Good morning, everyone, and welcome to Molina Healthcare's 2024 Investor Day. I'm Jeff Geyer, Vice President of Investor Relations. Before we begin today, I would like to remind everyone that today's event is being recorded. Shortly after the event ends, a replay will be available on the Investor Information section of our website, www.molinahealthcare.com, where you can also find a copy of the presentation materials we'll discuss today. Turning to the event, we will start the morning with Joe Zubretsky, our President and Chief Executive Officer. Joe will provide a deep dive into our long-term strategy of sustaining profitable growth and how we expect to achieve our growth objectives. Following Joe's presentation, Mark Keim, our Chief Financial Officer, will speak to our compelling financial profile.
After the conclusion of the presentation, we will then have a live Q&A session with Joe and Mark, and they will be joined by Jim Woys, our Chief Operating Officer. Finally, our presentation and remarks today will include numerous forward-looking statements, including, without limitation, the forward-looking statements described on slide three of the presentation. These forward-looking statements are made under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Actual future results may differ materially due to numerous risk factors as discussed in the company's annual report on Form 10-K and in our other reports filed with the SEC. Our forward-looking statements represent our judgment as of today, Friday, November 8th, 2024. I will now turn the presentation over to Joe.
Good morning, everybody. Good to see a lot of familiar faces here today. The title of today's session with all of you, our Investor Day, is Value Creation: The Next Wave. We very easily could have called it Value Creation: Riding the Wave because you're not going to hear a lot of a different story, much of a different story here today. We're in the right businesses, and we are going to stay in these businesses, stick to our knitting, stay in our swim lanes. These are high-growth businesses. We've built a great platform, and we can sustain the trajectory we have been on for the past three years for the next three. Now, we're going to unveil our plan here today called Sustaining Profitable Growth. As you come to know from us, when we put a number on a piece of paper, it is a plan.
It's not a hope, a dream, or an aspiration. We put our name next to it, and then we drive at it hard. And every dollar of investment, every ounce of energy will be going into delivering on it. The plan is empirical. It's based on empirical data. It's built from the bottoms up. We're going to show you brick by brick, block by block, how this plan is built to deliver the results we say we're going to deliver over the next three years. It's data-driven, and it's fact-based. I hope, our hope today is you will not leave here wondering what we're going to do because we'll lay it out with abundant clarity. Now, I know how this works. Everybody's already flipped to page 80 or 85 to try to find the answer.
I'm not a communication expert, but I find it far more effective to give you the answer upfront and then let all the detail that Mark and I will discuss over the next couple of hours act as supporting data for where we're headed. So a very simple schematic. Here's what we said we would do. Here's what we did. Here's what we will do. Now, the numbers on the left side of this page should be very, very familiar to you. Those were the targets we set out years ago: 13%-15% premium CAGR, balanced equally with organic growth in the footprint, strategic initiatives, and M&A. We believed we would be able to sustain 4%-5% pre-tax margins and grow earnings per share 15%-18%. Numbers you're very familiar with.
Middle of the page, what did we deliver over the past five years? We beat the premium growth rate by nearly five points, came in at 19%, and it was very equally balanced between the footprint, strategic initiatives, and M&A. If we outperformed one of those lines, very successful in $9 billion of acquisitions, a little over 10 now with the Connecticut acquisition coming from M&A. And we were able to do that in holding serve with a 4.7% pre-tax margin. Not easy to do when you're growing at nearly 20% a year. Now, the earnings per share growth rate was in the range, at the bottom of the range, but when you're growing that fast, your margins will be at the low end of the range, 15%.
Given that as our what we set out to do and what we delivered, the right side of the page is where we're going. We will be able to grow premium over the next three years to 2027 at a rate of , very equally balanced between our current footprint, strategic initiatives, and M&A. We believe we'll be able to continue and sustain the 4%-5% pre-tax margin range and grow earnings per share at 13%-15% with a little bit of juice from share repurchases on top of the top line growth. What we said we would do, what we delivered, and what we will do in driving a little deeper on what we will do over the next three years. That growth rate, 7%-9% organic, 4% from acquisitions.
Pre-tax margin, we really believe, truly believe, even with all the noise right now with the redetermination shift, the acuity shift due to redetermination, that on a mixed adjusted, on a mixed equivalent basis, I should say, our medical loss ratio, medical cost ratio should settle in at the 87.5%-88.5% range, similar to the targets we set out three years ago. Given the growth that we've had and given the growth we will enjoy, we also believe we'll be able to drive our G&A ratio down. It's hovering around 7% now, high sixes. This is headed toward the low sixes, given all the productivity improvements that we've made and given the fixed cost leverage that we have the discipline of enjoying.
4%-5% pre-tax margin, holding serve on the MCRs at 87.5%-88.5%, and a G&A ratio that today is hovering around 7% and will improve over time down into the mid- to- low sixes. And so if you're growing the top line at 11%-13%, you should be able to grow earnings at . And even though we're deploying a lot of capital to organic growth, even though we're deploying a lot of capital to M&A, there still is capital, excess capital to buy back 2% of our share count over time. Grow the top line at 11%-13%, earnings growth 11%-13%, 2 points of share repurchase, adjusted earnings per share growth of 13%-15%. That's the story. And today, Mark and I will take you through the building blocks of how we expect to achieve that.
So here's my agenda today. We'll cover some of this rather briefly. We'll talk about the franchise. We'll do a brief retrospective. The guts of the presentation is the growth model. And we'll take you through exactly how we built the growth model. As I said, very bottoms up, very empirical, fact-based, data-driven. I do want to talk about the franchise that we built because the word franchise is actually, I think, overused. Sometimes it's meant to be a well-known brand. But franchise value is having the people, the processes, and the technology to have durable and sustainable value creation. Are you referenceable with your state customers? With that footprint and how we built it, we're referenceable with the customers. We have 5.7 million happy members. And the durability and sustainability is what franchise is all about. This isn't just merely a collection of contracts.
Seven years ago when we started this journey, it was more of a collage, and now I would call it a mosaic of well-organized, very, very clear set of products, geographies, and people, processes, and technologies to create durable and sustainable value. That's what franchise truly means. I'm sure everybody's tired of looking at maps all week, but I don't get tired of looking at this one. This is our 21-state portfolio, $38 billion of revenue you see on the right side of the page, Medicaid being the flagship. We're a pure play. We take capitated risk. We like low-income, high-acuity, capitated risk, people in government-sponsored programs. Being a pure play doesn't mean you can't be geographically diversified, which we think is really important for two reasons. One, it de-risks the rate cycle. Every state is on a different fiscal year, and states don't collaborate on rates.
They may be observing the same trends. They're not collaborating on rates. So having a well-diversified state portfolio de-risks the rate cycle. It also de-risks the reprocurement cycle. If your average contract is four or five years old, then 20% of your revenue is going to be reprocured every single year. It doesn't actually happen that way, but that's the point. So having a very wide portfolio with not huge amounts of revenue concentrated in a few geographies, we think creates a great risk management profile for the company. And again, Medicaid's the flagship. To repeat the strategy, by M&A or by winning a new contract, you plant the Medicaid flag and then surround it with the Marketplace business and our D-SNP product. That's how we attack it. Now, the products are highly synergistic for a couple of reasons.
One, it's not just because they're government-sponsored healthcare, but you've seen this picture before. Continuity of care is incredibly important to our customers, whether it's CMS or a state Medicaid department. Duration of member is very important to us as financial stewards of your capital because the present value of a member is a huge value creator. With the product suite that we have, we can create continuity of care for the member and duration of membership, so the net present value of a member is very, very high. People income up and income down in and out of the Medicaid business into highly subsidized Marketplace. And of course, with 11,000 Americans a day aging into Medicare, 50,000 a year from our non-Medicaid portfolios, just at Molina, we can capture our members who are becoming disabled or aging into Medicare with our very, very valuable MAPD and D-SNP products.
So the product synergy isn't just thematic. It actually creates clinical value and financial value. Now, bear with me. I'm going to do a bit of a retrospective, but I want to put it in context. We have a saying here at Molina. I coined it. It has various levels of popularity, but it goes like this: When we reach a milestone, reaching a milestone is not a cause for celebration. It's a cause for consternation because reaching a milestone merely marks the point in time when one sets a new, bold, audacious goal. Get into the end zone, move the goalpost. Very simple. But I think I want to do this.
I want to do this because I can talk a lot about how we do things here that might be a differentiator, but there's nothing like the recent past that supports the thesis that if we stay true to what we're doing, stay the course, we can produce results similar to what we produced over the past five years. So a bit of a retrospective. We like what we've produced versus the MCO peers, whether it's revenue growth, EPS growth, or total shareholder return. We're really proud of that. We started this journey. When I started this journey seven years ago, the stock was at $65. It reached a high of $425, and it settled back. But the TSR story, we're really proud of it. Premium growth, 19% five-year CAGR. We've nearly doubled the size of the company since 2019.
We've grown from $16 billion to $38 billion of high-quality revenue. High quality, great margin. And we did it in a very balanced way. $6 billion off the footprint, $7 billion from new contract wins, and $9 billion of very accretive acquisitions. Drilling on that a little bit, the Medicaid flagship did really well, came in at 12%. Medicare was a little light. The MMP flattened out. We thought we had a low-income MAPD strategy that would work better, and it didn't. But 5% in Medicare isn't bad given that we're generally a D-SNP-only company. And of course, Marketplace at 11%. Organic revenue growth on a consolidated basis, 11% against the prior target of 8% to 10%. Not bad. Really proud of the teams that did this. We built four years ago, four and a half years ago, we built a business development apparatus, an engine.
You go at it one at a time. Whether it's a reprocurement where on the left side of the page, we've reprocured nearly all the states we needed to, except for Virginia. That's still under protest. We'll see what happens. Reprocured every state that we had to reprocure. $7 billion of new procurements already in the revenue run rate, $3.5 billion yet to be realized, sitting in embedded earnings. $10.5 billion of new procurement revenue. That tells a real story. One win, maybe luck, two wins, maybe it's trend. When you got 10 or 12 wins here, this is durable and this is sustainable. Mark Menkowski and Mark Keim, sitting on both ends of me here, we built this an M&A engine, again, four or five years ago. You can see the logos here. Magellan was the first one, about $3 billion of revenue at the time.
