Molina Healthcare, Inc. (MOH)
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UBS Global Healthcare Conference

Nov 9, 2026

Summary

2027 earnings building blocks point to at least $9.50, with additional upside if Medicaid MLR improves. A 6% membership decline assumption, Florida contract ramp-up and rate-versus-trend remain key considerations.

A. J. Rice
Analyst, UBS

Wherever you want. I will sit here. I am sitting here on the edge. All right, I think we will get going with our next presentation. We are very pleased to have Molina Healthcare with us today, and Mark Keim is the Chief Financial Officer, is going to represent the group. Mark, thanks for participating in our conference this year. Coming out of the third quarter, what gives Molina confidence that the company is approaching a positive turn, particularly as it relates to Medicaid, and what remains your biggest source of uncertainty, if I could ask you?

Mark Keim
CFO, Molina Healthcare

Well, A.J., thanks for having us here, and it is always great to see you. Thanks so much. We outlined on our third quarter earnings call the building blocks to $9.50. That is a starting point. That is not guidance. That is also before the impacts of MLR year-over-year on the Medicaid business. You mentioned uncertainty. I would put it in the category of cautious optimism. But when we look at next year, the two big drivers, the membership impact of OB3, obviously with work requirements and biannual redeterminations, there is some uncertainty around membership.

I think the environment for that is probably improved in the last few weeks. Guess we will talk more about that later this morning. But the other one is certainly rates versus trend. For Medicaid, we are coming off a 92.6% in our guidance for 2026. The building blocks to $9.50 assume no change to that for next year. Any benefit on the MLR line is only upside to the $9.50.

A. J. Rice
Analyst, UBS

Okay. And you have talked about embedded earnings of $9 that you hope to realize at some over the next few years. How much of that embedded earnings is due to an expectation and improvement of legacy Medicaid and Medicare margins, and what components of that are largely in place, and it is just a glide path to get to those, and what require future operating performance?

Mark Keim
CFO, Molina Healthcare

Yeah, so thanks for asking that. The $9 of embedded earnings, just to level set, I do not know how some of our competitors do it, but at Molina, embedded earnings are what we call a new store concept. It is not about changes to the legacy business. It is about new discrete pieces of business that we bring in, typically RFPs and acquisitions, things like that. So the $9 is truly incremental things, not the legacy business. I mentioned we would harvest $4 of the $9 of embedded earnings in 2027, and what that specifically comes from is the Florida CMS Kids contract. In 2026, we expect to lose about $1.50 on Florida CMS Kids. We expect to get that to at least break even in 2027. So that is $1.50. We announced that we would be leaving our MAPD or general issue Medicare business for 2027.

That currently loses $1, so that is a good guy for $1. Then finally, we have become very good at harvesting the leverage in our G&A administration ratios with growth. Next year, we will grow $3 billion from $42 billion to $45 billion of premium revenue. Associated with that, we will drive $1.50 of G&A efficiencies. So that is the $4 that we will harvest in 2027. The remaining $5 is for 2028 and 2029.

A. J. Rice
Analyst, UBS

Okay. When you think about, I know you said you are not giving guidance for next year at this point, but when you think about first half, second half, is some of that $4 going to skew more to the back half, or you see that sort of evenly allocated over the year?

Mark Keim
CFO, Molina Healthcare

Yeah, that is probably a little in the weeds at the moment. I am not ready to give guidance, let alone the seasonality. But A.J., I will make a more broad comment. Typically at Molina, we are a little front-end loaded in our earnings. We are typically anyplace between 55% and 70% front-end loaded across the year. That is not commentary on next year, but typically expect us to be a little front-end loaded.

A. J. Rice
Analyst, UBS

Okay. All right. We have the base of $5.25 this year, $4 of embedded earnings, $9.25. I think you said $9.50. Somewhere in that range, there is sort of natural growth that comes with that number. Any other headwinds or tailwinds to consider? Again, I know you are not giving formal guidance, but to point to?

