Centene (CNC) 10-Q 24 Apr 23 2023 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2023	Apr. 21, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2023
Document Transition Report	false
Entity File Number	001-31826
Entity Registrant Name	CENTENE CORPORATION
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	42-1406317
Entity Address, Address Line One	7700 Forsyth Boulevard
Entity Address, City or Town	St. Louis,
Entity Address, State or Province	MO
Entity Address, Postal Zip Code	63105
City Area Code	314
Local Phone Number	725-4477
Title of 12(b) Security	Common Stock $0.001 Par Value
Trading Symbol	CNC
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		548,769,258
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 15,853	$ 12,074
Premium and trade receivables	15,210	13,272
Short-term investments	2,135	2,321
Other current assets	1,811	2,461
Total current assets	35,009	30,128
Long-term investments	15,833	14,684
Restricted deposits	1,313	1,217
Property, software and equipment, net	2,478	2,432
Goodwill	18,836	18,812
Intangible assets, net	6,730	6,911
Other long-term assets	2,783	2,686
Total assets	82,982	76,870
Current liabilities:
Medical claims liability	17,504	16,745
Accounts payable and accrued expenses	10,781	9,525
Return of premium payable	2,077	1,634
Unearned revenue	2,398	478
Current portion of long-term debt	97	82
Total current liabilities	32,857	28,464
Long-term debt	18,223	17,938
Deferred tax liability	522	615
Other long-term liabilities	6,194	5,616
Total liabilities	57,796	52,633
Commitments and contingencies
Redeemable noncontrolling interests	20	56
Stockholders' equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at March 31, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 614,355 issued and 551,714 outstanding at March 31, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022	1	1
Additional paid-in capital	20,121	20,060
Accumulated other comprehensive earnings (loss)	(915)	(1,132)
Retained earnings	10,471	9,341
Treasury stock, at cost (62,641 and 57,093 shares, respectively)	(4,636)	(4,213)
Total Centene stockholders' equity	25,042	24,057
Nonredeemable noncontrolling interest	124	124
Total stockholders' equity	25,166	24,181
Total liabilities, redeemable noncontrolling interests and stockholders' equity	$ 82,982	$ 76,870

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
Stockholders' equity
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	800,000,000	800,000,000
Common stock, shares issued (in shares)	614,355,000	607,847,000
Common stock, shares outstanding (in shares)	551,714,000	550,754,000
Treasury stock (in shares)	62,641,000	57,093,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenues:
Premium and service revenues	$ 34,952	$ 34,232
Premium tax	3,937	2,953
Total revenues	38,889	37,185
Expenses:
Medical costs	29,434	27,838
Cost of services	870	1,988
Selling, general and administrative expenses	3,011	2,745
Depreciation expense	142	156
Amortization of acquired intangible assets	183	199
Premium tax expense	4,011	3,006
Impairment	20	0
Total operating expenses	37,671	35,932
Earnings from operations	1,218	1,253
Other income (expense):
Investment and other income	353	52
Debt extinguishment	0	3
Interest expense	(180)	(160)
Earnings before income tax	1,391	1,148
Income tax expense	261	296
Net earnings	1,130	852
(Earnings) loss attributable to noncontrolling interests	0	(3)
Net earnings attributable to Centene Corporation	$ 1,130	$ 849
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 2.05	$ 1.46
Diluted earnings per common share (in dollars per share)	$ 2.04	$ 1.44
Weighted average number of common shares outstanding:
Basic (in shares)	550,779	583,230
Diluted (in shares)	553,845	590,658
Premium
Revenues:
Premium and service revenues	$ 33,825	$ 31,889
Service
Revenues:
Premium and service revenues	$ 1,127	$ 2,343

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS (LOSS) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Statement of Comprehensive Income [Abstract]
Net earnings	$ 1,130	$ 852
Change in unrealized gain (loss) on investments	253	(715)
Change in unrealized gain (loss) on investments, tax effect	(61)	171
Change in unrealized gain (loss) on investments, net of tax	192	(544)
Reclassification adjustment, net of tax	2	2
Foreign currency translation adjustments, net of tax	23	(20)
Other comprehensive earnings (loss)	217	(562)
Comprehensive earnings	1,347	290
Comprehensive (earnings) loss attributable to noncontrolling interests	0	(3)
Comprehensive earnings attributable to Centene Corporation	$ 1,347	$ 287

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Millions	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Earnings (Loss)	Retained Earnings	Treasury Stock	Noncontrolling Interest
Balance (in shares) at Dec. 31, 2021		602,704
Treasury stock (in shares) at Dec. 31, 2021						20,225
Balance at Dec. 31, 2021	$ 26,940	$ 1	$ 19,672	$ 77	$ 8,139	$ (1,094)	$ 145
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	848				849		(1)
Other comprehensive earnings (loss), net of tax	(562)			(562)
Common stock issued for employee benefit plans (in shares)		3,221
Common stock issued for employee benefit plans	28		28
Fair value of unvested equity awards in connection with acquisition	60		60
Common stock repurchases (in shares)						846
Common stock repurchases	(71)					$ (71)
Stock compensation expense	70		70
Balance (in shares) at Mar. 31, 2022		605,925
Treasury stock (in shares) at Mar. 31, 2022						21,071
Balance at Mar. 31, 2022	$ 27,313	$ 1	19,830	(485)	8,988	$ (1,165)	144
Balance (in shares) at Dec. 31, 2022	550,754	607,847
Treasury stock (in shares) at Dec. 31, 2022	57,093					57,093
Balance at Dec. 31, 2022	$ 24,181	$ 1	20,060	(1,132)	9,341	$ (4,213)	124
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	1,130				1,130
Other comprehensive earnings (loss), net of tax	217			217
Common stock issued for employee benefit plans (in shares)		6,508
Common stock issued for employee benefit plans	12		12
Common stock repurchases (in shares)						5,548
Common stock repurchases	(423)					$ (423)
Stock compensation expense	61		61
Purchase of redeemable noncontrolling interest	$ (12)		(12)
Balance (in shares) at Mar. 31, 2023	551,714	614,355
Treasury stock (in shares) at Mar. 31, 2023	62,641					62,641
Balance at Mar. 31, 2023	$ 25,166	$ 1	$ 20,121	$ (915)	$ 10,471	$ (4,636)	$ 124

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	Dec. 31, 2022	Dec. 31, 2021
Par value (in dollars per share)	$ 0.001
Common Stock
Par value (in dollars per share)	0.001	$ 0.001
Treasury Stock
Par value (in dollars per share)	$ 0.001	$ 0.001

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash flows from operating activities:
Net earnings	$ 1,130	$ 852
Adjustments to reconcile net earnings to net cash provided by operating activities
Depreciation and amortization	346	390
Stock compensation expense	61	70
Impairment	20	0
(Gain) loss on debt extinguishment	0	(3)
Deferred income taxes	(159)	12
(Gain) on divestiture	(79)	0
Other adjustments, net	7	22
Changes in assets and liabilities
Premium and trade receivables	(1,938)	(3,099)
Other assets	(315)	(299)
Medical claims liabilities	759	1,767
Unearned revenue	1,919	81
Accounts payable and accrued expenses	1,548	957
Other long-term liabilities	970	401
Net cash provided by operating activities	4,269	1,151
Cash flows from investing activities:
Capital expenditures	(225)	(242)
Purchases of investments	(1,619)	(1,700)
Sales and maturities of investments	1,148	1,047
Acquisitions, net of cash acquired	0	(1,504)
Divestiture proceeds, net of divested cash	443	0
Other investing activities, net	0	(2)
Net cash (used in) investing activities	(253)	(2,401)
Cash flows from financing activities:
Proceeds from long-term debt	287	100
Payments and repurchases of long-term debt	0	(526)
Common stock repurchases	(423)	(71)
Proceeds from common stock issuances	0	27
Payments for debt extinguishment	0	(27)
Purchase of noncontrolling interest	(58)	0
Other financing activities, net	11	(1)
Net cash (used in) financing activities	(183)	(498)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	2	33
Net increase (decrease) in cash, cash equivalents, and restricted cash and cash equivalents	3,835	(1,715)
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period	12,330	13,214
Cash, cash equivalents, and restricted cash and cash equivalents, end of period	16,165	11,499
Supplemental disclosures of cash flow information:
Interest paid	144	139
Income taxes paid	11	11
The following table provides a reconciliation of cash, cash equivalents, and restricted cash and cash equivalents reported within the Consolidated Balance Sheets to the totals above:
Cash and cash equivalents	15,853	11,237
Restricted cash and cash equivalents, included in restricted deposits	312	262
Total cash, cash equivalents, and restricted cash and cash equivalents	$ 16,165	$ 11,499

