• 2023 Full Year Diluted EPS of $4.95; Adjusted Diluted EPS of $6.68 
• 2023 adjusted diluted EPS of $6.68, up over 15% from $5.78 in 2022.
• 2023 health benefits ratio of 87.7%, consistent with 2022.
• Executed on capital deployment with $1.6 billion of share repurchases in 2023.
• Successful portfolio review execution, completing the final two international divestitures in the past two months: Circle Health and Operose Health.
• Increased 2024 premium and service revenues guidance by $2.5 billion.

ST. LOUIS, Feb. 6, 2024 /PRNewswire/ -- Centene Corporation (NYSE: CNC) ("the Company") announced today its financial results for the fourth quarter and year ended December 31, 2023. In summary, the 2023 fourth quarter and full year results were as follows:

"Our fourth quarter and full year 2023 adjusted EPS results are slightly ahead of previous guidance, providing our organization with tangible, positive momentum as we enter 2024. Looking ahead, we are excited by the opportunities we see within our core businesses as we execute against our strategic plan, fortify our foundational assets and drive cost savings. With increased focus and reduced complexity, Centene is well positioned to continue navigating the dynamic operating landscape while creating shareholder value," said Chief Executive Officer of Centene, Sarah M. London.

Other Events

• In January 2024 and December 2023, we completed the divestitures of Circle Health Group (Circle Health) and Operose Health Group (Operose Health), respectively.
• In January 2024, Centene's New Hampshire subsidiary, NH Healthy Families, was selected by the New Hampshire Department of Health and Human Services to continue providing physical health, behavioral health and pharmacy services for New Hampshire's Medicaid managed care program, known as Medicaid Care Management (MCM). The contract is expected to begin in September 2024 for a five-year term.
• In January 2024, Centene announced the appointment of Michael Carson as President and Chief Executive Officer of its Medicare business, Wellcare. Carson succeeds Richard Fisher, who was appointed Senior Vice President of Financial Operations, reporting to Centene's Chief Operating Officer, Susan Smith.
• In December 2023, Centene's Arizona subsidiary, Arizona Complete Health, the largest Medicaid health plan in Arizona, was selected by the Arizona Health Care Cost Containment System – Arizona's single state Medicaid agency – to provide managed care for the Arizona Long Term Care System (ALTCS). The program supports nearly 26,000 Arizonans who are elderly and/or have a physical disability (E/PD) with physical and behavioral healthcare, as well as provides pharmacy benefits. The new ALTCS-E/PD contract is anticipated to begin in October 2024, subject to the resolution of third-party protests, and is a three-year term with four optional one-year extensions, for a total of seven possible contract years.
• In November 2023, Centene announced the appointment of Susan Smith as its Chief Operating Officer, effective January 1, 2024.

Awards & Community Engagement

• In January 2024, Fortune named Centene to its 2024 list of World's Most Admired Companies. This marks the sixth consecutive year Centene has been named to Fortune's list, which includes the most respected and reputable companies around the world, as ranked by peers within their respective industries.
• In January 2024, Centene's Georgia subsidiary, Peach State Health Plan, and the Centene Foundation announced a $2.2 million funding commitment to Augusta University. The funding will facilitate the expansion of the University's Medical College of Georgia 3+ Primary Care Pathway Program, as well as support the launch of a new loan forgiveness program for the university's Dental College of Georgia students who commit to five years of practice in rural and underserved areas.
• In December 2023, Centene's Chief Executive Officer, Sarah M. London, was named one of Modern Healthcare's 100 Most Influential People of 2023. Now in its 22^nd year, the list honors individuals in healthcare for their leadership and impact on the industry.
• In November 2023, Centene's subsidiary, Iowa Total Care, and the Centene Foundation, announced a partnership with Central Iowa Shelter & Services to create an on-the-ground Housing Command Center and a mobile application designed to address certain challenges people and communities face as a result of social determinants of health. The Centene Foundation and Iowa Total Care are funding these initiatives and will invest $2.55 million over the course of two years.
• In October 2023, Centene was named to the 2023 Fortune Best Workplaces for Women list, ranking 67 out of 100 companies in the Large Company category. This marks the first time Centene has appeared on the annual list, which recognizes companies that demonstrate high employee-ranked scores in trust, fairness and pride among women employees.

