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Molina Healthcare, Inc. (MOH)

Q3 2013 Earnings Call· Wed, Oct 30, 2013

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Transcript

Operator

Operator

Ladies and gentlemen, thank you for standing by. Welcome to the Molina Healthcare Third Quarter 2013 Earnings Conference Call. [Operator Instructions] As a reminder, this conference is being recorded, Wednesday, October 30, 2013. I would now like to turn the conference over to Juan José Orellana, Senior Vice President of Investor Relations. Please go ahead, sir.

Juan Jose Orellana

Analyst

Thank you, Circe. 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 30, 2013. The company's Earnings Release was issued today after the market closed and is now posted for viewing on our company website. On the call with me today are Dr. Mario Molina, our CEO; John Molina, our CFO; Terry Bayer, our Chief Operating Officer; and Joseph White, our Chief Accounting 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 judgments as of October 30, 2013, and we disclaim any obligation to update such statements except as required by 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 Dr. Mario Molina.

Joseph Mario Molina

Analyst

Thank you, Juan José. And hello, everyone. Our third quarter results once again demonstrate our ability to strengthen our company by capturing the long-term opportunities available to us while executing our near-term initiatives, such as organic growth, acquisitions and operational improvements. And while 2 items, the prior period developments in Texas and the ramp-up of general administrative costs associated with building for future growth, affected our strong operating results. We are pleased with the quarter, particularly since the medical margin improved in all but one of our health plans. John will discuss in greater detail our financial results for the quarter during his remarks. Let's start with a topic that's generated considerable media coverage in the last few weeks: the marketplace. As you know from all the headlines, the rollout of the Affordable Care Act program has been stalled by technical difficulties with federal and state health insurance marketplace websites. Please remember that we are participating in the marketplaces in 9 states, where there is a mix of federal and state-run health insurance exchanges. However, given the technical difficulties and the reliability of the information, we believe it is premature to comment on enrollment figures at this time. We are focused on improving our marketplace platform by continuing to build on our provider network, preparing our call centers to take additional calls and in making our own web portal more robust. Investments in the operational readiness of our platform must be made regardless of the enrollment. Lastly, in anticipation of glitches with the health insurance marketplaces, we had delayed some of our marketing and outreach activities to the second half of the fourth quarter to allow for more time for website fixes. Given the current struggles and confusion associated with the marketplace rollout, we will be increasing our initial fourth…

John C. Molina

Analyst

Thank you, Mario. Good afternoon, everyone. Today, we reported net income from continuing operations of $0.16 per diluted share, compared to a net loss from continuing operations of $0.01 per diluted share reported in the third quarter of 2012. Significantly, we experienced negative prior period development in our Texas health plan of $14 million, which represented approximately $0.16 per diluted share. This negative PPD largely relates to claims incurred in 2012. We are pleased with these results, which, with a couple of exceptions, were consistent with our expectations. We continue to benefit from our efforts to deliver medical care more efficiently. We increased our revenue as a result of our recent acquisition in New Mexico, and our revenue diversification efforts continued to bear fruit. On the other hand, administrative expenses related to the revenue we won't receive until 2014 reduced our earnings. And we continue to be concerned about the adequacy of premium rates for California ABD population. With that said, let's look at the third quarter in more detail. Premium revenue in the third quarter grew to $1.6 billion, representing a 9% increase over the same period last year. The increase in premium revenue was mainly driven by a 5% increase in enrollment and a 4% increase in revenue per member per month. As I've just noted, we have made substantial progress in delivering medical care more efficiently. Our consolidated medical care ratio decreased to 87.3% in the third quarter of 2013 compared with 91.1% in the same period last year. Medical care ratios decreased and medical margins increased at all health plans except Florida. Put another way, per-member per-month revenue grew by almost 4%, while medical costs per-member per-month held steady. This is clear proof of improved core operational performance and gives us confidence as we prepare for…

Operator

Operator

[Operator Instructions] Our first question comes from the line of Justin Lake with JPMorgan. Justin Lake - JP Morgan Chase & Co, Research Division: First question is on the prior period costs in the quarter. Can you flesh that out a little bit more in terms of where those costs came from,, and more importantly, your level of confidence that the poll issues have been recognized in the third quarter results?

