Impact of the One Beautiful Bill Act on Medicaid Payments and Future Revenue
The legislation includes significant changes to Medicaid, including limits on payments and provider taxes starting in 2028, phased in over five years through 2032.
Projected 2025 net benefit from Medicaid programs is approximately $1.2 billion, with an estimated reduction of $360-$400 million annually from 2028 to 2032.
Uncertainty remains around implementation and state responses, with some states still seeking approval and potential for new programs despite the bill.
Adjusted G&A ratio was 6.1%, reflecting lower incentive compensation and productivity enhancements.
Balance sheet remains strong with $100 million parent company cash, $260 million subsidiary dividends harvested, and debt reduced by $200 million to 1.9x trailing EBITDA.
Marketplace segment MCR was 85.4%, higher than expected, including impacts from ConnectiCare acquisition and member reconciliations.
Medicaid segment MCR was 91.3%, above the long-term target range, with pressures from behavioral health, pharmacy, inpatient and outpatient care.
Medicare segment MCR was 90%, above target, driven by higher utilization in acute populations, especially long-term services and supports and high-cost drugs.
Molina Healthcare reported adjusted earnings per share of $5.48 on $10.9 billion of premium revenue for Q2 2025.
The consolidated Medical Cost Ratio (MCR) was 90.4%, reflecting a challenging medical cost trend environment.
Year-to-date consolidated MCR is 89.8% with an adjusted pretax margin of 3.6%.
Impact of US Healthcare Policy Changes and Uninsured Population on Quest Diagnostics
Management assesses the potential impact of the 'One Big Beautiful Bill' on Quest Diagnostics, estimating a maximum 30-40 basis point volume impact in 2026 due to increased uninsured individuals.
They highlight that the bill reduces US healthcare spending by approximately 1.5% of the total $5 trillion annual healthcare expenditure, with minimal immediate impact on Medicaid and exchange-based revenues.
Management emphasizes that most exchange enrollees are employed and have incomes, thus likely to maintain insurance coverage or pay higher premiums, mitigating volume loss.
Impact of State Reimbursement Rate Increases for 2026
Illinois finalized a 3.9% rate increase to $30.80/hour, effective January 1, 2026, adding approximately $17.5 million in annualized revenue with low 20% margins.
Texas finalized a 9.9% rate increase to $17.13/hour, effective September 1, 2025, adding approximately $17.7 million in annualized revenue with margins just over 20%.
Both increases are subject to federal approval and are expected to positively impact revenue and margins in 2026.
Recognition of Top-Ranked Rehabilitation Hospitals and Strategic Development Achievements
Eight hospitals recognized among the nation's best by U.S. News & World Report, with Kessler Institute for Rehabilitation ranked #4 for 33rd consecutive year.
Opened new facilities including a 12-bed hospital with UPMC in Pennsylvania, a neuro transitional care unit in Missouri, and expansions in Florida.
Plans to open multiple new hospitals in 2026 and 2027, including partnerships with Banner Health and Cox Health Systems, with a focus on high-demand markets.
Adjusted EBITDA grew 8.4% over prior year quarter, with a substantial portion from core operations.
Adjusted EBITDA margin improved by 30 basis points compared to prior year quarter.
Cash flow from operations was $4.2 billion; capital expenditures were $1.2 billion; share repurchases were $2.5 billion; dividends were $171 million.
Contract labor improved to 4.3% of total labor costs from 4.6% in prior year quarter.
Equivalent admissions increased 1.7% for the quarter and 2.3% year-to-date.
Managed care equivalent admissions grew 4% year-to-date, Medicare grew 3%, Medicaid was slightly down, and self-pay was slightly up but below expectations.
Revenue grew 6.4%, driven by greater demand, improved payer mix, and consistent patient acuity.
Supply expense increased slightly due to cardiac-related device spending.
The company reported a 24% increase in diluted earnings per share as adjusted to $6.84 for Q2 2025.
Major Capitated Contract with National Healthcare System
AdaptHealth signed a 5-year definitive agreement to become the exclusive provider for a major national healthcare system covering over 10 million members across multiple states.
The contract is projected to generate over $1 billion in revenue during its term, with adjusted EBITDA margins aligned with the company's enterprise margins.
Once fully ramped, this partnership will elevate capitated revenue to at least 10% of total revenue, significantly increasing recurring revenue.
The contract is expected to start generating revenue 2-3 months after infrastructure setup, with full ramp-up by 2027.
Management emphasized this as a historic, transformative deal that supports long-term growth and market consolidation.
Adjusted EBITDA was negative $83 million in Q2 2025 versus negative $3 million in Q2 2024, reflecting risk adjustment and Part D cost impacts partially offset by cost initiatives.
Medical cost trends were around 6% in the first half of 2025, consistent with prior expectations.
Medical margin was negative $53 million in Q2 2025 compared to positive $106 million in Q2 2024, driven by underperformance in burden of illness programs and prior period adjustments.
Medicare Advantage membership declined to 498,000 from 513,000 year-over-year, reflecting a measured growth approach and market exits.
Q2 2025 revenue was $1.4 billion, down from $1.48 billion in Q2 2024, primarily due to lower risk adjustment and unfavorable Part D development.
Impact of Proposed Medicare Reimbursement Reform on Market Dynamics
CMS announced the WISeR model leveraging AI and machine learning to curb fraud, targeting product categories including skin substitutes, effective January 1, 2026, through 2031.
Proposed 2026 physician fee schedule and OPPS will set a fixed payment of $125.38 per square centimeter for skin substitutes across all outpatient care settings.
Management views these reforms as long-overdue, expecting a more rational market environment that favors product efficacy over price competition.
Company plans to submit comments supporting the new reimbursement methodology and advocating for clarification and potential adjustments, emphasizing confidence in their evidence-backed products.
Barbara highlighted ongoing concerns with CMS' final hospice and home health rules, noting a modest 2.6% rate increase for hospice but significant dissatisfaction with the lack of full cost recovery.
The proposed 2026 home health rule includes continued cuts, with cumulative reductions exceeding 20% since PDGM implementation, despite rising care costs and demand for home-based services.
Management emphasized that these reimbursement cuts threaten access to care, especially in rural and underserved areas, and could force closures or consolidations of branches.
Enhabit is actively engaging with trade associations and policymakers to oppose these cuts, arguing that the industry provides cost-effective care that reduces overall healthcare expenditures.