Mark Keim
CFO, Molina Healthcare

Yeah, let me walk through explicitly the math to when we say at least $9.50. We start with $5.25, which is guidance for 2026. We add the $4 of embedded earnings I talked about. In addition to that, Marketplace currently loses about $0.75 a share. We expect to at least get that to break even next year, so add another $0.75, you are at $10. When we say at least $9.50, one headwind you have to consider is for 2027, California UIS, or Undocumented Immigration Status members, will go back to fee-for-service due to federal regulation. That will be a $0.20-$0.25 headwind for us, so $10 comes on back to about $9.75. We say at least $9.50.

A. J. Rice
Analyst, UBS

Okay. Okay. Is there natural growth almost every year you are going to get something that you would speak to at this point, or it is too early?

Mark Keim
CFO, Molina Healthcare

Well, the natural growth is in our revenue projections.

A. J. Rice
Analyst, UBS

Okay.

Mark Keim
CFO, Molina Healthcare

Remember, we're going $42 billion to $45 billion. The other thing, I'd just remind everybody that $9.50 in the building blocks is before improvement on the MLR.

A. J. Rice
Analyst, UBS

Right

Mark Keim
CFO, Molina Healthcare

In our legacy Medicaid business. Remember, we're at 92.6 in guidance this year. Anything better than 92.6 accrues something better to the building blocks.

A. J. Rice
Analyst, UBS

Okay. To sort of pivot and specifically talk about Medicaid framework a little bit. You're saying you're looking at roughly a 6% rate growth against a 5.5% and 6% medical cost trend. Is that enough to start to recapture some of the margin pressure of the last few years?

Mark Keim
CFO, Molina Healthcare

Here's the way to think about it. If we're jumping off a 92.6, if rates and trend are exactly equal, you would probably be a 92.6 next year. If there is an imbalance between rates and trend, it will improve or reduce the MLR. So right now, we're saying 6% in our rate outlook, not 100% complete, but that's our best guess at the moment, and we're saying 5.5%-6% on trend. If trend comes in at the lower end of that range, obviously you've got a 50 basis points benefit to the MLR line.

A. J. Rice
Analyst, UBS

Okay. You have said on the cost side that you are seeing stabilization in Medicaid. Is that across the board, or there is particular pockets that are moderating in terms of pressure points? Any comment there?

Mark Keim
CFO, Molina Healthcare

Good. When we talk about trend, we think about it really in two categories. We are saying 5.5% trend for 2026. We are saying 5.5%-6% for 2027. But within that are two categories. There is what we call core trend, which is just utilization rates, regular trend. But on top of that is acuity mix shift. As membership declines, there is an impact sometimes on MLR. That is the acuity mix shift. We are seeing about a stable 4.5% on core. Now, that is higher than it used to be. Years ago, core trend in Medicaid was a much lower number. But A.J., what we are seeing on that 4.5%, it appears to be a very stable number now. It is higher than it used to be, but stable. Higher is okay if it is stable, because it will get caught up in rates. What is driving a lot of that is LTSS.

It is the usual subjects, A.J. LTSS, BH, professional office visits, and of course, high-cost drugs. But I am not really seeing much fluctuation. They continue to run at a higher rate. Stable is good.

A. J. Rice
Analyst, UBS

Okay. When you talk about, that is interesting, the core at 4.5%, and then the acuity shift on top of that is what is getting you to 5.5%-6.5%. Is the debate between the industry and the states around the 4.5% pretty settled? The states understand that, and it is really trying to gauge how much of an acuity shift, or is there still some catching up to be done on the 4.5% even?

Mark Keim
CFO, Molina Healthcare

Okay. Every state's a little bit different, but across the board, there is catching up to do on the 4.5%.

A. J. Rice
Analyst, UBS

Okay.

