CENTENE CORP (CNC) Risk Factors

Recent key developments

Concrete developments — dated events, named agreements and instruments, legal proceedings — that CENTENE CORP surfaced in its latest filing.

• In the second quarter of 2025, an independent actuarial firm's data suggested materially higher aggregate morbidity of Marketplace membership, reducing expected net risk adjustment revenue for 2025.2025 Q2
• Expiration of the public health emergency and resulting Medicaid redeterminations process led to higher health benefits ratio due to acuity profile of remaining members and gaps in eligibility for those rejoining Medicaid plans.
• Two Medicare Advantage contracts received notice of termination for plan year 2025.2025
• On January 26, 2026, CMS released its draft 2027 Medicare rate announcement.January 26, 2026
• CMS regulations will require beneficiaries dually enrolled in Medicare and Medicaid to receive integrated care through Medicare Advantage D-SNPs beginning in 2030, with certain restrictions beginning in 2027.2030
• CMS removed the fee-for-service adjuster from risk adjustment data validation audit methodology beginning audit year 2018.2018
• CMS announced an intent to accelerate timing and expand scope of risk adjustment data validation audits.2025
• Centene is protesting the Texas and Georgia Medicaid reprocurements in which it was not a successful bidder.
• Centene's 2026 PDP bids were below the benchmarks for all 34 CMS regions, compared to 2025 when below in 33 of 34 regions.2026
• As of January 1, 2026, PDP membership increased to over 8.7 million members from 8.1 million in December 2025.January 1, 2026
• The Inflation Reduction Act reduced federal reinsurance from 80% to 20% and introduced a $2,000 cap on member out-of-pocket expenses.2025
• Centene elected into the Part D Premium Stabilization Demonstration program, which subsidizes premiums and provides risk corridor protection.
• In 2024, Change Healthcare, Inc. experienced a cybersecurity incident that impacted Centene and some of its subsidiaries.2024
• Non-cash goodwill impairment of $6.7 billion recorded in Q3 2025 following a quantitative impairment analysis triggered by market conditions including the OBBBA and stock price decline.2025 Q3
• Final Rule published June 25, 2025 repealed Special Enrollment Period for individuals under 150% FPL effective August 25, 2025.June 25, 2025
• Enhanced APTC extended eligibility expired December 31, 2025.December 31, 2025
• OBBBA beginning January 1, 2026 requires full reimbursement of excess APTC for mis-estimated income and prohibits APTC for Special Enrollment Period associated with income.January 1, 2026
• New York intends to terminate Essentials Plan-5 for individuals 200%-250% FPL by July 1, 2026.July 1, 2026
• Medicare sequestration 2% cap extended through 2029 by Bipartisan Budget Act of 2019.2029
• CMS issued guidance on November 14, 2025 implementing the OBBBA prohibition on states imposing higher tax rates on Medicaid MCOs than commercial insurance by end of fiscal 2026.November 14, 2025
• As of December 31, 2025, consolidated indebtedness was $17.4 billion.December 31, 2025