ModivCare - Q1 2024

Transcript

Operator (participant)

Good morning, and welcome to Modivcare's First Quarter 2024 Financial Results Conference Call. At this time, all participants are in a listen-only mode. A question-and-answer session will follow the formal presentation. If you would like to ask a question, please press star one on your telephone keypad. You may press star zero for operator assistance during the conference. Please note that this conference call is being recorded. I will now turn the call over to Kevin Ellick, Head of Investor Relations. Mr. Ellick, you may now begin.

Kevin Ellich (Head of Investor Relations)

Good morning, and thank you for joining Modivcare's First Quarter 2024 Earnings Conference Call and Webcast. Joining me today is Heath Sampson, Modivcare's President and Chief Executive Officer, and Barbara Gutierrez, Modivcare's Chief Financial Officer. Before we get started, I wanna remind everyone that during today's call, management will make forward-looking statements under the Private Securities Litigation Reform Act. These statements involve risks, uncertainties, and other factors that may cause actual results or events to differ materially from expectations. Information regarding these factors is contained in today's press release and in the company's filings with the SEC. We will also discuss non-GAAP financial measures to provide additional information to investors. A definition of these non-GAAP financial measures and, to the extent applicable, a reconciliation to their most directly comparable GAAP financial measures, is included in our press release and Form 8-K.

A replay of this conference call will be available approximately one hour after today's call concludes and will be posted on our website, Modivcare.com. This morning, Heath will begin with opening remarks. Barbara will review our financial results and guidance, and then we'll open the call for questions. With that, I'll turn the call over to Heath.

Heath Sampson (President and CEO)

Good morning, and thank you for joining our first quarter 2024 earnings call. I'm pleased to report that in the first quarter, revenue increased 3% and Adjusted EBITDA of $32 million was in line with our guidance range. These results are the outcome of our continued strategic transformation efforts. The progress made on our initiatives provides conviction that we can achieve our financial targets and exit the fourth quarter of 2024 with an expected run rate Adjusted EBITDA between $220 million and $230 million, and a free cash flow conversion of 40%-50%, excluding the impact from our expected debt refinancing. Over the past two years, our focus on operational improvements, technology advancements, and sales has underpinned our no margin, no mission culture. This has significantly enhanced our differentiated competitive positioning.

As we complete this transformation in 2024, the tangible improvements in our KPIs are now being reflected in our financial results, with an improving cost structure as well as growing sales. Additionally, Medicaid redetermination is in line to slightly better than expected and concluding in the second quarter, providing line of sight of our earnings trajectory and cash flow. One of our top priorities is addressing our 2025 senior unsecured notes. While it's premature to provide specifics, the refinancing process is well underway. Our refinancing efforts are focused on balancing capital flexibility, particularly in terms of debt prepayment options and optimizing our overall cost of capital. We also remain committed to deleveraging our balance sheet, recognizing the significant value this brings to our shareholders.

With our debt expected to be refinanced soon, clear insights into the effects of Medicaid redetermination and healthcare normalization on our profits and working capital, along with new sales onboarding, a robust pipeline, and continued cost structure optimization, we are positioned to deleverage effectively and grow our business. Additionally, potential opportunities to monetize assets, including our minority equity stake in Matrix Medical, will provide other avenues to delever. In the first quarter, we secured $36 million in NEMT annualized contract value, or ACV, from a Mississippi state contract and multiple MCO contracts. After March 31, we continued our momentum by renewing and expanding our state contract in Maine. We also received notification to negotiate a multi-year extension with one of our largest state contracts.

With several state RFPs expected this year for both renewals and expansions, our status as the incumbent, backed by a solid track record of renewals and new business wins, positions us very well. Since we transformed our go-to-market strategy, we have successfully retained all state NEMT contracts, with our last loss in 2022, which again, was largely due to legacy performance issues. We also secured $142 million of annual revenue from new MCO wins in 2023 across various regional and national contracts. However, our progress was materially offset by a first quarter 2024 reduction in volume from a large payer that began diversifying its transportation providers two years ago, largely again, due to our past performance rather than our current capabilities. Nevertheless, we remain this payer's largest NEMT provider and a key innovation partner.

Despite this, and when looking at the individual contracts and customer win-loss rates, we are proud, yet not satisfied or complacent, of our ability to expand our market share. Next, I'll provide an update on Matrix Medical. Matrix recently refinanced its debt, which had an upcoming maturity. Matrix financial results were consistent with the improvement seen throughout 2023. The business is growing very well. We continue to have confidence in the value of Matrix nationwide network of 2,800 in-home nurses and its refreshed positioning, addressing whole person health. The management team at Matrix has made significant strides over the last year. Along with our partners, we are balancing the timing of the sale versus the continued progress financially and with the innovative platform and technological advancements they are making.

That said, I expect that we will have the opportunity to monetize our minority equity stake in the latter half of 2024 or the first half of 2025. Similar to Matrix, our supportive care services, leveraging our national platform, are increasingly crucial in the evolving U.S. healthcare landscape. As healthcare shifts toward providing high quality services to vulnerable populations, our supportive care service offerings are essential for managing chronic conditions. The market now demands more than basic services. Our customers expect insights and actions that directly lower costs, improve outcomes, and enhance member satisfaction. Our technology and clinical investments are helping us secure significant competitive advantage as the industry adjusts to the regulatory environment and evolving customer needs, leading legacy NEMT providers, monitoring, and personal care point solution providers to lose market share.