Organization and Operations

Organization and Operations	3 Months Ended
	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Operations	Organization and Operations Basis of Presentation The accompanying interim financial statements have been prepared under the presumption that users of the interim financial information have either read or have access to the audited financial statements included in the Form 10-K for the fiscal year ended December 31, 2022. The unaudited interim financial statements herein have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission. Accordingly, footnote disclosures that would substantially duplicate the disclosures contained in the December 31, 2022 audited financial statements have been omitted from these interim financial statements, where appropriate. In the opinion of management, these financial statements reflect all adjustments, consisting only of normal recurring adjustments, which are necessary for a fair presentation of the results of the interim periods presented. Certain 2022 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2023 presentation, including reclassifications related to the Company's new segment reporting structure as outlined below. These reclassifications have no effect on net earnings or stockholders' equity as previously reported. Segment Reporting In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment, and corresponding 2023 divestitures, the Company has revised the way it manages the business, evaluates performance, and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment, and (4) an Other segment. The Medicaid, Medicare, and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. Specifically, the Medicaid segment includes the Temporary Assistance for Needy Families (TANF) program, Medicaid Expansion programs, the Aged, Blind, or Disabled (ABD) program, the Children's Health Insurance Program (CHIP), Long-Term Services and Supports (LTSS), Foster Care, Medicare-Medicaid Plans (MMP), which cover beneficiaries who are dually eligible for Medicaid and Medicare, and other state-based programs. The Medicare segment includes Medicare Advantage, Medicare Supplement, Dual Eligible Special Needs Plans (D-SNPs), and Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D. The Commercial segment includes the Health Insurance Marketplace along with individual, small group, and large group commercial healthcare products. The Other segment includes the Company's pharmacy operations, vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others. Accounting Guidance Not Yet Adopted The Company has determined that there are no recently issued accounting pronouncements that will have a material impact on its consolidated financial position, results of operations, or cash flows.

Acquisitions and Divestitures

Acquisitions and Divestitures	3 Months Ended
	Mar. 31, 2023
Business Combination and Asset Acquisition [Abstract]
Acquisitions and Divestitures	Acquisitions and Divestitures On January 5, 2023, the Company completed the divestiture of HealthSmart, its third-party health plan administration business. On January 10, 2023, the Company signed and closed on a definitive agreement to divest Centurion, its prison healthcare business. During 2022, the Company recorded impairment charges related to goodwill and other current assets associated with the pending divestitures. The Company could receive up to an additional $35 million in cash based on the reprocurements of certain Centurion contracts. The Company will recognize the appropriate amount of contingent consideration related to the additional $35 million when realized or realizable. On January 20, 2023, the Company completed the divestiture of Magellan Specialty Health for approximately $646 million in cash and stock, including an estimated working capital adjustment and recognized a pre-tax gain of $79 million. The stock consideration was subsequently sold in April 2023 for cash proceeds of $245 million. The Company could also receive up to an additional $150 million in cash and stock in 2024 based on certain 2023 performance metrics. The Company will recognize the appropriate amount of contingent consideration related to the additional $150 million when realized or realizable.

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	3 Months Ended
	Mar. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Short-term and Long-term Investments, Restricted Deposits	Short-term and Long-term Investments, Restricted Deposits Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2023 December 31, 2022 Amortized Cost Gross Gross Fair Value Amortized Cost Gross Gross Fair Value Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 489 $ — $ (12) $ 477 $ 695 $ — $ (16) $ 679 Corporate securities 10,523 32 (668) 9,887 10,127 12 (778) 9,361 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 312 — — 312 256 — — 256 Short-term time deposits 198 — — 198 204 — — 204 Municipal securities 4,131 15 (213) 3,933 4,055 6 (280) 3,781 Asset-backed securities 1,492 2 (57) 1,437 1,396 — (70) 1,326 Residential mortgage-backed securities 1,187 4 (105) 1,086 1,165 2 (121) 1,046 Commercial mortgage-backed securities 1,067 1 (87) 981 961 — (99) 862 Equity securities (1) 250 — — 250 5 — — 5 Private equity investments 540 — — 540 529 — — 529 Life insurance contracts 176 — — 176 169 — — 169 Total $ 20,369 $ 54 $ (1,142) $ 19,281 $ 19,566 $ 20 $ (1,364) $ 18,222 (1) Investments in equity securities as of March 31, 2023 primarily consisted of shares received as part of the Magellan Specialty Health divestiture consideration. These shares were subsequently sold in April 2023. The Company's investments are debt securities classified as available-for-sale with the exception of equity securities, certain private equity investments and life insurance contracts. The Company's investment policies are designed to provide liquidity, preserve capital and maximize total return on invested assets with the focus on high credit quality securities. The Company limits the size of investment in any single issuer other than U.S. treasury securities and obligations of U.S. government corporations and agencies. As of March 31, 2023, 99% of the Company's investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At March 31, 2023, the Company held certificates of deposit, equity securities, private equity investments, and life insurance contracts, which did not carry a credit rating. Accrued interest income on available-for-sale debt securities was $141 million and $132 million at March 31, 2023 and December 31, 2022, respectively, and is included in other current assets on the Consolidated Balance Sheets. The Company's residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association, or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company's commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AAA and a weighted average duration of 4 years at March 31, 2023. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2023 December 31, 2022 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value U.S. Treasury securities and obligations of U.S. government corporations and agencies $ (2) $ 249 $ (10) $ 170 $ (5) $ 342 $ (11) $ 184 Corporate securities (72) 2,755 (596) 5,683 (340) 5,368 (438) 3,400 Municipal securities (18) 1,161 (195) 1,945 (142) 2,437 (138) 995 Asset-backed securities (5) 310 (52) 928 (29) 786 (41) 486 Residential mortgage-backed securities (10) 319 (95) 652 (55) 629 (66) 352 Commercial mortgage-backed securities (8) 188 (79) 697 (49) 513 (50) 330 Total $ (115) $ 4,982 $ (1,027) $ 10,075 $ (620) $ 10,075 $ (744) $ 5,747 As of March 31, 2023, the gross unrealized losses were generated from 6,109 positions out of a total of 6,936 positions. The change in fair value of available-for-sale debt securities is primarily a result of movement in interest rates subsequent to the purchase of the security. For each security in an unrealized loss position, the Company assesses whether it intends to sell the security or if it is more likely than not the Company will be required to sell the security before recovery of the amortized cost basis for reasons such as liquidity, contractual, or regulatory purposes. If the security meets this criterion, the decline in fair value is recorded in earnings. The Company does not intend to sell these securities prior to maturity and it is not likely that the Company will be required to sell these securities prior to maturity; therefore, the Company did not record an impairment for these securities. In addition, the Company monitors available-for-sale debt securities for credit losses. Certain investments have experienced a decline in fair value due to changes in credit quality, market interest rates, and/or general economic conditions. The Company recognizes an allowance when evidence demonstrates that the decline in fair value is credit related. Evidence of a credit related loss may include rating agency actions, adverse conditions specifically related to the security, or failure of the issuer of the security to make scheduled payments. The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2023 December 31, 2022 Investments Restricted Deposits Investments Restricted Deposits Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value One year or less $ 2,011 $ 1,981 $ 570 $ 569 $ 2,207 $ 2,179 $ 534 $ 532 One year through five years 8,008 7,556 546 518 7,651 7,147 524 490 Five years through ten years 4,131 3,821 245 224 4,066 3,613 224 195 Greater than ten years 144 140 2 2 135 129 — — Asset-backed securities 3,746 3,504 — — 3,522 3,234 — — Total $ 18,040 $ 17,002 $ 1,363 $ 1,313 $ 17,581 $ 16,302 $ 1,282 $ 1,217 Actual maturities may differ from contractual maturities due to call or prepayment options. Equity securities, private equity investments and life insurance contracts are excluded from the table above because they do not have a contractual maturity. The Company has an option to redeem at amortized cost substantially all of the securities included in the greater than ten years category listed above.

