of which will determine that 2019 earnings trajectory. We look forward to reporting that outlook to you in February, when we announce fourth quarter earnings. We are very pleased with our results to-date. We remain committed to executing the fundamentals of managed care and ensuring that our operating and financial platforms can produce sustainable results. When this is done, we will turn our focus to positioning the company for the inherent growth in this very attractive government managed care sector.
With that, I will turn the call over to Tom Tran for more detail on the financials.
Thomas Tran -- Chief Financial Officer
Thank you, Joe and good morning. As described in our earnings release we report third quarter's earnings per diluted share of $2.90 and adjusted earnings per diluted share of $2.97, excluding the amortization of intangible assets. These strong results were driven by the continued improvement of our day-to-day operational processes that affect medical cost and administrative expenses. Favorable cost trends across almost of our products, as well as our ongoing margin recovery initiatives.
First, let me quickly highlight a few of the items that we call out in our earnings release, particularly as it relates to the $0.35 earnings per diluted share of out-of-period non-run rate items. Regarding California, the state imposed a retroactive risk corridor for the state fiscal year ended June 30th 2017, which we noted last quarter as a potential exposure. The state formerly present their contract amendment this quarter, which we then agreed to. As a result we record in the quarter a $57 million pre-tax charge or $0.65 per diluted share. This charge has little impact on how we view the profitability of our California Medicaid business going forward.
Excluding this charge the California Medicaid expansion product operated within an acceptable medical care ratio in the quarter. We recorded a $5 million benefit in the quarter for Marketplace cost-sharing reduction or CSR subsidies for 2017 days of service. This benefit relates to the reprocessing of claims data for CSR eligible members and allow us to reduce our liability with CMS. We recorded a $37 million pre-tax gain on the sale of our MMS subsidiary, which we sold for approximately $230 million.
We recorded $5 million of restructuring cost in the quarter primarily related to two items; the ongoing true up of our initial lease abatement estimates as we continue to rationalize our office space; and cost associated with our 2018 IT restructuring plan that is focused on improving our IT operations with outsourcing and/or co-sourcing various aspects of the technology function, which will provide significant future cost savings.
Finally as part of the repurchase of the 2020 convertible notes and related embedded call option termination. We incur approximately $10 million of expenses. These costs primarily related to the acceleration of the remaining discount amortization on those notes, as we continue to simplify our capital structure. Regarding our tax position, our full year effective tax rate improved to a range of 32% to 33% from 35% to 36% for our previous guidance, due to improved earnings for the year as our marginal tax rate is approximately 22%. This improvement result in the third quarter benefit of $0.34 earnings per diluted share. However for the nine months ending result fully reflect our expected annual tax rate. So our nine-month result need not be adjusted for tax items.
I will now spend a few minutes discussing our reserve position. Our reserve approach is consistent with prior quarters and our position remains strong. The favorable development we experienced in 2018 from 2017 has increased slightly to approximately $230 million, including the explicit margin that we hold. We continue to have favorable intra-year reserve development, and as we have stated in the past we intended to include the same level of conservatism in the quarter and reserve balances.
Days and claims payable are up approximately four days sequentially. Approximately two days of the increase are attributable to the expansion of the quality review process for claims payment, which involves certain extra review steps prior to finalizing payment. The remaining two days are due to normal fluctuation in the reserve balance.
Turning to our balance sheet and cash flow. We have continued to look for strategic opportunities to delever the balance sheet as we outlined during Investor Day and our capital actions year-to-date have result in a benefit of approximately $0.30 earnings per diluted share for the year. As of September 30th 2018, the company had unrestricted cash and investments of approximately $390 million at the parent company. We continue to be more capital efficient at the health plan level ensuring a more consistent and regular dividend flow to the parent company.
At the end of the third quarter, our health plans at aggregate statutory capital and surplus of approximately $2.1 billion, which represent more than 350% of risk-based capital. Our operating cash flows are strong. However operating cash flows was negative in the quarter primarily due to our payment of the Marketplace risk transfer for fiscal year 2017.
