EX-99.1 2 exhibit991.htm PRESS RELEASE exhibit991.htm
Exhibit 99.1

GRAPHIC
 
 
NEWS RELEASE
 
Contact:
Investor Relations Inquiries
Edmund E. Kroll
 
Senior Vice President, Finance & Investor Relations
 
(212) 759-0382
 
 
Media Inquiries
 
Deanne Lane
 
Vice President, Media Affairs
 
(314) 725-4477

FOR IMMEDIATE RELEASE

Centene Corporation reports $0.44 earnings per diluted share for the third quarter 2010;
$0.48 from operations excluding a $0.04 charge for net investment writedowns

ST. LOUIS, MISSOURI (October 26, 2010) -- Centene Corporation (NYSE: CNC) today announced net earnings from continuing operations for the quarter ended September 30, 2010, of $22.4 million, or $0.44 per diluted share; $0.48 from operations excluding a $0.04 charge for net investment writedowns.  The discussions below, with the exception of cash flow information, are in the context of continuing operations and all financial ratios exclude premium taxes.
 
Third Quarter Highlights
 
·  
Quarter-end managed care at-risk membership of 1,470,800, an increase of 84,400 members, or 6.1% year over year.
 
·  
Premium and Service Revenues of $1.082 billion, representing 9.5% year over year growth.
 
·  
Health Benefits Ratio (HBR) of 84.2%, compared to 83.7% in the prior year.
 
·  
General and Administrative (G&A) expense ratio of 12.2%, compared to 13.2% in the prior year.
 
·  
Earnings from operations of $40.2 million, compared to $38.0 million in the prior year.
 
·  
Earnings from continuing operations, net of income tax expense, of $22.4 million.
 
·  
Diluted earnings per share from continuing operations of $0.44, including a $0.07 charge per diluted share related to an impairment of an investment in a software company and realized security gains of $0.03 per diluted share recognized during the third quarter of 2010.
 
·  
Cash flows from operations of $72.6 million, which is 3.2 times net earnings from continuing operations.
 
·  
Days in claims payable of 47.1, including pharmacy claims payable.
 
Other Events
 
—  
In April 2010, we began offering an individual insurance product, under the names of Commonwealth Choice and CeltiCare Direct, for residents of Boston and surrounding cities who do not qualify for other state funded insurance programs.

—  
In July 2010, we closed on the acquisition of certain assets of NovaSys Health, LLC, a leading third party administrator in Arkansas that complements our existing Celtic business.

—  
In August 2010, we announced the acquisition in Florida of certain assets in non-reform counties of Citrus Health Care, Inc., a Medicaid and long-term care health plan.  We expect the transaction to close at year end.

—  
In September 2010, Celtic Insurance Company, Inc. was awarded a contract with the Texas Department of Insurance to provide affordable health insurance plans for Texas small businesses under the new Healthy Texas initiative.  We expect operations to commence during the fourth quarter of 2010.

—  
In September 2010, our new subsidiary, IlliniCare Health Plan, was selected as one of two vendors to provide managed care services to older adults and adults with disabilities under the Integrated Care Program in six counties of Illinois.  We expect operations to commence in the first half of 2011.

—  
In October 2010, one of our highly regarded health programs, Start Smart for Your Baby®, won the Platinum Award for Consumer Empowerment at the URAC Quality Summit.  Also in October, Absolute Total Care, our South Carolina health plan, received the prestigious New Health Plan accreditation from the National Committee for Quality Assurance (NCQA), a private, not-for-profit organization that sets standards for monitoring and improving healthcare quality.

 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 2
 
Michael F. Neidorff, Centene’s Chairman and Chief Executive Officer, stated, "A strong operational quarter and exceptional new business activity set the stage for meaningful 2011 performance."

The following table depicts membership in Centene’s managed care organizations, by state:

   
September 30,
 
   
2010
   
2009
 
Arizona
    19,300       17,400  
Florida
    116,300       84,400  
Georgia
    300,900       303,400  
Indiana
    213,300       200,700  
Massachusetts
    34,400       500  
Ohio
    161,800       151,200  
South Carolina
    90,600       46,100  
Texas
    428,100       450,200  
Wisconsin
    106,100       132,500  
Total at-risk membership
    1,470,800       1,386,400  
Non-risk membership
    35,900       63,200  
Total
    1,506,700       1,449,600  

The following table depicts membership in Centene’s managed care organizations, by member category:

     September 30,  
     
2010
     
2009
 
Medicaid
    1,122,800       1,040,000  
CHIP & Foster Care
    219,100       263,400  
ABD & Medicare
    94,500       82,500  
Other State programs
    34,400       500  
Total at-risk membership
    1,470,800       1,386,400  
Non-risk membership
    35,900       63,200  
Total
    1,506,700       1,449,600  
Statement of Operations

·  
Premium and service revenues increased 9.5% for the three months ended September 30, 2010 over 2009 as a result of membership growth and net premium rate increases.  This increase was moderated by the removal of pharmacy services in two states in 2010.  These pharmacy carve outs had the effect of reducing 2010 third quarter revenue by approximately $48 million.
 