Membership

The following table sets forth membership by line of business:

Premium and Service Revenues

The following table sets forth supplemental revenue information ($ in millions):

Statement of Operations: Three Months Ended December 31, 2023

• For the fourth quarter of 2023, premium and service revenues increased 5% to $35.3 billion from $33.6 billion in the comparable period of 2022. The increase was driven by membership growth in the Marketplace business due to strong product positioning as well as overall market growth, partially offset by recent divestitures in the Other segment and lower Medicaid membership due to redeterminations.
• Health benefits ratio (HBR) of 89.5% for the fourth quarter of 2023 represents an increase from 88.7% in the comparable period in 2022. The increase is primarily driven by the $250 million premium deficiency reserve recorded in connection with the 2024 Medicare Advantage business.
• The SG&A expense ratio was 9.9% for the fourth quarter of 2023, compared to 9.5% in the fourth quarter of 2022. The adjusted SG&A expense ratio was 9.7% for the fourth quarter of 2023, compared to 9.3% in the fourth quarter of 2022. The increases were driven by growth in the Marketplace business, which operates at a meaningfully higher SG&A ratio as compared to Medicaid, along with Medicare distribution costs. The increases were partially offset by ongoing SG&A reduction initiatives and continued leveraging of expenses over higher revenues. The SG&A expense ratio in the fourth quarter of 2023 was also impacted by severance costs due to a restructuring partially offset by lower acquisition and divestiture related costs.
• The effective tax rate was (61.9)% for the fourth quarter of 2023, compared to 644.4% in the fourth quarter of 2022. The effective tax rate for the fourth quarter of 2023 reflects lower state taxes and tax effects of divestitures. The effective tax rate for the fourth quarter of 2022 reflects the tax effects of previously pending and completed divestitures, including the Magellan Rx divestiture gain, and impairments, including the non-deductible impairment of our Health Net Federal Services business. For the fourth quarter of 2023, our effective tax rate on adjusted earnings was 30.6%, compared to 23.6% in the fourth quarter of 2022.
• Cash flow provided by operations for the fourth quarter of 2023 was $217 million, primarily driven by net earnings, partially offset by decreased unearned revenue driven by the early receipt of payments from CMS in the third quarter pertaining to the fourth quarter.

Statement of Operations: Year Ended December 31, 2023

• For the full year 2023, premium and service revenues increased 3% to $140.1 billion from $135.5 billion in the comparable period of 2022 driven by 88% membership growth in the Marketplace business as a result of strong product positioning as well as overall market growth and Medicaid rate increases and organic growth. The increases were partially offset by divestitures, Medicaid membership redeterminations and pharmacy carve outs in early 2023.
• HBR of 87.7% for the full year 2023 was flat compared to 87.7% in 2022. The 2023 HBR was positively impacted by growth in the Marketplace business, which runs at a lower HBR, and strong performance from pricing discipline and execution, offset by the $250 million premium deficiency reserve recorded in connection with the 2024 Medicare Advantage business.
• The SG&A expense ratio was 9.0% for the full year 2023, compared to 8.6% for the full year 2022. The adjusted SG&A expense ratio was 8.9% for the full year 2023, compared to 8.4% for the full year 2022. The increases were driven by growth in the Marketplace business, which operates at a meaningfully higher SG&A ratio as compared to Medicaid, along with Medicare distribution costs. The increases were partially offset by ongoing SG&A reduction initiatives and continued leveraging of expenses over higher revenues.
• The effective tax rate was 25.0% for 2023, compared to 38.7% for 2022. The effective tax rate for 2023 reflects the tax effects of the distribution of long-term stock awards to the estate of the Company's former CEO, divestiture gains and losses, lower state taxes and the pending divestiture of Circle Health. The 2022 effective tax rate reflects the tax effects of previously pending and completed divestitures, including the Magellan Rx divestiture gain, and impairments, including the non-deductible impairment of our Health Net Federal Services business. For the full year 2023, our effective tax rate on adjusted earnings was 24.9%, compared to 25.8% in 2022.
• Cash flow provided by operations for the full year 2023 was $8.1 billion, or 3.0 times net earnings and 2.2 times adjusted net earnings.