Let me offer some additional thoughts on our revised guidance. We have raised our full year guidance to a range of $8.80 to $9 per diluted share, an increase of $1.65 on a GAAP basis and an increase of $2.60 on the pure performance basis at the midpoint from our previous guidance issue on August 1st. This increase is comprised of the following; first our medical cost baseline continues to develop favorably and we have managed cost trend to below our forecast trend rate. Second, we project that our Marketplace product will perform better than we previously projected, due to better revenue retention and lower medical costs. And third, we expect our performance of our Medicaid product will remain steady in the fourth quarter.
Now to bridge our results in the first nine months of the year to our revised guidance in the fourth quarter. Our peer performance earnings per diluted share was $7.01 for the nine months ending September 30th 2018. We estimated that our fourth quarter earnings per diluted share at the midpoint of approximately $1.90. On a sequential basis, our fourth quarter earnings per diluted share is projected to be lower than our third quarter's earnings primarily due to three reasons. First, the expected Marketplace seasonal decline in membership and increase in medical costs.
Second the catch-up benefit from the lower effective tax rate in the third quarter will not repeat in the fourth quarter. And third an increase in our general and administrative expense ratio for the fourth quarter, which is projected to be at 8%. This increase is due to seasonal spending, including sales and marketing initiatives related to the open enrollment period for Marketplace and Medicare; expenses related to certain IT projects that were delayed from the third quarter into the fourth; and expenses related to certain transformation initiatives that began in the third and fourth quarters, which will contributed to 2019 earnings and beyond.
Finally, let me offer a few additional points of consideration relating to our revised guidance. Our guidance assumes no prior period development and our guidance was developed based on GAAP rather than adjusted earnings per diluted share, which would exclude the amortization of intangible asset.
This concludes our prepared remarks. Operator, we are now ready to take questions.
Questions and Answers:
Operator
Thank you. We will now begin the question-and-answer session. (Operator Instructions) And our first question is comes from Justin Lake of Wolfe Research. Please go ahead.
Justin Lake -- Wolfe Research -- Analyst
Thanks, good morning. Joe, thanks for the 2019 outlook. maybe you can give us a little more color there in terms of just starting with the 2018 numbers. Can you talk about what you think are reasonable jump off point for 2018 is versus the $8.80 to $9. Are there areas where you don't think the margins are sustainable like potentially the 9% to 10% in the individual business?
Joseph Zubretsky -- President and Chief Executive Officer
Sure Justin. When you cut through all the puts and takes of the quarter it's a solid $3 quarter and a very solid $9 year, our guidance at $8.90 at the midpoint. The quality of earnings in 2018 is very strong and we think that's a great jumping off point for planning our trajectory into 2019. I cited the various factors that one always takes into consideration when forming a plan; the continued strength of our Medicaid rates; the competitive positioning of our Medicare and our Marketplace rates. Can we continue to manage our medical cost baseline in trend as effectively, as we have this year?
And then certainly the $500 million of profit improvement initiatives we outlined for you at Investor Day, certainly some of that has in order to the benefit of 2018, but most of that is still yet to be harvested. So the 2018 baseline is a great jumping off point, I think we've outlined the puts and takes that are endemic to the industry and those specific to Molina. And over the long-term, we are committed to growing our earnings per share and our pre-tax earnings off of 2018 solid baseline.
Justin Lake -- Wolfe Research -- Analyst
That's helpful. And then just a follow-up there. Maybe another way to come out of this is just, net income margins. Clearly relative to peers they're now toward the higher-end of the range. To grow up here with a shrinking, with the top line that look like it's going to be down next year given the membership losses before accelerating in 2020? Where do you think the margins on a net income basis can kind of sustain if relative to what you kind of put out there at Investor Day, given you are already there?
Joseph Zubretsky -- President and Chief Executive Officer
We've challenged the operating team to aspire to be the most margin producers in our space. We're going to produce Medicaid margins just under 2.5% this year after tax, Medicare margins at nearly 3.5% and Marketplace at nearly 9% averaging to the 3.2% after-tax margin in our guidance. Clearly the Marketplace has outperformed our expectation this year without question. We've managed it effectively, we've put 58 points of rate into the market last year. But this year, we only put low single-digit rate increases into the market, because our rate actions no longer needed to be corrected.
And so I think the question on the Marketplace isn't whether we can sustain the margins? Is can we continue to hold on to the membership at the margin we produced this year. But it's a solid product, it's performing well, and we're just now learning how our prices are comparing to our competitors and we'll have a better outlook for you when we report our fourth quarter.