$9 billion of revenue acquired, $1.4 billion sitting in Connecticut, and on the next page, you'll see how it's actually manifested itself in the earnings per share power of the company, both the new procurements and the announced M&A. Why? Because we measure it with embedded earnings. That's what we do. Really proud of the teams that have produced this result. Really proud of them. I'm going to spend a minute here because this is a really important page because it tells the growth story in very, very simple terms. For embedded earnings, we started this back in 2020 when we had $2.50 in embedded earnings. Embedded earnings defined as the earnings accretion from a new contract win or an M&A deal. We've added in that period of time, $9. $9 of embedded earnings were added during that four-year period of time. As the chart shows, we've harvested $5.50.
It's sitting inside our 2024 run rate with $6 left over. Now that $6 is slightly higher than you saw just a few weeks ago because we've now added the Ohio MMP win, and we'll talk about that later, but the reason this is important is if we can continue to grow earnings per share at 15%, and we always have 20%-25% of our earnings per share run rate sitting in embedded earnings, and it's got a two-year harvesting schedule, then what you're saying is earnings per share is growing looking backwards at 15%, and I have two-thirds of my forward growth rate already in the bank. It's in contract backlog, and the hardest part of this is getting the revenue.
Harvesting the earnings isn't easy, but once we have the revenue, which is the hardest part, we've proven that when we open up the Molina Playbook and Mark and Jim and all of our operators apply the discipline and rigor, we harvest the earnings. $5.50 of our $23.50 has already been realized in embedded earnings. $6 to go, $9 added during this period of time. The goal is to always have 20%-25% of our earnings per share run rate sitting in embedded earnings to support a view of our forward growth rate. Now, I'm not sure what you're expecting me to what tone you expect me to take when I talk about the current environment. We all know it's noisy.
But the way we look at it, and the way I think all of you should look at it, is I think you have to ask yourself a question that we ask ourselves all the time. And it's sort of like, is this climate change or a period of inclement weather? Our view is there's noise in the system, whether it's the acuity shift in the Medicaid rolls, whether it's the political and regulatory environment. It's a little noisy out there. But this too shall pass. This industry and our company have figured out how to navigate through atmospheric disturbance, and that's what this is. Pretty severe in some cases, but we can navigate through it. And so let's talk a little bit about the current environment and why for the long term, we think these businesses are great businesses to be in.
The environment, while it presents some day-to-day management challenges, is not an existential threat to managed care or managed Medicaid. Are these high-growth markets? I'm not going to bore you with these details. You guys have all the data that we have. These are high-growth markets. Managed Medicaid projected to grow at 6%, $460 billion in spend. Medicare duals projected to grow at 10%, $150 billion in spend. In marketplace, there's going to be some noise with enhanced subsidies, likely, but long term could grow at 5%. $750 billion of addressable market spend, those are the products we're in. High-growth markets, big addressable market. And our market share is large enough to be relevant and meaningful, but not so large that you can't believe we can grow it. We'll talk about that in a few minutes. National market share, you can see across the page.
In-state market share, you can read across the bottom of the page. We believe that market share gains in all of these businesses are part of the growth story, and I'll break that down for you business by business just in a few minutes. Our market share, large enough for scale and relevancy, but low enough where you can absolutely believe that we can grow it by a point or two over time. Now, we only had two days to react to Tuesday, and so what we purposely did here is we made this election result agnostic. We weren't going to scramble around for the next two days, the last two days, and figure out how to put together a game theory and what might happen here, but here's the model. Here's the way we think about it.
Take your favorite topic, whatever it is, whatever policy change that you think is either favorable or unfavorable to our business or anybody else's business, and process it through the process that needs to be undertaken in order to achieve it. Very simple, and there's so many ways things can get done policy-wise, but we listed out the main ones on the right side of the page. State-level legislation and regulation, federal legislation, budget reconciliation, of course, executive orders, regulatory rulings, et cetera. Lots of ways things can get done. When we take the things that one would be concerned about having to manage through over the next three years, process it through what does it take to get it done, and who is in control of that particular process, which side of the aisle, who's in the White House, those types of things.
It's hard to come up with a major existential threat to the business. On the margin, perhaps. But we've been dealing in this business with on the margin regulatory and political changes forever. That's what we do. Regulations come out, you process them, you lobby against them if they're not favorable, they get changed, and then you put in your people, your process, and technology to address it. So we're not going to go through sort of a game theory here of who won the White House, who's controlling the Senate, and who's controlling the House.
But if you take any issue, we listed nine of them on the left side of the page, and process it through how change gets impacted, we believe that changes are more or less for our business on the margin and not existential threats to transformational changes of how we think about running the place. Wrapping up this section on the environment, our businesses are just well-positioned. The Medicaid environment is solid. And whether work requirements get passed here and there, no matter what happens, we can power through it. But if rates have to be actually sound, entitlement programs aren't going away. The economy is still a barbelled economy. The low-wage service economy is still a huge part of the U.S. economy. And penetration of managed Medicaid becoming greater and greater slowly, but greater over time.
The Medicaid environment is solid to support the thesis that we can continue to sustain profitable growth in Medicaid. Medicare Duals, you'll hear in a few minutes. I would call this fluid, but very positive. It's not clear yet how actually the rules around integration will play out. But with a large Medicaid footprint and as a Medicaid player, I'm feeling really good about where the policy changes are headed toward the integration of Medicare and Medicaid to service the full Duals population. And of course, everybody's talking about whether the enhanced subsidies will persist in Marketplace. But putting that aside, we have now proven that we can run this business effectively. When we outperform, we can invest excess margin in growth, and we're targeting mid-single-digit margins in this business. And we now have a platform that we have a lot of confidence in. Irrational pricing has left.
The risk pool has stabilized, which makes it easier to price forward to a target where you can sustain a mid-single-digit margin and grow. The environment for our businesses, in our view, is very attractive, even though currently, as we sit here today, it's a little noisy. Inclement weather, not climate change. So let's drill through the growth model. I'll take you through the consolidated view of it, and then I'll take you through business by business. So you saw these numbers before, but now they're broken out by line of business. Organically, we're going to grow 7%-9%, 4% from acquisitions, a total of 11%-13%. Medicaid, 7%-9%. Medicare, 12%-14%. I'll explain that in a minute. Seems high. Marketplace, 5% with optionality. We want to see how the subsidies play out before picking a hard number.
7%-9% organically, add 4% from M&A, consolidate will grow . Now, is two points lower than the prior growth rate. But I will remind you, we grew from $16 billion to $38 billion. We're still on track to produce $41 billion next year, $46 billion in 2026. And this is headed to $52 billion-$55 billion in 2027. So while the percentage growth rate might look lower, it's off an incredibly higher base. And $15 billion of revenue growth over the next three years is slightly higher than the $14 billion of revenue growth we've achieved over the last three. In raw dollars, the growth trajectory is the same, but because we outperformed, the baseline's higher, the growth rate's a little lower. This is just it in percentage terms.
We didn't do this out of convenience, like it's well-balanced because you picked four, four, and four. No. It's well-balanced because on a bottoms-up basis, it is well-balanced. I don't think we've over-projected what the current footprint would produce. Current footprint is how many members come into the different programs and what yield are you getting to offset trend. And you'll see this business by business in a few minutes. Our strategic initiatives at the midpoint, another 4%, and a third from accretive M&A. , well-balanced between organic, two-thirds organic, one-third inorganic, and in the organic, equally balanced between what the footprint can produce by just showing up and what you have to work hard at in harvesting strategic opportunities. In dollars, that four, four, and four% is $5 billion, $5 billion, and $5 billion. Equally distributed.
$5 billion off the accretive footprint, $5 billion off the strategic initiatives at the midpoint, $5 billion off of M&A. This is headed to $52 billion-$55 billion in 2027, and the checkpoints along the way are intact. Mark will tell you in a few minutes. We'll show you the revenue guide or the revenue outlook for next year at $41 billion. We're still on track for $46 billion in 2026, which is what we said previously, and that projects out to $52 billion or $55 billion in 2027. Now, this is really, really interesting. I'm going to just go back one, so you look at $4 billion-$7 billion and $5 billion of things you have to do in order to produce that $52 billion-$55 billion. That's $9 billion-$12 billion of new stuff. Okay? Five of it is in the bank. Five of it's in contract backlog.
Currently in flight, ConnectiCare at $1.4 billion, Texas Star CHIP $1.3 billion. We just kind of ran the table on the MMP and the Massachusetts integrated programs. $1.8 billion of revenue in contract backlog just on those programs. Then, of course, Texas Star hitting run rate, New Mexico hitting run rate. If we need to produce $9 billion-$12 billion of new revenue to hit our $52 billion-$55 billion, $5 billion of it is in contract backlog. Contract backlog, securing the revenue, is the hardest part of achieving embedded earnings. Because once I unleash these guys and all of their operators with the Molina Playbook, the earnings accretion, while nothing's guaranteed, happens pretty routinely. Business by business. No surprises here. Now, I'm going to pause on this page, not just to tell the Medicaid story, but to get you familiar with the model. Of course, this is much simplified.
Our models are very, very granular, very locally driven. But this is at a high level. Here's how we built the model. If you recall, I said that our organic growth rate in Medicaid would be 7%-9%. 4% of it is from the current footprint, a combination of membership growth and premium yield. 2% of it from in-flight initiatives. I just showed you on the prior page, we have revenue contract backlog. It's secure. It just needs to be harvested. Which means we only need 1%-3% from projected initiatives in order to hit our 7%-9%. Those projected initiatives, I'll show you on a few pages, total $7 billion. We only need to harvest 30% of it to hit and achieve our 7%-9% growth rate.
Now, you say, "Jeez, why did you discount it so much?" Conservatism, execution risk, call it what you want. But a 7%-9% organic growth rate in Medicaid off the current footprint, in-flight, in harvesting, just a small portion of some really attractive strategic opportunities calculates to a 7%-9% growth rate, which we think is very attractive. This is the same model you're going to see for the other businesses. I'll rip through each one of these. These are things you already know. But let's take the RFP states, the market share, and the carve-in opportunities one by one. And again, this is an oversimplification. We have very granular models on how we built this. But from the new state RFP opportunity, there's $30 billion of opportunity that has contract inception dates for 2025, 2026, and 2027.
There's another $20 billion of RFP opportunities we'll be working on during the next three years, but likely have contract inception dates in 2028 and beyond. So we'll be working on $50 billion of opportunities, $30 billion of which has the opportunity to become revenue during the planning horizon. And we're only projecting 15% market share, which is $5 billion. That's the number you saw on the prior page that goes into sort of the melting pot of opportunities that we only need 30% of in order to achieve our goal. 30 and 20 is 50. 30 hits the revenue stream, 15% market share, and put a discount on it for execution risk and conservatism. Really proud of the team we've built. We've said this before. We have a very, very disciplined screen on what to chase. We seem to have picked our spots pretty well.