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date. The following table summarizes fair value measurements by level at March 31, 2023, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 15,853 $ — $ — $ 15,853 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 156 $ — $ — $ 156 Corporate securities — 9,853 — 9,853 Municipal securities — 3,291 — 3,291 Short-term time deposits — 198 — 198 Asset-backed securities — 1,437 — 1,437 Residential mortgage-backed securities — 1,086 — 1,086 Commercial mortgage-backed securities — 981 — 981 Equity securities 248 2 — 250 Total investments $ 404 $ 16,848 $ — $ 17,252 Restricted deposits: Cash and cash equivalents $ 312 $ — $ — $ 312 U.S. Treasury securities and obligations of U.S. government corporations and agencies 321 — — 321 Corporate securities — 34 — 34 Certificates of deposit — 4 — 4 Municipal securities — 642 — 642 Total restricted deposits $ 633 $ 680 $ — $ 1,313 Total assets at fair value $ 16,890 $ 17,528 $ — $ 34,418 The following table summarizes fair value measurements by level at December 31, 2022, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 12,074 $ — $ — $ 12,074 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 366 $ 5 $ — $ 371 Corporate securities — 9,328 — 9,328 Municipal securities — 3,165 — 3,165 Short-term time deposits — 204 — 204 Asset backed securities — 1,326 — 1,326 Residential mortgage backed securities — 1,046 — 1,046 Commercial mortgage backed securities — 862 — 862 Equity securities 3 2 — 5 Total investments $ 369 $ 15,938 $ — $ 16,307 Restricted deposits: Cash and cash equivalents $ 256 $ — $ — $ 256 U.S. Treasury securities and obligations of U.S. government corporations and agencies 308 — — 308 Corporate securities — 33 — 33 Certificates of deposit — 4 — 4 Municipal securities — 616 — 616 Total restricted deposits $ 564 $ 653 $ — $ 1,217 Total assets at fair value $ 13,007 $ 16,591 $ — $ 29,598 The Company utilizes matrix-pricing services to estimate fair value for securities which are not actively traded on the measurement date. The Company designates these securities as Level II fair value measurements. In addition, the aggregate carrying amount of the Company's private equity investments and life insurance contracts, which approximates fair value, was $716 million and $698 million as of March 31, 2023 and December 31, 2022, respectively.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets As discussed in Note 1. Organization and Operations, in 2023 the Company updated its segment structure. Prior year information has been adjusted to reflect the change in segment reporting. The following table summarizes the changes in goodwill by operating segment ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, December 31, 2021 $ 10,194 $ 1,592 $ 5,424 $ 2,561 $ 19,771 Acquisition and purchase accounting adjustments — — — 1,077 1,077 Divestitures — — — (1,533) (1,533) Reallocation 4 — — (4) — Impairments — — — (370) (370) Translation impact — — — (133) (133) Balance, December 31, 2022 $ 10,198 $ 1,592 $ 5,424 $ 1,598 $ 18,812 Translation impact — — — 24 24 Balance, March 31, 2023 $ 10,198 $ 1,592 $ 5,424 $ 1,622 $ 18,836

Medical Claims Liability

Medical Claims Liability	3 Months Ended
	Mar. 31, 2023
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability As discussed in Note 1. Organization and Operations, in 2023 the Company updated its segment structure. Prior year information has been adjusted to reflect the change in segment reporting. The following table summarizes the change in medical claims liability for the three months ended March 31, 2023 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2023 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 Less: Reinsurance recoverable 7 — 19 — 26 Balance, January 1, 2023, net 11,246 3,431 1,902 140 16,719 Incurred related to: Current year 20,813 5,163 4,177 418 30,571 Prior years (803) (155) (172) (7) (1,137) Total incurred 20,010 5,008 4,005 411 29,434 Paid related to: Current year 12,679 2,988 2,541 294 18,502 Prior years 6,834 2,145 1,063 132 10,174 Total paid 19,513 5,133 3,604 426 28,676 Balance, March 31, 2023, net 11,743 3,306 2,303 125 17,477 Plus: Reinsurance recoverable 9 — 18 — 27 Balance, March 31, 2023 $ 11,752 $ 3,306 $ 2,321 $ 125 $ 17,504 The following table summarizes the change in medical claims liability for the three months ended March 31, 2022 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2022 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Less: Reinsurance recoverable 23 — — — 23 Balance, January 1, 2022, net 9,822 2,286 2,014 98 14,220 Acquisitions — — — 249 249 Incurred related to: Current year 19,289 5,098 3,423 751 28,561 Prior years (514) (52) (149) (8) (723) Total incurred 18,775 5,046 3,274 743 27,838 Paid related to: Current year 12,022 2,674 2,012 690 17,398 Prior years 5,643 1,624 1,319 76 8,662 Total paid 17,665 4,298 3,331 766 26,060 Balance, March 31, 2022, net 10,932 3,034 1,957 324 16,247 Plus: Reinsurance recoverable 12 — — — 12 Balance, March 31, 2022 $ 10,944 $ 3,034 $ 1,957 $ 324 $ 16,259 Reinsurance recoverables related to medical claims are included in premium and trade receivables. Changes in estimates of incurred claims for prior years are primarily attributable to reserving under moderately adverse conditions. Additionally, as a result of minimum health benefits ratio (HBR) and other return of premium programs, the Company recorded $159 million and $67 million as a reduction to premium revenue in the three months ended March 31, 2023 and 2022, respectively.

Affordable Care Act

Affordable Care Act	3 Months Ended
	Mar. 31, 2023
Affordable Care Act [Abstract]
Affordable Care Act	Affordable Care Act The Affordable Care Act established risk spreading premium stabilization programs as well as a minimum annual medical loss ratio (MLR) and cost sharing reductions. The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2023 December 31, 2022 Risk adjustment receivable $ 887 $ 838 Risk adjustment payable (1,556) (780) Minimum medical loss ratio (176) (103) Cost sharing reduction payable (89) (99)

Debt

Debt	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): March 31, 2023 December 31, 2022 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,393 $ 2,393 $2,300 million 2.45% Senior Notes due July 15, 2028 2,303 2,303 $3,500 million 4.625% Senior Notes due December 15, 2029 3,277 3,277 $2,000 million 3.375% Senior Notes due February 15, 2030 2,000 2,000 $2,200 million 3.00% Senior Notes due October 15, 2030 2,200 2,200 $2,200 million 2.50% Senior Notes due March 1, 2031 2,200 2,200 $1,300 million 2.625% Senior Notes due August 1, 2031 1,300 1,300 Total senior notes 15,673 15,673 Term loan facility 2,169 2,183 Revolving credit agreement 359 58 Finance leases and other 260 253 Debt issuance costs (141) (147) Total debt 18,320 18,020 Less: current portion (97) (82) Long-term debt $ 18,223 $ 17,938 Of the Company's total debt, approximately 12% is variable rate debt. Approximately 11% uses the London Interbank Offered Rate (LIBOR) as a reference rate pursuant to the terms of the Company Credit Facility and approximately 1% uses the Sterling Overnight Index Average (SONIA) as a reference rate. The debt agreements that may be impacted by the discontinuation of LIBOR have provisions included that are sufficient for the Company to transition from the existing LIBOR rates to the prevailing successor market rates as necessary. The document governing the Company Credit Facility includes provisions to convert from LIBOR to the Secured Overnight Financing Rate (SOFR) at the time LIBOR ceases to be published.

Leases

Leases	3 Months Ended
	Mar. 31, 2023
Leases [Abstract]
Leases	Leases The following table sets forth the right-of-use (ROU) assets and lease liabilities ($ in millions): March 31, 2023 December 31, 2022 Assets ROU assets (recorded within other long-term assets) $ 2,578 $ 2,554 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 177 $ 180 Long-term (recorded within other long-term liabilities) 3,144 3,133 Total lease liabilities $ 3,321 $ 3,313 As of March 31, 2023, the weighted average remaining lease term for the Company was 20.5 years. The average remaining lease term of the Circle Health portfolio is 27.0 years. Excluding Circle Health, the company's portfolio average remaining lease term is 8.5 years. The lease liabilities as of March 31, 2023 reflect a weighted average discount rate of 5.7%.

Stockholders' Equity

Stockholders' Equity	3 Months Ended
	Mar. 31, 2023
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity The Company's Board of Directors has authorized a stock repurchase program of the Company's common stock from time to time on the open market or through privately negotiated transactions. In 2022, the Company's Board of Directors authorized increases under the program including $3,000 million in June 2022 and an additional $2,000 million in December 2022. With these increases, the Company is authorized to repurchase up to $6,000 million, inclusive of past authorizations. As of March 31, 2023, the Company had a remaining amount of $2,429 million available under the Company's stock repurchase program. In April 2023, the Company repurchased an additional 3 million shares for $200 million. The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended March 31, 2023 2022 Shares Cost Shares Cost Share buybacks 4,852 $ 377 — $ — Income tax withholding 696 46 846 71 Total share repurchases 5,548 $ 423 846 $ 71