Justin Lake -- Wolfe Research -- Analyst
Thanks.
Operator
Our next question comes from Josh Raskin of Nephron Research. Please go ahead.
Josh Raskin -- Nephron Research -- Analyst
Hi, thanks. I guess similar sort of line of questioning around margin sustainability. And I guess the first thing is I think you mentioned Joe long-term you guys want to keep I think 2018 levels of profitability and so or I'm sorry levels of earnings. And so should we think about on a lower top line this 2019 does that mean 2019 steps back and then longer term we get back to the $9 or is that now what you're saying?
And then the second question just in terms of the sustainability looking at the G&A side, you guys are running at about a 7% ratio. And so I'm just curious is that a sustainable number in light of the fact that you're going to be trying to reinvigorate the growth engine? I look at things like $24 million or CapEx for the first nine months, and it just feels like that can't be sustainable if you're really trying to grow the business. So maybe just help with the couple of those questions. Thanks.
Joseph Zubretsky -- President and Chief Executive Officer
Sure. With respect to 2019 revenue at our Investor Day, we laid out an outlook, which suggested that the 2019 premium revenue would be about $15.6 billion. At that time, of course, we're accounting for the total loss of Florida and the total loss of the New Mexico Medicaid contract. We've since recovered two reasons in Florida $0.5 billion, and the Mississippi implementation will be an incremental $300 million to 2019. There are other growth opportunities in our existing portfolio. Our Marketplace business should grow next year with rates now filed in Utah and Wisconsin.
As you know, we are very successful in our Washington reprocurement, where we have fewer competitors and many other regions we won and so our membership will grow. Ohio carved-in the behavioral benefit halfway through to this year we'll get a full year of that next year. And we picked up 70,000 members mid-year in Illinois and we'll get a full year effect of that in 2019. So all in all, I think the premium revenue picture without giving you a specific forecast is a lot better than the outlined -- that what we outlined at our Investor Day.
Your second question was about G&A. There is more G&A to harvest here. We've redeployed a lot of that G&A to the front lines. Our net 600 headcount reduction was net of resources we put in the field to control medical cost. We will spend money on many of our transformational initiatives that will produce better baseline medical cost that will put a little pressure on it next year. But we are very determined to control our fixed cost and to leverage our fixed cost, and we think there's upside to the G&A ratio as well.
Josh Raskin -- Nephron Research -- Analyst
Got it. And I'm sorry, just to clarify my question on 2019 was with the understanding that premiums probably go from about $17.5 billion this year to maybe just under $17 billion next year now, obviously a lot better than what you guys were talking about previously. My question was around the earnings, I think you've made the comment that 2018, the long-term, you wanted to maintain that level of profits that you're seeing in 2018 that run rate $9 number. So I was just asking more on the combination if you got a little bit lower top line on a year-over-year basis, did it sound like earnings per share in your mind for 2019 just directionally would have to take that step back on lower revenues and then eventually get back to where you are. What was that now, what you are implying?
Joseph Zubretsky -- President and Chief Executive Officer
Again, without giving a specific forecast even with the revenue declines next year, we are pretty committed to growing earnings per share and pre-tax earnings off of the 18 base. Too early to give you the specific 2019 trajectory, but we are committed even in the phase of the revenue decline on the two lost contracts, we're committed to that long-term objective.
Josh Raskin -- Nephron Research -- Analyst
Got it. That's perfect, thanks.
Operator
Our next question comes from Ana Gupte of Leerink Partners. Please go ahead.
Ana Gupte -- Leerink Partners -- Analyst
Thanks, good morning. Yeah, so again following up on the margins with the three plus margins -- net margin that you have right now. Do you expect there's still runway for expansion? And is that likely to come mostly from additional mix shifting to the exchanges which are really high margin? Or is there still core MLR improvement from claims editing, payment integrity, PBM or anything else in Medicare, Medicaid? And the on G&A, are you still looking to drive more efficiency? Or are we just looking at leverage at this point as you grow on the cost side anyways?