On the other hand, our hybrid engagement model, which combines digital tools like monitoring devices in homes or community stations and omni-channel connections with human interaction from our contact centers, in-home care, and transportation services, not only effectively manages care for hard-to-reach members with multiple chronic conditions, but also significantly boosts our win rates in mobility and monitoring core services. This is a standout result of our transformation. Furthermore, this approach is creating new revenue channels by compensating us for reducing healthcare costs, improving outcomes, and enhancing member satisfaction, with a meaningful impact of our revenue projected in 2025 and beyond. We are actively addressing challenges from COVID's impact on working capital and the necessary adjustments to our cost structure.

Our ongoing efforts to boost the revenue-driving capabilities of our NEMT segment, while transitioning us to a more competitively advantaged platform, this shift not only enhance our cash flow, but also facilitate deleveraging, propelling additional growth and scale. Beyond our unique platform, we possess the optionality to enhance shareholder value through our three business segments and our minority equity investment in Matrix, each of which has scale and holds substantial value. Now I'll address our segment highlights, starting with NEMT. Our cost savings initiatives are progressing as scheduled. We expect to achieve at least $34 million of in-year cost savings and approximately $60 million in annualized savings beyond 2024. These savings are driven by our NEMT transformation, including our digital integration and technology advancements. The savings are reflected in our unit cost or per trip metrics, as well as KPIs like call-to-trip ratio.

The initiatives in NEMT that are driving the savings this year are in three areas: Member experience, which is focused on our contact centers, interaction with our members and transportation providers. Transportation services, which is focused on automating ride assignment, as well as standardizing and centralizing trip management. And purchased services, which is the actual cost of providing the trip. The savings here will come from our multimodal strategy, which is shifting more trips to rideshare, mass transit, select high quality and lower cost transportation providers, and other alternative options. I want to reiterate, the savings and initiatives have been identified and actioned, and approximately 60% are standard run rate savings, and we have clear actions for achieving our sales targets for this year and beyond. Medicaid redetermination continues to track in line or slightly better than our projections.

As a reminder, we had $7 million impact of Adjusted EBITDA in 2023, and an incremental $26 million to $30 million impact is expected in 2024. Redetermination is coming to an end in the second quarter, and the financial impact will flatline in the second half of 2024. The industry is expecting 20% to 30% of the members that were disenrolled due to procedural terminations will be re-enrolled over the next several quarters, which will be an incremental tailwind to our financial performance. Shifting to personal care. The first quarter results were impacted by higher-than-expected wage increases and higher centralized costs that will be synergized this year. A critical strategy is that, that is embedded in our transformation is focused on platform implementation, shared service centralization, and compliant enhancement, while implementing a sophisticated member referral and caregiver matching system.

With these consolidated systems and processes in place, we can improve operating efficiencies, which will help drive growth. We expect to exit the year in line with our long-term revenue growth rates of 7% to 9% and Adjusted EBITDA margin of 10% to 12%. Last week, CMS issued the long-awaited final rule, ensuring access to Medicaid services, otherwise known as the 80/20 rule for personal care services. While the 80% provision was maintained in the final rule, we are pleased that the clinical nursing cost will be included in the 80% calculation. We were also pleased that the implementation timeline increased from four to six years before it goes into effect. Ultimately, we anticipate legal challenges and legislation could change the rule before it's even implemented. However, we expect to be able to offset any impact with operating efficiencies and growth.

Next, New York CDPAP, or the Consumer Directed Program, whereby a member can be taken care of by a family member or a person of their choice, has encountered challenges from the state. This is a relatively small part of our business, however, we are staying engaged. In the event that there are changes, we believe we could participate in the change or convert members to more traditional home care services that we provide. In remote patient monitoring, we continue to see solid growth and performance, and we're seeing good progress with payers as we shift to an access to care model driven by our hybrid digital and human touch engagement model. As noted earlier, our monitoring solutions are contributing nicely to NEMT and PERS sales growth, and more specifically, to the innovative revenue streams that generate payments to us for cost savings, improved outcomes, and member engagement.

Currently, we have over 40 programs delivering this model. The results are very promising, with high customer engagement to expand. We continue to scale and expect meaningful revenue in 2025 and beyond. Meeting our expectations in the first quarter was an important step towards achieving our 2024 financial targets and our conviction to generate free cash flow in the second half of the year, as well as refinancing our 2025 notes with prepayable debt. We have confidence in our strategy, competitive positioning, and execution throughout the year, and we will continue to consider available strategic avenues to optimize our capital structure and drive long-term shareholder value.

Our outlook for the year remains unchanged, and we are confident in achieving our fourth quarter run rate, adjusted EBITDA of $220 million to $230 million, with a free cash flow conversion rate of 40% to 50%, excluding the impact of the expected debt refinancing. As we approach the final stages of our transformation, we're seeing a lower cost structure and increasing revenue, and we have clarity on the completion of Medicaid redetermination. With the volatility and unpredictability in cash flow behind us, our capital needs for funding working capital are expected to peak in the second quarter and expected to decrease in the third and fourth quarters as healthcare utilization stabilizes. I'd like to thank all our team members as we've navigated change and challenges over the last several months.