We've won most of what we've chased. Not perfectly, but most of what we've chased. We look at all the different criteria that would lead one to believe that we could win, or the incumbents are so strong, the provider environment isn't friendly enough to do it. We look at all these different screens in order to pick where we're going to go. Our formula is to go in two years before the RFP to work the system. We have an incredibly strong proposal writing team. Not only did we win, but we actually score really, really high on our written proposals and our oral presentations. But you can see we have a formula. The formula has worked. We have very strict selection criteria, and we seem to have picked our spots pretty well. So our prioritization model seems to have worked.
And as I said on the prior page, you see where we're headed. Places like when Nevada's in process right now, we're heading to North Carolina. Tennessee might reprocure. Certainly, Georgia is still out there. But you can look at the prior map and say, "Here's where we are. Here's where we're going." And this is the formula that allows us to win. Market share is not that easy to increase, but you need to focus on the right stuff. And with the market shares you see across the page, we have a couple of states. Nebraska, we're over 30%. Washington, we're close to 55%. But in most states, we might be 20% or 25%, but mostly in the 10-20 range. 1% market share is $1.5 billion across our entire footprint. But it doesn't just happen. You can't just wish it to happen.
There's stuff you have to do. So the team has done a great job. We have a customer experience center of excellence that focuses on this. How do members leave voluntarily and involuntarily? How do members enroll voluntary and involuntary? Go at those four nodes and drive at it. Providers can engage members and keep them in the system. Quality scores create better auto assignment algorithms. Certainly, the redetermination process, it's not a new thing. How do you work with your enrollees to keep them in the system if they are eligible? And of course, community involvement, charitable giving, all the community events to create brand awareness and loyalty. So you actually need to do these things in order to grow market share.
We believe that with our new center of excellence, which we've developed about two years ago, it was hard to sort of gauge market share during the pandemic with all the wild shifts in membership. But we believe we can grow market share at 1% across our footprint on average, which is a $1.5 billion revenue opportunity. When we showed this page the last time we were together, Medicaid expansion was on it. We've taken it off. We don't think Texas, Mississippi, Florida, and others will expand. But there are still LTSS carve-in opportunities and foster care carve-in opportunities, totaling $2.5 billion, 20% market share, another $500 million of opportunity. So go back to that other page.
$5 billion in new procurements, $1.5 billion in market share, $0.5 billion in potential carve-ins, a $7 billion pot of opportunity, which we only need 30% of to support our 7%-9% growth rate. And as I said, we've built operations and machines to do this hard work. It doesn't happen by wishing it to happen. It only happens by investing the money and the human resources and making it happen. That's the Medicaid organic growth story. This is a bit fluid, but not in a negative sense. Everything is really moving in the right direction. If you look at the right side of the page, we have a very modest view of the footprint at 3%.
Because we just ran the table on Michigan, Ohio, and Massachusetts, we actually have $1.8 billion of revenue that just appeared over the past number of weeks. 9% of the growth rate comes just from allowing that business, allowing that revenue to begin to manifest into our earnings stream. So what did you do? We discounted heavily the strategic opportunities. At this early stage, to be perfectly honest, I didn't feel comfortable, nor did Mark, of putting a growth rate on north of 12%-14%. But if I'm a betting person, I would tell you by mid-2025, particularly with that contract backlog that's sitting in the middle of the page, this will get updated to be a bigger number. But the revenue opportunity is $1 billion. We've only had to project harvesting 15% of it in order for this to work.
But the signs of where this is headed, particularly with the way Michigan and Ohio approach the MMP demonstrations, the way Illinois is approaching the MMP demonstrations, bodes well for a company that's got a decent product and a very deep and wide Medicaid footprint. And so we are a bit conservative here because all of this is late-breaking news. My sense is we'll drive harder at the strategic initiatives. And if Illinois were successful in converting the Illinois business from MMP to a commercial HIDE or FIDE, that in-flight number will probably grow. But for now, 12%-14% of Medicare. This is just a profile of the business. Sometimes this gets lost. People ask me, "Are you in Medicare?" Well, we're not in Medicare, really, traditional Medicare. We're basically in the duals business. $4.8 billion of our $5.6 billion of revenue is the duals.
A lot of it is sitting in the MMPs. And look, that stuff just doesn't convert. We had a bid hard in Ohio and Michigan. Right? A complex proposal. How are you going to create an integrated value prop for these members? And we swung with the best of them, and we won. And grew revenue in the meantime. So that MMP number will be converted to commercially based HIDE and FIDEs over time. Then, of course, there's our D-SNP business for total duals. And the non-duals business is mainly Bright in California. Now, as you know, we withdrew from 13 states in our MAPD product. Two, three years ago, we thought we could put an MAPD product out there that would appeal to low-income individuals who maybe weren't eligible for a D-SNP. But we couldn't scale it. So we pulled it back.
$200 million of revenue comes out of our projection. The Bright business is hugely leverageable, particularly when we go after the 400,000 dual eligibles in LA County. A very target-rich environment for dual eligibles, so that's the platform. You've written about this. You know about this. I'm not going to bore you with the details, but I warn you or caution you, drawing generalities of how this is going to work is pretty dangerous. Because while CMS came out with kind of what I'll call the master rule, "Here's how we intend for this to work," they've deferred to the states on actually how to implement it. Now, most of the states, particularly the ones we recently have experience in, are making the decision that in order to be a decent player in my market, you need to be in Medicaid. Exclusively aligned enrollment. They need to be together.
We're very well positioned. So there's different scenarios. Will the states still allow D-SNP only? We don't know. They could. Or are they going to exclusively align and make sure that only MCOs with Medicaid and Medicare can enroll in Duals? Either way, these are attractive markets. Obviously, the scenario two is better for us as the D-SNP only players won't grow as much or even enjoy a contract in the state. So fluid, but all trending very, very positive for a company like ours. This just makes the point I've been making all along. We have five demonstrations. Texas and South Carolina are just going to transition the members without a procurement. Michigan, Ohio, and Illinois are doing a procurement. We're two for two. With a statewide, nearly a statewide award in Michigan and a statewide award in Ohio, and revenue increments.
Illinois has left, and Texas and South Carolina will convert. Not only do we believe we'll keep our $1.8 billion in revenue, which was always a risk, but based on these conversions, our revenue in these businesses will grow. Two for two in the conversions of MMP to HIDE and FIDE. Illinois probably announced toward the end of the year or early next year. Of course, because of our very low share that I showed you on the other page, we believe we can grow share in the current county footprint we have. In the states where we are, where there's county expansion to occur, we can also expand share. 1% in the former, 2% in the latter, $1 billion of total opportunity. We still have very low share, even though a very successful D-SNP business, very low share. Marketplace.
Now, this is one where, because our target isn't growth, our target is a mid-single-digit pre-tax margin, the growth rate is always sort of viewed as optionality. We think the footprint grows. The yield is probably mid-single digits. Membership is probably a very low number. We're going to attempt to grow this business. Mark will talk about this in a minute, but we have two years now of excess margin to invest in growth. And we already did that and intend to continue to do that. But here, we're just saying, "Let's put a 5% number on it. Let's see how these next two years play out, whether the excess margin we invested in growth actually occurs," which we think it will. But right now, particularly with the subsidy, with the termination of the enhanced subsidies, we're just not sure where it's going.
But this is a very attractive business for us. We've done great on the margin line. We've got a great platform. Small, silver, and stable is still sort of the mantra. The risk pool is actually pretty stable. All the irrational pricing is gone. But the growth rate is a very modest 5% because it's optionality, because the target is a mid-single digit margin. This is just telling you where the business was and where it's going. It's nothing new here. It's a 21 million member market now. Some people say that it's going to shrink by 20% if the enhanced subsidies terminate. That's probably correct. We're probably estimating the same. But that doesn't make it a bad business. It's a correction. And going forward, it's going to be a very attractive business for us. This is just another picture of that same phenomenon.
21 probably ends up at 21 in 2027 with the enhanced subsidy people leaving and then normal growth coming in, so probably a 21 million member market three years out, and here's the same model. Our market shares are pretty low. There's $2 billion of revenue opportunity. Because of optionality, we've taken none of it, but $2 billion of revenue opportunity either growing share in our current footprint and expanding the current footprint to include all of our Medicaid geographies and a couple of additional states. Right now, I think we're in 14 states. $2 billion of opportunity, but we have not harvested any of that into our forward growth rate yet. Let's see how the next couple of years play out as we invested excess margin in growth, and then we'll probably put a more fine-tuned number on this. That's the organic growth story. Medicare, Medicaid, Medicare, and Marketplace.
But another part of our growth story is the M&A story. Securing the revenue stream, whether you win it in a bid or whether you're buying it from someone who already won it and only paying less than 25% of revenue for it, is an incredibly valuable allocation of capital. Our M&A platform, we use internally generated cash flow. We have not gone to the capital markets to fund our growth story. The idea is to buy a long-dated stable revenue stream. I don't really care much how it performs. In fact, the worst it has performed, unless I have to pay for it, but that doesn't mean it can't be turned around. We look at what we have, what we're buying, and take the Molina playbook, apply it in due diligence to the target, and tell me whether you can't get the target margin.
And so far, with $5.50 of embedded earnings and our $23.50 run rate, we've been very successful at doing that. Underperforming properties, buy it, apply sweat equity, and deliver value. The M&A pipeline is still strong. We're asked about this all the time. How big is the M&A pipeline? You still have opportunities. There's 250 potential targets. Not all of them are in the mature pipeline. We have dozens of opportunities that we're working with in various stages of maturity. Early stage discussions, relationship building, some late stage discussions. Can't go through them, obviously. But the pipeline is full. The team is very active. Mark, myself, and Mark Menkowski over here are spending a lot of time. And testimony to that is what we've done. I'm not going to rip through the logos again, but all the way from 2019 through 2024, announced and closed, very value creating.
Very value creating. And when you look at the tail of the tape, $9 billion of revenue acquired, not counting Connecticut, less than 25% of revenue at the purchase price, half of which, by the way, is regulatory capital, which means you'd have to use that anyway if it was organic. So you're paying very little for the goodwill value of these companies. The returns on equity are fantastic. And M&A itself has added $4 to embedded earnings and $2.65 in current embedded earnings. This has been an incredibly valuable part of the strategy and one that 5% of our growth rate is M&A. It's going to be whatever it is. If it ends up being eight, nine, or 10, fine. Long-dated revenue, don't care how it performs. Buy it efficiently. Use internally generated capital.