John C. Molina

Analyst

That's a great question, Justin. So these are related to claims dating back to 2012 that were adjudicated, and so we thought that they were put to bed, so to speak. But providers appealed, and due to some operational issues that we had discovered this year relating back to 2012, we ended up paying additional monies out and then reserving for the final cleanup. I would say that this quarter finally puts to bed the operational issues that we suffered in Texas, beginning in February of 2012. And I think most importantly, as Terry has talked about, we've turned over a lot of the management in Texas, and they're much more confident that the operational issues in Texas are behind us. Justin Lake - JP Morgan Chase & Co, Research Division: Okay, great. And then on the industry tax, sounds like you're a little less certain in terms of the lack of deductibility which follows on some of your peers saying the same thing. Is it reasonable to think that the -- can you give us -- I guess, what I'm asking, is there any way to kind of quantify if we were to say 100% of that deductibility is at risk or the lack of deductibility? Do you feel like it's happenstance that you're having this -- the more difficult conversation with or uncertainty around? Or should we -- can you assume the entirety of that market deductibility might be at risk into 2014? Any way to kind of quantify that for us?

John C. Molina

Analyst

Yes, I don't think we can quantify it for you simply because most of the states have not addressed the issue. So when we say that we lack certainty, it is not because the states have said they're not going to reimburse this for us, it's just that they are silent. Many of the states have told us they're waiting for instructions from CMS. I believe that Michigan is the only state that has affirmatively stated that they intend to reimburse us for it. Justin Lake - JP Morgan Chase & Co, Research Division: Okay. And mechanically, is it your expectation that sometime between now and let's say during -- early next year, you're going to get a rate increase that'll be effective January 1? That will basically making poll on the industry tax -- big step a state tends to make you whole. Is that the way they should work?

Joseph W. White

Analyst

This is Joe speaking. I think that most -- the conversation with most states is that they would prefer, and I think we would prefer, they make a lump sum payment rather than building the amount into the ratings. So most states are indicating that they will make us hold on the tax piece, perhaps not the income tax deductibility but the tax piece upon our determination of how much we're going to owe the feds. So if we [indiscernible] even outside of the rate structure. Justin Lake - JP Morgan Chase & Co, Research Division: Okay. And then one last question. The -- obviously, there's a lot of opportunity. You're making some investments early on to cover that. Any update in terms of how we should think about your revenue growth over the next 2 years, thinking about 2014 year-over-year. And then I know you have that $12.5 billion number out there. Any -- are you thinking there's upside to that number given the opportunity out there? Just any update there will be great.

John C. Molina

Analyst

Sure, Justin. This is John. In terms of the revenue growth over the next 2 years, we're sticking with our $12.5 billion number. Justin Lake - JP Morgan Chase & Co, Research Division: How should we think about '14?

John C. Molina

Analyst

You can think about '14 when we give guidance in February.

Operator

Operator

Our next question comes from the line of Josh Raskin with Barclays.

Joshua R. Raskin - Barclays Capital, Research Division

Analyst · Barclays.

I guess more pressing issues. Fourth quarter. So I'm just trying to understand some of these G&A costs. I guess my first question would be how much of it relates to the market size or, as you call it, exchanges?

John C. Molina

Analyst · Barclays.

You know, we're not going to split out, Josh, how much relates to this product or that product. In some respects, there is spillover, right? So as people go to the websites and think that they may be eligible for a marketplace product, find that they're eligible for Medicaid. Then, how do we differentiate the cost for that? What we do is we look at when we anticipate the enrollment's going to be, make sure we're staffed up to handle that enrollment and let the numbers follow.