Earnings Per Share

Earnings Per Share	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2023 2022 Earnings attributable to Centene Corporation $ 1,130 $ 849 Shares used in computing per share amounts: Weighted average number of common shares outstanding 550,779 583,230 Common stock equivalents (as determined by applying the treasury stock method) (1) 3,066 7,428 Weighted average number of common shares and potential dilutive common shares outstanding 553,845 590,658 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 2.05 $ 1.46 Diluted earnings per common share $ 2.04 $ 1.44 (1) The reduction in common stock equivalents is primarily driven by the distribution of long-term stock awards to the estate of the Company's former CEO during the first quarter of 2023, which were fully dilutive prior to their distribution. The calculation of diluted earnings per common share for the three months ended March 31, 2023 and 2022 excludes 1,606 thousand shares and 923 thousand shares, respectively, related to anti-dilutive stock options, restricted stock, and restricted stock units.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2023
Segment Reporting [Abstract]
Segment Information	Segment Information In early 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment, and corresponding 2023 divestitures, the Company has revised the way it manages the business, evaluates performance, and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. Prior year information has been adjusted to reflect the change in segment reporting. The Medicaid, Medicare, and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. The Other segment includes the Company's pharmacy operations, vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others. Factors used in determining the reportable business segments include the nature of operating activities, the existence of separate senior management teams, and the type of information presented to the Company's chief operating decision-maker to evaluate all results of operations. The Company does not report total assets by segment since this is not a metric used to allocate resources or evaluate segment performance. Segment information for the three months ended March 31, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 22,227 $ 5,876 $ 5,252 $ 470 $ 33,825 Service — — — 1,127 1,127 Premium and service revenues 22,227 5,876 5,252 1,597 34,952 Premium tax 3,937 — — — 3,937 Total external revenues 26,164 5,876 5,252 1,597 38,889 Internal revenues — — — 3,867 3,867 Eliminations — — — (3,867) (3,867) Total revenues $ 26,164 $ 5,876 $ 5,252 $ 1,597 $ 38,889 Medical costs $ 20,010 $ 5,008 $ 4,005 $ 411 $ 29,434 Cost of services $ — $ — $ — $ 870 $ 870 Gross margin (1) $ 2,217 $ 868 $ 1,247 $ 316 $ 4,648 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended March 31, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,121 $ 5,757 $ 4,132 $ 879 $ 31,889 Service — — — 2,343 2,343 Premium and service revenues 21,121 5,757 4,132 3,222 34,232 Premium tax 2,953 — — — 2,953 Total external revenues 24,074 5,757 4,132 3,222 37,185 Internal revenues — — — 6,450 6,450 Eliminations — — — (6,450) (6,450) Total revenues $ 24,074 $ 5,757 $ 4,132 $ 3,222 $ 37,185 Medical costs $ 18,775 $ 5,046 $ 3,274 $ 743 $ 27,838 Cost of services $ — $ — $ — $ 1,988 $ 1,988 Gross margin (1) $ 2,346 $ 711 $ 858 $ 491 $ 4,406 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies Overview The Company is routinely subjected to legal and regulatory proceedings in the normal course of business. These matters can include, without limitation: • periodic compliance and other reviews and investigations by various federal and state regulatory agencies with respect to requirements applicable to the Company's business, including, without limitation, those related to payment of out-of-network claims, submissions to the Centers for Medicare and Medicaid Services (CMS) related to risk adjustment payments, or the False Claims Act, the calculation of minimum MLR and rebates related thereto, submissions to state agencies related to payments or state false claims acts, pre-authorization penalties, timely review of grievances and appeals, timely and accurate payment of claims, cybersecurity issues, including those related to the Company's or the Company's third party vendors' information systems, and the Health Insurance Portability and Accountability Act of 1996 and other federal and state fraud, waste and abuse laws; • litigation arising out of general business activities, such as tax matters, disputes related to healthcare benefits coverage or reimbursement, putative securities class actions, and medical malpractice, privacy, real estate, intellectual property and employment-related claims; and • disputes regarding reinsurance arrangements, claims arising out of the acquisition or divestiture of various assets, class actions, and claims relating to the performance of contractual and non-contractual obligations to providers, members, employer groups and others, including, but not limited to, the alleged failure to properly pay claims and challenges to the manner in which the Company processes claims, claims related to network adequacy and claims alleging that the Company has engaged in unfair business practices. Among other things, these matters may result in awards of damages, fines or penalties, which could be substantial, and/or could require changes to the Company's business. The Company intends to vigorously defend itself against legal and regulatory proceedings to which it is currently a party; however, these proceedings are subject to many uncertainties. In some of the cases pending against the Company, substantial non-economic or punitive damages are being sought. The Company records reserves and accrues costs for certain legal proceedings and regulatory matters to the extent that it determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. While such reserves and accrued costs reflect the Company's best estimate of the probable loss for such matters, the recorded amounts may differ materially from the actual amount of any such losses. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings, which may be exacerbated by various factors, including but not limited to, they may involve indeterminate claims for monetary damages or may involve fines, penalties or punitive damages; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; involve a large number of parties, claimants or regulatory bodies; are in the early stages of the proceedings; involve a number of separate proceedings and/or a wide range of potential outcomes; or result in a change of business practices. As of the date of this report, amounts accrued for legal proceedings and regulatory matters were not material, except for the reserve estimate as described below with respect to claims or potential claims involving services provided by Envolve Pharmacy Solutions, Inc. (Envolve), as the Company's pharmacy benefits management (PBM) subsidiary. It is possible that in a particular quarter or annual period the Company's financial condition, results of operations, cash flow and/or liquidity could be materially adversely affected by an ultimate unfavorable resolution of or development in legal and/or regulatory proceedings, including as described below. Except for the discussion below, the Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow, or liquidity. California On October 20, 2015, the Company's California subsidiary, Health Net of California, Inc. (Health Net California), was named as a defendant in a California taxpayer action filed in Los Angeles County Superior Court, captioned as Michael D. Myers v. State Board of Equalization, Dave Jones, Insurance Commissioner of the State of California, Betty T. Yee, Controller of the State of California, et al., Los Angeles Superior Court Case No. BS158655. This action is brought under a California statute that permits an individual taxpayer to sue a governmental agency when the taxpayer believes the agency has failed to enforce governing law. Plaintiff contends that Health Net California, a California licensed Health Care Service Plan (HCSP), is an "insurer" for purposes of taxation despite acknowledging it is not an "insurer" under regulatory law. Under California law, "insurers" must pay a gross premiums tax (GPT), calculated as 2.35% on gross premiums. As a licensed HCSP, Health Net California has paid the California Corporate Franchise Tax (CFT), the tax generally paid by California businesses. Plaintiff contends that Health Net California must pay the GPT rather than the CFT. Plaintiff seeks a writ of mandate directing the California taxing agencies to collect the GPT, and seeks an order requiring Health Net California to pay GPT, interest and penalties for a period dating to eight years prior to the October 2015 filing of the complaint. This lawsuit is being coordinated with similar lawsuits filed against other entities (collectively, Related Actions). In March 2018, the Court overruled the Company's demurrer seeking to dismiss the complaint and denied the Company's motion to strike allegations seeking retroactive relief. In August 2018, the trial court stayed all the Related Actions pending determination of a writ of mandate by the California Court of Appeals in two of the Related Actions. In March 2019, the California Court of Appeals denied the writ of mandate. The defendants in those Related Actions sought review by the California Supreme Court, which declined to review the matter. Upon the return of the matter to the Los Angeles County Superior Court, motions for summary judgment were scheduled. Health Net California's motion for summary judgment was heard by the Court in March 2020. In March 2020, the Court granted Health Net California's motion for summary judgment. In September 2020, the plaintiff appealed the Court's decision. The Company intends to continue its vigorous defense against these claims; however, this matter is subject to many uncertainties, and an adverse outcome in this matter could potentially have a materially adverse impact on the Company's financial condition, results of operations and cash flows. Beginning in April 2021, several lawsuits have been filed against the Company and its subsidiaries, alleging that the defendants failed to prevent Health Net members' personal and health data from being exposed in connection with a data breach involving Accellion's File Transfer Appliance. The Company denies any wrongdoing, and at a mediation in September 2021, the Company reached a settlement with plaintiffs in three of the pending class actions which, if approved by court, should resolve most or all of the pending litigation related to this matter. In addition, claims related to these lawsuits are anticipated to be covered in part by the Company's insurance carrier. As a result, while these matters are subject to many uncertainties, the Company does not believe that an adverse outcome in these matters is likely to have a materially adverse impact on the Company's financial condition, results of operations and cash flows. Pharmacy Benefits Management Matters On March 11, 2021, the State of Ohio filed a civil action against the Company and the Company's subsidiaries, Buckeye Health Plan Community Solutions, Inc. and Envolve, in Franklin County Court of Common Pleas, captioned as Ohio Department of Medicaid, et al. v. Centene Corporation, et al. The complaint alleged breaches of contract with the Ohio Department of Medicaid relating to the provision of PBM services and violations of Ohio law relating to such contracts, including among other things, by (i) seeking payment for services already reimbursed, (ii) not accurately disclosing to the Ohio Department of Medicaid the true cost of the PBM services and (iii) inflating dispensing fees for prescription drugs. The plaintiffs sought an undisclosed sum of money in damages, penalties, and possible termination of the contract with Buckeye Health Plan. The Company has reached no-fault agreements with the Attorneys General, including Ohio, to resolve claims and/or allegations made by the states related to services previously provided by Envolve. As a result of the settlement, the Ohio Attorney General's litigation against the Company was dismissed. Additionally, the Company is in discussions to bring final resolution to similar concerns in other affected states. Consistent with those discussions, the Company recorded a reserve estimate of $1,250 million in the second quarter of 2021 related to this issue, inclusive of the above settlements and rebates that the Company determined in the course of the matter are payable across products. Additional claims, reviews or investigations relating to the Company's historical PBM business across products may be brought by other states, the federal government, or shareholder litigants, and there is no guarantee the Company will have the ability to settle such claims with other states within the reserve estimate the Company has recorded and on other acceptable terms, or at all. This matter is subject to many uncertainties, and an adverse outcome in this matter could have an adverse impact on the Company's financial condition, results of operations and cash flows.