And if it produces these kinds of numbers, it's an incredibly accretive set of activities. I'm often asked about this. I'm only going to spend a couple of minutes on this. But I've often been asked, "Gee, you seem to be performing well. How do you do it?" We do have a playbook. We do have a playbook. And some of this sounds very trite. I hate to, it sounds very trite. It sounds silly. Focusing on the fundamentals. This is a three R's and a cloud of dust business. There are no trick plays. You have to grind it out every single day across the dimensions of managed care in order to manage capitated risk, manage it well clinically, operationally, regulatorily, and financially. Focusing on the fundamentals, disciplined approach to operating. We do have a Molina playbook.
We have a way of doing things inside the company, operating model, management process, org design, and talent that I'm not sure it's headline news anywhere, but it's disciplined, it's rigorous, it's religious. We have a playbook. We have a balanced view of our constituencies. Very much Friedmanist principles. We're here for our shareholders. That's the way I believe. That's the way my team believes. But you can't deliver superior returns to shareholders without 18,000 very engaged and happy employees who are serving members really well that becomes referenceable across the entire United States of America in the halls of government. So we balance the needs of all of our constituencies with our shareholders being in the center. We're here to deliver superior returns. But we know we can't do that without servicing the needs of all of our constituencies.
We talk about that all the time, and we live and we breathe it. Lastly, the team. I can't get emotional about numbers, but talking about the team, sometimes I do. I'm so proud of this team and what they've done. They're an incredible collection of individuals. It's more than a collection of individuals. It is a team. It's team before self. It's collaboration that I've never seen before in any company I've ever been in. You'll hear from some of them today. We focus on the fundamentals. We stay true to our playbook. We have a balanced view of our constituencies. I'll stack this team up against anybody in the industry. In summary, you've seen the page before. We're going to grow our revenue at . Deliver $41 billion next year. The same $46 billion we promised before in 2026.
On its way to $52 billion-$55 billion in 2027. Two-thirds of it organic, one-third of it M&A. We're going to target, and we're going to sustain a 4%-5% pre-tax margin target. We believe the 87.5%-88.5% is a reasonable target once the risk pool settles down. We're going to drive the G&A ratio down from its current level of 7% to something with a six handle permanently. That'll give us the opportunity to grow earnings at . With a little bit of capital allocated to share repurchase, which Mark will talk about later, we will grow earnings per share at 13%-15%. You can do the math off of $23.50 of where that's headed. The investment thesis is strong. I won't repeat it. We are pure play. We like the businesses we're in.
We've had a great track record. This plan is a continuation of the same path we've been on, both in financial trajectory and strategic trajectory. The margins in this business are attractive. The environment, a little noisy right now, will stabilize, and with a proven management team, the sustainability and durability of the franchise is what will carry us through. Thanks for listening to the growth story. Now I'm going to turn it to my partner, Mark, to talk about our compelling financial profile. Mark.
We're pleased to see you all today. Seems like we spent more time on the phone than actually meeting each other. So it was great to put the names with the faces this morning. This morning, I'm going to do exactly what you would expect me to do, which is talk a lot about 2024, talk about 2025, our capital. But let me start off with Molina margin mechanics. I get various questions all the time. How do the numbers really work? Why is Molina different? So what a great chance to do that. Simply put, Molina has best-in-class margins. Look at the chart. These are the stat MCRs right out of the stat filings. How does Molina do it? Well, Joe is fond of saying, "We get the same rates as everybody else in a particular market. There's four or five players in a market.
We get the same rates." Those corridors, we all have the same corridors. Wait a minute, the member mix. No, it's pretty evenly spread. Almost every market, just about every MCO, pretty much has the same acuity profile. So then what's the differentiator? It's got to be medical management. How's that work? Well, we do one thing, and we do it with a singular focus: medical management on folks on government-funded plans. This is what we call the wheel of medical management. A number of things in there will look familiar, but let me hit the highlights. It starts with the medical economics platform. It's so important to be able to look across 21 states and say, "Where are the hotspots? Where are different conditions popping up? Where are certain geographies popping up? Where are certain demographics popping up?
What specific providers, by proper noun, are popping up?" Once you see that, you can go address it, find out why, put in the right actions. Really important. Utilization management, this is a little cliché, but it's true. Right treatment at the right time, right setting at the right cost. That's the formula. High acuity care management, I bet you you all know this. We have a range of members. On the low end, TANF members, medical costs are about $300 per member per month. On the high end, our dual members, probably $3,000 per member per month. If you intensely focus on those high acuity members, you can really make a dent on the highest cost members. And that's what we do. Network contracting, fee for service, value-based.
On the fee for service side, we're all working on the Medicaid fee schedule, but we're able to benchmark, see where we are versus the competitors, and make sure we have the most competitive rates. Value-based contracting, sure, Medicaid's not as far along as maybe Medicare is. But increasingly, our state partners are looking for value-based contracting for compliance reasons, and we are increasingly finding value in it. Payment integrity, prepay, postpay, it's all about getting the right settlement of costs. A lot of times people think about fraud, waste, and abuse. Sure, it's that. But it's also about errors, duplication, and just making sure we settle at the right costs. It's amazing how much devil is in the details on payment integrity. We do that pretty well.
Then lastly, a little while ago, a couple of years ago, Joe established Centers of Excellence around these three areas, which are so disproportionately part of our medical costs. Behavioral health, you know what we've learned is that the cost of behavioral health is not so much on the behavioral health conditions themselves. Those same members tend to have disproportionate physical health. So by concentrating on those members, you're really addressing both sides of that equation. Pharmacy, we all know about GLP-1s, high-cost drugs. Everyone's aware of that. We've got a cost center of excellence that looks very specifically at that every day. LTSS, long-term supports and services, what is that? It's home care-based services. It's skilled nursing facilities. We have a lot of spend in this company on that. These three areas are a very large slug of our overall medical costs. So we're intensely focused on them.
So the next question, invariably, fine, is it sustainable? I like to look at this chart, and it seems to resonate with folks. Pick an example market. This is a hypothetical market. But there might be four players. There's Molina on the low side on the MCRs and a few others with higher MCRs. When a regulator sets the rates, when the actuary sets the rates, they set the rate on that total market, not any particular MCO. So you can see Molina in this example has a benefit to the total market. As long as Molina can continue to outperform the total market, these margins are sustainable. Because again, rates are set at the market average, not MCO-specific. Big part of our formula. Now the last thing is you can't cut corners to get there. The last bullet on the page says, compliance, you got to meet your standards.
Quality, you got to meet your standards. Quality can be penalties. Quality can be revenue withholds that you've got to earn back. You can't cut corners to hit this, otherwise you don't have a business. Big part of our formula. Risk corridors. The tutorial I always give that seems to resonate with people, how does it work? In 2022, we reported an 88%. In that year, just for example, our true medical costs were probably an 86%. Because there were corridors, minimum MLRs, and profit sharing, we booked 2% of corridor expense. That's the reported 88. Now, for example, along comes a trend inflection, bad rates. That underlying 86% maybe goes to an 87%. You're still booking 1% of corridor expense, but we call that the buffer. It offsets the trend.
The beauty of the system is if actuarially sound rates prevail, the next rate cycle will put us right back to where we were. The 87% drops down to an 86%. We book the extra 2% of corridor expense. We report the 88%. That's the cushion effect. Another one of Joe's pearls of wisdom, 10 bps on G&A ratios, just as valuable as 10 b ps on the MLR. In fact, if you look at the numbers, 10 bps on G&A is worth a little more because of the way the numbers work. The beauty of G&A is you could argue we're more in control of it than we are in medical costs. Medical costs, you got trends, things move around a little bit. Every dollar of G&A, we approve. We're fully in control. Having discipline here is critical.
The first two bullets on the page are the points I'd really talk to. We're in planning process right now. Every cost center in the company has a fixed cost leverage algorithm. We know what their fixed costs are. We know what their variable is. Give them something for inflation. Give them something for volume. They got to hit that number. That's the way you lock in fixed cost leverage with certainty, but we don't stop there. Fill that. Now give me productivity. Everybody gets a productivity metric. Not only do you have to get your fixed cost leverage, you got to be a little bit better this year than you were last year. It's an important part of the formula. How do we do it? Everything else on the page. Outsource, commoditize functions, renegotiate with vendors. Automation, digitization, and of course, we're a no-frills environment.
That's the way we run this place, but you can't starve the company. If you're really good at the left side of the page, you create enough funding for the right side of the page. On that list is everything you would expect. How do you reinvest back into an MCO? The overarching theme is every one of those has to have ROI. We do it because we're a better business down the road, and we fund it by being very disciplined in the short term. The equation's working well, and it's important we keep the discipline. Let's turn to guidance. The right side of this page reminds us that the initial guidance and the current guidance are pretty close. Now we got there in a different way. Premium revenue, $38 right on. EPS, $23.50 right on. MCR on a consolidated basis, we're a little hotter. Look at Medicaid.
We're up 100 bps from initial guidance. Medicare, we're up 30. Marketplace, boy, what a year they're having. 400 basis points better than my initial guidance. G&A, Joe mentioned, we'll continue to focus on that. We're coming in at 6.8% for the year. Rolled all up, pre-tax margins almost right on. Share count just a little bit better. Remember, we did a small repurchase in the third quarter. So feeling very good about this year's guidance. Let me remind you what we talked about on the third quarter earnings call. We jumped off at 90.8% in the second quarter. But wait a minute, that's really a 90.6% if you take out the two California moving pieces. Remember, there was a one-timer in the second quarter, a one-timer in the third quarter. Pull those out. They're non-recurring. They're noise. 90.8% becomes 90.6%. New store.
I think you know the story here, but every year we're growing so much, we put on the new state businesses. They always come in hotter, and within a year, year and a half, they're going to get to target margins. The reason we really call attention to it this year is we put on a lot more than we normally do. 20% of the Medicaid business this year is new state. That 20% started off at a 95% MCR. By the end of the year, it'll be at an 89.5%. Every quarter, we get benefit from that coming back down to the mean. That's the 30 bps . Then finally, in the third quarter, we had a headwind, as you can see, of about 20 bp s. Let's talk about the trend. Strong trend. 2.6% in the third quarter. You know the story.