Mark Keim
CFO, Molina Healthcare

We've been very clear that across the country, most markets are underfunded by about 300 basis points. So before you even consider new trend, you have to consider something for catching up on the underfunding that's currently in the market. We believe the markets are underfunded by 300 basis points, so rates should pick up some of that, as well as anticipate new core trend.

A. J. Rice
Analyst, UBS

Okay. In speaking about some of the implementation of new eligibility requirements, work rules, et cetera, I think you've talked about a 6% membership headwind for next year with some follow-on potentially in 2028. How are you translating that membership headwind and other factors around work rule implementations into sort of an earnings framework?

Mark Keim
CFO, Molina Healthcare

Yeah, absolutely. So as always, too soon to give guidance, but we like to be pretty transparent in laying out the building blocks. A lot of you make the models. You need to think constructively in a framework how to do that. So on the revenue impact of OB3, we laid out a view next year where $42 billion of 2026 premium revenue grows to $45 billion. Within that, we fully contemplated the loss of 6% of the members. So there's the revenue component. As I just mentioned, on Medicaid MLR, we're thinking 5.5%-6% next year, 4.5% is core, but the potential headwind from that membership loss is the 1%-1.5%.

A. J. Rice
Analyst, UBS

Okay.

Mark Keim
CFO, Molina Healthcare

Just placeholders at the moment. You can imagine we will be a lot more explicit when we give our earnings guidance in February, but I think at this early stage, that is a helpful framework.

A. J. Rice
Analyst, UBS

Okay. The medical frailty rule proposed by CMS was struck down. That was generally viewed as a little more onerous definition than the original definition put forward by Congress. What is your perspective on that? Does that give you more optimism that the likely potential dis-enrollment under the work rules will not be as difficult as thought?

Mark Keim
CFO, Molina Healthcare

Yeah, A.J., it is a very timely question. I am not ready to change our initial assumption of 6% membership decline for next year. We will revisit that when we do guidance in February. I think the events of the last couple weeks are particularly helpful when you think about work requirements. The big thing I would point to is Massachusetts versus Oz. Several big things came out of that, one of which, states now have a lot more autonomy in how they administer and define frailty. You can imagine states will be much more flexible in how they do that. That probably creates a softer landing for members with frailty. Second, members who do have frailty will now have six months to document it as opposed to immediately be terminated, which delays any implication and also lets folks fully get prepared.

The last one I would point out is the states in the plaintiff case now have until May 1st to start the implementation of work requirements, which is a delay. A.J., what do you take away from that? Implementation is delayed, and I think the requirements are a lot softer. It sets one to think that it is probably a softer landing on at least the initial impacts, if not the ultimate impacts.

A. J. Rice
Analyst, UBS

Okay. You had said even in the last quarter that some of the states are prospectively making adjustments to rates and potential, looking ahead to potential acuity shifts. Can you frame how widespread that is and what you are actually seeing?

Mark Keim
CFO, Molina Healthcare

Yeah. I will repeat most of what I said on the third quarter earnings call. 55% of our revenues come up on January 1st. We know 80% of those rates, either in draft form or final form. A handful of them have already included rate cell adjustments explicitly for acuity shift. A few of the others have said they have not put it in yet, but as draft rates go to final, they expect to put something in for that. I am not going to get into ticking and tying on particular states or the exact impact, but you can imagine states are conceding this is there already, and it is a part of our rate cycle.

A. J. Rice
Analyst, UBS

Okay. Is there any comment about the natural drag that you expect on MLR that you need to overcome from what is happening with the work rules specifically?

Mark Keim
CFO, Molina Healthcare

Well, on the loss of members in particular, in our trend assumption, we said 1%-1.5%.

A. J. Rice
Analyst, UBS

Right

Mark Keim
CFO, Molina Healthcare

On top of core. So, from our early estimates, that's what you'd need to jump over.

A. J. Rice
Analyst, UBS

That is mostly driven by the implementation of the work rules.