Joseph Zubretsky -- President and Chief Executive Officer
With respect to our margins, you specifically, Ana, mentioned Medicaid. With an 89.9% year-to-date MCR, there's still room for improvement in our core Medicaid business. Maybe 100 or 200 basis points long-term in the MCR, and we're committed to improving our Medicaid margins. On the G&A side, yes, there is more efficiency, there's leverage, fixed cost leverage as we grow, there is more efficiency and we will redeploy some of that efficiency back to the front line to make sure that we do not skip on utilization control resources, which was part of the medical cost problem the company experienced. We also are going to invest in some these transformational initiatives. It will cost money, if we outsource or close doors our IT operation. We are spending more money, on payment integrity routines and front line utilization control. So there will be a little bit of upward pressure on the G&A ratio, as we improve our processes, but it should have a corresponding, an exponential effect on our medical cost line.
Ana Gupte -- Leerink Partners -- Analyst
And then on the rate side, just finally, you have like a mid-60s exchange loss ratio and you said only one region had the MLR floor issue. But are there any rate pressures that states may be bringing to your attention with such lower loss ratios you're probably not alone? And then on the tax reform side, might they start to put pressure on the rates in Medicaid, is that sustainable over the long-term?
Joseph Zubretsky -- President and Chief Executive Officer
On the second question, the Medicaid rates it's a very rational rate environment right now, as we accept the Medicare rates that are being offered to us. For the most part the rates are actuarially sound. They always seem to come in a little bit lower than you absorb medical cost trend, but they suspect you to find managed care savings and we do that routinely. The tax reform conversation really isn't part of the rate dialogue with the states.
On the Marketplace side, we are just now learning how our rates are going to stack up against our competitors. Our average rate increase for the Marketplace and that we filed in 2018 for 2019 was 4%. These rate increases no longer need to be corrective, they just need to accurately reflect medical cost trend, the acuity of our population and the metallic benefit designs that we put into the market. So we're pretty comfortable that our strategy in the Marketplace, which was the hold on to our membership ranks and maximize contribution margin dollars for 2019 will hold. And that will position us well to file rates in 2019 that will allow us to grow into 2020.
Ana Gupte -- Leerink Partners -- Analyst
Thanks for the color. Appreciate it.
Operator
Our next question comes from Sarah James of Piper Jaffray. Please go ahead.
Sarah James -- Piper Jaffray -- Analyst
Thanks and congratulations on the turnaround execution. You've previously talked about focusing on the turnaround before you turn back to top line growth acceleration. Given the progress is running ahead of schedule, how are you thinking about when it's right to explore top line opportunities again, thinking specifically as non-incumbent RFPs, M&A, but also anything like organic M&A, your fixed (ph) market expansions? Thanks.
Joseph Zubretsky -- President and Chief Executive Officer
Well as we continue to focus on our margin recovery and sustainability efforts, as you suggested there are still more to do. Some of those opportunities have yet been harvested. And that is our primary focus here at the company. In the meantime, we also recognize that the sales cycle in this business is very long. And if you don't start building the engine today to grow then you won't grow in 2019, 2020 and 2021. So we are hard at work, rebuilding our RFP response unit, we're hard at work rebuilding our new contract business development unit.
In the meantime there are plenty of opportunities in our existing footprint, in our existing product line to grow. If we can win more regions in Texas, when Texas finally announces the STAR+ contract, if we won seven more regions and add our current market share could be over $1 billion of incremental opportunity. Ohio strongly considering putting their ML, their long-term services and supports business into managed care. So there are plenty of opportunities in our Marketplace. We believe that this is could be twice the size it is today and we can hold onto our margin and have it be a very good allocation of capital in the portfolio at a very attractive margin.
So before we go into new, new, I think there's plenty of opportunities in our existing footprint and our existing product line to grow. But in the meantime we are rebuilding that greenfield business development operation, so we can participate in RFPs in 2019, 2020 for the benefit of 2021.
Sarah James -- Piper Jaffray -- Analyst
That's very helpful. And one more you've previously talked about $0.50 upside not in guidance from capital deployment related to debt and convert. Can you update us on how much of that has been achieved? And if the remainder is on the table for 2019, or if we should be thinking further out? Thanks.
