CNC — Deck
Centene is the largest US Medicaid carrier, paid fixed monthly per-member premiums by 30 state Medicaid agencies, CMS, and the ACA Marketplace, and keeping whatever spread is left between rate and medical cost.
The whole story sits on whether $3.00 FY26 EPS lands, from a team that just missed FY25 by 71%.
- The reset. Management reaffirmed FY25 adj EPS above $7.25 on the Q1 2025 call. On July 25, 2025 an 8-K withdrew the guide; FY25 adj EPS landed at $2.08. Stock dropped 40% in a single session and over $11B of market value vanished.
- The new guide. FY26 adj EPS guided above $3.00 — roughly 40% growth off the cratered base. Mid-30% Marketplace rate increases are filed across 95% of the 2026 book and Medicaid composite rate is locked at +5.5%. The math is mechanical if HBR holds.
- The unresolved bet. 92¢ of every premium dollar is medical cost; a 100-bp HBR miss wipes out half of normalized operating income. Asking the same forecasting team to nail FY26 within ~60 bps of HBR is the pivot of the entire thesis.
A four-year compounding story unwound in 90 days.
Before: 2021–2024 was disciplined compounding. Adjusted EPS rose from $5.15 to $7.17, capped by a Q4 2024 guide of above $7.25 for FY25 framed around the "durability of earnings power." Buybacks ran $3B in 2024 alone.
Pivot: On July 25, 2025 an independent actuary report from Wakely showed the Marketplace risk pool was running 12+ points sicker than priced. Same-day 8-K withdrew guidance; Q2 GAAP EPS landed at -$0.51; shares bottomed at $25.08 two weeks later. Q3 added a $6.7B goodwill impairment against the WellCare and Magellan deals.
Today: The base business is cleaner — Magellan unwind announced, Medicare Stars recovered to 60% in 3.5★+, Marketplace repriced for 2026. But "value creation plan," "high-89s HBR," and "12–15% LT EPS growth" are gone from the deck — quietly retired, not formally retracted.
The GAAP loss is real; the cash conversion is not what broke.
Of the $7.6B FY25 operating loss, $6.7B was a non-cash goodwill writedown of WellCare and Magellan. Operating cash flow grew from $0.2B to $5.1B as state-directed payment timing reversed; the $4B revolver is undrawn; days-in-claims-payable held at 46. The break was in the income statement, not in cash conversion or reserve adequacy — but a repeat of $4–5B operating cash flow in FY26 is what would validate the "non-cash" framing of 2025.
FY26 estimates drift up, FY27 drifts down — the snapback does not compound.
- FY26 ($3.02). Revised up from $2.99 over 90 days. The mechanical case: mid-30% Marketplace rate increases filed on 95% of the book, +5.5% Medicaid composite rate locked, ~60 bps of HBR improvement implied. Pure rate-catch-up math.
- FY27 ($3.98). Revised down from $4.13 over the same window. OBBBA work requirements arrive Jan 2027 and will raise morbidity of remaining Medicaid Expansion members; APTC expiry already cut Marketplace from 5.5M to 3.5M for 2026; management has pre-warned the 2027 MA advance notice is "more pressured than industry expectations."
- The wedge. Three regulatory levers — Medicaid acuity, ACA subsidies, MA rate notices — all hit 2027 before the rate cycle can catch them. Bulls need the FY27 line to inflect up after Q2 2026; the analyst community is currently bending it the other way.
Q1 2026 prints in 2 days, into a class-action overhang and an insider signal that cuts both ways.
- April 28, 2026. Q1 prints. Consensus EPS $1.85, HBR 89.3% vs 87.1% prior year (+220 bps). The first clean read on whether the +mid-30s Marketplace repricing is actually showing in the loss ratio.
- Securities class actions. Hagens Berman, Levi & Korsinsky, Faruqi, Rosen filed coordinated suits summer 2025, alleging the gap between Q1 2025 reaffirmed guidance and the July 25 withdrawal is the litigable disclosure window. Cases active, no settlement. House Judiciary Republicans separately subpoenaed eight ACA insurers including Centene.
- The CEO buy. On Aug 8, 2025, two weeks after the guide was pulled, Sarah London bought 19,230 shares at $25.50 in an open-market Form 4 (~$490K). The single most bullish insider signal in the dataset — and in direct tension with the class-action narrative.
Lean cautious — the rate-cycle math is real, the credibility rebuild is not yet earned.
- For. EV/Sales 0.09× and EV/EBITDA 3.8× are a 5–9× discount to peers; FY25 generated $5.1B of operating cash flow despite the GAAP loss; balance sheet swung to net cash with the $4B revolver undrawn.
- For. Marketplace pricing resets every January; +mid-30% rate increases across 95% of the 2026 book are mechanically locked in. The 2025 ACA shock has a pricing solution and the solution is filed.
- Against. Same management team reaffirmed FY25 above $7.25 in Q1 2025 and reset to $1.75 three months later — a 71% miss after the reaffirmation. Underwriting above $3.00 FY26 from the same forecasting tools is the bet bulls are actually taking.
- Against. Consensus FY27 EPS is drifting down ($4.13 → $3.98) while FY26 drifts up — the analyst community is already signaling that 2027 morbidity (OBBBA + APTC) overwhelms the 2026 rate cycle. The smartest line in the estimate sheet bends bearish.
Watchlist to re-rate: Q1 2026 Medicaid HBR (April 28) vs the 93% Q4 baseline; the sign of prior-period development through Q2; FY27 consensus EPS revision tape after the July print.