Mark Keim
CFO, Molina Healthcare

That's right.

A. J. Rice
Analyst, UBS

Obviously, there's just been some attrition in Medicaid generally. Talk about the administrative cost burden and what you're doing to keep that right-sized and appropriate, and what if enrollment trends as you expect?

Mark Keim
CFO, Molina Healthcare

We do a pretty disciplined job at Molina of looking at fixed costs and variable costs. Almost every cost center in the company knows its split between fixed and variable, and we manage the company that way. Just to lay out the result of that process, we are going to grow $3 billion in revenue next year from $42 billion to $45 billion, and in the presence of that, I mentioned we take $1.50 out of G&A costs. So even in a shrinking legacy book, the company is still growing, and we are still harvesting leverage out of that.

A. J. Rice
Analyst, UBS

Okay. I am going to ask you in a minute specifically about Florida, but just in general, over the last few years, we have seen some volatility in the way people forecast membership projections on new contracts, the ramp-up in profitability, even the timing on when those contracts actually begin. Out of those factors or considerations, have they led Molina to make any changes in the way they approach new RFPs, or in the way they invest ahead of a formal launch?

Mark Keim
CFO, Molina Healthcare

Yeah. I would say largely no change. Our RFP machine has been pretty successful, A.J. We have retained 90% of our reprocurements, and we have won 80% of our new procurements. We are always sympathetic to states' particular needs, whether it is social determinants of health, substance use disorder, whatever their main focus is. We will continue to do that. There are protests in the market on some of our wins, but honestly, that is business as usual, A.J. The folks on the way out generally protest, so I would not say there is a meaningful change here.

A. J. Rice
Analyst, UBS

Okay. With awards delayed in Georgia and Texas, how do you manage readiness cost and capital commitments in the face of uncertainty about the timing of those launches? Are these delays impacting the way states approach procurements in any way?

Mark Keim
CFO, Molina Healthcare

Yeah. I'd say on both of those, they're under protest, but again, that's business as usual. Just a reminder, we originally had Georgia and Texas as implementing in 2027. They may be delayed. To be conservative, we've taken them out of 2027 revenue build and pushed them into 2028. But the good news is, we're never caught by surprise on the timing of an implementation. So we know what the readiness cost is, we know what the capital commitment is. Both are easily in our numbers, just a matter of when. And the states give enough lead time on implementation once contracts are completely certified that we have more than enough time to ramp up. Expense isn't really a problem.

A. J. Rice
Analyst, UBS

Okay. And you talked about new RFP activity that you're involved in and tracking. Is there anything changing, A, given the demands and asks in these RFPs that are interesting and worth calling out on? And how's the OB3 rollout? Our sense is state Medicaid directors are facing a lot these days. Has that affected the timing on any of the RFPs that are out there?

Mark Keim
CFO, Molina Healthcare

Every state's a little bit different, but across the boards, I wouldn't say so. A.J., the big thing that I do see changing over the last year or two is reference ability. It's not enough just to write that you can do something really well. Increasingly, states are checking how your performance is in other states. They actually call other states and check references. So, as Joe Zubretsky says, it's not enough just to be good at writing essays. You've actually got to be able to do the performance, and they check. That bodes really well here at Molina.

A. J. Rice
Analyst, UBS

Okay.

Mark Keim
CFO, Molina Healthcare

So we like that a lot.

A. J. Rice
Analyst, UBS

That's interesting. Specifically on Florida, such a big contract for you, what are the two or three operational milestones that matter to move the business from the initial startup losses, which were as expected, to sustain profitability? Can you remind us of the expected pacing on those?