Joshua R. Raskin - Barclays Capital, Research Division

Analyst · Barclays.

Well, okay. So, John, I guess others have suggested across -- broadly across health care services land that the marketplaces are getting pushed back and delayed. And so they're actually pushing back some of the marketing and the spending, et cetera, to wait until the exchanges are fully operational, et cetera. So I sort of think about your strategy was theoretically one of defense in nature where you're going to try and maintain that churn population in your plans, and now maybe there's less people jumping into exchanges. So I'm just curious why you'd be spending more and not less.

John C. Molina

Analyst · Barclays.

Because unlike some of the other plans, we were -- are trying to maximize the Medicaid, the welcome mat, which were -- as Mario talked about, reports are that those seem to be the biggest initial pushes for people, and we want to make sure that people continue to try and sign up. Whether it's through the websites or calling our call centers and getting navigators, getting the paper applications in, we feel that we can't let the issue die.

Joshua R. Raskin - Barclays Capital, Research Division

Analyst · Barclays.

Okay. And so -- and most of your states have the ability for members to select their plan, correct, before they get auto-assigned if they turn out to be Medicaid-eligible already?

Joseph Mario Molina

Analyst · Barclays.

That's correct, Josh. This is Mario.

Joshua R. Raskin - Barclays Capital, Research Division

Analyst · Barclays.

Okay. Okay, that's helpful. The second question on taxes. When you say sort of operational issues, et cetera, it sounds just basically like you guys denied claims that turned out you shouldn't have denied them. And so now they're -- now you have to pay them out. I guess I'm curious, does that change your perspective on sort of the run rate cost trend that you're seeing in Texas? Do you feel like you're adequately reserved for future trends? And do you think rates should be retroactively reset to sort of accounts with these higher costs?

Joseph W. White

Analyst · Barclays.

And now, this is Joe speaking. Well, first of all, we think we've caught up with this, and we don't anticipate any more unfavorable prior period development for this issue. The second point is we really feel like, with the -- we feel like Texas is treating us fairly. I think it's a fair statement after the rate increase we received on September 1, so we would not anticipate going back and asking for anything.

Joshua R. Raskin - Barclays Capital, Research Division

Analyst · Barclays.

Got you, okay. And then just last question. If we could just take a step back, how do you guys think about net margins? It's been a couple of years now of depressed overall sort of net margins. And what do you think is to that -- 2015. Let's skip '14 because I know there's a lot of ramp-up there as well. But when you're doing $12.5 billion on the top line, theoretically, a more normalized G&A level, et cetera, what's the net margin for your overall book of business supposed to look like?

John C. Molina

Analyst · Barclays.

Josh, I think we've been pretty consistent in saying 2%.

Joshua R. Raskin - Barclays Capital, Research Division

Analyst · Barclays.

And there's nothing that you see -- I mean, it just feels like with some of the additional G&A, et cetera, but you think that normalizes over time and you're sticking with the 2%.

Joseph Mario Molina

Analyst · Barclays.

Josh, this is Mario. I'm really encouraged by the progress we've made in the medical cost area this quarter. And so, yes, we're going to stick with that 2%. I think that eventually, as the enrollment grows, the percentage that we're spending on admin will drop. And if we can continue to make progress, as we have been on the medical costs, we think those numbers are achievable in the long term.

Operator

Operator

Our next question comes from the line of Sarah James with Wedbush.

Sarah James - Wedbush Securities Inc., Research Division

Analyst · Wedbush.

I just wanted to follow up on the 2015 guidance question. It -- I mean, it seems like there's a few positive items that weren't incorporated in the last update of guidance. Now we have a higher expansion, which, at a previous investor day, you guys had talked about it being in the $650 million range. There's South Carolina duals, which I was estimating to be another $350 million to $600 million in revenue. And then the Florida acute win, which could be about $410 million. So it just seems like there's a lot of positive news that's not yet baked into the 2015 guidance. Just wondering if you could give thoughts on if there's any additional headwinds that are offsetting that or if it's just being conservative at this point.