·  
The consolidated HBR for the three months ended September 30, 2010 of 84.2% was an increase of 0.5% over the comparable period in 2009.  A reconciliation of the change in HBR from the prior year is presented below:

Third Quarter 2009
      83.7%  
Florida health plan performance
    0.9  
Net changes in other markets
    (0.4)  
Third Quarter 2010
      84.2%  
         

·  
Consolidated G&A expense as a percent of premium and service revenues was 12.2% in the third quarter of 2010, a decrease from 13.2% in the third quarter of 2009.  The decrease in G&A ratio is primarily a result of leveraging our expenses over higher revenues and decreased variable compensation expense during the quarter ended September 30, 2010.
 
      · 
Earnings per diluted share from continuing operations were $0.44, compared to $0.51 in the third quarter of 2009, including a $0.07 charge per diluted share related to an impairment of an investment in a software company and realized security gains of $0.03 per diluted share recognized during the third quarter of 2010.  Earnings per diluted share also reflect an increase in diluted shares outstanding resulting from the first quarter 2010 stock offering.
 
 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 3
 
Balance Sheet and Cash Flow

At September 30, 2010, we had cash and investments of $928.1 million, including $895.4 million held by our regulated entities and $32.7 million held by our unregulated entities.  Medical claims liabilities totaled $457.1 million, representing 47.1 days in claims payable, a decrease of 1.1 days from June 30, 2010.  Total debt was $264.2 million and debt to capitalization was 24.7%.

Cash flow from operations for the quarter ended September 30, 2010 was $72.6 million.  Cash flow from operations for the nine months ended September 30, 2010 was $(25.7) million and was impacted by 1) $38.7 million decrease in unearned revenue due to advance payments received in December 2009 for January 2010 premium payments and 2) $68.1 million increase in premium and related receivables primarily for September premium payments deferred by one state until October 2010.

A reconciliation of the change in days in claims payable from the immediately preceding quarter-end is presented below:

Days in claims payable, June 30, 2010
    48.2  
   Timing of claims payments
    (0.9 )
   Impact of decrease in membership
    (0.3 )
   Pharmacy payment timing
    0.1  
Days in claims payable, September 30, 2010
    47.1  
         
 
Outlook

The table below depicts our guidance from continuing operations for 2010:

   
Full Year 2010
 
   
Low
 
High
 
Premium and Service revenues (in millions)
  $ 4,250   $ 4,350  
Earnings per diluted share (EPS)
  $ 1.76   $ 1.80  
HBR %
    83.5%     84.5%  
G&A %
    12.4%     12.9%  
               
 Diluted Shares Outstanding (in thousands)         50,500       
               

Based upon known rate adjustments and discussions with our states that finalize rates in the second half of the year, we estimate our 2010 composite premium rate increase to be between 1.5% and 2.5%.
 
Conference Call
 
As previously announced, we will host a conference call Tuesday, October 26, 2010, at 8:30 A.M. (Eastern Time) to review the financial results for the third quarter ended September 30, 2010, and to discuss our business outlook.  Michael F. Neidorff and William N. Scheffel will host the conference call.
 
Investors and other interested parties are invited to listen to the conference call by dialing 877-887-1134 in the U.S. and Canada; +1-412-317-0794 from abroad; or via a live, audio webcast on our website at www.centene.com, under the Investors section.

A replay will be available for on-demand listening shortly after the completion of the call for the next twelve months or until 11:59 PM (Eastern Time) on Tuesday, October 25, 2011, at the aforementioned URL, or by dialing 877-344-7529 in the U.S. and Canada, or +1-412-317-0088 from abroad and entering the playback conference number 444970.

 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 4
 
About Centene Corporation

 
Centene Corporation, a Fortune 500 company, is a leading multi-line healthcare enterprise that provides programs and related services to the rising number of under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and long-term care, in addition to other state-sponsored programs, and Medicare (Special Needs Plans). Centene's CeltiCare subsidiary offers states unique, "exchange based" and other cost-effective coverage solutions for low-income populations. The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health, life and health management, managed vision, telehealth services, and pharmacy benefits management.