Mark Keim
CFO, Molina Healthcare

Yeah. Let me set the stage on that. We just implemented Florida CMS Kids in October, so we're just a month into it. In the fourth quarter, though, I expect to lose $1. It's not unusual for a startup, especially a $6 billion contract. What are the components of the fourth quarter performance? I'm expecting about a 99% MLR, and I'm expecting a 5% pre-tax loss. Now, how does that turn around? Because next year, we're going to get to break even at least. In the fourth quarter, that 99% MLR is burdened by 2% of one-time costs. Those of you who are kind of insurance accountants will know that when you hang up new revenue in insurance, you have to book one-time reserves, PFAD, LAE, things like that. The reported 99% is really a 97%.

The reported 5% loss, forecasted 5% loss, is really a 3% loss. To get to break even, I need to pick up about 300 bps next year. Whenever you implement a new business, your first quarter is usually pretty inefficient. On the medical cost side, you haven't fully implemented all the things that managed care does to constrain costs. On the G&A side, you usually run a little less efficiently right out of the gate. You can imagine a transition, the phones ring more than they otherwise would as people move from plan to plan. Picking up that 300 bps, I think, is well in our view next year. If I had to pick, most of it will come from the medical cost line, some of it will come from G&A.

A. J. Rice
Analyst, UBS

Okay. All right. I don't know if this is a fair question, but one of your peers-

Mark Keim
CFO, Molina Healthcare

You are going to ask it anyway?

A. J. Rice
Analyst, UBS

Of course. One of your peers talked about heavier utilization in Florida as it relates to this Kids contract as they transition out of that contract. To the extent you have any visibility on that early on, did you see anything like that? Is there anything worth calling out there?

Mark Keim
CFO, Molina Healthcare

A couple of things on that. We are only a month in, so to talk about actual performance at this point would be inappropriate. Most of my views at this point are from an actuarial perspective. The program is different than the one the incumbent ran, both from a G&A perspective, a member mix perspective, and a benefits perspective. From an actuarial perspective, the rates that we got for the October 1 rate cycle, we are very comfortable with. The only other thing I would mention, A.J., is we have proven time and time again, Molina makes money where others don't.

A. J. Rice
Analyst, UBS

Okay.

Mark Keim
CFO, Molina Healthcare

We outperform the market typically by 300 basis points. I cannot comment on other folks' cost structures, but we feel pretty good about this going in.

A. J. Rice
Analyst, UBS

Okay. When you think about the path to profitability in Florida, what would make it happen faster? What would make it take longer? What is the big variable when you go into a big new contract like that?

Mark Keim
CFO, Molina Healthcare

I'd go back to the framework I just laid out. If we need to pick up 300 basis points next year just to get to break even, think a little bit more than half is on the medical cost side than G&A. The items that drive both of those are obviously the drivers, but I think most of the tools to get where we need to get are well within our sight.

A. J. Rice
Analyst, UBS

Okay. Is there a big skew between first half and second half on how you're thinking that progresses, or is it pretty steady all over the course of the year?

Mark Keim
CFO, Molina Healthcare

I think we'll give you a better view on that when we do guidance in February. You have two things. One, we're growing into a new footprint.

A. J. Rice
Analyst, UBS

Right

Mark Keim
CFO, Molina Healthcare

which will mean we get better over time, but you also have a rate cycle, which is October 1st to October 1st. That will kind of affect things through the year. I will reserve judgment on that, but we feel pretty good about the overall path to break even for the year.

A. J. Rice
Analyst, UBS

Okay. Maybe pivot over to Medicare for a minute. With the Medicare business increasingly focused on the dual-eligible members, how does the company view its differentiated advantage versus others that are competing?

Mark Keim
CFO, Molina Healthcare

Yeah, let us talk about that. Next year, our Medicare business will be strictly a duals business. EAE, which is exclusively aligned enrollment, is a really big deal in the duals environment. The strong form of EAE says that if you service duals members, you must be the MCO on the Medicare side and the Medicaid side. That bodes really well for players with strong Medicaid footprints. Put another way, if you have a Medicaid footprint, you probably already have a Medicare contract, or it is easy to get one very quickly. If you are on the Medicare side and you do not have a Medicaid contract, these are hard to get. They come up every four to six years, and you have to compete for them. So in markets that enforce strong form EAE, we have a significant advantage.