It's redetermination acuity, the mix of leavers and joiners. Then the stayers ran hot as well. Is it the stayers running hot? Is it reconnects? We'll tell you it's a little bit of both. Strong trend in the third quarter. The good news is on rates, very strong reaction from our state partners. In that 1.9%, our five on-cycle rate adjustments and seven off-cycle rate adjustments. The five on-cycle are just a function of when the fiscal years come up. I take real confidence, though, in the seven off-cycle. These are state partners that came forward voluntarily to say, "We recognize the trend inflections, and we're going off-cycle with some adjustments." Finally, the 50 bp s of corridors. We talked about how that works. Put those together, 20 bps of pressure. We wound up at a 90.5%. Let's jump to Q4. This completes our guidance for the year.
We're jumping off at 90.5%. Take out California. Remember the one time. You're really jumping off at 90%. Can I get to an 89%? Yes. Here's how we can do it. New states keep doing their thing. We talked about that. I think in this case, I'm going to have a tailwind of 80 bp s. I'm expecting. We know we have about 80 points of known rates. It's three new states coming in on cycle, and it's the third quarter kind of coming in and having their carryover effect. A lot of that's just timing. If they raise midway through the third quarter, you're going to get incremental benefit in the fourth quarter, right? Then finally, corridors. So rates, I think, being pretty attractive. I think trend settles at something more normal. Corridors will do their thing.
Depends how everything shapes up, but that's a view on how we get to 89%. Just for context, full year guidance, how did we get here? Beginning of the year, we had an 89% in our guidance for Medicaid. California retro items between the second, third, and the fourth quarter. Put some pressure on that. That's 30 bps . New store did exactly what we thought it would do. Neutral. Then the surprises of the third and fourth quarter. Trend 3% higher than I initially thought. I initially thought trend of 3% for the full year. We're going to be at 6% the way I see it now. So 3% incremental trend across the full year. The good news is, look at those rates. It's the third quarter ones I told you about. It's the fourth quarter ones we know about.
I had thought rates would be about 3% or 4.5%, entirely on the strength of the third and fourth quarter actions. And then finally, corridors. We talked about how that formula works, but roughly half of that cushion we carry, the 2%, I'm expecting to take back to the bottom line. So an 89% goes to a 90% in spite of some pretty meaningful pressures. One question you may have, but what's in that trend? The left side just reminds you of three went to a six.
Within three going to a six, I initially thought the acuity shift (we knew it was coming) would be about 2% of net trend and about 1% on the core net. As we know, it's really probably six. What happened? Acuity shift was a little more than we thought. It's some combination of those leavers and those joiners just putting a little more pressure on.
And then finally, the core trend, a little more than I thought. That's the stayers, the people that didn't leave, the people that didn't join, and the reconnects, the people that left but quickly came back. Put those together, that's the six. Now, it's important to point out, on the acuity shift, that's behind us. Redetermination's behind us. So you can take that one out of the equation. Now, the 3% of core trend, how do I think about that for 2025? We're working through that. I think the fourth quarter will be very insightful on what the new normal is, so we'll be able to project a trend into next year. So then just a retrospective on EPS guidance for the year. We started off at $23.50. We wound up at $23.50. $2.70 up, $2.70 down. It's the pieces we talked about. Marketplace.
Remember, we thought we were at 78%. We're down to a 74% on the MLR. G&A leverage. Remember, we thought we were at 7%. We're at a 6.8%. Net investment income. It's been a good year. In spite of yesterday's cut, we expected that. It's been a good year. I'm probably $30 million ahead on net investment income than where I thought. Then the headwinds. Medicaid. We're up meaningfully from where we thought. The discussion we just had. The California retro item. And then finally, Medicare. Running just a little bit hot. Remember, guidance was 88%. We're at 88.3%. So the pieces came together a little different than we thought, but guidance held throughout the year. Let's look at 2025. Known on-cycle rates in the third quarter, five of them for 4.5%. That's in the numbers we just talked about.
9% on the three states that gave us on-cycles for the fourth quarter. Remember, we said seven off-cycle rates in the third quarter, 1.5%. Now, the good news is, look across the bottom. Our rate cycle, which is the fiscal years of our state partners, very well timed for where we are in this moment. January 1st, 55% of our revenue reprices, which, given the fact set, is pretty good because we've got very developed data on medical claims. Most of those 10 states, we have draft rates right now. Now, draft, I like to think of it as the actuarial component of negotiating. The state leads with a number. Our actuaries look at it. Our actuaries look at it, and the process goes back and forth. It's very iterative. We're not ready to release what those rates are because they're very much in flux, very much in motion.
The other thing is, without having a firm view on trend, how do you put them in context? Now, I'm also continuing to expect off-cycle rate adjustments as more data develops. Fourth quarter, first quarter, let's see how that develops. 2025 premium. We know the building blocks. We're going to jump off 38. We've got some headwinds. We're conservative guys. We've got Virginia coming out, but we have a very strong protest in Virginia, which means that we'll keep it at least for a better part of the year and maybe indefinitely. I've got it in 100% out for the moment. Redeterminations are a headwind. Why? Didn't they stop? They did. But the weighted average math, if you look at the 2024 losses, there's a little bit of that just carries over on a weighted average basis into 2025.
And then finally, Joe mentioned how we exited a bunch of MAPD markets. Small headwind there. Let's do the build. Current footprint, $1.7 billion. As Joe says, just for waking up, you get a little rate. Members keep coming. Organically grows in our footprint. That's the $1.7 billion. RFP wins. You know about those. And then ConnectiCare. I've got that closing in very early January, which means we'll take a full year of revenue benefit for it. $1.4 billion. Do the build. And strategic initiatives is up here just to remind us we're not done. Sure, it's November, but we're always working on something, and we can potentially have some more upside for the year. So that's a look on how 2025 top line comes together. Now, your next question is, but tell me about EPS. Let's do the building blocks. Embedded earnings. Joe said we're now at six.
That's up another, what, $0.25 from the last time we talked? That's Ohio and Michigan, Massachusetts. Right now, those embedded earnings are pretty evenly split between acquisitions and new contracts. In 2025, I expect we'll harvest about $2 out of that. In the acquisitions, that's ConnectiCare and Bright, a portion of them. Remember, they unfold over years. And on new contracts, that's largely LA, California, Nebraska, Iowa. So we'll take a portion of that, $2, I believe, in upside for the new year. On the remainder, spread between 2026 and 2027, hey, didn't embedded earnings used to be a two-year concept? Well, it's a three-year concept now because these wins on the MMPs, the FIDE-SNPs, the HIDE-SNPs, they don't even incept until 2026, and they'll go through two years to get to full scale.
We're now looking to 2026 and 2027 on the tail of a few of those items, but think more in 2026 than 2027. Let's do the MCR. This page is not guidance. This page isn't an outlook. Think of it as a what-would-you-have-to-believe page. Again, with the uncertainties on rates, the uncertainties on trend, we're not ready to give you a number. But I think it's very constructive to look at the pieces. The other thing that's important is, let's jump off the second half of the year, not the full half of a full year. 2024 was definitely a tale of two cities, right? What we saw in the first half, very different than what we saw in the second half. If the second half is the new normal, the new run rate, let's jump off the second half. So how do you do that?
89.7%, third quarter, California items got to come out. That's a one-timer. New store Medicaid, this is the year-over-year comparison. They ran a 92% in 2024. So if they're at target in the new year, you'll get a nice benefit. So what combination of rates, trends, and risk corridors can give me 20 bps of good guy? I don't know. I'm not ready to lay out a vision for that. The data's developing as we speak. But what do you have to believe to get to a 20 basis point benefit? There's a number of scenarios I can give you exactly that. Rates. We're hopefully in a very good rate environment. We think so. Trend. I really have to see how fourth quarter develops here, but hopefully there's a new normal on trend. And then finally, risk corridors will do their thing depending on how rates and trends shake out.
But you can see a path to getting to 89%, which is the top end of our long-term guidance. Remember, 88%, 89% on Medicaid? There's a path here to get to the top end of our long-term guidance. Okay, so what happens to EPS? You're jumping off $23.50. Let's do the easy ones first. Embedded earnings. We said $2. Share repurchase. That's easy. We did the $500 million of share repurchase in the third quarter. That maps out to about $0.40 of benefit next year. Net investment income, I'm not going to give you a number because we all have to look at our crystal ball and say, "What's the Fed going to do?" But let me give you the components. This year, we had $9 billion of assets. We'll have a little more next year, split between cash and bonds.
We averaged 4.6% on that to get to the numbers we're going to book this year. Bonds probably hold up fairly well. Cash is going to go with what the Fed does. Insert your own assumptions there. You'll get some impact as a headwind here on EPS. Then lastly, current footprint. Not ready to give you a number there. A lot of what we talked about on the Medicaid MLR is going to drive our assumption for that number. So more to come on that as rates harden and as trends really develop off the data we're seeing. Let's go to capital. The company has low leverage. Look at those stats. 1.4 times EBITDA, 35% net debt to cap. Got low leverage. Reserve strength. Everyone loves DCP. I guess in many ways, it's one of the best ways you have to look at reserve strength. We're at 48.
I reminded a few people that if you look over the last four years, we've ranged between 47 and 51 with an average of 49. 48, we're almost on the average. It's a pretty tight range. People say, "Well, gee, isn't that a metric of reserve power? And are you recognizing your expenses?" We're very stable on our expense recognition. Why this number bounces around is don't forget, there's two components on IBNR. Your expense recognition and your cash payments. If cash payments are a little bit lumpy, a little bit timing, you're going to get some iteration here. So it's not unusual for 47, 48, 49. We feel very good about our reserve strength. Everyone likes to talk about operating cash flow. It's easy to pick off the earnings release, but what really matters is getting cash up to the parent. Dividends from the states up to the parent.
When it's at the parent, we can redeploy it. We've been very effective at getting cash through dividends from our subsidiaries up to the parent. Then finally, acquisition capacity. I pushed this one out a year. In the fourth quarter of 2025, what firepower will we have? Why is it out a year? Well, when you sign a deal, it can be up to a year for regulatory approval signed to close. You're looking at what firepower do you have when you would actually close a transaction. So a year from now, I expect to have $4.5 billion deployable for M&A. So we feel very well capitalized, very well situated for the growth we want to have. I'm not doing a very good job keeping up with the pages, am I? Lastly, capital deployment discipline. Three things you can do with capital.