Joseph Zubretsky -- President and Chief Executive Officer
We originally gave you a $0.50 estimate, and if you recall, I think at that time our share price is about $85, which meant that the cash that we've used to buying the converts was purchasing a lot more of the converts than it is at $125 to $130. So that estimate for the full year is now $0.30, but we've bought in a lot of those convertible notes, we've reduced our share count and the potential volatility in EPS as a result of that. But I think Tom said in his prepared remarks that the estimate for the year on our capital actions is about a $0.30 benefit for the entire year.
Sarah James -- Piper Jaffray -- Analyst
Thank you.
Operator
Our next question comes from Steve Tanal of Goldman Sachs. Please go ahead.
Steve Tanal -- Goldman Sachs -- Analyst
Good morning, guys. Thanks for the question. So it seems like you're implying further improvement in the Medicaid loss ratio next year will offset likely lower margins in the Marketplace. And I guess, if I think about that, is that now about the TANF population was -- where the Medicaid sort of loss ratio is running there? And does that become inevitably more dependent on rate updates to the extent that sort of a lower acuity, lower utilizing population where there is maybe, I guess in theory less you can do?
Joseph Zubretsky -- President and Chief Executive Officer
Well we definitely think there's upside to our core Medicaid performance. Sightings in fact here TANF is still running over 89% year-to-date. ABD is running at 92% just under 92%, which is respectable. But we actually think that we can more effectively manage the long-term support and services benefit that embedded in the ABD product more effectively, and we can improve our net 92% performance. And expansion is doing well at 87%, we're getting -- still getting very, very effective rates.
So the business is performing well, I think that there is upside in our ABD line and upside in our TANF line. Just being more effective on the front line utilization controls, the rate environment that continues to be stable and we can continue to effectively manage our medical cost baseline and trend. We all believe that there's upside to those performance logistics.
Steve Tanal -- Goldman Sachs -- Analyst
Okay, that's really helpful. And just sort of separately on the Marketplace business, kind of, given the way minimum MLR rebates are assessed on a rolling three-year basis. Is there anything you can tell us about the impact of -- I guess what -- would effectively be swapping 2018 obviously really strong here with 2015 less strong and sort of the outlook for earnings and margin next year?
Joseph Zubretsky -- President and Chief Executive Officer
Good observation. The old poorly performing years are rolling off, but we still have room. As you suggested it's a three-year rolling average. We only triggered the minimum MLR in one state that being New Mexico, and we fully considered our position as we filed our 2019 rates. So no we don't expect of the rates that we filed still do not imply a triggering of the minimum MLR in any of our other states. And if we did, we certainly would included in any forecast we give you for 2019.
Steve Tanal -- Goldman Sachs -- Analyst
Awesome. Really helpful. Just lastly for me just on Marketplace enrollment, the expectations for increased enrollment there. Can you talk about any new markets or geographies you're entering? Or should we think about that as more of a same-store end market growth rate?
Joseph Zubretsky -- President and Chief Executive Officer
We're in seven, we've refiled if you remember we're in Utah and Wisconsin a year ago, we came out in 2018, we're going back in for 2019. We expect that Wisconsin and the positioning of our pricing in our product will provide some meaningful membership growth in Wisconsin. Utah probably a less sell, but those are the two states, we'll be in nine states in 2019 and we're going to consider expanding our Marketplace footprint to be everywhere, we're in Medicaid in 2020, which would be, I think South Carolina, Illinois and New York.
Steve Tanal -- Goldman Sachs -- Analyst
Awesome. Very helpful. Thanks a lot.
Operator
Our next question comes from Dave Windley of Jefferies. Please go ahead.
Dave Windley -- Jefferies -- Analyst
Hi, good morning. Thanks for taking my questions. So Joe thinking about your $500 million plan just a few subpart questions here. One has this year benefited from anything that would have been say outside of that plan? Two, you mentioned that you've harvested some of that plan, but still a lot of it to go, would you care to put numbers on or may be a proportion of the $500 million that you think you're already seeing flow-through the P&L?
And then as you -- I guess in the extreme and it's been asked a little bit already this morning, but in the full harvesting of the $500 million Molina would seem to get to margin levels that would be very high relative to peers. And I guess, I'd be curious your view on the difficulty or the reasonableness of pushing margins in -- at Molina to that, kind of, to that spread against similar books of business?
