Paul Sanchez
Molina Healthcare is an American health insurance company that provides Medicaid and Medicare health plans. The company was founded in 1980 and has since expanded to offer Marketplace plans in several states. Molina Healthcare aims to provide quality health care to individuals and families, particularly those receiving government assistance or with low incomes. The company has been selected for duals demonstration projects, serving members eligible for both Medicaid and Medicare. Molina Healthcare also offers customer support and a 24/7 Nurse Advice Line for its members.
| Characteristics | Values |
|---|---|
| Type of Insurance | Medicaid and Medicare |
| Target Audience | Individuals and families with low incomes |
| Services | Virtual Urgent Care, Behavioral Health, HealthPlus MIChild, and Medicaid programs |
| States | Idaho, Louisiana, Maine, New Jersey, West Virginia, U.S. Virgin Islands, Washington, New Mexico, Florida, Utah, Michigan, Illinois, Wisconsin |
| Customer Service | 24/7 Nurse Advice Line |
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What You'll Learn
Molina Medicaid
Molina Healthcare has been providing affordable and quality healthcare for over 30 years. Since 1985, the company has focused on government-paid healthcare programs such as SCHIP and Medicaid. The first Molina Medical clinic was opened in Wilmington, California, in 1980 to provide healthcare to low-income families and individuals.
Molina Healthcare acquired Unisys' health information management business in December 2010, creating Molina Medicaid Solutions (MMS). MMS has Medicaid Management Information Systems (MMIS) contracts with several US states, including Idaho, Louisiana, Maine, New Jersey, West Virginia, and the US Virgin Islands. In 2014, Molina Healthcare began offering Marketplace plans in nine states where it offered Medicaid health plans.
Molina Healthcare has been actively acquiring other companies' Medicaid programs and assets. In 2015, it acquired the HealthPlus MIChild and Medicaid programs of Michigan, as well as the Medicaid assets of Integral Health Plan, Inc. in Florida. In 2018, Molina Healthcare lost its Medicaid contract with the state of New Mexico and, in 2019, with Texas. Despite these losses, Molina Healthcare continues to expand its Medicaid offerings. In 2021, it acquired Cigna's Medicaid contracts in Texas, further solidifying its presence in the Medicaid market.
Molina Healthcare generally covers any prescription drug listed in its formulary as long as it is medically necessary. However, a 2023 report revealed that Molina Healthcare's Medicaid plans for financially vulnerable people had some of the highest denial percentages in the country, with over 25% of requests for prior authorization of services being denied. Despite this, Molina Healthcare remains a significant provider of Medicaid services, with approximately 11 million people receiving coverage through the company's exchange as of 2016.
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Molina Medicare
Molina Healthcare offers Medicare Advantage plans, also known as Part C, which combines Parts A, B, and D (Prescription Drug Coverage) into a single comprehensive plan. This means that individuals with Medicare or both Medicare and Medicaid coverage can benefit from having all their needs met under one plan with one card.
Molina Healthcare works closely with state governments to provide quality healthcare services to those who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). They also offer Marketplace plans, known as Exchange in some states, for individuals who are ineligible for Medicaid but do not have access to health insurance through their employment. These plans help remove financial barriers and minimize out-of-pocket expenses.
Molina prioritises member-centred care, aiming to provide quality healthcare that meets the unique needs of individuals with Medicare and/or Medicaid coverage. Their mission is to deliver healthcare to people receiving government assistance, ensuring accessibility and affordability.
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Marketplace plans
Molina Healthcare offers Marketplace (known as Exchange in some states) plans in many of the states where it offers Medicaid health plans. Marketplace plans provide highly subsidised commercial coverage for people whose incomes make them ineligible for Medicaid and who don't have access to health insurance through their employment.
Molina Healthcare's Marketplace plans are designed to meet the needs of individuals with Medicare or both Medicare and Medicaid coverage. They offer comprehensive, quality benefits and programs, including access to a large selection of doctors, hospitals, and other healthcare providers at little or no out-of-pocket cost.
Molina Healthcare also provides Medicare Advantage plans and is a leader in the Medicare-Medicaid plans program as part of a member-centred healthcare approach for people eligible for both Medicaid and Medicare.
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Molina Healthcare acquisitions
Molina Healthcare is a US company that provides managed healthcare services under the Medicaid and Medicare programs and through state insurance marketplaces. It offers Marketplace (known as Exchange in some states) plans in many of the states where it offers Medicaid health plans.
Molina Healthcare has completed 5 acquisitions with an average acquisition amount of $350 million. Its most active year was 2020, with 3 acquisitions, and it has averaged nearly 1 acquisition per year over the past three years, including 1 in 2024.
In July 2024, Molina Healthcare acquired ConnectiCare Holding Company, Inc. for $350 million. ConnectiCare provides services for primary healthcare and was founded in 1981. At the time of the acquisition, ConnectiCare served approximately 140,000 members across Marketplace, Medicare, and certain commercial products.
In December 2023, Molina Healthcare amended the terms for the acquisition of Bright HealthCare's California Medicare business.
Molina Healthcare also partnered with BeMe Health in August 2024 to address adolescent mental well-being for youth in foster care.
Other acquisitions include Cityblock, which expanded with Molina to enhance care for D-SNP Massachusetts members in April 2024.
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Molina Healthcare grants
Molina Healthcare provides a wide range of quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). They also offer Medicare Advantage plans, which provide comprehensive benefits and programs, such as access to a large selection of healthcare providers, at little to no out-of-pocket cost. Additionally, Molina Healthcare offers Marketplace plans in states where they have Medicaid plans. These Marketplace plans provide subsidized commercial coverage for people who are not eligible for Medicaid and do not have access to health insurance through their employment.
Molina Healthcare is committed to investing in building stronger communities by improving people's health and lives. They previously had a Molina Community Innovation Fund, which has now been replaced by the MolinaCares Foundation. The MolinaCares Foundation works with community partners to determine potential investments that support mutual goals in enhancing health and well-being.
The Molina Healthcare Charitable Foundation, a 501(c)(3) established in 2020, aims to improve the health and well-being of disadvantaged populations by funding innovative and meaningful programs and solutions. One example of their work is the MolinaCares High School Scholarship program in Iowa, which provides $2,000 scholarships for students enrolling in certified nursing assistant, licensed practical nurse, registered nurse, or bachelor of science in nursing programs.
Molina Healthcare's grants and initiatives, such as their work with the MolinaCares Foundation and the Molina Healthcare Charitable Foundation, demonstrate their commitment to improving access to quality healthcare and enhancing the well-being of communities across the United States.
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Frequently asked questions
Molina Healthcare is an individual and family health insurance company.
Molina offers Medicaid, Medicare, and Marketplace plans.
Molina Healthcare offers plans in many states, including California, Washington, New Mexico, Florida, Utah, Michigan, Wisconsin, and Maine.
Molina plans include access to a large selection of doctors, hospitals, and other healthcare providers, as well as options for online and behavioural health services.