I also like the idea that not only can we drive market share because of that, the underlying fundamentals of organic growth in duals are strong. It grows quicker than the Medicare market, it grows quicker than the Medicaid market. We are excited about the outlook for duals.

A. J. Rice
Analyst, UBS

Interesting. I probably should know this, but when you look at your markets in which you are in Medicare, are most of them strong EAE markets, or is it sort of a mix?

Mark Keim
CFO, Molina Healthcare

Many are strong, and my personal expectation is states will increasingly move to strong. Even weak form today will eventually move to strong. A.J., the reason it is compelling-

A. J. Rice
Analyst, UBS

Right

Mark Keim
CFO, Molina Healthcare

to have the same member in two different MCOs means a lot of inefficiency for the member and a lot of inefficiency for the medical costs. Putting everything together in an integrated fashion just makes for a better member experience and certainly reduces costs. I think you are going to see a lot more movement there.

A. J. Rice
Analyst, UBS

When I think about trying to grow that business, what is the main constraint on growing and scaling that business? Can you leverage the existing Medicaid enrollment to drive growth here, or how should we think about that?

Mark Keim
CFO, Molina Healthcare

Well, definitely being a major Medicaid player in these markets is a big benefit. Folks on Medicaid know the Molina name. In fact, some people don't think they're on Medicaid, they think they're on Molina.

A. J. Rice
Analyst, UBS

Okay.

Mark Keim
CFO, Molina Healthcare

Which is a strong statement about our brand. EAE is certainly very helpful in driving members to us. Brand recognition is certainly a great tailwind for us.

A. J. Rice
Analyst, UBS

Okay. There's a lot of discussion about competing special needs products and the proliferation of C-SNP products, et cetera. Is that changing this market in any way, changing the competitive landscape for you?

Mark Keim
CFO, Molina Healthcare

That's a really good question, A.J. 2027 is the first year of EAE, be it strong form or weak form. EAE applies to duals products. C-SNPs are not a duals product, so they're kind of a workaround. Plans that don't have Medicaid that would otherwise be forced out try to use a C-SNP to still be relevant in the market. Now, we're seeing that in a few states, but I have to think states that are truly looking for an integrated experience or members that are truly looking for an integrated experience, will see through that. I'll be curious what the future on C-SNPs as a workaround really is, because it a little bit flies in the face of integrated tools.

A. J. Rice
Analyst, UBS

Are we expecting anything specific from the administration on that

Mark Keim
CFO, Molina Healthcare

I'm not sure I can comment. What will be interesting is this year is the first year where that C-SNP workaround is kind of a relevant strategy.

A. J. Rice
Analyst, UBS

Right.

Mark Keim
CFO, Molina Healthcare

Let's see how folks react to that.

A. J. Rice
Analyst, UBS

Right. I know it's less relevant when you're going and focused on duals, but open enrollment, any early comment about that and what you're seeing?

Mark Keim
CFO, Molina Healthcare

I wouldn't want to get ahead of myself on that. We're encouraged by the products we put in the market, and so far, we're encouraged by what we're seeing.

A. J. Rice
Analyst, UBS

Okay. Molina's Marketplace, just pivoting over to the Marketplace, ACA exchanges, et cetera, has been shrinking substantially over the last few years, down, I think you're down seven states heading into next year. We've seen other players exit the market. What does management need to see to make this a segment where the company will begin again to invest for growth?