It's their dedication and hard work that make Modivcare a special place to be. Now, I'll turn the call over to Barb, who will share additional details about our financial results and outlook for 2024. Barb?

Barbara Gutierrez (CFO)

Thank you, Heath, and good morning, everyone. First quarter 2024 revenue increased 3% year-over-year to $685 million, driven by 2% NEMT growth, 5% PCS growth, and 7% RPM growth. First quarter net loss was $22 million, and adjusted net loss was $1.2 million or 9 cents per diluted share. First quarter adjusted EBITDA was $32 million or 4.7% of revenue, in line with our guidance range. As we discussed last quarter, EBITDA was expected to decrease in the first quarter, primarily due to the timing of NEMT contract losses occurring in the quarter, with contract wins being onboarded in subsequent quarters. Turning to a review of our segment financials. NEMT first quarter revenue increased 2% year-over-year to $479 million.

NEMT revenue incrementally benefited from successful execution of contract settlements and negotiated pricing increases that were more favorable than expected. Average monthly membership decreased 12% sequentially to 29.1 million, due to previously announced contract losses and Medicaid redetermination. Trip volume increased slightly quarter-over-quarter, while revenue per trip decreased 4% due to mix changes. Sequentially, NEMT gross margin decreased 180 basis points, primarily due to lower revenue per trip, higher utilization related to mix, and lower membership. Notably, purchased services expense per trip decreased 2.4%, and payroll and other expense per trip was flat sequentially at $6.90, even as trip volume modestly increased.

This quarter's decrease in service cost unit metrics, following last quarter's strong decline, is evidence that our cost savings initiatives are progressing, which includes lower purchased services expense per trip and stable payroll and other expense per trip. NEMT adjusted EBITDA was in line with our expectations at $27 million, or 5.7% of revenue. We expect to see margins improve throughout the year due to the onboarding of new contracts in the second and third quarters, as well as the execution of our cost initiatives. During the first quarter, our membership was impacted by Medicaid redetermination of approximately 600,000 members. Our top five states with full risk contracts are 80% through their respective redetermination periods. Redetermination impacted first quarter revenue by $10 million and adjusted EBITDA by approximately $5 million.

Overall, Medicaid redetermination is tracking in line to slightly better than we previously expected. Based on updated information, we now expect redetermination to adversely impact revenue by $60 million and Adjusted EBITDA by $26 million-$30 million in 2024, versus our original range of $20 million to $40 million. Additionally, MCOs and states are starting to see 20% to 30% re-enrollment of eligible members who were procedurally disenrolled in 2023. Our guidance includes a modest amount of re-enrollment, but the timing is hard to predict. Turning to our home division. First quarter personal care revenue increased 5% year-over-year to $184 million, driven by 2% growth in hours and 3% growth in revenue per hour. We continue to make steady progress, driving hours growth and converting applicants to caregivers.

The reimbursement rate increase this quarter was largely driven by favorable increases in minimum wages in New York. However, we expect a more subdued reimbursement rate environment for the remainder of the year. Personal care adjusted EBITDA was $11 million, or 6% of revenue, which was lower than expected, primarily due to wage growth outpacing rate increases in certain states, as well as grant income tapering off. Lastly, we received several reimbursement rate increases that didn't take effect until March first. The benefit of these increases will be fully realized in the second quarter. Going forward, we expect wage increases to moderate and operating efficiencies will drive leverage in G&A, leading to EBITDA margins returning to an expected range of 10% for the year. RPM revenue increased 7% year-over-year to $20 million.

We expect new contract wins and referral sales to further accelerate growth for the remainder of the year toward our revenue growth target of 10%. Gross margin declined year-over-year and sequentially, primarily due to higher churn in our Medicare Advantage business, related to members who lost eligibility and higher deactivation costs. The first quarter is seasonally the highest churn quarter for the year, but this quarter was higher than we anticipated. RPM adjusted EBITDA was $6.3 million, or a 31% margin. Our business trends are normalizing, and we continue to expect RPM margins in the mid-30% range, despite slightly higher service expense during Q1. Turning to our cash flow and balance sheet.

During the first quarter, free cash flow was $2 million, consisting of net cash provided by operating activities of approximately $10 million, offset by capital expenditures of $8 million, which was 1% of revenue. NEMT working capital dynamics were in line with our expectations. Contract receivables increased by $10 million sequentially to $154 million. Contract payables increased by $11 million quarter over quarter to $128 million. We ended the first quarter in a net receivable position of $26 million, essentially flat sequentially. Our revolving credit facility balance increased by $7 million to $121 million. But importantly, our net debt remained flat, with $10 million in cash on the balance sheet as of March 31.

We ended the first quarter with approximately $1.1 billion of debt, and our bank-defined net leverage ratio increased sequentially to 4.9 times as of March thirty-first, against our maximum net leverage covenant of 5.5 times. As Heath stated, we are in the process of refinancing our 2025 unsecured senior notes. We are currently pursuing financing solutions that provide flexibility for prepayment to support our priority to delever while managing our overall cost of capital. We will provide updates as the refinancing progresses, but we are focused to complete it expeditiously while optimizing the best outcome. As a reminder, we continue to expect free cash flow to be negative in the first half of 2024, as the second quarter includes settlement of certain contract payables and payment of our semiannual cash interest.