Organization and Operations (Po

Organization and Operations (Policies)	3 Months Ended
	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying interim financial statements have been prepared under the presumption that users of the interim financial information have either read or have access to the audited financial statements included in the Form 10-K for the fiscal year ended December 31, 2022. The unaudited interim financial statements herein have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission. Accordingly, footnote disclosures that would substantially duplicate the disclosures contained in the December 31, 2022 audited financial statements have been omitted from these interim financial statements, where appropriate. In the opinion of management, these financial statements reflect all adjustments, consisting only of normal recurring adjustments, which are necessary for a fair presentation of the results of the interim periods presented. Certain 2022 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2023 presentation, including reclassifications related to the Company's new segment reporting structure as outlined below. These reclassifications have no effect on net earnings or stockholders' equity as previously reported.
Segment Reporting	Segment Reporting In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment, and corresponding 2023 divestitures, the Company has revised the way it manages the business, evaluates performance, and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment, and (4) an Other segment. The Medicaid, Medicare, and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. Specifically, the Medicaid segment includes the Temporary Assistance for Needy Families (TANF) program, Medicaid Expansion programs, the Aged, Blind, or Disabled (ABD) program, the Children's Health Insurance Program (CHIP), Long-Term Services and Supports (LTSS), Foster Care, Medicare-Medicaid Plans (MMP), which cover beneficiaries who are dually eligible for Medicaid and Medicare, and other state-based programs. The Medicare segment includes Medicare Advantage, Medicare Supplement, Dual Eligible Special Needs Plans (D-SNPs), and Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D. The Commercial segment includes the Health Insurance Marketplace along with individual, small group, and large group commercial healthcare products. The Other segment includes the Company's pharmacy operations, vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others.
Accounting Guidance Not Yet Adopted	Accounting Guidance Not Yet Adopted The Company has determined that there are no recently issued accounting pronouncements that will have a material impact on its consolidated financial position, results of operations, or cash flows.

Short-term and Long-term Inve_2

Short-term and Long-term Investments, Restricted Deposits (Tables)	3 Months Ended
	Mar. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Short-term and long-term investments and restricted deposits by investment type	Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2023 December 31, 2022 Amortized Cost Gross Gross Fair Value Amortized Cost Gross Gross Fair Value Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 489 $ — $ (12) $ 477 $ 695 $ — $ (16) $ 679 Corporate securities 10,523 32 (668) 9,887 10,127 12 (778) 9,361 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 312 — — 312 256 — — 256 Short-term time deposits 198 — — 198 204 — — 204 Municipal securities 4,131 15 (213) 3,933 4,055 6 (280) 3,781 Asset-backed securities 1,492 2 (57) 1,437 1,396 — (70) 1,326 Residential mortgage-backed securities 1,187 4 (105) 1,086 1,165 2 (121) 1,046 Commercial mortgage-backed securities 1,067 1 (87) 981 961 — (99) 862 Equity securities (1) 250 — — 250 5 — — 5 Private equity investments 540 — — 540 529 — — 529 Life insurance contracts 176 — — 176 169 — — 169 Total $ 20,369 $ 54 $ (1,142) $ 19,281 $ 19,566 $ 20 $ (1,364) $ 18,222 (1) Investments in equity securities as of March 31, 2023 primarily consisted of shares received as part of the Magellan Specialty Health divestiture consideration. These shares were subsequently sold in April 2023.
Fair value of available-for-sale investments with gross unrealized losses by investment type and length of time	The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2023 December 31, 2022 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value U.S. Treasury securities and obligations of U.S. government corporations and agencies $ (2) $ 249 $ (10) $ 170 $ (5) $ 342 $ (11) $ 184 Corporate securities (72) 2,755 (596) 5,683 (340) 5,368 (438) 3,400 Municipal securities (18) 1,161 (195) 1,945 (142) 2,437 (138) 995 Asset-backed securities (5) 310 (52) 928 (29) 786 (41) 486 Residential mortgage-backed securities (10) 319 (95) 652 (55) 629 (66) 352 Commercial mortgage-backed securities (8) 188 (79) 697 (49) 513 (50) 330 Total $ (115) $ 4,982 $ (1,027) $ 10,075 $ (620) $ 10,075 $ (744) $ 5,747
Contractual maturities of short-term and long-term investments and restricted deposits	The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2023 December 31, 2022 Investments Restricted Deposits Investments Restricted Deposits Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value One year or less $ 2,011 $ 1,981 $ 570 $ 569 $ 2,207 $ 2,179 $ 534 $ 532 One year through five years 8,008 7,556 546 518 7,651 7,147 524 490 Five years through ten years 4,131 3,821 245 224 4,066 3,613 224 195 Greater than ten years 144 140 2 2 135 129 — — Asset-backed securities 3,746 3,504 — — 3,522 3,234 — — Total $ 18,040 $ 17,002 $ 1,363 $ 1,313 $ 17,581 $ 16,302 $ 1,282 $ 1,217

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2023
Fair Value Disclosures [Abstract]
Assets and Liabilities, Based Upon Observable or Unobservable Inputs, Level Input Definitions	Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date.
Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis	The following table summarizes fair value measurements by level at March 31, 2023, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 15,853 $ — $ — $ 15,853 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 156 $ — $ — $ 156 Corporate securities — 9,853 — 9,853 Municipal securities — 3,291 — 3,291 Short-term time deposits — 198 — 198 Asset-backed securities — 1,437 — 1,437 Residential mortgage-backed securities — 1,086 — 1,086 Commercial mortgage-backed securities — 981 — 981 Equity securities 248 2 — 250 Total investments $ 404 $ 16,848 $ — $ 17,252 Restricted deposits: Cash and cash equivalents $ 312 $ — $ — $ 312 U.S. Treasury securities and obligations of U.S. government corporations and agencies 321 — — 321 Corporate securities — 34 — 34 Certificates of deposit — 4 — 4 Municipal securities — 642 — 642 Total restricted deposits $ 633 $ 680 $ — $ 1,313 Total assets at fair value $ 16,890 $ 17,528 $ — $ 34,418 The following table summarizes fair value measurements by level at December 31, 2022, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 12,074 $ — $ — $ 12,074 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 366 $ 5 $ — $ 371 Corporate securities — 9,328 — 9,328 Municipal securities — 3,165 — 3,165 Short-term time deposits — 204 — 204 Asset backed securities — 1,326 — 1,326 Residential mortgage backed securities — 1,046 — 1,046 Commercial mortgage backed securities — 862 — 862 Equity securities 3 2 — 5 Total investments $ 369 $ 15,938 $ — $ 16,307 Restricted deposits: Cash and cash equivalents $ 256 $ — $ — $ 256 U.S. Treasury securities and obligations of U.S. government corporations and agencies 308 — — 308 Corporate securities — 33 — 33 Certificates of deposit — 4 — 4 Municipal securities — 616 — 616 Total restricted deposits $ 564 $ 653 $ — $ 1,217 Total assets at fair value $ 13,007 $ 16,591 $ — $ 29,598

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table summarizes the changes in goodwill by operating segment ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, December 31, 2021 $ 10,194 $ 1,592 $ 5,424 $ 2,561 $ 19,771 Acquisition and purchase accounting adjustments — — — 1,077 1,077 Divestitures — — — (1,533) (1,533) Reallocation 4 — — (4) — Impairments — — — (370) (370) Translation impact — — — (133) (133) Balance, December 31, 2022 $ 10,198 $ 1,592 $ 5,424 $ 1,598 $ 18,812 Translation impact — — — 24 24 Balance, March 31, 2023 $ 10,198 $ 1,592 $ 5,424 $ 1,622 $ 18,836

Medical Claims Liability (Table

Medical Claims Liability (Tables)	3 Months Ended
	Mar. 31, 2023
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability for the three months ended March 31, 2023 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2023 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 Less: Reinsurance recoverable 7 — 19 — 26 Balance, January 1, 2023, net 11,246 3,431 1,902 140 16,719 Incurred related to: Current year 20,813 5,163 4,177 418 30,571 Prior years (803) (155) (172) (7) (1,137) Total incurred 20,010 5,008 4,005 411 29,434 Paid related to: Current year 12,679 2,988 2,541 294 18,502 Prior years 6,834 2,145 1,063 132 10,174 Total paid 19,513 5,133 3,604 426 28,676 Balance, March 31, 2023, net 11,743 3,306 2,303 125 17,477 Plus: Reinsurance recoverable 9 — 18 — 27 Balance, March 31, 2023 $ 11,752 $ 3,306 $ 2,321 $ 125 $ 17,504 The following table summarizes the change in medical claims liability for the three months ended March 31, 2022 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2022 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Less: Reinsurance recoverable 23 — — — 23 Balance, January 1, 2022, net 9,822 2,286 2,014 98 14,220 Acquisitions — — — 249 249 Incurred related to: Current year 19,289 5,098 3,423 751 28,561 Prior years (514) (52) (149) (8) (723) Total incurred 18,775 5,046 3,274 743 27,838 Paid related to: Current year 12,022 2,674 2,012 690 17,398 Prior years 5,643 1,624 1,319 76 8,662 Total paid 17,665 4,298 3,331 766 26,060 Balance, March 31, 2022, net 10,932 3,034 1,957 324 16,247 Plus: Reinsurance recoverable 12 — — — 12 Balance, March 31, 2022 $ 10,944 $ 3,034 $ 1,957 $ 324 $ 16,259