Mark Keim
CFO, Molina Healthcare

Yeah. Marketplace, the ACA could be a really good product. It could be a great segment. The problem with Marketplace and the ACA is there's too much risk pool volatility. It seems like they change the rules every year. CSRs are in, CSRs are out. Subsidies enhanced in, subsidies enhanced out. Open enrollment rules change. Special enrollment period rules change. Program integrity rules change. There's just so much volatility in the market. What we say at Molina is we can underwrite any risk, whether it's high or low, but we need a stable risk pool. And what we've seen is a lot of instability in Marketplace. So, our exposure is relatively low at the moment. If we can see some stability in that risk pool, we'd love to play in it.

A. J. Rice
Analyst, UBS

Yeah. You probably partially answered it in that answer, but when you think about the markets you're exiting versus the markets you're staying in, what are the principal points of difference?

Mark Keim
CFO, Molina Healthcare

I think you had the data point. We're going to be on exchange in seven markets for 2027, probably five with meaningful local scale. How we pick that reduced footprint is partially where are the market fundamentals attractive that we think we have a stable risk pool? Secondly, where can we achieve local scale? Because when we think about any of our businesses, national scale is a relevant factor, but local scale is very important, especially when you get to the risk pool.

A. J. Rice
Analyst, UBS

Okay. So thinking about this going forward, is success in the Marketplace business mostly about just getting pricing right, or is there other things that need to change to make this an attractive and viable space?

Mark Keim
CFO, Molina Healthcare

Stable risk pool. If you have a stable risk pool, you can get pricing right.

A. J. Rice
Analyst, UBS

Right.

Mark Keim
CFO, Molina Healthcare

The other thing is local scale. If you're subscale, you wind up having performance skews because you're on the tail of a normal curve. Local scale, you need a proper representative view of the market, which gives you a proper exposure. We need all those things to really have a good strategy.

A. J. Rice
Analyst, UBS

Okay. On capital allocation and deployment, how do you balance investing in existing business recovery, pursuing acquisitions, and returning capital to shareholders while earnings are still below the level you believe the business can generate? Are capital deployment decisions different when the business is in an earnings recovery mode?

Mark Keim
CFO, Molina Healthcare

A.J., the quick answer is, from a capital allocation perspective, nothing's changed. This market, I believe, is in a trough in 2026. Looks like things are getting better for 2027. Our margins are far from historically where we've enjoyed, but still they're positive. We're making roughly 1%-1.5% on our businesses for the most part, and that is still a positive net income compared to the market, which in many cases is losing money. Even in depressed earnings environment, our balance sheet is super strong. Cash at the parent is very strong. When I think about capital allocation, I'll give you the usual pecking order, A.J. We love organic growth. Nothing's better than the returns on organic growth for us, 50% ROEs on organic growth. M&A is very attractive for us. Why?

Because we tend to buy properties so close to organic growth multiples that the returns are just super. Then lastly, share repurchases. Anytime I have excess capital, we'll look to redeploy capital in that direction, but it's the third on the list. I'd say that pecking order doesn't change at all, A.J. Even in this depressed environment, if you believe that margins are returning, and we do, you'll invest for the future.

A. J. Rice
Analyst, UBS

The company's done a number of acquisitions over the years of troubled plans and states or turnaround situations. Any comment on the pipeline and your appetite for that in this environment?

Mark Keim
CFO, Molina Healthcare

In a trough year like 2026, you can imagine many players are struggling, particularly not-for-profit players. Our M&A pipeline is at any point staying close to many of those potential players. Sometimes it's years in development. Mission-based companies often don't want to abandon the mission until the capital is in a tough spot. We've done a very good job over the past of capitalizing on those kind of positions, giving a nice transition to those plans, and growing our business at the same time. A.J., I can't comment on particular acquisition targets, but the pipeline is always there, and we're hopeful we'll have something to announce soon.

A. J. Rice
Analyst, UBS

Okay. With the balance sheet and subsidiary capital, any comment on what matters most? Given where we're at in the turnaround and the challenge of the last couple years, is there any issues where that's being a constraint on your ability to grow?

Mark Keim
CFO, Molina Healthcare

The balance sheet?