We expect free cash flow to be positive in the second half of the year based on the improvement in Adjusted EBITDA and net working capital being a source of cash. We expect that we will exit the year with Adjusted EBITDA to free cash flow conversion of 40% to 50%, excluding the impact from the expected debt refinancing. Free cash flow conversion may decrease by approximately 10% as a result of our refinancing. We maintained our 2024 revenue guidance in a range of $2.7 billion to $2.9 billion and Adjusted EBITDA in a range of $190 million to $210 million. For the remainder of 2024, here are a few qualitative items for you to consider. Medicaid redetermination is tracking in line to slightly better than our original expectations.

We expect to lose additional members in the second quarter as redetermination is anticipated to conclude by mid-year. We continue to expect a slightly net positive impact on adjusted EBITDA from business development for 2024, driven by the onboarding of our NEMT contract wins and contract repricing, offsetting the attrition from earlier in the year. Cost savings are expected to be in a range of $34 million to $38 million, net of investment and digital service costs. We expect utilization within our contract mix to be a headwind as healthcare utilization normalizes. Adjusted EBITDA from home is expected to grow in the high single digit millions of dollars for the year. We expect to invest $2 million to $4 million for the year in innovation strategies and G&A.

Over the remaining quarters for 2024, we expect a steady progression and ramp in Adjusted EBITDA, driven by new contract implementations, greater benefit from cost savings, the diminishing impact from Medicaid redetermination, and improvement in our home segment, all contributing to financial results consistent with our full year guidance. In summary, our first quarter results were in line to modestly better than we expected. These results set a solid foundation for the year, and we expect to see sequential improvement as we progress throughout the year. We expect to have our refinancing done in the near term, and we will continue focusing on execution and driving operational improvements and results. I'd like to thank all of our team members for their continued dedication and passion for serving our clients and members. With that, operator, please open the call for questions.

Operator (participant)

Thank you. We'll now be conducting a question-and-answer session. If you'd like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you'd like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment please, while we pull for questions. Thank you. Our first question is from Bob Labick with CJS Securities. Please proceed with your question.

Bob Labick (President and Director of Research)

Good morning. There's a lot to unpack here.

Heath Sampson (President and CEO)

Good morning.

Bob Labick (President and Director of Research)

But congratulations on a solid start to, you know, normalizing things for us here.

Heath Sampson (President and CEO)

Thanks, Bob.

Bob Labick (President and Director of Research)

Yeah. So, I wanted to start with NEMT, obviously, a lot of moving parts there. But overall, I think results, at least from our perspective, were, you know, better than expected, better than feared. So, you know, good, good start there. The biggest changes to the model, really, you know, on a macro, is the impact on redetermination and then the shift, the mix shift from the contracts that you lost to the new contracts you're winning. So maybe, help us understand how that plays out in the P&L this year. Maybe particularly utilization and purchased service costs, kind of are offsetting, you know, directionally from where we thought. So how might this be different to prior expectations? How should we think about those two key drivers with the mix shift, you know, the redetermination and the contract change shift?

Heath Sampson (President and CEO)

Yeah, well, the first item that you hit on, Medicaid redetermination, is the big item, right? You know, 12 months ago, we—there was fears in the marketplace on what it was going to be. And yes, it's hitting us right now, as expected, and is a main driver for where we are in Q1, and most importantly, we'll be done with it in Q2. And then secondarily, it's right where we expect it to be, but still, still material. The other—and that really affects our full risk contracts because the membership goes down, and that's a big driver. The other item that we talked about is the mix change. So as we disclosed last quarter, that we lost a number of members through this one large payer.

Those coming off, coupled with Medicaid redetermination, has changed our mix, and especially as we are onboarding these new sales wins that we've had over the last 12 months or so and continued into Q1. So that mix change, and I don't know if people realize that all our contracts that we have, though everything averages to what we give, there's a lot of diversity around utilization. The big differences that are obvious are between, like, Medicare has typically a lower utilization, and then within Medicaid, it depends on where you are in that specific state, 'cause there could be high utilizers, for example, if it's heavy dialysis. Point being, mix really matters, and you hit on a big point because of redetermination and the large volume that came out.

A lot of the large volume that came out was within the Medicare space or dual space and lower utilizers. So that is the big change, and you'll, you'll see that utilization from a mathematical perspective, actually is up. But really from the standpoint from a macro, where healthcare utilization is, yes, higher, but in line with our expectation. That's probably the most important point, in line with our expectations. But to you all, it's definitely up. So if you remember, we expected at the end of 2024, the, the complete normalization of healthcare usage and utilization, and we had that at about 10%. Now, with this mix change, again, as expected, it'll be at about 11%. So big, big model change when you're looking at things.

But in line with that mix change, there's other things that happen within our P&L, and you hit on it, purchased services. So the purchased services within this mix change will come down significantly based on the type of contracts we have in place. So those two factors, when adjusted, will make you in line and be able to better predict what our P&L is gonna be at the end of 2024.

Bob Labick (President and Director of Research)

Okay, super. That, that's really helpful and makes sense there. And then you touched on this, so maybe we can talk about it a little more, too. Congratulations on the success. Another, you know, sales win, obviously, you won a bunch last year. You won another contract or a couple more in the first quarter. Just talk about the pipeline here. Any, you know, potential surprise losses, or how's your visibility going forward? I mean, wins are great. We just wanna avoid losses, because you already have the wins lined up. So maybe visibility there, please.