Joseph Mario Molina

Analyst · Wedbush.

Sarah, this is Mario. I think we've done a pretty good job at detailing all the headwinds. And you're right. There is still considerable upside from these new contracts, new programs, new states. And that's why I'm so optimistic. We have not provided an update on guidance. We're going to do that in February, but you've outlined some of the new issues.

Sarah James - Wedbush Securities Inc., Research Division

Analyst · Wedbush.

Okay. It just seemed like it could go up by at least $1 billion or more. Got it. And then in Ohio, there's a few moving pieces. We have the new members coming in, in August, and then last quarter, you spoke to benefit from risk adjusters. And now there's an ABD revenue reduction. So if you could just give a little bit more detail. Are the new members coming in around the risk score range that you anticipated? Was there any benefit on some of those numbers from risk adjusters or did it some other way and if that's related at all to the ABD revenue reduction?

Joseph W. White

Analyst · Wedbush.

This is Joe speaking, Sarah. No, these -- the margin impression we're talking about in Ohio doesn't have anything to do uniquely with the new members that came on July 1. The risk adjustment issue isn't effective July. The risk adjusters for the ABD population overall for the entire State of Ohio were reset, and we've always had a very aggressive effort at capturing costs, ensuring that information with the state and getting our members the right medical care they need. As a result, we've traditionally attracted members with more complex needs and met those needs and been able to document that with the state. It just so happens that on the latest reset, either because of member mix changes or because other health plans are doing a better job in terms of their encounter submissions, proportionally, we received a reduction in risk adjusters. But it doesn't speak into anything that happened with the new membership coming on July 1.

Sarah James - Wedbush Securities Inc., Research Division

Analyst · Wedbush.

Okay, that's helpful. And last question. In the prepared remarks, a concern was voiced over the California ABD rates. So just wondering if you could talk a little bit about that? And in context of your new settlement, wouldn't that be covered by the margin guarantee?

John C. Molina

Analyst · Wedbush.

Sarah, this is John. To the extent that our margin for the California plan falls below 3.25%, for whatever reason, the new settlement would kick in. We do continue to believe that the rates are set too low for the benefits and the utilization and that the ABD members in California are yenning. We continue to share that data with the state, and I believe that the next rate cycle, the state will actually utilize health plan data as opposed to fee-for-service data trended forward. So we are hoping that, that will be reflected in rates come next year.

Joseph Mario Molina

Analyst · Wedbush.

Sarah, this is Mario. There's one other point I want to make on that, too. While we have a settlement agreement with the state of California, that offers us some protection on the margins. Most health plans in California do not. So most of the Medicaid plans in California continue to be concerned, as we are, about the adequacy of rates. And we will all continue to press the issue with the state because we want the rates to be set appropriately, regardless of any kind of settlement. The rates need to be fair. They need to reflect the acuity of the patients that we're serving whether there's a settlement agreement or not.

Operator

Operator

The next question comes from the line of Kevin Fischbeck with Bank of America Merrill Lynch.

Kevin M. Fischbeck - BofA Merrill Lynch, Research Division

Analyst · Bank of America Merrill Lynch.

Okay. Just wanted to follow up maybe on that California item. Is it -- I think you mentioned that it was going to cover 75% of the population in '14 and then 50% after that. Can you go into what's driving that, wipe out the entire population?

Joseph W. White

Analyst · Bank of America Merrill Lynch.

Sure. It's Joe speaking. We just wanted to make the concept as clear as we can in terms of how the arithmetic works. The way the agreement works is that the -- to the extent that our margin differs from 3.25% margin, we will receive 75% of that difference in margin for our entire revenue. So we didn't quite find a simpler way to say it.

Kevin M. Fischbeck - BofA Merrill Lynch, Research Division

Analyst · Bank of America Merrill Lynch.