Joseph Zubretsky -- President and Chief Executive Officer
Well thanks for the question. And as a reminder I always remind folks when we talk about these profit improvement plans that one, it first goes to fund any deficit you get in rates. Rates always seemed to lag medical cost trend by a basis point here or there, and it first goes to fund that. If you remember the chart we showed you at the Investor Day, we have to sort of contingency reserve sitting out there, so adjusting that somewhere you'll get a bad rate, somewhere the rate might be actuarially unsound. And you're always using your profit improvement issues to first offset that deficit before anything drops through.
And as you suggest you're absolutely correct. We would then look at our profit improvement plans and the margin that we are creating as a result of it, through reinvest in growth. We do not push margins up as high as you suggest and sacrifice growth when the time comes. So the $500 million could drop through the margins. And if we aspire to be the best margin producer in the industry may be we get there or maybe we'll reinvest that in top line growth.
The original question was about how much of the $500 million has fallen through to 2018. And without parsing it item by item, we definitely benefited this year by more effective utilization management. We definitely benefited this year by working the network harder, claim payment integrity certainly added some benefit this year to our medical cost line. And as we suggested we continue to be more effective at SG&A control. I would say that the more technically challenging, the more operationally complex items that you saw in our chart at our Investor Day still have yet to be harvested.
So bottom line, I would say a significant amount of the $500 million has yet to have been harvested and manifest in earnings. You'll be seeing over the next two to three months announcements from us on partnerships that we are creating with world-class vendors to partner up and take advantage of high acuity care management maybe a recontracting of our pharmacy. Clearly we are anticipating co-sourcing or outsourcing our IT operation, you'll see some announcements for us on that front over the next two to three months.
Dave Windley -- Jefferies -- Analyst
Helpful. Thank you.
Operator
Our next question comes from Steven Valiquette of Barclays. Please go ahead.
Steven Valiquette -- Barclays -- Analyst
Thanks, and good morning, and also the good questions have been addressed already. Just talk a little bit on that last one. Looking at your citing and throughout this year that, some lower in-patient cost has also been part of the upside. So just curious kind of where you stand, just got to (ph) know a little bit deeper on that last question. Just on contract renegotiations on the in-patient side whether that's something that has played a role this year and that's something also still, kind of, how do you just thinking about that category in particular? Thanks.
Joseph Zubretsky -- President and Chief Executive Officer
Yes. I think we've managed our in-patient cost really effectively, we had some cost pressures in Washington that we previously announced. We had some behavioral in-patient pressures in New Mexico that we previously talked about. But for the most part one, trend seems to be very stable in most regions around the country, so just the general environment for trend. And second, we have been more managing it more effectively. And we did see in all our statistics admits per thousand, short in-patient stays, average length of stay, ER visits, admissions out of the ER. Whatever stat you want to focus on we have been managing it very effectively. And so the in-patient and the facility cost are component of trend has been, a) stable and performing well; and secondly we've been managing it better than we had in the past.
Steven Valiquette -- Barclays -- Analyst
Okay. Alright, great. Thanks.
Operator
Our next question comes from Kevin Fischbeck of Bank of America Merrill Lynch. Please go ahead.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Great, thanks. I just wanted to circle back with the G&A commentary, because it seems like you're talking on the one hand about significant savings, but then also kind of making some investments that you might push up G&A with the MLR benefit. And then I guess -- separately I guess you're talking about maybe investing for growth in RFPs in the future wasn't sure of that, can put upward pressure on G&A. I guess when you put that altogether are you looking for G&A as a percent of revenue to continue to trend down? Or this is more about, hey, there are savings that we can reinvest elsewhere to drive improvement elsewhere your top line or MLR?
Joseph Zubretsky -- President and Chief Executive Officer
Kevin we're not prepared to give an -- sort of a pinpoint forecast on our G&A ratio beyond 2018. But those are the headwinds and tailwinds to our G&A ratio. And I view the upward pressure if we continue to invest in things that improve our medical cost baseline, I consider that to be have an excellent return, and we would make that trade all day long. So, yes, there are going to be some upward pressures as we invest in some of these processes that will produce significant benefits to the company.