Heath Sampson (President and CEO)

Yeah. Well, first off, there's a lot that we're proud of. We could spend all day going through the entire organization on the great things that have happened, but really in our go-to-market strategy, the team that we've added there, all the way from people that can drive new sales through marketing, through our product organization that's building the right solutions that meet our customers' needs, and then even beyond just the transaction of a trip, to really think about this as an access to care platform, and then again, building the necessary capabilities to ensure that that meets our customers' needs. So with that transformation of our go-to-market strategy, it's resulting in the results. The sales that started last year and the sales that continue this quarter, I'm really excited about even how the rest of the year comes out.

So I couldn't be more proud of what this organization has done. We've really changed the culture and capabilities and our go-to-market strategy. So, and then the losses, you know, again, the loss last quarter, a lot of that had to do with legacy items and the need for them to diversify away from us. Again, that specific payer, I'll just repeat what I said last quarter, we're still the largest NEMT broker and innovation partner with them. So we did not lose anything this quarter. It would be. I'm sure we will, but based on what we're doing right now, our wins will outpace our losses. So I feel really good about the team and showing up in the results, and I expect that pace to continue.

Bob Labick (President and Director of Research)

Okay, super. Last one for me, and I'll get back in line. But just on the PCS, you know, I think explained pretty well what happened in the quarter in terms of margins and the expectation for year-end. But as a generalist, maybe you could help simplify the message on the 20% gross margin proposal from CMS, particularly as it relates to clinical nursing input. I don't know how that relates to you but just kinda simplify that one for me would be awesome.

Heath Sampson (President and CEO)

Yeah. Well, first off, our focus really over these last 12 months, and especially over these last kinda 6 months since we have great new leadership in there with Anne and Damon and the rest of the team there on the PCS side, we're building a platform. This organization historically was made up of a lot of individual businesses and individual locations that were doing great work, but very challenging to scale and grow when you have it. So that has been the focus, and really, I'm proud of this platform we're building there. And then we do expect to get back to the right level of growth at the right margin after we finish with these investments.

But to your, to your question around the 80/20, that we knew it came out, so that, that 20% gross margin cap that is being proposed. Again, most importantly, it doesn't need to be implemented till 6 years from now, and we do think there'll be challenges around that. But there was something in there that is very beneficial, is what is the definition of the 20%, and including these clinical costs or these nurse costs are really helpful for us, because the, really, the impact, if this was implemented, would be very manageable for us. So it was a good outcome by including those, those clinical costs, 'cause that margin, you know, historically, from a gross margin, we're at 21% to 22%, and if you include the nurse costs, that really covers a lot of, of, of that as well.

So long story short, we do believe that this rule will develop and change. We're in a really good position as a large-scale company, and even if it was to get in place 6 years from now, just because of how it was defined, we feel like we're in a really good spot to grow and maintain strong, strong margins.

Bob Labick (President and Director of Research)

Okay, super. Thank you so much. I'll jump back in queue.

Heath Sampson (President and CEO)

Thanks.

Operator (participant)

Thank you. Our next question is from Raj Kumar with Stephens. Please proceed with your question.

Raj Kumar (Research Analyst)

Hi, and, good morning. Just kinda wanted to dive deeper into the home segment. Just kinda wanted to see, like, if there's kinda differentiation in terms of, you know, NEMT does have, like, a more of a back half ramp story to it, just given redeterminations and implementation of new contract wins. But, you know, PC and RPM seem like, just based on your commentary, that it may have, like, a smoother path to, you know, getting towards those 2024 targets. So just wanted to get confirmation on that. And then just as a follow-up, just kind of walk us through, like, the acceleration in membership for RPM, you know, kind of versus 1Q.

Heath Sampson (President and CEO)

Yeah. So the home segment made up of PCS and RPM, actually, there will be, specifically in PCS, because of what we had in Q1, which we explained, a lot of that has to do with some of the costs that we've added to do with this transformation. We expect that those costs will come out. In addition, with the team gelling on the new platform that we're building, we actually expect growth to accelerate as well, so. But it is smoother, right, than mobility. There still is a lot in mobility because of the timing of getting our sales on and our cost out. But there is still a growth that we expect within PCS as well as RPM.

RPM, too, in the, in the Q1, the timing difference between some of the business that, that came off related to the MA biz. We have a large client that is MA, and they didn't win as much business, so we didn't get as much volume, and we had some costs that stayed on. So we expect that that will accelerate coming out of Q1 as well. But you're not at the slope that NEMT is, and it's a reasonable plan to ensure that we hit our targets as we come out.

Raj Kumar (Research Analyst)

Great. Thank you. And then, just as my second question, just kinda wanted to double-click on the 80/20 provisions and just trying to get your updated thoughts on... Just like, I know, like, company in the past has talked to a 23%-24% gross margin target, kinda longer term. And given the definitional changes and what adjustments you can make, do you think that's still achievable longer term? Or, or if there's, like, a kinda updated baseline based on the adjustments that you think you guys can make.

Heath Sampson (President and CEO)

Yeah. So, it depends what state you're in, is depending what your gross margin's gonna be. That's hence why a lot of people are arguing around this. Not a one-size-fits-all makes sense across the country. For us, where we are in our states, again, our gross margin was historically around 22%, 21.5% to 22%, so much more manageable as we go down. And I'll repeat again, having the clinical costs or the nursing costs in that, really, the gap is in 2%. It's less than, definitely less than 2% to get down to 20%. So it's very manageable under the current construct that we have. But there's other provisions in the proposal that really require and demand centralization, better compliance, better reporting.