Oh, so they're different, okay. Okay, the difference is in margin, I thought you were talking about different revenue streams. I guess when you talked about the revenue streams that this sort of applied to, I think you said TANF, ABD and then duals, is Medicaid expansion something different? Or does that fall into one of those buckets?

John C. Molina

Analyst · Bank of America Merrill Lynch.

It would fall -- this is John -- it would fall into the settlement agreement. The reason that it steps down Year 2 is because the premise is that the settlement is to make up for prior years where the rates were not adequate. So implicit in that is the state is going to continue to work to make sure the rates are more adequate in the future. The closer they get to getting the absolute right rate, the less we will need it, so the less that they're going to fund that differential.

Kevin M. Fischbeck - BofA Merrill Lynch, Research Division

Analyst · Bank of America Merrill Lynch.

Okay, that makes sense. And then just going back to the G&A spend, wonder if maybe you can try and cut it in a different way. Which is -- I mean, you have a couple of new contracts like Imperial or maybe South Carolina or Texas tools coming to more focus. How much of that is -- of this higher spend is because of some of those clearly delineated new -- or more focus on until the revenue opportunities versus some of the other stuff, that's just kind of executing on something you already know about. How much is really new revenue opportunities?

John C. Molina

Analyst · Bank of America Merrill Lynch.

You now probably say so -- as Joe -- or I mean, as I mentioned, $30 million was the differential between third quarter of this year, third quarter of last year. I think another probably 25% is going to go to the new contracts on top of that. Plus, then you got to layer in the increased advertising and outreach we're going to be doing and then the operational ramp-up as well.

Kevin M. Fischbeck - BofA Merrill Lynch, Research Division

Analyst · Bank of America Merrill Lynch.

Okay, that's helpful. And when you have in here care coordination, medical management capabilities, that's more tied to new markets rather than kind of looking at something and saying, "Oh, I do need to do more in our existing markets," or does it encompass both?

Joseph Mario Molina

Analyst · Bank of America Merrill Lynch.

Yes, this is Mario. I think that it encompasses both. For example, the duals contracts are going to require us to have more in the way of care managers, probably some additional medical directors, and that's in an existing state. In a place like South Carolina, it will bring up a whole new health plan. We've got to hire all the staff for that health plan, including the care management. So it overlaps, and it really is a function of the growth and the change in the mix of patients that we're going to be experiencing.

Operator

Operator

The next question comes from the line of Tom Carroll with Stifel. Thomas A. Carroll - Stifel, Nicolaus & Co., Inc., Research Division: So I mean, most everything I've been thinking about has been talked about here tonight. I guess relative to your Investor Day, which was fairly positive in my view, and today, what would you say is kind of the largest item within your expectations that has changed? Maybe it sounds like a decision to spend more on the G&A side. Or I don't want to put words in your mouth. Maybe that's the answer. But maybe if you could talk to kind of like what is really changed between the Investor Day and today that's creating the change in guidance and a different view of fourth quarter and all that kind of stuff?

John C. Molina

Analyst

Well, so, Tom, this is John. Let me first -- maybe I misheard you, but you seemed to imply that we had a positive Investor Day and today's not so positive. I'm like Mario. I'm pretty optimistic, and I think that our net in that PPD from Texas would've been right on our number. We still would have said that we're incurring higher costs in Q4, and that's really the operational readiness, the G&A spend, in part because we did win some new business and in part because the issues related to the marketplace is causing us to want to increase the outreach.