Balance Sheet

At December 31, 2023, the Company had cash, investments and restricted deposits of $37.3 billion and maintained $200 million of cash and cash equivalents in its unregulated entities. Medical claims liabilities totaled $18.0 billion. The Company's days in claims payable was 54 days, which is an increase of one day as compared to the third quarter of 2023, and flat as compared to the fourth quarter of 2022. Total debt was $17.8 billion, which included $150 million of borrowings on the $2.0 billion Revolving Credit Facility at year end.

During the fourth quarter of 2023, the Company repurchased 397 thousand shares for $27 million. In total, the Company repurchased 22.9 million shares for $1.6 billion through the stock repurchase program for the full year 2023. As of February 6, 2024, $5.2 billion remains available under the Company's stock repurchase program.

Outlook

The Company is increasing its 2024 premium and service revenues guidance range by $2.5 billion to a range of $134.5 billion to $137.5 billion to reflect additional Commercial premium revenue from a stronger than expected Marketplace open enrollment. The Company reiterates its 2024 adjusted diluted EPS guidance floor of greater than $6.70.

Conference Call

As previously announced, the Company will host a conference call Tuesday, February 6, 2024, at 8:30 a.m. ET to review the financial results for the fourth quarter and year ended December 31, 2023.

Investors and other interested parties are invited to listen to the conference call by dialing 1-877-883-0383 in the U.S. and Canada; +1-412-902-6506 from abroad, including the following Elite Entry Number: 3061147 to expedite caller registration; or via a live, audio webcast on the Company's website at www.centene.com, under the Investors section.

A webcast replay will be available for on-demand listening shortly following the completion of the call for the next 12 months or until 11:59 p.m. ET on Tuesday, February 4, 2025, at the aforementioned URL. In addition, a digital audio playback will be available until 9 a.m. ET on Tuesday, February 13, 2024, by dialing 1-877-344-7529 in the U.S., 1-855-669-9658 in Canada, or +1-412-317-0088 from abroad, and entering access code 7739225.

Non-GAAP Financial Presentation

The Company is providing certain non-GAAP financial measures in this release as the Company believes that these figures are helpful in allowing investors to more accurately assess the ongoing nature of the Company's operations and measure the Company's performance more consistently across periods. The Company uses the presented non-GAAP financial measures internally in evaluating the Company's performance and for planning purposes, by allowing management to focus on period-to-period changes in the Company's core business operations, and in determining employee incentive compensation. Therefore, the Company believes that this information is meaningful in addition to the information contained in the GAAP presentation of financial information. The Company strongly encourages investors to review its consolidated financial statements and publicly filed reports in their entirety and cautions investors that the non-GAAP financial measures used by the Company may differ from similar measures used by other companies, even when similar terms are used to identify such measures. The presentation of non-GAAP financial measures is not intended to be considered in isolation or as a substitute for the financial information prepared and presented in accordance with GAAP.

The Company is unable to provide a reconciliation of its 2024 adjusted diluted EPS target to the corresponding GAAP measure without unreasonable effort due to the difficulty of predicting the timing and amounts of various items within a reasonable range. As such, this has been excluded from the reconciliation below.

The Company believes the presentation of non-GAAP financial measures that excludes amortization of acquired intangible assets, acquisition and divestiture related expenses, as well as other items, allows investors to develop a more meaningful understanding of the Company's core performance over time.

The tables below provide reconciliations of non-GAAP items ($ in millions, except per share data):

To provide clarity on the way management defines certain key metrics and ratios, the Company is providing a description of how the metric or ratio is calculated as follows:

• Health Benefits Ratio (HBR) (GAAP) = Medical costs divided by premium revenues.
• SG&A Expense Ratio (GAAP) = Selling, general and administrative expenses divided by premium and service revenues.
• Adjusted SG&A Expense Ratio (non-GAAP) = Adjusted selling, general and administrative expenses divided by premium and service revenues.
• Adjusted Effective Tax Rate (non-GAAP) = GAAP income tax expense (benefit) excluding the income tax effects of adjustments to net earnings divided by adjusted earnings (loss) before income tax expense.
• Adjusted Net Earnings (non-GAAP) = Net earnings less amortization of acquired intangible assets, less acquisition and divestiture related expenses, as well as adjustments for other items, net of the income tax effect of the adjustments.
• Adjusted Diluted EPS (non-GAAP) = Adjusted net earnings divided by weighted average common shares outstanding on a fully diluted basis.
• Debt to Capitalization Ratio (GAAP) = Total debt, divided by total debt plus total stockholder's equity.
• Average Medical Claims Expense (GAAP) = Medical costs for the period divided by number of days in such period. Average medical claims expense is most often calculated for the quarterly reporting period.
• Days in Claims Payable (GAAP) = Medical claims liabilities divided by average medical claims expense. Days in claims payable is most often calculated for the quarterly reporting period.

In addition, the following terms are defined as follows:

• State-directed Payments: Payments directed by a state that have minimal risk but are administered as a premium adjustment. These payments are recorded as premium revenue and medical costs at close to a 100% HBR. In many instances, the Company has little visibility to the timing of these payments until they are paid by a state.
• Pass-through Payments: Non-risk supplemental payments from a state that the Company is required to pass through to designated contracted providers. These payments are recorded as premium tax revenue and premium tax expense.

About Centene Corporation

Centene Corporation, a Fortune 500 company, is a leading healthcare enterprise that is committed to helping people live healthier lives. The Company takes a local approach – with local brands and local teams – to provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene offers affordable and high-quality products to nearly 1 in 15 individuals across the nation, including Medicaid and Medicare members (including Medicare Prescription Drug Plans) as well as individuals and families served by the Health Insurance Marketplace and the TRICARE program. The Company also contracts with other healthcare and commercial organizations to provide a variety of specialty services focused on treating the whole person. Centene focuses on long-term growth and value creation as well as the development of its people, systems and capabilities so that it can better serve its members, providers, local communities and government partners. 

Centene uses its investor relations website to publish important information about the Company, including information that may be deemed material to investors. Financial and other information about Centene is routinely posted and is accessible on Centene's investor relations website, https://investors.centene.com.