That costs money, and that's a lot of stuff that we've been doing for the last 18 months, and we'll have that in place, so. And then we'll be able to get scale and leverage off of that as we grow ours, as well. So the 10% to 12% EBITDA margin that we've laid out is definitely possible, even after the 80/20 rule did come in place. Again, that's 6 years from now. We don't think it'll be that, but we will believe that we're in a good spot to grow and manage through and hit those EBITDA targets that we've always said.

Raj Kumar (Research Analyst)

Awesome. Thank you. That's all for me.

Heath Sampson (President and CEO)

Thanks.

Operator (participant)

Thank you. Our next question is from Brian Tanquilut with Jefferies. Please proceed with your question.

Taji Phillips (Equity Research Senior Associate)

Good morning. You have Taji Phillips on for Brian. Thank you for taking my question. So maybe first.

Heath Sampson (President and CEO)

Sure.

Taji Phillips (Equity Research Senior Associate)

To kind of dive a little bit deeper on the cost savings initiative. Clearly in the bridge you outlined in the slide deck, you show $1 million being realized in the quarter, but then another $33 million to $37 million left in the tank. Maybe can you tell us what gives you confidence in your ability to execute on this, and, you know, kind of lay out what else needs to happen for you to realize these savings throughout the year?

Heath Sampson (President and CEO)

Yeah, it's a critical part of the remainder of this year. There's another slide that you'll see there that shows about 60% is run rate, so we've done a lot of good work. And then the remainder of that is actions that we've identified and are executing on. The bridge, which is a good bridge to show, even though it was a $1 million quarter-over-quarter sequential quarter, we had a lot before, right? So the run rate coming off of 2023 into this year is really driving a lot of those savings. So the $1 million had a lot to do with the growth in trip volume and utilization as well. But we feel good about getting that $34 million to $36 million in year.

And then even beyond that, because of the run rate and because of the initiatives that we are putting in now, I expect that it'll be about a $60 million full year benefit, as we enter 2025. So yes, there is a lot of work that needs to still happen, but we have identified it, and again, it's about 60% of that $30+ million run rated from previous execution that we've had.

Taji Phillips (Equity Research Senior Associate)

Great. Appreciate the color. And then just back on personal care, just, you know, wanna go back to this comment about how you're expecting these, like, delayed reimbursement increases. Maybe can you talk about the magnitude of those and I guess how you're working to stabilize purchased services? Because obviously, that expense line had pretty much triggered the shortfall this quarter.

Heath Sampson (President and CEO)

Yeah. So it puts that kind of, what, maybe $5 million-ish delta from in the bridge that you see there when you net it all out. About $1 million is about a reimbursement, so the reimbursement rates that we expect to get. So, another $2 million, which is in the G&A and also in the service expense, is based on us getting the synergies after these consolidation, centralization efforts and automation efforts that we have. And the other $2 million is around, is just higher service expense, and we expect we will grow and get leverage out of that, specifically in a couple of states where we know that we have growth targets that allow us to get leverage. So that's how it breaks down. We have plans, and we expect to be able to get back to the margins and growth rates that we had prior.

Rishi Parekh (Managing Director and Senior Analyst)

Thank you.

Heath Sampson (President and CEO)

Thank you.

Operator (participant)

Our next question is from Pito Chickering with Deutsche Bank. Please proceed with your question.

Pito Chickering (Director and Senior Equity Research Analyst)

Hey, good morning, guys. So two questions for me here. Matrix, I think this is the first time you've given color like this sort of on the monetization of Matrix. I guess, so two questions on that one. I guess, what gives you guys confidence that that asset can be monetized over the next sort of 12 months? And then, you know, we're not asking for prices here, but any ranges of multiples of sort of where you think some sort of transaction can be realized?

Heath Sampson (President and CEO)

Yeah. Well, similar, similar to what I talked about, how proud I am of my team here, and then specifically around go-to-market, the same is for Matrix. Catherine and her team, Catherine's the CEO there. What they've done over the last 18 months, and really over the last 6 months, We had a board meeting, a couple of weeks ago, and we're going through everything, and it's just, tremendous work that is done. So the results and the financials are there and growing and stable. And then the other conviction that the team has, and, and I'm, I have as well, is the platform they're also building to really leverage more care in the home or more outcome change in the home, and it really gets down to their technology implementation that they've had.

So you couple those two things together and the sustained success that this team has. And then, again, as importantly, 2,800 nurses that are in people's homes, and there's a lot of value that they can have on the healthcare system. So and there's a lot of inbound, so we have a lot of confidence that we'll be able to get them to another owner and grow beyond that. So, which is why I gave that guidance and confidence around our ability to do that. So, the multiples are gonna be good because of the great effort that they had, so I'm not gonna comment on what they're actually gonna be.

Obviously, if you and we get this question, and Pito, you may have asked this before, "Hey, are we gonna get the Signify multiple, which is a 30x EBITDA?" No, that's not possible, but it's gonna be well above the kind of standard healthcare services multiples. So I feel really good about it, and, again, thanks to that team and the execution. We'll get it done.