A. J. Rice
Analyst, UBS

Yeah.

Mark Keim
CFO, Molina Healthcare

Not at all. We have, at the moment, $600 of cash at the parent, and that's only growing with more subsidiary dividends into next year. Debt to cap is under 45%. We have ample capital for growth. At this point, it's about the M&A pipeline, it's about the RFP pipeline, and organic growth. We are not capital constrained. The biggest issue for our business and the industry is the return of margins. We are very optimistic that we get to 2.5% target margins in the strategic planning period that we talked about at an investor day. With that optimism, A.J., we'll deploy capital.

A. J. Rice
Analyst, UBS

Okay. I'd probably be remiss if I didn't ask you something about last week's events and the election and so forth, and the way that played out. Obviously, we're all trying to still figure it out. I think the initial reaction is things will be more favorable potentially on Medicaid and funding of that and so forth, and maybe some relief on the work rules. I'm not sure what the industry would even ask for there. That'd be a question to potentially ask. Then it's also, I think there's some favorability around, perception favorability around Marketplace and revisiting the enhanced subsidies, et cetera. Any early read, reaction, what you think you or the industry might ask for? That's probably, leave it at that.

Mark Keim
CFO, Molina Healthcare

Yeah, so a couple things. What everyone has commented was, not only was last week a blue wave, it was a blue tidal wave, right? It was quite incredible. Senate, now very Democratic. House, very Democratic, the majority in both. At least five governors have swung from Republican to Democrat. So, it is a tidal wave. Now, practically, what does it mean? In the Senate, they need 60 seats to avoid the filibuster. They don't have that. They've got something short of it. Even if they have it, the president can veto whatever they're pushing for. This reconciliation, once again, the president can veto. What that probably points to is a more Democratic environment, somewhat helpful for our businesses, but you might see gridlock for the next couple of years just because of that dynamic and the president's veto, likely some gridlock.

I think the Democratic agenda would most likely see some relaxation on some of the OB3. Maybe the subsidies come back in place. With gridlock, I'm not sure you'll see that. There are some things, though, that probably have bipartisan support, both sides of the aisle. You have to think the IDR, the No Surprises Act, is in everyone's crosshairs these days just because of the economic consequences it's produced. Pharmacy transparency seems to have bipartisan support. So, A.J., I think at the margin, it's helpful federally. Within the states, I have to think that a swing to Democratic governors and the implementation of work requirements and increasing flexibility by the states on how they enforce that, I think that's only a good thing for frailty and the general dis-enrollment of work requirements. So, looking forward to seeing how that plays out.

A. J. Rice
Analyst, UBS

Any thoughts on state-level Medicaid expansion, whether any of the states that have, there's 10, I guess, that haven't moved forward, whether any of those might revisit it?

Mark Keim
CFO, Molina Healthcare

Yeah, I think it is a great and relevant question. I think some of these governors will make some of their intentions more clear as January 1 approaches. I think the things you have to think about, the sentiment is probably there to do it, right?

A. J. Rice
Analyst, UBS

Right.

Mark Keim
CFO, Molina Healthcare

To go to expansion. On the flip side, where is the funding come from? States are still constrained on funding. With OB3, there are increasing funding constraints going forward. I think the other thing states probably have to think about is if you do not have expansion, but you do have a large Marketplace population, how do you think about maybe the movement of Marketplace subsidized members back over to expansion, and does that work in the state's favor or not? That is probably a little bit of a different dynamic at every state, but these are the things they have to think about. Let us see how that plays out.

A. J. Rice
Analyst, UBS

Okay. Well, with that, I think I will wrap it up. That was a great discussion. Thanks so much, Mark, for participating in the conference this year. Next up in this room, I think, is Acadia, and that will start at about 11:00. So, thanks so much.

Mark Keim
CFO, Molina Healthcare

A.J., thanks so much.

A. J. Rice
Analyst, UBS

All right.