Joseph Mario Molina

Analyst

Okay, Tom, this is Mario. Tom, let me just finish. I think that if you take the claims issue that we have in Texas and if you take the $2.5 million we spent on Illinois with basically no membership and you reverse that, we would've exceeded analyst expectations for the quarter. The medical costs came down pretty much across the board, and I think it was, absent that, a very strong quarter. John's right. We are spending more to build up for our growth next year. And some of these things, like the Imperial County, we're running around, putting together a network and bringing up a new service area that we really hadn't anticipated was going to come so quickly. So there are some things that we have to spend that have been accelerated. But overall, and John's having a field day with this, I'm actually optimistic, and I'm not usually the optimistic one. Thomas A. Carroll - Stifel, Nicolaus & Co., Inc., Research Division: Okay, that's a very fair framework. I appreciate that. I didn't mean to imply anything. I guess I was getting at it sounded like you maybe made a decision to kind of crank the G&A a bit more, which, again, I think is just -- is what I'm hearing in the conversation tonight?

Joseph Mario Molina

Analyst

That's true. Thomas A. Carroll - Stifel, Nicolaus & Co., Inc., Research Division: Okay. The -- I'm good with that. The medical claims payable number is up a bit. I mean, maybe what's driving that? If you could.

Joseph W. White

Analyst

It's Joe speaking. It's a number of things. if you're looking at the consolidated number on the balance sheet, John had mentioned that we're -- date in claims payable is up. That's about $16 million this quarter. We also just had some minor timing issues in terms of cap payment, which drove it up, and we've also in this quarter, and we talked about this in the cash flow section. There are a number of states that views us a vehicle to pass through certain payments to providers, usually hospitals. These are cases where states will give money to us and then instruct us to pay the sort of hospitals or other providers. And it just so happened we got a lot of those payments late in the quarter, so -- and didn't have a chance to disperse them until early October. So we can... Thomas A. Carroll - Stifel, Nicolaus & Co., Inc., Research Division: So where might that...

Joseph W. White

Analyst

Go ahead. Thomas A. Carroll - Stifel, Nicolaus & Co., Inc., Research Division: I was just going to say, directionally, where -- what does that number look like a quarter from now?

Joseph W. White

Analyst

It's up about $138 million versus December, and about $16 million of that's IPMP. So I think the rest of that more or less reverses next quarter. I think John alluded to the fact in his remarks, we had a lot of onetime items. I'd -- won't say onetime items. We've just had a lot of items we think that are going to reverse in December, or in the fourth quarter. Thomas A. Carroll - Stifel, Nicolaus & Co., Inc., Research Division: Okay. And then one last thing, just kind of conceptually, given the newness of the duals programs and the Florida LTC program, and these things that just keep getting delayed, more so than we've seen in the prior, I don't know, decade or 15 years where new programs started up, and we do tend to see delays, right? But it feels like kind of more so than usual. Do you have a dialogue going with any of your state partners to perhaps provide some recourse to you down the line to make up for some of the G&A drag that you're absorbing right now? Is that part of the conversation at all?

Joseph Mario Molina

Analyst

Tom, this is Mario. No, we've not specifically addressed that with them. And I think that the reason we're seeing all these delays is that the state and federal government are trying to bring up a lot of programs simultaneously. In past years, these things would roll out, one this year, one next year. But CMS is trying to bring these duals, all these duals contracts up in a period of about 2 years. It's an aggressive timeframe, and I think that they're struggling just in terms of the staff that they have. I think the government shutdown kind of hurt things a little bit. And I also think that the state are struggling because remember, in this recession, states laid off staff. And so now that things are turning around and they're bringing up these new programs, a lot of the people that were there several years ago are now gone. So you've got new staff who are younger, have less experience. Or in many cases, you just don't have the staff, period, that they had in previous years. And I think that's what's -- a lot of what's driving the delays.

Operator

Operator

Our next question comes from the line of Dave Windley with Jefferies.

David H. Windley - Jefferies LLC, Research Division

Analyst · Jefferies.

On California, would you be willing to call out specifically what rate increase you think you need to kind of bring the ABD rates to adequacy or conversely and talk about what your ABD MLR is right now?

John C. Molina

Analyst · Jefferies.

We generally don't split out MCRs by line of business.

Joseph Mario Molina

Analyst · Jefferies.