Pito Chickering (Director and Senior Equity Research Analyst)

Okay, great. And then so our second question, just, you know, looking at the first quarter EBITDA results versus your sort of fourth quarter guidance, so like, you know, $56 million. Can you just walk us through just, you know, how would you be bridging 1Q to 4Q in terms of margins sort of throughout the year, kind of, you know, where do we see the biggest margin improvements? And then sort of you touched on some of the questions, but, you know, what are the biggest key drivers as far as those margins getting better?

Heath Sampson (President and CEO)

Yeah. Well, so similar to what we said last quarter, and well, as I think Barb even said in hers, the ramp is in the back part of the year, and so I'm focusing on mobility here first. And it, and it really gets to the stuff implementing the sales that we had. So again, those are some sales that we've already sold, and those, those are coming on now, and I expect them to come on more in Q3. So that's an important item, but that would show why the ramp is in the back half of the year. Redetermination being done, and then really the kind of normalized growth within Medicaid post Q2 when redetermination is done.

And then the last component that is still needed to execute on, and it also is back-end weighted in Q3 and Q4, is the cost out. And again, we're 60% done from a run rate perspective, but we still have work to do there. So, consistent with what we said before, the EBITDA target's around an 8% range exit rate in NEMT, and then in personal care, we do expect a ramp and be exiting at that 10% EBITDA rate, and then monitoring is gonna have that steady growth there, too. So though it is a ramp, it's Q3, Q4 driven, specifically mobility. It's a lot of those things that we've done in the past that will ensure that we hit those Q3, Q4 targets.

Pito Chickering (Director and Senior Equity Research Analyst)

Great. Great. Thanks so much.

Heath Sampson (President and CEO)

Thanks.

Operator (participant)

Thank you. Our next question is from Rishi Parekh with J.P. Morgan. Please proceed with your question.

Rishi Parekh (Managing Director and Senior Analyst)

Hi, thanks for taking my questions. On my first question, I was hoping that you could walk us through your MA exposure through the various divisions and specifically within NEMT, what services are currently being utilized by those NEMT MA members?

Heath Sampson (President and CEO)

Yeah, we have. I think it's about 18%. 16%, it's in the deck. It's a small font. 16% of our revenue is MA. For us, so that's. And then on the other segments, monitoring, it's higher. Personal care, there's no exposure on MA. And in the monitoring side, again, it's pretty concentrated to one client, and. We feel good about where those projections are. So within NEMT, that 16%, a lot of it was higher before, and that was part of what we lost in Q1. But MA is a critical benefit that continues to grow across all transportation, and we expect that we will win and grow in MA as well.

Probably the biggest thing from a market perspective, and it gets back to what I talked about a little bit earlier, it's different than Medicaid. So you really have to understand the member and understand when that trip is taken and how that trip is taken. So if you have the right insight and technology, you can service that member at the right cost, and a lot of those efforts we put in place. So, but as you know, MA, just across the board for payers, is a top issue, and many supplemental benefits are going to be cut. Transportation's one of them that is gonna continue. So though it's 16%, we do expect it to grow and it's manageable and a big part of our business as we move forward.

Rishi Parekh (Managing Director and Senior Analyst)

And sorry, what are the-- Within the NEMT business, what trips? Is it mostly for dialysis, physician offices, majority of the trips are?

Heath Sampson (President and CEO)

Well, so MA is not dialysis for us, the bigger volume for that is in the Medicaid side. There's duals within the MA that will have the dialysis. So it is your adult daycare, but there is the normal kind of breakdown of the different trip types, but it's less dialysis and more in line with what you'd expect with people that are over 65.

Rishi Parekh (Managing Director and Senior Analyst)

Okay, great. And then, I believe your New Jersey contract's up for renewal later this August. I'm not sure if that's the contract that's currently under RFP. I believe this is also a fairly sizable contract. Can you just provide us with some idea as to how that process is going? Is it still expected to be an exclusive contract? What's your visibility around it, and can you quantify your exposure?

Heath Sampson (President and CEO)

Yeah, so we have a good slide in the deck that talks about what's in the renewals. And, you know, the state business is a critical part. And New Jersey, that you said, is one of our important customers, which we've had for many, many years. We have a really strong relationship with them. Why? Because we're performing, and we do more for their members than just the trip. And we're an important part of their community within New Jersey on ensuring that people are working and the transportation providers are fulfilling their commitments. So my point is, we're really deep within New Jersey, performing well. We have a very low-cost platform, so we meet and check all the boxes. So I feel good about our ability to renew all of our state business, and even gain some state business.

The other thing we said there, in the script, because of what we have done over the last 6-12 months, our win rate in renewals, as well as gaining new business, is very strong. So I expect that to continue. And that $600 million of renewals that we have this year, I expect we will win more of that than lose. So, but, but again, on that, those are RFPs this year. I don't expect any impact from any changes, both positively or if there is something negatively that comes off until 2025.

Rishi Parekh (Managing Director and Senior Analyst)

Okay, and just the last question on PCS. You've also obviously noted that it might be an area or a segment that you may look to sell. You know, Addus has made some comments in terms of their dislike of New York. Would love to just better understand where you are in this process, and, you know, do you view it as a multi-year process, or do you view it to be aligned with your Matrix asset sale process?