Reinvest it in the business, go on M&A, or return it to shareholders. This is the pecking order of capital allocation. We really like growing organically. Three checks on that, probably 25% of our allocation. Why? 60% ROEs. On average, we have 60% return on equity on organic growth. It's as good as it gets. Accretive acquisitions. Probably 50% of our capital going forward on accretive acquisitions. Typically, the ROE is in the 30-ish area ROE. Very attractive. And then finally, we will return to shareholders through stock repurchases. Stock repurchase is the best way to go. It's the tax-free way to put money back in shareholders' hands. So feel very good about this. A lot of firepower to go do what we need to do and three great alternatives to return capital. On the long-term side, reiterate what Joe said this morning.
On growth, Medicaid 7%-9%, 12%-14%, shakeout at 7%-9%. You throw acquisitions on top, . MCR targets have not changed. Now, if the portfolio mix changes, the number at the bottom, of course, changes. But those are the same targets we've been working with now for quite some time. Roll it up. You've got the MCR. You've got the G&A ratio at 7% and likely better. 4%-5% continues to be our target range. I'm going to take a page that Joe introduced earlier in the discussion and just maybe expand it a bit. Remember, Joe said $5 billion, $5 billion, $5 billion, or 4%, 4%, 4%. This just explodes that a little bit and says, "Well, gee, on strategic initiatives at the midpoint, you wanted 5%." Well, 3.9%, you've already announced.
So you've got to find $0.6 billion-$3.3 billion to fulfill this plan. M&A, $5 billion. Well, Connecticut is $1.4 billion. You need to go find $3.6 billion. 50% of this growth story is already announced and identified. So we feel good about that. Now, the one to pick at here is the projected strategic initiatives. $0.6 billion-$3.3 billion. How are you going to find that? This page is what do you have to believe? Joe ran through a set of opportunities that totaled $10 billion. We need $0.6 billion-$3.3 billion. At the midpoint, we need to find 20% of it and execute. This management team is pretty confident we can do that. A lot of attractive opportunity here. We think we can drive a fair amount of growth. So roll it all up. 11%-13% on the top line.
We talked about the ability to find operating leverage in our G&A area. That's 0%-1% over time. For this, I'm going to call it 0%. We're conservative. Would you bank the 1% maybe to offset margin? Is it a hedge? Maybe it falls through. I hope it does. We're conservative. Call it 0%. 11%-13% on the net income line. Annual repurchases over time, about 2% accretion. We're at 13%-15%. Let's bring it home with the investment thesis. Joe hit these same pages. I think they're pretty important to today's story. 11%-13% on top line growth. You see the components. 4%-5% pre-tax margins. You see the components, how we get there. And finally, adjusted EPS growth, the numbers we just went through. And as Joe highlighted, what's really important is we continue to bank those embedded earnings.
So any given year, you're seeing our performance, but you're also building your models with known and explicit EPS assumptions on the things we've already announced and banked. So a really important part of the story. Lastly, on the investment thesis, I'm not going to hit the points. Hopefully, they jump off the page from today's discussion. Probably the best thing we can do is invite Joe and Jim Woys back up on stage and take your questions.
A.J. Wait for the mic. There you go, A.J. Thanks.
Hi. It's A.J. Rice from UBS. Maybe I'll just ask a couple of quick ones, hopefully. On the commentary about the trend in Medicaid from Q3 to Q4, you're looking for an improvement, although you obviously said you're still watching it. Two-thirds of the surprise has been from the effect of redetermination, and one-third is a core underlying trend issue. What do you think is going to get better from Q3 to Q4 that makes you more optimistic about the Q4 MLR?
So a lot of that story is redetermination has greatly slowed down, right? We're now seeing the weighted average effect of what generally ended in Q2, a little bit in Q3. So that weighted average has played itself through. What I'm expecting in Q4 is a little bit more on the stayers and the reconnects. I think we're at a new normal such that that's not a lot of pressure off what we saw in the Q3, but I build in a little bit, as you can see. So it's less in Q4 about redetermination for the obvious math reasons and more about the continuation of stayers and reconnects.
Okay. And then maybe I'll just ask two more broad ones. M&A is obviously a part of the story. And you talk about all the potential targets you've identified. We've got a Trump administration that a lot of people think is going to be more lenient on M&A and antitrust. How many of those targets just won't engage because they think there's no point in engaging, and maybe you now see the pipeline accelerate?
I would say on the ability or the proclivity to engage, it's more or less tied to performance in this business than it is to somebody's view of the antitrust environment. This is a tough business that's going through an interesting period of time. And many of these not-for-profit companies just aren't operating not only to peak performance, to performance that's good enough to sustain their capital base. So I think it's more performance-related. These businesses are really tough.
And when some of these targets get religion about coming to the table, it's more or less performance-related. That dynamic is actually helping more of these targets come to seek a partner that has the capital and the resources where they can continue to fulfill their local mission, but with an expert operator and capital provider to help them.
And then my just last one, a point of clarification. You talked about the RFPs and you target the ones that you think you could be successful and play to your strengths. But it seems like increasingly that's a lot of the RFPs out there. What percentage of the RFPs do you end up going for, and what would make you not go for one?
It would be what else is in the pipeline. Strength of incumbency. There were a couple that we passed on in the past number of years that we either had too much going on, it was too early in our turnaround, or we thought the strength of the incumbency were impossible to unseat. We're going to go after a lot of these. The pipeline, as you saw in the logo chart, is actually a bit thinner now than it was five years ago, but we pretty much ran the table on the opportunities we selected. A couple we didn't chase, and Kansas was a disappointment.
But other than that, we were very, very successful. I don't think there's going to be a lot of competing priorities here. But if we have two or three acquisitions that we're integrating and there's a marginal RFP opportunity, maybe we stand down. It's very situational. Thanks, A.J. Josh?
I guess a question just on the duals and moving into these integrated plans. So I guess just you mentioned the importance to your state partners. Most important thing is continuity of care. And so what gives you confidence that over time the states are going to be willing to move those dual members into different plans, suggesting other plans that don't have the Medicaid contract? What gives you confidence that they're going to be sort of forceful enough to move some of those members? And then if you could just tell us just the logistics around that, are there differences in the financials or revenue numbers or anything like that as they move from sort of traditional plans into these new FIDEs and HIDEs?
Answer the last question first. The best benchmark we have is our MMP demonstrations, which are fully integrated products. We're doing the Medicare side. We get paid by CMS, and we're doing the Medicaid side. We get paid by the states. The PMPM on those products, it's $3,000 a month, the PMPMs. So the contribution value per member, if you're near your target MCR, is significant. And you'll have the member for a really good duration. They won't switch if they're being served well. So the financial profile of what will become a FIDE and HIDE, a commercial-based FIDE and HIDE, we think is incredibly attractive.
On your first question, it is unclear, but it's all moving in the right direction that states are moving toward exclusively aligned enrollment. I can't tell you what Medicare plan to be in, but I can tell you what Medicaid plan you're in. And I need you in the same plan for the same MCO in my state. They can do that. And a lot of them will. So it's all moving in the right direction toward exclusively aligned enrollment where you need to be in both. The two data points that we have, actually we have three.
California has a very complicated transition formula, which was very favorable to us. But the two MMPs that just transitioned, we're going to allow you to warm transfer your MMP members to the commercial FIDE and HIDE, and you need to have both sides of the equation in a very operationally integrated approach in order to serve my members. That's where it's headed.
Josh, the only thing I'd add is it's very clear CMS wants to see the same MCO on both sides of the dual. And most states do too. One conceivable scenario is that current positions are grandfathered in, but as new members come in, they'll be pushed to members to MCOs that are on both sides. So maybe not an abrupt change to the market, but you can see states moving in that direction.
In fact, California did.
Exactly.
California said, "We're moving to exclusively aligned enrollment, but if you have a D-SNP-only member, we're going to allow you to keep them grandfathered in, but no new enrollment." Exactly. So it'll trade over time. We'll go here and then back there next, okay?
Hi, Andrew Mok from Barclays. You have a number of important states coming up for renewal on 1/1. Can you give us an update how rates are progressing, how discussions are progressing there? What's a good outcome at this point? How do you advocate for actually sound rates when trend is a moving target the way it is in the second half of the year?
Sure. I'll just frame it and then turn it to my two partners here. 55% of our revenue renews on 1/1. We have draft rates on a handful of them. As Mark said, the draft rate is a draft. It's certainly being negotiated and debated. But without a context of what trend is, if it's 8%, it sounds strong, but if trend's 10%, it's not. If it's 4%, but trend's 2%, it is strong. So without a context of how trend develops in the fourth quarter, we're not going to just out of context talk about the strength of the rate because we don't know. Mark, do you? Mark or Jim, anything to add?
Yeah, absolutely. There seems to be a notion out there that actuaries, state actuaries, are looking at data from two years ago. Well, as a baseline, they may be, but on trend, they're looking at data as recently as three months ago. Why three months ago? Well, the current month is always in an accrual because you just don't have data to pick your current month medical expense. Typically, last month, I've got a pretty good view. The month before that, I've got a really good view because the data's developed such that within the last three-month window, I probably have 90% accuracy on what was truly in medical costs. We're using as recently as that data to help inform discussions with these actuaries. They're looking at a range of data, but looking at data as recently as three months old to determine where trends are.
Obviously, we're looking at that right now sitting in November, even talking about that for rates that are as soon as January. We say draft rates, and I made the comment that they're not hardened yet because that discussion and that data development has yet to play out. Now, on the question of trend, we're not ready to pick a number yet. You have to develop a view on trend to really take a view on the rates themselves. That's all very much in flux right now.
What gave us great optimism over the strength of the rate cycle was not our forecast for 1/1, but what happened in the second half of the year. We got. It's $345 million of rate updates just in the second half across a bunch of states on cycle and off cycle. That was a, what, 230 basis point increase, 230 basis increase to the second half to our run rate. States responded to the acuity shift, both on cycle and off cycle, and the way they responded and gave us 230 basis points of lift in the second half means that they're responding to the acuity shift, they're responding to GLP-1s, they're responding to the behavioral cost phenomenon, which is rippling through the country. They're responding to all that.
Great. And maybe just a quick follow-up. If I look at the Medicaid MCR components in the bridge you have for 2025, it looks like risk corridors is a headwind. Do I have that correct? And can you help us understand the assumptions behind that?
Sure. So there's always the interplay of rates, trend, and corridors. If rates are better than trend, the corridors will start to pick some of it back up. If rates are worse than trend, if you've got money left in the corridors, they'll be a good guy. So in the example I think you're looking at, it was spatial, it was conceptual, it wasn't hard numbers, but it showed rates outpacing trend. And whenever that happens in certain states, we'll start putting money back into corridor expense depending on the attachment points.