So in other words, no.

David H. Windley - Jefferies LLC, Research Division

Analyst · Jefferies.

Yes, understand that. You've called it out several times in the -- on the -- or talked about it several times in the call, I thought I'd try to get the heart of the issue. The other question I have is around your G&A discussion and readiness. I think you had previously talked about 2014 seeing that number decline somewhat. Now in 2013, the number is going up. I'm wondering how we should think about that trajectory for 2014 off of this new base?

John C. Molina

Analyst · Jefferies.

We're -- this is John. We're still expecting, as a percent of revenue, that the G&A will go down in 2014.

David H. Windley - Jefferies LLC, Research Division

Analyst · Jefferies.

And any magnitude on that?

Joseph Mario Molina

Analyst · Jefferies.

This is Mario. I think a lot of it's a function of the membership growth, right? Because as the revenues grow, a lot of the G&A costs will be fixed. So as the revenues grow, G&A as a percent goes down. You have got fixed costs embedded in this with staff that we've already hired and we've been training. Some of the things are variable, like the amount we spend on advertising and outreach, and that we have a little bit more control over. But as Terry has pointed out in the past, when we go through these readiness reviews, the states want to see bodies in those chairs, and they want to be sure that we're fully staffed. And then what's happened is that they have pulled the rug out from under us and said, "We're going to delay this for 2 or 3 months." And it's been a problem. Whether that ever gets addressed or not, I don't know. I hope that at some point, state recognizes the additional costs that they caused us to incur, but I can't guarantee it.

David H. Windley - Jefferies LLC, Research Division

Analyst · Jefferies.

So maybe I'll ask in a slightly different way. I was thinking in terms of dollars of spend going down. Would you expect that you're actually -- especially in light of ramping that number up in the fourth quarter, would you expect the dollars or readiness spend to decline in 2014 or just to decline as a percent of revenue?

John C. Molina

Analyst · Jefferies.

This is John. I would say decline as a percent of revenue because as the infrastructure build up on most of these programs, you got the operational ramp which will take over. And as Mario said, it really depends on when our enrollment becomes and how big that operational ramp is. But then also, the cycle starts over again, right? So now we're starting to prepare for the South Carolina and Texas duals, which is some more infrastructure build. But as a percentage of revenue, I think you'll see it go down. In terms of the growth, in terms of the total dollars, it should slow down, but it will still be up.

David H. Windley - Jefferies LLC, Research Division

Analyst · Jefferies.

Okay. And last question on Florida. That's the one market that you talked about where medical loss ratio did not decline. What remediation steps are you taking there? Is it all rate or can actually do something operationally to improve?

Joseph W. White

Analyst · Jefferies.

It's Joe speaking. We've seen some indication that it did. Like in Ohio, a rebasing that took effect earlier this year in terms of the fee schedule may have impacted us. We're also due to hear very shortly on the rate adjustment effective September 1. The state's a little bit late on that, but we'll have to wait and see what that -- when that number comes in before we can really assess where we're at in Florida. We've done a very good job in the last few years in Florida, though, for lowering health care costs. And they're certainly considerably below where they were a couple of years ago.

Operator

Operator

The next question comes from the line of Chris Rigg with Susquehanna International Group.

Christian Rigg - Susquehanna Financial Group, LLLP, Research Division

Analyst · Susquehanna International Group.

I just want to make sure I heard you correctly. With regard to the California settlement agreement, did you say the maximum remuneration is $40 million?

John C. Molina

Analyst · Susquehanna International Group.

Yes.

Christian Rigg - Susquehanna Financial Group, LLLP, Research Division

Analyst · Susquehanna International Group.

Okay. So I guess I just -- my real question stems from that. So if I look at your peer who has a similar agreement -- they're larger, but they're not 6.5x to 7x larger than you guys in the state. So can you help us understand why their maximum amount on a relative basis is so much greater than yours?

Joseph Mario Molina

Analyst · Susquehanna International Group.