The information provided in this press release contains forward-looking statements that relate to future events and future financial performance of Centene.  Subsequent events and developments may cause the Company’s estimates to change.  The Company disclaims any obligation to update this forward-looking financial information in the future.  Readers are cautioned that matters subject to forward-looking statements involve known and unknown risks and uncertainties, including economic, regulatory, competitive and other factors that may cause Centene’s or its industry’s actual results, levels of activity, performance or achievements to be materially different from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements.  Actual results may differ from projections or estimates due to a variety of important factors, including Centene’s ability to accurately predict and effectively manage health benefits and other operating expenses, competition, changes in healthcare practices, changes in federal or state laws or regulations, inflation, provider contract changes, new technologies, reduction in provider payments by governmental payors, major epidemics, disasters and numerous other factors affecting the delivery and cost of healthcare.  The expiration, cancellation or suspension of Centene’s Medicaid Managed Care contracts by state governments would also negatively affect Centene.

This release includes earnings per diluted share excluding certain charges for net investment writedowns, which is a non-GAAP financial measure.  Management believes that this non-GAAP financial measure provides information that is useful to investors in understanding period-over-period operating results and enhances the ability of investors to analyze Centene’s business trends and to understand Centene’s performance.  This non-GAAP financial measure should not be considered in isolation, or as a substitute for the corresponding GAAP financial measure and may not be comparable to similar measures used by other companies.
 
 
[Tables Follow]

 
 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 5
 
CENTENE CORPORATION AND SUBSIDIARIES

CONSOLIDATED BALANCE SHEETS
(In thousands, except share data)
(Unaudited)

   
September 30,
2010
   
December 31,
 2009
 
ASSETS
           
Current assets:
           
Cash and cash equivalents of continuing operations, including $5,389 and $8,667, respectively, from consolidated variable interest entities
  $ 397,519     $ 400,951  
Cash and cash equivalents of discontinued operations
    147       2,801  
Total cash and cash equivalents
    397,666       403,752  
Premium and related receivables, net of allowance for uncollectible accounts of $1,336 and $1,338, respectively, including $3,208 and $11,313, respectively, from consolidated variable interest entities
    182,379       103,456  
Short-term investments, at fair value (amortized cost $30,667 and $39,230, respectively)
    30,857       39,554  
Other current assets, including $2,023 and $4,507, respectively, from consolidated variable interest entities
    63,408       64,866  
Current assets of discontinued operations other than cash
    1,678       4,506  
Total current assets
    675,988       616,134  
Long-term investments, at fair value (amortized cost $463,877 and $514,256, respectively)
    479,164       525,497  
Restricted deposits, at fair value (amortized cost $20,527 and $20,048, respectively)
    20,589       20,132  
Property, software and equipment, net of accumulated depreciation of $127,969 and $103,883, respectively, including $138,008 and $89,219, respectively, from consolidated variable interest entities
    311,195       230,421  
Goodwill
    247,757       224,587  
Intangible assets, net
    24,608       22,479  
Other long-term assets, including $2,806 and $30, respectively, from consolidated variable interest entities
    28,398       36,829  
Long-term assets of discontinued operations
    7,478       26,285  
Total assets
  $ 1,795,177     $ 1,702,364  
LIABILITIES AND STOCKHOLDERS’ EQUITY
               
Current liabilities:
               
Medical claims liability
  $ 457,085     $ 470,932  
Accounts payable and accrued expenses, including $20,926 and $14,020, respectively, from consolidated variable interest entities
    145,877       132,001  
Unearned revenue
    52,936       91,644  
Current portion of long-term debt
    663       646  
Current liabilities of discontinued operations
    4,531       20,685  
Total current liabilities
    661,092       715,908  
Long-term debt
    263,513       307,085  
Other long-term liabilities
    66,355       59,561  
Long-term liabilities of discontinued operations
    285       383  
Total liabilities
    991,245       1,082,937  
                 
Commitments and contingencies
               
                 
Stockholders’ equity:
               
Common stock, $.001 par value; authorized 100,000,000 shares; 51,716,723 issued and 49,265,875 outstanding at September 30, 2010, and 45,593,383 shares issued and 43,179,373 shares outstanding at December 31, 2009
    52       46  
Additional paid-in capital
    400,213       281,806  
Accumulated other comprehensive income:
               
Net unrealized gain on investments, net of tax
    9,661       7,348  
Retained earnings
    428,344       358,907  
Treasury stock, at cost (2,450,848 and 2,414,010 shares, respectively)
    (47,976 )     (47,262 )
Total Centene Corporation stockholders’ equity
    790,294       600,845  
Noncontrolling interest
    13,638       18,582  
Total stockholders’ equity
    803,932       619,427  
Total liabilities and stockholders’ equity
  $ 1,795,177     $ 1,702,364  
 
 
 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 6
 

 
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except share data)
(Unaudited)

 
 
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
 
2010
 
2009
 
2010
   
2009
 
Revenues:
                         