Okay. Hi, thanks. Steve Baxter from Wells Fargo. I just want to go back to the duals alignment opportunity. In that scenario too that you laid out, if you win the RFPs and you're alongside maybe a more traditional MA plan, can you talk about what gives you maybe the right to win, how you're going to influence members to pick your plan maybe versus competitors? Then I guess secondarily, how are you guys going to approach cost trend in 2025? Will you assume something that's more normalized, or will you assume a higher level of trend in the guidance?
On the trend, Mark will take you through the numbers, and Jim here controls all of the clinical and operational activities that control trend. Why don't you take the financial part and Jim take the operational part?
On the trend, we're not ready to give you a number. When we look at Medicaid, what we are going to do is as fourth quarter develops, I have an assumption you see what I'm thinking fourth quarter will be for trend. If that's right, that will inform a view on next year. Not ready to give you that yet, but we will as our data develops. And again, on the rates, it's hard to take a view on the rates until you have that same view on trend. So more to come when we actually give guidance.
Jim?
When we think about sort of medical management and what you heard from Mark earlier when he went through the slide around what's foundational for us. And probably the strongest part of the foundational for us is what Joe talked about. We have a standard playbook, and everything is really based upon a platform and a way to go, a way that we proceed. One of the benefits of the way we've organized at Molina is that we have a single platform for claims platform or administrative platform. We're 100% in the cloud from an IT perspective. It's very determinable. It's very practical.
The enterprise at the corporate level determines policies and procedures, and they're deployed and executed in the field. So it's very predictable for us. And it's not that we have to do anything heroic. What we do is really, as Joe said, get back to the basics. And we do the fundamentals very well from a perspective of how we do care management, how we do utilization management, best-in-class payment integrity, as Mark said. And it's based upon a standard platform that we're consistent across the entire board of how we operate our business.
First part of your question, Steve, had to do with the duals and the operational integration of it. It really is an integrated product, and very few companies have this. Jim is in charge of building our integrated product. And you're absolutely right. It's not an MMP demonstration anymore. You're not going to get auto assignment. It's going to be broker. You got to have broker loyalty. We have broker loyalty. We have a whole broker platform. So we have the skills to do this. The next generation of this is our customer is saying, "No, no, no. The member doesn't call one 800 number when they have a Medicare question, another 800 number when they have an LTSS question. This is truly an integrated product, one membership card, one operating platform." Jim, you want to describe that?
Yeah. I mean, the advantage we have, as I said, a single platform is we think about different, I think, from our competitors where they run Medicaid off of one platform and Medicare off a different platform. We run them both together. And so to the extent that we can look at a uniform membership platform and look at that, we can combine these two today. We do it today with our MMP product. So we're one of the largest MMP programs in the country. We do that integrated product today. So conversion from an MMP to where we go for an integrated dual platform, we're already halfway there or most of the way there already. And it's building that capability so that when you think about delivering that benefit to the member, it's transparent.
They don't know whether it's the Medicare benefit or the Medicaid benefit. And that's where we build the strength with our customer from. That's why we, I think, are still successful in our two awards or three awards so far in the MMP conversions is because we've demonstrated that we can manage that member in a holistic sort of way in a combination of both benefits.
Buried inside your question was another allusion to why a state would move in one direction versus another. Be very clear about this. Even though the Medicare medical cost is going to be probably 75% or 80% of the spend of the integrated product, it's being governed and managed at the state level like a Medicaid contract. You need to have a SMAC agreement, a state Medicaid contract in order to be in this business. And the state controls who has a D-SNP license. So if a state is determined to go exclusively aligned, they're going to determine the universe of players. Now, that's not uniform. All states are going to be different, but the early signs are states are clearly moving in that direction, which should advantage somebody with a very wide and deep Medicaid footprint.
Right.
Then we'll go back here. Thanks. Ryan Langston, TD Cowen. I'm interested in the Centers of Excellence that you talked about with LTSS, behavioral, and pharmacy. Can you maybe give us a sense on kind of what types of initiatives you're working on and maybe even just some historical achievements or lessons learned?
You want to tee it up? They mostly report to you, and then I'll come in at the end.
Sure. So the concept again is back is foundational for us because if you think about it, we have to do stuff in a uniform way across 21 different states, three different product lines. The way we get there, right, is local execution in the markets, standardized like the franchise model we talk about, but requires at the enterprise level specialty capabilities that can look at different types of care like LTSS or behavioral health or pharmacy in a way that can provide that guidance to the local market for execution, building medical management programs that can be deployed across the enterprise.
And again, based back on a single platform, it's much easier to deploy in 21 different states a new medical management program across a single platform versus multiple platforms. We can do it more consistently, be much more nimble, and create real value in delivering sort of specialized programs, specialized services, and consistency across the entire enterprise. I think that's the.
Yeah, I'll pick LTSS for an example. It's really interesting. The Medicaid talks about visits and short stays and observation days and all. LTSS is an hours times rate business. It's getting people in and out of skilled nursing facilities at the right time and at the right cost, getting them home and community-based services at the right time and at the right risk category with the right amount of hours. It's a completely different business. What's the number, Mark? $7 billion-$8 billion of our medical costs.
That's right.
Has nothing to do with paying a hospital or a doc. It's paying a home service worker. It's a different model. It's very clinically based. 400 nurses are on the front line, hundreds of nurses on the front line determining how many service hours somebody is getting. And that's the cost of goods sold. The cost of goods sold is hours times rate, and you have to control it. We have an entire operation that just focuses on hours times rate and skilled nursing facility admins. That's all they do.
And then just real quick follow-up on the $5 billion acquisition $1.4 billion you've already announced for the $3.6 billion left. Any of that actually identified or fairly far along in the process?
Yeah, thanks. The pipeline is very rich with this gentleman has been trying to ask a question here for about 10 minutes. The pipeline is very rich with opportunities that have a maturity stage to them where we're very confident that if we have $1.4 billion of the $5 billion and only $3.6 billion to go, and we've done $9 billion over the past three years, we're good. Yes, sir.
Thank you, Joe. Appreciate it. Michael Ha, Baird. So on the topic of LTSS, I know on your slide you mentioned $2.5 billion of carve-in opportunities. When I look at and think about Medicaid industry growth, LTSS has shared dollars from carve-ins. Less than, I think, half of states have carved it in. But the value prop seems exceedingly attractive to states and reducing costs and to the payers themselves. So what's holding back states? What's the point of sensitivity? Is it the disintermediation of SNFs? What can get that pace of carve-ins accelerated going forward?
We have extensive, and you're absolutely right, extensive lobbying efforts, lobbying advocacy efforts, I'll call them, to try to get it to move in. The first and foremost, you have to recognize that if you think the healthcare lobby, the health insurance lobby is powerful across the country and states, the nursing home lobby is equally or more powerful. And having unmanaged care and LTSS for skilled nursing facilities is the best place to be. But if states want to control it, it should go managed. It's going to probably get there slowly, but we're pretty confident that over time it'll get into managed care. And we've demonstrated that we can reduce the state's budget by managing this. We've absolutely demonstrated it.
Thank you. And just one more question. Maybe this one's for Mark on the embedded or the 2025 EPS guide, which I know you haven't guided to yet, but the $2 of embedded earnings, $0.40 a share repo on top of $23.50, that's $25.90, which is right in line with the street. I know the other two bars, current footprint and investment income, a lot of variables, still figuring it out. But if I would just look at the slide, the bar on current footprint looks larger than investment income headwind. Is that the right directional sort of view to think about it? Net net, it's another positive.
Well, I'll note these are artist renderings. Look, on the growth in our core business, our core footprint, as I hope I stressed a number of times, the MOR discussion was a, what would you have to believe, the 20 bp s on the combination of trend, rates, and corridors. But it wasn't guidance. It wasn't even an initial outlook. We need to let these rates harden. The 55% in 10 states that come up January 1st, we need to really understand what those rates are. It's very in flux. And again, even if I knew those numbers today, I'd be reluctant to share them because without having a firm pick on trend, what do they mean? So we're going to hold judgment on that.
As Joe has mentioned a couple of times, we're encouraged by the way our state partners are working with us both on cycle and off cycle. And if our picks are right, the fourth quarter will settle to a new normal so that I'm pretty comfortable giving a trend number for next year. But until I do, treat that box as an artist rendering.
Thank you.
This is a question from George. It's George Hill from Deutsche Bank. Mark, I was looking at slide 60, which shows how the Medicaid rates are kind of set at the market average, and Molina continues to outperform the market as it relates to medical cost management. I guess my question could be, do you have an opinion on where your competitors are falling down and kind of what drives the continued outperformance of Molina versus its peers? Because you're kind of winning based upon the lesser competence of your peers to manage medical costs, it seems. And I would ask kind of how sustainable is that advantage? And I guess, can you talk about how Molina continues to stay ahead of its peers as it relates to medical cost management?
Yeah. I'll tee it up and then kick it to you because I think it's really important because in managed Medicaid, Mark said this, we repeat it all the time. If you think of the four nodes of performance in a managed Medicaid and a Medicaid MCR, we all have the same rates. We're all subject to exactly the same corridors. And I think you should assume, and I think it would be proper to assume that if four players have 25% market share, there could be some mixed effects of acuity of membership, but likely not.
You have a broad swath of the market. The only thing that could be differentiated is the management of what we call gross trend to net trend, the effects of managed care, which is the wheel, the wheel of medical management. I can't tell you. I can only tell you what we do. This guy is in charge of all the operational activities and currently the clinical activities. And these are run hard. They're run disciplined. And as I always say, in this business, if you don't focus on 10 basis points, it's going to turn into 100.
And if you don't focus on 10 cents PMPM, it's going to be a buck before you know it. And that's the discipline you have to have. I can't comment on what others are doing. We all have the same rates. We all have the same corridors. We're all observing the same trend. It's the management of gross to net that has to be the differentiator. Did I leave anything out?
And Joe, the only thing I'd add is what I always say about Molina is we're big enough to be relevant in all the big company ways, yet we're small enough that we really run it in a very hands-on way. It's very personal to us. If Molina were part of any of our big competitors, we would just be a division without maybe the same ownership that this management team runs this company with. So maybe that's a different answer to your same question.
One here, and then we'll go back to Justin right here. And then Justin.
Thank you. Alex Kuznetsov from Thrivent. Can you please talk a little bit about the competitiveness of the RFP processes as it's becoming more competitive lately? Specifically, do you see Humana maybe becoming like a Big Five player, five years down the road?