Heath Sampson (President and CEO)

Well, so, Matrix definitely is gonna be something we sell. For us, and our job, my job, is to ensure that we drive shareholder value. And the best way to drive shareholder value, when I look at each of the individual parts, is to build the best platform, the lowest cost platform that grows. And that's exactly what we're doing for personal care, and that's really our focus. But we always will be looking to see what is the right thing to do from shareholder value. So there's a lot of demand for personal care. Personal care, and there's lots of companies, whether that's Addus, whether that's other, some large privates, and that are doing wonderful things around personal care and the value that that adds to the person's healthcare outcomes. So it's a critical part of healthcare.

So that's our focus, and there will be demand for personal care, and then I do expect there'll be trades that happen around personal care from an M&A perspective. So everything's on the table for us, but our focus and priority right now is to do what I said before: build a platform that's growing and can generate cash flow. And that's the focus of ours right now.

Rishi Parekh (Managing Director and Senior Analyst)

Great. Thank you.

Operator (participant)

Our next question is from Mike Petusky with Barrington Research. Please proceed with your question.

Mike Petusky (Managing Director and Senior Investment Analyst)

Hey, good morning, guys. Right off the bat, I'm gonna apologize. I missed part of this call, so if you commented on this, if you could just comment on it quickly, I'd appreciate it.

Heath Sampson (President and CEO)

Okay.

Mike Petusky (Managing Director and Senior Investment Analyst)

For my benefit. Did you guys speak to that receivable that was sort of out there after last quarter and, you know, I think it was, like, $35-$36 million? Have you, have you guys spoken to that or commented on that?

Barbara Gutierrez (CFO)

Yeah, we did. We did in, I think in the prepared remarks, we commented that we received a significant amount of that, of that, that payment in the quarter.

Mike Petusky (Managing Director and Senior Investment Analyst)

Okay.

Barbara Gutierrez (CFO)

We are still. Yeah, so it was helpful to our cash flow for sure.

Mike Petusky (Managing Director and Senior Investment Analyst)

Okay. All right. Okay, and then, Heath, I was just wondering, you know, you said a lot of positive things about Matrix and what they've done in the last, you know, 18 months, last 6 months, said that they're growing well. Believe that they'll get a really good, you know, multiple, maybe not Signify, but a really good multiple. I but I'd love to know, can you give any help on either trailing adjusted EBITDA or run rate EBITDA or something that's sort of, you know, then you, you may not get questions around multiple, 'cause we can sort of guess at that if, if we have a good sense of, you know, what the EBITDA range is.

Heath Sampson (President and CEO)

Yeah. So, the most important thing that we set this company up to have the right successful exit, so I'm not gonna give you exact specifics. But I'll go back to something that I said before, and this may not be satisfying to you, but it's consistent with what I've said for modeling purposes. I said there's a range between $50 million and $100 million of EBITDA, and that was a year and a half ago. So you can do your own extrapolations within that. The point being, it's very strong and growing, but that's the right way to think about it.

Mike Petusky (Managing Director and Senior Investment Analyst)

Well, Heath, can I just, can I just ask a sort of clarifying question on that? I think when you made that comment in the past, you said, "The right way to think about a takeout is on that multiple." But I don't think, and maybe you did clarify this, and I just didn't, I just didn't pick up on it. I don't think at that time, you've or when I've heard you say it, I don't think you've ever said, "Hey, they're actually in that range." Like, is that what you're saying, that they're in a range of $50 million to $100 million now?

Heath Sampson (President and CEO)

Yeah. No, I said that. I said that.

Mike Petusky (Managing Director and Senior Investment Analyst)

Okay.

Heath Sampson (President and CEO)

Yeah. So.

Mike Petusky (Managing Director and Senior Investment Analyst)

Okay. Fair, fair, fair enough. And just going back to the receivable real quick. When you said you collected, like, I mean, is it fair to say, like, 75% of that or?

Heath Sampson (President and CEO)

Yeah, I think we, it definitely, 75% is about right, actually. And the point there is, and why we said what we said last quarter, was because just to clarify around what our cash flow expectations, that was the main driver for the miss. But the other reason why we're giving this type of information is it's a critical, important client of ours, of a large payer, and we expect that they will be critical going forward. And though there is some negotiation around that client in itself, we did collect about 75% of that $36 million.

Mike Petusky (Managing Director and Senior Investment Analyst)

And again, this, I may have missed this as well in the prepared, but, did you guys comment on sort of your hoped-for timing on the refi? I mean, is that hopefully a Q2 event, or could that slip into Q3?

Heath Sampson (President and CEO)

Yeah. Yeah, so it's Q2. For us, that's the right way to think about it because we're executing on it now, so we expect to be done before the end of Q2.

Mike Petusky (Managing Director and Senior Investment Analyst)

All right. Thank you so much.

Heath Sampson (President and CEO)

Great, thanks.

Operator (participant)

Thank you. There are no further questions at this time. I would like to hand the floor back over to Heath Sampson for any closing comments.

Heath Sampson (President and CEO)

Great. Thank you for participating in our call this morning, and for the interest in Modivcare. Our updated investor presentation has been posted on our website. If you want a follow-up call or questions, please contact Kevin, our Head of Investor Relations. We look forward to speaking with many of you over the next coming days, weeks, and months before we report on our second quarter 2024 results in August. Again, thank you to you all, thank you to the team, and have a great day. This concludes our call.

Operator (participant)

This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.