Sure, this is Mario. Remember, these are issues that go back to 2003. And a lot of the settlement comes out of those early years, and that was the time when we were much smaller. So it's -- you can't -- you're sort of comparing apples and oranges.

Christian Rigg - Susquehanna Financial Group, LLLP, Research Division

Analyst · Susquehanna International Group.

Okay. All right, that makes sense. And then when you think about the administrative spend in the fourth quarter, it was $30 million that you spiked down in the third quarter. So for the fourth quarter, can you give us what the number might actually be or how we should think about that?

Joseph W. White

Analyst · Susquehanna International Group.

It's Joe speaking. I think you could look to that incremental piece of the spending for the fourth quarter being $40 to $45 million.

Operator

Operator

The next question comes from the line of Carl McDonald with Citigroup.

Carl R. McDonald - Citigroup Inc, Research Division

Analyst · Citigroup.

Great. So 2 more California agreement questions. So the first one is if the California agreement had been in place in 2013, how much of an impact would it have had on the financials? I don't know if it's easier to do that relative to the 90% loss ratio or versus the $1.15 in earnings, but just be interested in the sensitivity for '13.

Joseph W. White

Analyst · Citigroup.

Carl, it's Joe. I honestly don't recall. We haven't looked since the close of second quarter. I think it closed the second quarter, that would have been substantial. I think it would've been $20 million or so, just a guess.

Carl R. McDonald - Citigroup Inc, Research Division

Analyst · Citigroup.

Sorry, $20 million as a guess for the year, or for a specific quarter?

Joseph W. White

Analyst · Citigroup.

I think it was just for those first 2 quarters.

Carl R. McDonald - Citigroup Inc, Research Division

Analyst · Citigroup.

Just for the first 2, okay.

Joseph Mario Molina

Analyst · Citigroup.

Carl, this is John. Be careful because we are getting some rate increases in October and in January that are going to help the overall profitability of the California plan, as well as we have seen, I think, some pretty good strides in utilization management as we now have over a full year with the ABD's enrollment. We've always talked about taking an era from 2 to 3 quarters to get utilization in line. I think in California, it took a little bit longer because when the ABDs were enrolled, we had less flexibility to change treatment regimens. And so we're now 15 to 18 months down the line, we're able to do some managed care, these patients were able to bring, some of the utilization are more in line.

Carl R. McDonald - Citigroup Inc, Research Division

Analyst · Citigroup.

And then another question just on the difference between your agreement and HealthNet. I think you said yours was 3 years in length versus theirs was 7 years. Any difference in the rationale versus the answer to Chris' question?

Joseph Mario Molina

Analyst · Citigroup.

I'll take that one. I've always said that I was not a big fan of this type of agreement because what it leads us doing is holding a receivable from the state of California, and I'm the kind of guy that likes to have my money upfront. So we did negotiate to have a shorter period of time for this agreement. I think if you look at the deals, though, they are otherwise very, very similar. The magnitude of the settlement that we have is smaller than HealthNet's because our Medicaid enrollment back in the early 2003, 2004 era was smaller, and we had just insured time period. But otherwise, I think it's pretty much the same agreement.

Operator

Operator

And our last question comes from the line of Matthew Borsch with Goldman Sachs.

Joseph Mario Molina

Analyst

Well, sounds like we lost Matt.

Operator

Operator

Yes, and we have no further questions at this time.

Joseph Mario Molina

Analyst

Well, I want to thank all of you for joining us. We will be having another Investor Day, I believe, in February. And again, it's uncharacteristic of me, but despite the prior period development in Texas, I am optimistic about the prospects. I think we've done a good job of bringing down medical care costs, and we've got huge growth opportunities in front of us. So we look forward to seeing what 2014 brings. Thank you.

Operator

Operator

Ladies and gentlemen, that does conclude the conference call for today. We thank you for your participation and ask that you please disconnect your line.