Certainly when you're chasing top line revenue it costs money, but there is more fixed cost leverage and there's more efficiency to be gained in our operation. Those are the ups and downs, but we're just not prepared yet to give you a pinpoint SG&A ratio forecast beyond 2018. But it's there, we're managing it very effectively, and we definitely think there's a more effective way to deploy our SG&A dollars.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Okay, and then I guess when you think about getting back to the growth side of the equation. We have been historically much better at protecting and expanding in-markets where you already are located. I mean what do you have to add capability wise to be successful in entering new markets?
Joseph Zubretsky -- President and Chief Executive Officer
We are currently sketching out the building of our -- rebuilding of our business development engine. You need to have a grounding, you need to be in the states developing network relationships and governmental relationships before the procurement drops. And in the past two years, this company has not really invested in any of that given the issues that was going through. So we're building all that under Pam Sedmak's leadership. We will develop a new business development engine that we think can compete with our rivals, and we can win our fair share. It's really not about the money, it's about really establishing yourself locally, building the relationships with the Department of Health Services and the regulators and making sure you have great network relationships, when the RFP drops you're prepared to go.
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Okay, thanks.
Operator
Our next question comes from Gary Taylor of JPMorgan. Please go ahead.
Gary Taylor -- JPMorgan -- Analyst
Hey, good morning. Really amazing performance this year, so you've done a great job. Two questions about that performance; the first one just going back to exchanges a little bit. Can you help us bridge this comment that you're looking -- you're either running or anticipating for the year 9% to 10% after-tax margins in the exchange business with the 58% year-to-date MLR? And I guess presuming some seasonal uptick in the 4Q may be you end the year closer to 70%, but still implies somewhere between a 20% and 30% G&A load to only get to a 9% to 10% after-tax margin. Can you bridge that for us?
Thomas Tran -- Chief Financial Officer
Yeah, your numbers are directionally in the right zone there. So in this business the G&A tend to be high, you have commissions, you have sales and marketing. So certainly it's really in the upper teen to not just 20%. And our fourth quarter you're right, the medical care ratio is going to be higher than what we experienced so far year-to-date. Last earnings call, we talk little bit about that, that they tend to be somewhat in the 80s, but we believe that given the trajectory that we are in today, it will be much less than that, more likely saw with the seven as opposed with an eight in front.
Gary Taylor -- JPMorgan -- Analyst
No, if we think about ultimately minimum MLRs at 80% in this business and G&A in upper teens to 20%, I mean that would imply a longer-term after-tax margin significantly lower than the 9% to 10%. Is that how we should be thinking about this? Or do you think you bring G&A down over time to saying something mid-single digit or better?
Joseph Zubretsky -- President and Chief Executive Officer
Our G&A loads and our product lines that aren't fully scaled are too high and they can be scaled. If we double the size of the business, our SG&A will not double. There is fixed cost leverage very, very clearly. The other thing as a reminder in the minimum MLR there's all the add backs, right? The number we produce for GAAP, there's all kinds of additions and subtractions to get to the number. So if you are operating in the mid to high 60s with our G&A load of 15% to 20%, we're still floating below the minimum MLR in many of our price, but your point is well taken. There a practical cap in the margins you can achieve, because of the minimum MLR. And if we ever get there, it's a high class problem we have, we'll fully consider it and the rates we file and we'll grow more.
Gary Taylor -- JPMorgan -- Analyst
One other question for you Joe. Just thinking about your comments that there's still significant amount of the $500 million opportunity you identified that could flow-through to earnings. When that takes place if that does take place it really seems that you're completely redefining the margin profile with still primarily Medicaid business, and redefining that margin profile versus your peers and versus history. And we've always heard companies and it's business talk about over caps at the state level, politics and visibility of margins et cetera. So in just six months here you've redefined the profile to some degree and you suggest there's still further to go. How do we think about this historic concept that there were -- these pre-tax caps at the state level and just sort of the visibility of the margins politically?
Joseph Zubretsky -- President and Chief Executive Officer
It's a very fair comment, and that's why every time I show a forecast or projection, I always have what I call the rate yield detriment in the analysis, because you'll never store it, that you're going to get fully paid for your medical cost trend. And I always say that over time profit improvement always ends up in rates somehow and somewhere. So you're right, over time just the process of the negotiating and accepting rates from states, profit improvement will end up in rates over time that in itself puts a practical (ph) cap in what you can achieve.