Forward-Looking Statements

All statements, other than statements of current or historical fact, contained in this press release are forward-looking statements. Without limiting the foregoing, forward-looking statements often use words such as "guidance," "believe," "anticipate," "plan," "expect," "estimate," "intend," "seek," "target," "goal," "may," "will," "would," "could," "should," "can," "continue" and other similar words or expressions (and the negative thereof). Centene Corporation and its subsidiaries (Centene, the Company, our or we) intends such forward-looking statements to be covered by the safe-harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995, and we are including this statement for purposes of complying with these safe-harbor provisions. In particular, these statements include, without limitation, statements about our future operating or financial performance, market opportunity, competition, expected activities in connection with completed and future acquisitions and dispositions, our investments and the adequacy of our available cash resources. These forward-looking statements reflect our current views with respect to future events and are based on numerous assumptions and assessments made by us in light of our experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors we believe appropriate. By their nature, forward-looking statements involve known and unknown risks and uncertainties and are subject to change because they relate to events and depend on circumstances that will occur in the future, including economic, regulatory, competitive and other factors that may cause our or our industry's actual results, levels of activity, performance or achievements to be materially different from any future results, levels of activity, performance, or achievements expressed or implied by these forward-looking statements. These statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions. All forward-looking statements included in this press release are based on information available to us on the date hereof. Except as may be otherwise required by law, we undertake no obligation to update or revise the forward-looking statements included in this press release, whether as a result of new information, future events, or otherwise, after the date hereof. You should not place undue reliance on any forward-looking statements, as actual results may differ materially from projections, estimates, or other forward-looking statements due to a variety of important factors, variables and events including, but not limited to: our ability to design and price products that are competitive and/or actuarially sound including but not limited to any impacts resulting from Medicaid redeterminations; our ability to maintain or achieve improvement in the Centers for Medicare and Medicaid Services (CMS) Star ratings and maintain or achieve improvement in other quality scores in each case that can impact revenue and future growth; our ability to accurately predict and effectively manage health benefits and other operating expenses and reserves, including fluctuations in medical utilization rates; competition, including for providers, broker distribution networks, contract reprocurements and organic growth; our ability to adequately anticipate demand and provide for operational resources to maintain service level requirements; our ability to manage our information systems effectively; disruption, unexpected costs, or similar risks from business transactions, including acquisitions, divestitures, and changes in our relationships with third parties; impairments to real estate, investments, goodwill, and intangible assets; changes in senior management, loss of one or more key personnel or an inability to attract, hire, integrate and retain skilled personnel; membership and revenue declines or unexpected trends; rate cuts or other payment reductions or delays by governmental payors and other risks and uncertainties affecting our government businesses; changes in healthcare practices, new technologies, and advances in medicine; increased healthcare costs; inflation and interest rates; the effect of social, economic, and political conditions and geopolitical events, including as a result of changes in U.S. presidential administrations or Congress; changes in market conditions; changes in federal or state laws or regulations, including changes with respect to income tax reform or government healthcare programs as well as changes with respect to the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act (collectively referred to as the ACA) and any regulations enacted thereunder; uncertainty concerning government shutdowns, debt ceilings or funding; tax matters; disasters, climate-related incidents, acts of war or aggression or major epidemics; changes in expected contract start dates; changes in provider, broker, vendor, state, federal, foreign, and other contracts and delays in the timing of regulatory approval of contracts, including due to protests; the expiration, suspension, or termination of our contracts with federal or state governments (including, but not limited to, Medicaid, Medicare or other customers); the difficulty of predicting the timing or outcome of legal or regulatory audits, investigations, proceedings or matters, including, but not limited to, our ability to resolve claims and/or allegations made by states with regard to past practices, including at Centene Pharmacy Services (formerly Envolve Pharmacy Solutions, Inc. (Envolve)), as our pharmacy benefits manager (PBM) subsidiary, within the reserve estimate we previously reported and on other acceptable terms, or at all, or whether additional claims, reviews or investigations will be brought by states, the federal government or shareholder litigants, or government investigations; challenges to our contract awards; cyber-attacks or other data security incidents; the exertion of management's time and our resources, and other expenses incurred and business changes required in connection with complying with the terms of our contracts and the undertakings in connection with any regulatory, governmental, or third party consents or approvals for acquisitions or dispositions; any changes in expected closing dates, estimated purchase price, or accretion for acquisitions or dispositions; losses in our investment portfolio; restrictions and limitations in connection with our indebtedness; a downgrade of our corporate family rating, issuer rating or credit rating of our indebtedness; the availability of debt and equity financing on terms that are favorable to us and risks and uncertainties discussed in the reports that Centene has filed with the Securities and Exchange Commission (SEC). This list of important factors is not intended to be exhaustive. We discuss certain of these matters more fully, as well as certain other factors that may affect our business operations, financial condition, and results of operations, in our filings with the SEC, including our annual report on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. Due to these important factors and risks, we cannot give assurances with respect to our future performance, including without limitation our ability to maintain adequate premium levels or our ability to control our future medical and selling, general and administrative costs. The guidance in this press release is only effective as of the date given, February 6, 2024, and will not be updated or affirmed unless and until we publicly announce updated or affirmed guidance.

MEDICAL CLAIMS LIABILITY

The changes in medical claims liability are summarized as follows (in millions):

Centene's claims reserving process utilizes a consistent actuarial methodology to estimate Centene's ultimate liability. Any reduction in the "Incurred related to: Prior periods" amount may be offset as Centene actuarially determines the "Incurred related to: Current period." Centene believes it has consistently applied its claims reserving methodology. Additionally, approximately $382 million was recorded as a reduction to premium revenues resulting from development within "Incurred related to: Prior periods" due to minimum HBR and other return of premium programs.

The amount of the "Incurred related to: Prior periods" above represents favorable development and includes the effects of reserving under moderately adverse conditions, new markets where we use a conservative approach in setting reserves during the initial periods of operations, receipts from other third party payors related to coordination of benefits and lower medical utilization and cost trends for dates of service December 31, 2022, and prior.