It can't get any more competitive than it's been, quite frankly. Everybody shows up. Everybody shows up. And not only are we winning, but we're scoring really, really high, sometimes by a little bit, sometimes by a lot. So name every big Medicaid player, they all show up. And that was a thesis somebody raised six months ago, maybe when the Georgia procurement came out, saying, "People are going to be competing harder for Medicaid." You can't compete any harder than everybody showing up in these bids, and we continue to win. I can't comment on a competitor's skill in this process.
I think the competitor you mentioned has done a good job of winning some contracts. They do show up in the bids, as does everybody else. But I can't comment on what they're doing right or wrong or differently. All I can just say is we show up strong, we score high, and our track record speaks for itself. Okay. Justin.
Thanks. A couple for Mark and then follow-up for Joe. Mark, just in terms of numbers, you talked about seven retros in the third quarter. I can't remember if you gave this previously, but any color in the third quarter, how much of that MLR impact from the retros was back to 2Q and 1Q?
Yeah, there was a little bit, but I think you asked this question on our third quarter earnings as well. There was a little bit, but what I did is net that in the fourth quarter for the net benefit of the three new ones. So what you're seeing into the fourth quarter is the net run rate or carryover. There was a lot of noise in there. Places like Texas didn't come on with their new rate until September. That means in the third quarter, I didn't get a full quarter benefit out of it. That was a good guy in the fourth quarter on a run rate basis. You're pointing out it worked the other way too with maybe some retros. I've netted all that, so your fourth quarter is a clean quarter over quarter compare.
Okay. And then when you put up that helpful slide in terms of trend acuity versus kind of same store, I think at least I was surprised that the same store number was bigger than the acuity being worse, right? It was 2% worse versus 1%. Can you give us a little more color in terms of the rejoiner impact within that 2% versus kind of the same store? What's driving the rejoiner? I think we can understand, right? That's just acuity, but just a different way of measuring acuity, I guess. But the same store piece, what are the moving parts there? And what did you see through the third quarter?
Yeah, so it's a really good question. And as we dive in and the data really develops, we're sharpening our view on the same thing. But here's what you have. On the stayers, there's no doubt there's a little uptick on the things we always talk about: behavioral health, pharmacy, LTSS. Definitely a little uptick there. And is that sustaining? We're going to find out here in October and November. But I'm expecting, as you can see in my numbers, not a meaningful increment on trend there. Now you're on to the rejoiners, the reconnects, as we call them. There are two kinds of reconnects.
There are seamless reconnects, the folks that fall off in like within a week or so are right back on, and then there's what we call reconnects with a gap. Two different stories there on MLR. On the seamless, they tend to be high users, high MLR. One of the reasons they know they lost coverage is within a week, something's not happening. So they tend to come back on. They're a little hotter. The reconnects with a gap, that can be three, four, five, six months, and they're only finding out because they went to the pharmacy to fill a script. They went to the something happened, and suddenly they realize they have coverage. They tend to be low MLR.
So the theory here, what I'm expecting to see and what I am seeing, is that a lot of the early pressure is because it's the seamless coming back in on the reconnects, whereas you'll have probably a good guy on the reconnects with a gap because they tend to come in with a claim, yes, but not high MLR.
Got it. And then, Joe, as you think about the exchange market for 2026, and we all work under the assumption that there's at least a decent chance that the enhanced subsidies go away, what's your thought in terms of, I think we can all, I guess we can all do the math in terms of the membership declines, but how worried are you that, or how do you think about the potential framework, let's say, of something happening into the risk pool, kind of like redeterminations? And how do you bid for that?
No, that's exactly the point. Look, we're all going to have to put up with whatever, pick your favorite number, 15% membership decline, fine. Any shift in a risk pool, you have to worry about what the remaining acuity looks like. So we're worried about two things, and we have to consider it in pricing. And I'll kick it to Mark here in a minute because he presides over the pricing. One is what happens late in 2025 when they learn they no longer have coverage, or what happens in 2026 with the acuity shift in the remaining risk pool. We have to consider that as we price the product. Now, truth be told, if you have a bronze product sitting alongside your silver, many of these members won't leave and become uninsured. They'll drop down into a low-priced bronze product.
We have bronze products in what, four or five states, and I think we're increasing by three states. So we'll capture some of that in bronze, we believe. But you do have to worry or be aware of, is there going to be a rush to utilization before I know I lose coverage? And then what does the risk pool look like in the year when the risk pool does change? We have to consider that in pricing. Anything to add?
The only thing I'd add for 2026 pricing is a lot of that risk pool shift you're talking about is likely to hit bronze, right? Because many folks will get priced out of silver, which means you'll have a very meaningful influx in bronze. Well, if you've been following the company, you know Keep It Silver is one of our tenets. We'll have a little bit more bronze, but we're certainly not exposed to bronze the way others are. So we'll be keeping an eye on that. At 6% of the total company portfolio, Marketplace is a relatively small exposure. We like silver. Let's see what happens with that risk pool. But as Joe mentioned, there's two dynamics here. The end of 2025, is there a use it or lose it dynamic? And in 2026, is there a shifting risk pool, as you've mentioned?
Thanks.
Thanks. I wanted to follow up. Dave Windley at Jefferies wanted to follow up on part of Justin's question right there on the reconnects, Mark. So when you talk about that seamless reconnect coming back on quickly, are you assuming in that, or not assuming, are you seeing in that that you're not getting retro premium at all, even if it's a seamless reconnect?
On seamless, you get the retro premium. On the reconnects with a gap, it's almost as if they're a new member. So you've lost them, and four or five months later, you're coming back with no retro premium.
Okay. So you're saying that that seamless reconnect is a heavy user?
Yes.
Got it. Okay. On quarter, and I apologize if you already touched on this, but relative to the 2% that you typically have from performance, where is that as you're exiting 2024? And how variable is that across states?
Sure. So 2% is on an enterprise basis, the chart that showed the last five years. This year, I expect to exit at about 1%. So we expect we've used about half the normal corridor cushion. Now, it ranges by states. Some states have significant corridors, others less so. Some almost have no corridors. So it ranges by their policy, and it also ranges by our performance. Across 21 states, you get fairly good diversification. But as we always say, corridors are an imperfect hedge. What really matters is, do you have the hedge where the trend spikes? And in 21 states being very diversified, I generally feel good about that. But every quarter, it's either a little better or a little worse than I thought on that hedge, if you will.
Okay. And then just one more, coming back to the leavers versus stayers. So as you were talking about this in your prepared remarks, you kind of talked about it being behind us. I guess we could have said in the summer, we thought maybe it might be behind us. I'm thinking about as we roll into 2025, is there still that impact? Could that impact still affect MLR in 2025? And/or are you just looking at that as new member core trend instead?
Yep. The way we're looking at it is if our new view of trend is 6% for the year, half of that, half of that, right? 3% was the acuity shift. That's in the baseline. And so when you're trending into 2025, you have to worry about or be aware of and project off of core trend. But that acuity shift has happened, particularly when the fourth quarter is run out, it'll be in the run rate, and we don't have to worry about a continuing erosion of the acuity shift, putting more pressure on the MCR. That'll be in the full year result.
Quarter, should we have been done, the headlines would have said yes. We had Nevada and Nebraska continue to trickle out a few more terminations in the third quarter, which is why we were off another 50,000 net as the company, one of the bigger drivers of why we were off 50,000. I believe folks are done now. If you think about it, states are fairly incented to get this wrapped up. It takes the pressure off their budgets.
John Stansel, JP Morgan. Just a question on the kind of 250 government health plan targets that you have. I mean, obviously, it's been a pretty volatile time for government health plans. What's the state of the small government health plan right now? Are you seeing a wide diversity of how they're performing? When we think about those opportunities, how do you see that pipeline?
I want to make sure I understand your question. Performance of?
The health of small government health plans that are kind of in that 250 range that you had talked about, the targets?
It's great to be single state, single geography until something goes wrong in your single state and your single geography. And so a lot of these small plans are struggling. We can operationally power through acuity shifts, and we certainly can financially power through them. Some of these small companies can't. Somebody asked the question before, is it the new view of the antitrust? I think A.J. asked, is it a new view of the antitrust environment bringing the targets to the table? No. It's, geez, this business is really hard. And when the environment is a little difficult, I start eroding capital.
And that brings them more to the table than any other situation. So the pipeline is very full. It's got targets ranging from early stage discussions to mature discussions to very active and engaged, hopefully moving toward a transaction. And as I said, when we only have to do five, $1.4 billion is in backlog. We've done nine in the past three years. All we need is $3.6 billion. We're good there. Yes, sir.
Hey, Adam Ron from Bank of America. Most of my questions have been answered, but you talked earlier about the regulatory environment, the change in administration, and the thing that you kind of threw away as like a throwaway comment was work requirements as something that you think might get floated. So are there any states that have implemented that? And in those states, what was the impact, and how should we think about it in that scenario?
In our state footprint, I think I'm going to get this right. In our state footprint, there are none. And is Georgia, which actually has them. And based on the information that I have, the impact has been marginal and minimal. Again, it's just one more thing to power through. A month and show up for community service. Is it real? Does it have real teeth? Or is it more or less going to be a compliance activity? We don't know. It's not something we're worried about, to be honest with you. And I think in our state footprint, there are none. And Georgia is the only one in our future footprints that actually has them. And I've been told the impact has been marginal.
Thank you. Just wanted to clarify, are you saying the decline in these claims payable in Q3 was driven by acceleration in medical claim settlement, or did I misunderstand that?
Sorry, can you restate the question?
So the decline in these claims payable in Q3, you kind of hinted that that's driven by acceleration in the speed with which claims are paid, right? Is that the correct understanding?
Sure. I had made the point that over the last four years, we averaged 49. We recorded a 48 in the third quarter. And the biggest driver of fluctuation in our DCP is when do check runs happen? It's more about the cash flow reducing the liability than any irregularity in the expense recognition increasing the liability.
That's helpful. Thank you.
Thank you.
Anything else? All right. Looks like we're done. Thank you for joining us today. Thank you. Thank you for joining us. Thank you for your support, your interest, your probing questions. It keeps us on our toes. We have a great story here. It's a value creation story. We call it the next wave. It's a continuation of what we have done well in the past three to five years and what we will continue to do well. And while it may not be exciting because there's no news here, there's excitement in value creation. And this team is confident that if we stay the course, execute on this plan, we will deliver superior shareholder returns over the next three years. Thanks for coming. Thanks for your time. Have a great week. Thank you.