But again our goal is to be low cost, we want to be very effective on the front lines, service our members and our provider partner as well, but the low cost. And if we can continue to do that we can either drop it through or we can reinvest it in top line growth. And that's our aspiration and that's we are trying to achieve here.
Gary Taylor -- JPMorgan -- Analyst
Great. Thank you.
Operator
Our next question comes from Zach Sopcak of Morgan Stanley. Please go ahead.
Zach Sopcak -- Morgan Stanley -- Analyst
Thank you for the call. And congrats on the quarter. And I wanted to ask first about exiting the pathways business. If you forget about that, I guess the loss you are taking on sale of the business. Was it a negative or positive earnings contributor in 2018, and should we think about that exit as a tailwind or headwind going into 2019?
Joseph Zubretsky -- President and Chief Executive Officer
The exit is clearly a tailwind. It was running an EBITDA loss for the year, if you recall the goodwill associated with that purchase was written off in the third quarter of 2017, which left a little bit of working capital and fixed assets in the business and selling it for a nominal purchase price still produce the loss. Negative EBITDA contributor and it would have required a lot of future investment in order to fix the business and there's always a private equity firm around who sees value in that, wants to put the hard work in. But it's just not core and was not a financial contributor.
Zach Sopcak -- Morgan Stanley -- Analyst
Got it. And just on that non-core comment, and now that you've exited MMS and Pathways. Is there anything else in your portfolio that you think is still non-core that you're still working on? Or do you think it's where you wanted to be?
Joseph Zubretsky -- President and Chief Executive Officer
No we like portfolio, we like the geographic diversity, we like the product lines depth and breadth. The portfolio right now is fine and we're focused on managed care, and that's what our focus is on.
Zach Sopcak -- Morgan Stanley -- Analyst
Okay, perfect. Thank you for the questions.
Operator
Our next question comes from Michael Newshel of Evercore ISI. Please go ahead.
Michael Newshel -- Evercore ISI -- Analyst
Thanks. Do you have a timeline in mind for retiring the remaining convertible debt and warrants? And also do you expect to have more deployable capital from subsidiary dividends next year. Then you talked about the Investor Day, just given the earnings out performance this year?
Joseph Zubretsky -- President and Chief Executive Officer
I'll take it at the time no matter (ph), but bear in mind that the 2020s are due in January of 2020. So whether we buy them in the open market, whether presented to us by January of 2020 they will be totally out of our capital structure --
Thomas Tran -- Chief Financial Officer
That's right, Joe. There's a balance remaining of approximately $315 million, so between now and January 2020, we will repay those convertible.
Michael Newshel -- Evercore ISI -- Analyst
Right, and then to retire the warrant -- the associated warrants as well, it's like a total of like $1 billion close to?
Joseph Zubretsky -- President and Chief Executive Officer
Exactly. And we're sitting now with between 3 and 4 -- close to $400 million in parent company cash. Obviously with the outlook for next year, I've harvest more cash flow to the parent, we have the $500 million revolver. So we have plenty of capacity as those notes are presented to us or as we go into the market we have the free cash flow at the parent to buy them.
Michael Newshel -- Evercore ISI -- Analyst
If they were to do at out next -- over the course of next year?
Joseph Zubretsky -- President and Chief Executive Officer
Absolutely.
Michael Newshel -- Evercore ISI -- Analyst
Alright. Thank you.
Operator
This concludes our question-and-answer session and concludes the conference call. Thank you for attending today's presentation. You may now disconnect.
Duration: 64 minutes
Call participants:
Ryan Kubota -- Assistant Vice President of Investor Relations
Joseph Zubretsky -- President and Chief Executive Officer
Thomas Tran -- Chief Financial Officer
Justin Lake -- Wolfe Research -- Analyst
Josh Raskin -- Nephron Research -- Analyst
Ana Gupte -- Leerink Partners -- Analyst
Sarah James -- Piper Jaffray -- Analyst
Steve Tanal -- Goldman Sachs -- Analyst
Dave Windley -- Jefferies -- Analyst
Steven Valiquette -- Barclays -- Analyst
Kevin Fischbeck -- Bank of America Merrill Lynch -- Analyst
Gary Taylor -- JPMorgan -- Analyst
Zach Sopcak -- Morgan Stanley -- Analyst
Michael Newshel -- Evercore ISI -- Analyst
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