Affordable Care Act (Tables)

Affordable Care Act (Tables)	3 Months Ended
	Mar. 31, 2023
Affordable Care Act [Abstract]
Schedule of net receivables (payables) related to the Affordable Care Act Programs	The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2023 December 31, 2022 Risk adjustment receivable $ 887 $ 838 Risk adjustment payable (1,556) (780) Minimum medical loss ratio (176) (103) Cost sharing reduction payable (89) (99)

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): March 31, 2023 December 31, 2022 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,393 $ 2,393 $2,300 million 2.45% Senior Notes due July 15, 2028 2,303 2,303 $3,500 million 4.625% Senior Notes due December 15, 2029 3,277 3,277 $2,000 million 3.375% Senior Notes due February 15, 2030 2,000 2,000 $2,200 million 3.00% Senior Notes due October 15, 2030 2,200 2,200 $2,200 million 2.50% Senior Notes due March 1, 2031 2,200 2,200 $1,300 million 2.625% Senior Notes due August 1, 2031 1,300 1,300 Total senior notes 15,673 15,673 Term loan facility 2,169 2,183 Revolving credit agreement 359 58 Finance leases and other 260 253 Debt issuance costs (141) (147) Total debt 18,320 18,020 Less: current portion (97) (82) Long-term debt $ 18,223 $ 17,938

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2023
Leases [Abstract]
ROU Assets and Liabilities	The following table sets forth the right-of-use (ROU) assets and lease liabilities ($ in millions): March 31, 2023 December 31, 2022 Assets ROU assets (recorded within other long-term assets) $ 2,578 $ 2,554 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 177 $ 180 Long-term (recorded within other long-term liabilities) 3,144 3,133 Total lease liabilities $ 3,321 $ 3,313

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	3 Months Ended
	Mar. 31, 2023
Equity [Abstract]
Class of Treasury Stock	The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended March 31, 2023 2022 Shares Cost Shares Cost Share buybacks 4,852 $ 377 — $ — Income tax withholding 696 46 846 71 Total share repurchases 5,548 $ 423 846 $ 71

Earnings Per Share (Tables)

Earnings Per Share (Tables)	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Calculation of Basic and Diluted Net Earnings Per Common Share	The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2023 2022 Earnings attributable to Centene Corporation $ 1,130 $ 849 Shares used in computing per share amounts: Weighted average number of common shares outstanding 550,779 583,230 Common stock equivalents (as determined by applying the treasury stock method) (1) 3,066 7,428 Weighted average number of common shares and potential dilutive common shares outstanding 553,845 590,658 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 2.05 $ 1.46 Diluted earnings per common share $ 2.04 $ 1.44 (1) The reduction in common stock equivalents is primarily driven by the distribution of long-term stock awards to the estate of the Company's former CEO during the first quarter of 2023, which were fully dilutive prior to their distribution.

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2023
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended March 31, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 22,227 $ 5,876 $ 5,252 $ 470 $ 33,825 Service — — — 1,127 1,127 Premium and service revenues 22,227 5,876 5,252 1,597 34,952 Premium tax 3,937 — — — 3,937 Total external revenues 26,164 5,876 5,252 1,597 38,889 Internal revenues — — — 3,867 3,867 Eliminations — — — (3,867) (3,867) Total revenues $ 26,164 $ 5,876 $ 5,252 $ 1,597 $ 38,889 Medical costs $ 20,010 $ 5,008 $ 4,005 $ 411 $ 29,434 Cost of services $ — $ — $ — $ 870 $ 870 Gross margin (1) $ 2,217 $ 868 $ 1,247 $ 316 $ 4,648 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended March 31, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,121 $ 5,757 $ 4,132 $ 879 $ 31,889 Service — — — 2,343 2,343 Premium and service revenues 21,121 5,757 4,132 3,222 34,232 Premium tax 2,953 — — — 2,953 Total external revenues 24,074 5,757 4,132 3,222 37,185 Internal revenues — — — 6,450 6,450 Eliminations — — — (6,450) (6,450) Total revenues $ 24,074 $ 5,757 $ 4,132 $ 3,222 $ 37,185 Medical costs $ 18,775 $ 5,046 $ 3,274 $ 743 $ 27,838 Cost of services $ — $ — $ — $ 1,988 $ 1,988 Gross margin (1) $ 2,346 $ 711 $ 858 $ 491 $ 4,406 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Acquisitions and Divestitures -

Acquisitions and Divestitures -Divestiture (Details) - USD ($) $ in Millions		1 Months Ended	3 Months Ended
	Jan. 20, 2023	Apr. 25, 2023	Mar. 31, 2023	Mar. 31, 2022	Jan. 10, 2023
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on disposition of business			$ (79)	$ 0
Centurion | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration on disposal (up to)					$ 35
Magellan Specialty Health | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration on disposal (up to)	$ 150
Consideration received on divestiture	646
Gain on disposition of business	$ (79)
Magellan Specialty Health | Disposal Group, Disposed of by Sale, Not Discontinued Operations | Subsequent Event
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of business		$ 245

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Debt Securities
Gross Unrealized Gains	$ 54	$ 20
Gross Unrealized Losses	(1,142)	(1,364)
Equity securities	250	5
Private equity investments	540	529
Life insurance contracts	176	169
Total, Amortized Cost	20,369	19,566
Total, Fair Value	19,281	18,222
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	489	695
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(12)	(16)
Fair Value	477	679
Corporate securities
Debt Securities
Amortized Cost	10,523	10,127
Gross Unrealized Gains	32	12
Gross Unrealized Losses	(668)	(778)
Fair Value	9,887	9,361
Restricted certificates of deposit
Debt Securities
Amortized Cost	4	4
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	4	4
Restricted cash equivalents
Debt Securities
Amortized Cost	312	256
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	312	256
Short-term time deposits
Debt Securities
Amortized Cost	198	204
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	198	204
Municipal securities
Debt Securities
Amortized Cost	4,131	4,055
Gross Unrealized Gains	15	6
Gross Unrealized Losses	(213)	(280)
Fair Value	3,933	3,781
Asset-backed securities
Debt Securities
Amortized Cost	1,492	1,396
Gross Unrealized Gains	2	0
Gross Unrealized Losses	(57)	(70)
Fair Value	1,437	1,326
Residential mortgage-backed securities
Debt Securities
Amortized Cost	1,187	1,165
Gross Unrealized Gains	4	2
Gross Unrealized Losses	(105)	(121)
Fair Value	1,086	1,046
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	1,067	961
Gross Unrealized Gains	1	0
Gross Unrealized Losses	(87)	(99)
Fair Value	$ 981	$ 862

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2023 USD ($) position	Dec. 31, 2022 USD ($)
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income | $	$ 141	$ 132
Positions from which gross unrealized losses were generated	6,109
Total investment positions	6,936
Commercial mortgage-backed securities
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Investments recorded at fair value that carry rating of AAA Plus, weighted average (in years)	4 years
Rated Securities | External Credit Rating, Investment Grade | Investment Securities
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations	99%

Short-term and Long-term Inve_5

Short-term and Long-term Investments, Restricted Deposits - Fair Value of Available-For-Sale Investments with Gross Unrealized Losses by Investment Type and Length of Time (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Unrealized Losses
Less Than 12 Months	$ (115)	$ (620)
12 Months or More	(1,027)	(744)
Fair Value
Fair Value, Less Than 12 Months	4,982	10,075
Fair Value, 12 Months or More	10,075	5,747
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Unrealized Losses
Less Than 12 Months	(2)	(5)
12 Months or More	(10)	(11)
Fair Value
Fair Value, Less Than 12 Months	249	342
Fair Value, 12 Months or More	170	184
Corporate securities
Unrealized Losses
Less Than 12 Months	(72)	(340)
12 Months or More	(596)	(438)
Fair Value
Fair Value, Less Than 12 Months	2,755	5,368
Fair Value, 12 Months or More	5,683	3,400
Municipal securities
Unrealized Losses
Less Than 12 Months	(18)	(142)
12 Months or More	(195)	(138)
Fair Value
Fair Value, Less Than 12 Months	1,161	2,437
Fair Value, 12 Months or More	1,945	995
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(5)	(29)
12 Months or More	(52)	(41)
Fair Value
Fair Value, Less Than 12 Months	310	786
Fair Value, 12 Months or More	928	486
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(10)	(55)
12 Months or More	(95)	(66)
Fair Value
Fair Value, Less Than 12 Months	319	629
Fair Value, 12 Months or More	652	352
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(8)	(49)
12 Months or More	(79)	(50)
Fair Value
Fair Value, Less Than 12 Months	188	513
Fair Value, 12 Months or More	$ 697	$ 330

Short-term and Long-term Inve_6

Short-term and Long-term Investments, Restricted Deposits - Contractual Maturities of Short-Term and Long-Term Investments and Restricted Deposits (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Investments
Amortized Cost
One year or less	$ 2,011	$ 2,207
One year through five years	8,008	7,651
Five years through ten years	4,131	4,066
Greater than ten years	144	135
Asset-backed securities	3,746	3,522
Amortized Cost	18,040	17,581
Fair Value
One year or less	1,981	2,179
One year through five years	7,556	7,147
Five years through ten years	3,821	3,613
Greater than ten years	140	129
Asset-backed securities	3,504	3,234
Fair Value	17,002	16,302
Restricted Deposits
Amortized Cost
One year or less	570	534
One year through five years	546	524
Five years through ten years	245	224
Greater than ten years	2	0
Asset-backed securities	0	0
Amortized Cost	1,363	1,282
Fair Value
One year or less	569	532
One year through five years	518	490
Five years through ten years	224	195
Greater than ten years	2	0
Asset-backed securities	0	0
Fair Value	$ 1,313	$ 1,217

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Assets
Cash and cash equivalents	$ 15,853	$ 12,074
Investments:
Equity securities	250	5
Total assets at fair value	34,418	29,598
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	477	679
Corporate securities
Investments:
Fair Value	9,887	9,361
Municipal securities
Investments:
Fair Value	3,933	3,781
Short-term time deposits
Investments:
Fair Value	198	204
Asset-backed securities
Investments:
Fair Value	1,437	1,326
Residential mortgage-backed securities
Investments:
Fair Value	1,086	1,046
Commercial mortgage-backed securities
Investments:
Fair Value	981	862
Investments
Investments:
Fair Value	17,002	16,302
Total investments	17,252	16,307
Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	156	371
Investments | Corporate securities
Investments:
Fair Value	9,853	9,328
Investments | Municipal securities
Investments:
Fair Value	3,291	3,165
Investments | Short-term time deposits
Investments:
Fair Value	198	204
Investments | Asset-backed securities
Investments:
Fair Value	1,437	1,326
Investments | Residential mortgage-backed securities
Investments:
Fair Value	1,086	1,046
Investments | Commercial mortgage-backed securities
Investments:
Fair Value	981	862
Investments | Equity Securities
Investments:
Equity securities	250	5
Restricted deposits
Investments:
Fair Value	1,313	1,217
Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	321	308
Restricted deposits | Corporate securities
Investments:
Fair Value	34	33
Restricted deposits | Municipal securities
Investments:
Fair Value	642	616
Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	312	256
Restricted deposits | Certificates of deposit
Investments:
Fair Value	4	4
Level I
Assets
Cash and cash equivalents	15,853	12,074
Investments:
Total assets at fair value	16,890	13,007
Level I | Investments
Investments:
Total investments	404	369
Level I | Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	156	366
Level I | Investments | Corporate securities
Investments:
Fair Value	0	0
Level I | Investments | Municipal securities
Investments:
Fair Value	0	0
Level I | Investments | Short-term time deposits
Investments:
Fair Value	0	0
Level I | Investments | Asset-backed securities
Investments:
Fair Value	0	0
Level I | Investments | Residential mortgage-backed securities
Investments:
Fair Value	0	0
Level I | Investments | Commercial mortgage-backed securities
Investments:
Fair Value	0	0
Level I | Investments | Equity Securities
Investments:
Equity securities	248	3
Level I | Restricted deposits
Investments:
Fair Value	633	564
Level I | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	321	308
Level I | Restricted deposits | Corporate securities
Investments:
Fair Value	0	0
Level I | Restricted deposits | Municipal securities
Investments:
Fair Value	0	0
Level I | Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	312	256
Level I | Restricted deposits | Certificates of deposit
Investments:
Fair Value	0	0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	17,528	16,591
Level II | Investments
Investments:
Total investments	16,848	15,938
Level II | Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	5
Level II | Investments | Corporate securities
Investments:
Fair Value	9,853	9,328
Level II | Investments | Municipal securities
Investments:
Fair Value	3,291	3,165
Level II | Investments | Short-term time deposits
Investments:
Fair Value	198	204
Level II | Investments | Asset-backed securities
Investments:
Fair Value	1,437	1,326
Level II | Investments | Residential mortgage-backed securities
Investments:
Fair Value	1,086	1,046
Level II | Investments | Commercial mortgage-backed securities
Investments:
Fair Value	981	862
Level II | Investments | Equity Securities
Investments:
Equity securities	2	2
Level II | Restricted deposits
Investments:
Fair Value	680	653
Level II | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	0
Level II | Restricted deposits | Corporate securities
Investments:
Fair Value	34	33
Level II | Restricted deposits | Municipal securities
Investments:
Fair Value	642	616
Level II | Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	0	0
Level II | Restricted deposits | Certificates of deposit
Investments:
Fair Value	4	4
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	0	0
Level III | Investments
Investments:
Total investments	0	0
Level III | Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	0
Level III | Investments | Corporate securities
Investments:
Fair Value	0	0
Level III | Investments | Municipal securities
Investments:
Fair Value	0	0
Level III | Investments | Short-term time deposits
Investments:
Fair Value	0	0
Level III | Investments | Asset-backed securities
Investments:
Fair Value	0	0
Level III | Investments | Residential mortgage-backed securities
Investments:
Fair Value	0	0
Level III | Investments | Commercial mortgage-backed securities
Investments:
Fair Value	0	0
Level III | Investments | Equity Securities
Investments:
Equity securities	0	0
Level III | Restricted deposits
Investments:
Fair Value	0	0
Level III | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	0
Level III | Restricted deposits | Corporate securities
Investments:
Fair Value	0	0
Level III | Restricted deposits | Municipal securities
Investments:
Fair Value	0	0
Level III | Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	0	0
Level III | Restricted deposits | Certificates of deposit
Investments:
Fair Value	$ 0	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 716	$ 698

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets (Details) - USD ($) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	$ 18,812	$ 19,771
Acquisition and purchase accounting adjustments		1,077
Divestitures		(1,533)
Reallocation		0
Impairments		(370)
Translation impact	24	(133)
Goodwill, Balance ending	18,836	18,812
Medicaid
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	10,198	10,194
Acquisition and purchase accounting adjustments		0
Divestitures		0
Reallocation		4
Impairments		0
Translation impact	0	0
Goodwill, Balance ending	10,198	10,198
Medicare
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	1,592	1,592
Acquisition and purchase accounting adjustments		0
Divestitures		0
Reallocation		0
Impairments		0
Translation impact	0	0
Goodwill, Balance ending	1,592	1,592
Commercial
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	5,424	5,424
Acquisition and purchase accounting adjustments		0
Divestitures		0
Reallocation		0
Impairments		0
Translation impact	0	0
Goodwill, Balance ending	5,424	5,424
Other
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	1,598	2,561
Acquisition and purchase accounting adjustments		1,077
Divestitures		(1,533)
Reallocation		(4)
Impairments		(370)
Translation impact	24	(133)
Goodwill, Balance ending	$ 1,622	$ 1,598

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1, 2023	$ 16,745	$ 14,243
Less: Reinsurance recoverable	26	23
Balance, January 1, 2023, net	16,719	14,220
Acquisitions		249
Incurred related to:
Current year	30,571	28,561
Prior years	(1,137)	(723)
Total incurred	29,434	27,838
Paid related to:
Current year	18,502	17,398
Prior years	10,174	8,662
Total paid	28,676	26,060
Balance, March 31, 2023, net	17,477	16,247
Plus: Reinsurance recoverable	27	12
Balance, March 31, 2023	17,504	16,259
Medicaid
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1, 2023	11,253	9,845
Less: Reinsurance recoverable	7	23
Balance, January 1, 2023, net	11,246	9,822
Acquisitions		0
Incurred related to:
Current year	20,813	19,289
Prior years	(803)	(514)
Total incurred	20,010	18,775
Paid related to:
Current year	12,679	12,022
Prior years	6,834	5,643
Total paid	19,513	17,665
Balance, March 31, 2023, net	11,743	10,932
Plus: Reinsurance recoverable	9	12
Balance, March 31, 2023	11,752	10,944
Medicare
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1, 2023	3,431	2,286
Less: Reinsurance recoverable	0	0
Balance, January 1, 2023, net	3,431	2,286
Acquisitions		0
Incurred related to:
Current year	5,163	5,098
Prior years	(155)	(52)
Total incurred	5,008	5,046
Paid related to:
Current year	2,988	2,674
Prior years	2,145	1,624
Total paid	5,133	4,298
Balance, March 31, 2023, net	3,306	3,034
Plus: Reinsurance recoverable	0	0
Balance, March 31, 2023	3,306	3,034
Commercial
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1, 2023	1,921	2,014
Less: Reinsurance recoverable	19	0
Balance, January 1, 2023, net	1,902	2,014
Acquisitions		0
Incurred related to:
Current year	4,177	3,423
Prior years	(172)	(149)
Total incurred	4,005	3,274
Paid related to:
Current year	2,541	2,012
Prior years	1,063	1,319
Total paid	3,604	3,331
Balance, March 31, 2023, net	2,303	1,957
Plus: Reinsurance recoverable	18	0
Balance, March 31, 2023	2,321	1,957
Other
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1, 2023	140	98
Less: Reinsurance recoverable	0	0
Balance, January 1, 2023, net	140	98
Acquisitions		249
Incurred related to:
Current year	418	751
Prior years	(7)	(8)
Total incurred	411	743
Paid related to:
Current year	294	690
Prior years	132	76
Total paid	426	766
Balance, March 31, 2023, net	125	324
Plus: Reinsurance recoverable	0	0
Balance, March 31, 2023	$ 125	$ 324

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 159	$ 67
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	$ 11,271

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 887	$ 838
Risk adjustment payable	(1,556)	(780)
Minimum medical loss ratio	(176)	(103)
Cost sharing reduction payable	$ (89)	$ (99)

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Mar. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total senior notes	$ 15,673,000,000	$ 15,673,000,000
Finance leases and other	260,000,000	253,000,000
Debt issuance costs	(141,000,000)	(147,000,000)
Total debt	18,320,000,000	18,020,000,000
Less: current portion	(97,000,000)	(82,000,000)
Long-term debt	18,223,000,000	17,938,000,000
Revolving credit agreement
Debt Instrument [Line Items]
Credit facility	359,000,000	58,000,000
Term loan facility
Debt Instrument [Line Items]
Credit facility	2,169,000,000	2,183,000,000
$2,500 million 4.25% Senior Notes due December 15, 2027 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,500,000,000
Interest rate	4.25%
Senior notes	$ 2,393,000,000	2,393,000,000
$2,300 million 2.45% Senior Notes due July 15, 2028 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,300,000,000
Interest rate	2.45%
Senior notes	$ 2,303,000,000	2,303,000,000
$3,500 million 4.625% Senior Notes due December 15, 2029 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 3,500,000,000
Interest rate	4.625%
Senior notes	$ 3,277,000,000	3,277,000,000
$2,000 million 3.375% Senior Notes due February 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,000,000,000
Interest rate	3.375%
Senior notes	$ 2,000,000,000	2,000,000,000
$2,200 million 3.00% Senior Notes due October 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000
Interest rate	3%
Senior notes	$ 2,200,000,000	2,200,000,000
$2,200 million 2.50% Senior Notes due March 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000
Interest rate	2.50%
Senior notes	$ 2,200,000,000	2,200,000,000
$1,300 million 2.625% Senior Notes due August 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 1,300,000,000
Interest rate	2.625%
Senior notes	$ 1,300,000,000	$ 1,300,000,000

Debt - Narrative (Details)

Debt - Narrative (Details) - Debt Total - Credit Availability Concentration Risk	3 Months Ended
	Mar. 31, 2023
London Interbank Offered Rate (LIBOR) And Sterling Overnight Index Average (SONIA)
Debt Instrument [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations	12%
LIBOR
Debt Instrument [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations	11%
Sterling Overnight Index Average (SONIA)
Debt Instrument [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations	1%

Leases - Right-of-use (ROU) Ass

Leases - Right-of-use (ROU) Assets and Lease Liabilities (Details) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Assets
ROU assets (recorded within other long-term assets)	$ 2,578	$ 2,554
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Other long-term assets	Other long-term assets
Liabilities
Short-term (recorded within accounts payable and accrued expenses)	$ 177	$ 180
Long-term (recorded within other long-term liabilities)	3,144	3,133
Total lease liabilities	$ 3,321	$ 3,313
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accounts payable and accrued expenses	Accounts payable and accrued expenses
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other long-term liabilities	Other long-term liabilities

Leases - Narrative (Details)

Leases - Narrative (Details)	Mar. 31, 2023
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	20 years 6 months
Weighted-average discount rate for operating leases	5.70%
Circle Health
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	27 years
Excluding Circle Health
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	8 years 6 months

Stockholders' Equity - Narrativ

Stockholders' Equity - Narrative (Details) - USD ($) shares in Millions, $ in Millions	1 Months Ended			3 Months Ended
	Apr. 25, 2023	Dec. 31, 2022	Jun. 30, 2022	Mar. 31, 2023	Mar. 31, 2022
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, increase to authorized amount		$ 2,000	$ 3,000
Stock repurchase program, authorized amount				$ 6,000
Stock repurchase program, remaining available				2,429
Common stock repurchases				$ 423	$ 71
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Common stock repurchases (in shares)	3
Common stock repurchases	$ 200

Stockholders' Equity - Share Re

Stockholders' Equity - Share Repurchase Activity (Details) - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Subsidiary, Sale of Stock [Line Items]
Common stock repurchases	$ 423	$ 71
Employee Stock Compensation Plan
Subsidiary, Sale of Stock [Line Items]
Income tax withholding (in shares)	696	846
Income tax withholding	$ 46	$ 71
Common Stock
Subsidiary, Sale of Stock [Line Items]
Share buybacks (in shares)	4,852	0
Common stock repurchases (in shares)	5,548	846
Share buybacks	$ 377	$ 0
Common stock repurchases	$ 423	$ 71

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Earnings attributable to Centene Corporation
Earnings attributable to Centene Corporation	$ 1,130	$ 849
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	550,779	583,230
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	3,066	7,428
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	553,845	590,658
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 2.05	$ 1.46
Diluted earnings per common share (in dollars per share)	$ 2.04	$ 1.44
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings (loss) per common share (in shares)	1,606	923

Segment Information (Details)

Segment Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Segment Reporting Information [Line Items]
Premium and service revenues	$ 34,952	$ 34,232
Premium tax	3,937	2,953
Total external revenues	38,889	37,185
Revenues	38,889	37,185
Medical costs	29,434	27,838
Cost of services	870	1,988
Gross margin	4,648	4,406
Operating Segments
Segment Reporting Information [Line Items]
Revenues	3,867	6,450
Eliminations
Segment Reporting Information [Line Items]
Revenues	(3,867)	(6,450)
Premium
Segment Reporting Information [Line Items]
Premium and service revenues	33,825	31,889
Service
Segment Reporting Information [Line Items]
Premium and service revenues	1,127	2,343
Premium and service revenues
Segment Reporting Information [Line Items]
Premium and service revenues	34,952	34,232
Medicaid
Segment Reporting Information [Line Items]
Revenues	26,164	24,074
Medical costs	20,010	18,775
Cost of services	0	0
Gross margin	2,217	2,346
Medicaid | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	3,937	2,953
Total external revenues	26,164	24,074
Revenues	0	0
Medicaid | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0
Medicaid | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	22,227	21,121
Medicaid | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0
Medicaid | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	22,227	21,121
Medicare
Segment Reporting Information [Line Items]
Revenues	5,876	5,757
Medical costs	5,008	5,046
Cost of services	0	0
Gross margin	868	711
Medicare | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0
Total external revenues	5,876	5,757
Revenues	0	0
Medicare | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0
Medicare | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,876	5,757
Medicare | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0
Medicare | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,876	5,757
Commercial
Segment Reporting Information [Line Items]
Revenues	5,252	4,132
Medical costs	4,005	3,274
Cost of services	0	0
Gross margin	1,247	858
Commercial | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0
Total external revenues	5,252	4,132
Revenues	0	0
Commercial | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0
Commercial | Premium
Segment Reporting Information [Line Items]
Premium and service revenues	5,252	4,132
Commercial | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0
Commercial | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,252	4,132
Other/Eliminations
Segment Reporting Information [Line Items]
Revenues	1,597	3,222
Medical costs	411	743
Cost of services	870	1,988
Gross margin	316	491
Other/Eliminations | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0
Total external revenues	1,597	3,222
Revenues	3,867	6,450
Other/Eliminations | Eliminations
Segment Reporting Information [Line Items]
Revenues	(3,867)
Other/Eliminations | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	470	879
Other/Eliminations | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	1,127	2,343
Other/Eliminations | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	$ 1,597	$ 3,222

Contingencies (Details)

Contingencies (Details) - Pending Litigation $ in Millions	Sep. 30, 2021 claim	Jun. 30, 2021 USD ($)
Loss Contingencies [Line Items]
Pending claims | claim	3
Reserve estimate | $		$ 1,250