Premium
$
1,060,559
 
$
960,009
 
$
3,085,802
   
$
2,754,713
 
Service
 
20,954
   
27,300
   
68,543
     
72,740
 
Premium and service revenues
 
1,081,513
   
987,309
   
3,154,345
     
2,827,453
 
Premium tax
 
40,348
   
50,925
   
113,009
     
182,685
 
Total revenues
 
1,121,861
   
1,038,234
   
3,267,354
     
3,010,138
 
Expenses:
                         
Medical costs
 
893,281
   
803,062
   
2,592,324
     
2,298,108
 
Cost of services
 
14,646
   
15,843
   
47,505
     
46,364
 
General and administrative expenses
 
132,095
   
130,024
   
401,072
     
381,524
 
Premium tax
 
41,591
   
51,295
   
114,885
     
183,785
 
Total operating expenses
 
1,081,613
   
1,000,224
   
3,155,786
     
2,909,781
 
Earnings from operations
 
40,248
   
38,010
   
111,568
     
100,357
 
Other income (expense):
                         
Investment and other income
 
713
   
3,750
   
11,912
     
11,781
 
Interest expense
 
(4,858
)
 
(4,064
)
 
(12,540
)
   
(12,210
)
Earnings from continuing operations, before income tax expense
 
36,103
   
37,696
   
110,940
     
99,928
 
Income tax expense
 
13,163
   
12,426
   
42,942
     
35,060
 
Earnings from continuing operations, net of income tax expense
 
22,940
   
25,270
   
67,998
     
64,868
 
Discontinued operations, net of income tax expense (benefit) of $26, $(792), $4,376 and $(1,148), respectively
 
260
   
(1,460
)
 
3,954
     
(2,394
)
Net earnings
 
23,200
   
23,810
   
71,952
     
62,474
 
Noncontrolling interest
 
538
   
2,542
   
2,515
     
2,518
 
Net earnings attributable to Centene Corporation
$
22,662
 
$
21,268
 
$
69,437
   
$
59,956
 
                           
Amounts attributable to Centene Corporation common stockholders:
                         
Earnings from continuing operations, net of income tax expense
$
22,402
 
$
22,728
 
$
65,483
   
$
62,350
 
Discontinued operations, net of income tax expense (benefit)
 
260
   
(1,460
)
 
3,954
     
(2,394
)
Net earnings
$
22,662
 
$
21,268
 
$
69,437
   
$
59,956
 
                           
Net earnings (loss) per common share attributable to Centene Corporation:
                         
Basic:
                         
Continuing operations
$
0.46
 
$
0.53
 
$
1.35
   
$
1.45
 
Discontinued operations
 
—  
   
(0.04
)
 
0.08
     
(0.06
)
Earnings per common share
$
0.46
 
$
0.49
 
$
1.43
   
$
1.39
 
Diluted:
                         
Continuing operations
$
0.44
 
$
0.51
 
$
1.30
   
$
1.41
 
Discontinued operations
 
—  
   
(0.03
)
 
0.08
     
(0.05
)
Earnings per common share
$
0.44
 
$
0.48
 
$
1.38
   
$
1.36
 
                           
Weighted average number of shares outstanding:
                         
Basic
 
49,238,406
   
43,001,870
   
48,552,135
     
43,023,431
 
Diluted
 
50,938,357
   
44,291,604
   
50,192,190
     
44,247,153
 
 
 
 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 7

 
CENTENE CORPORATION AND SUBSIDIARIES
 
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
(Unaudited)

   
Nine Months Ended September 30,
 
   
2010
   
2009
 
Cash flows from operating activities:
           
Net earnings
  $ 71,952     $ 62,474  
Adjustments to reconcile net earnings to net cash (used in) provided by operating activities:
               
Depreciation and amortization
    38,620       30,800  
Stock compensation expense
    10,224       11,428  
(Gain) loss on sale of investments, net
    (6,331 )     261  
(Gain) on sale of UHP
    (8,201 )      
Impairment of investment
    5,531        
Deferred income taxes
    7,012       4,516  
Changes in assets and liabilities:
               
Premium and related receivables
    (68,125     (381 )
Other current assets
    (2,932 )     (2,595 )
Other assets
    (990 )     (593 )
Medical claims liabilities
    (29,304 )     31,612  
Unearned revenue
    (38,708 )     54,725  
Accounts payable and accrued expenses
    (3,174     (17,656 )
Other operating activities
    (1,267     2,386  
Net cash (used in) provided by operating activities
    (25,693     176,977  
Cash flows from investing activities:
               
Capital expenditures
    (91,960 )     (42,696 )
Purchases of investments
    (382,730 )     (647,086 )
Proceeds from asset sales
    13,420        
Sales and maturities of investments
    452,128       546,640  
Investments in acquisitions, net of cash acquired
    (26,847 )     (31,533 )
Net cash used in investing activities
    (35,989 )     (174,675 )
Cash flows from financing activities:
               
Proceeds from exercise of stock options
    2,394       1,717  
Proceeds from borrowings
    53,812       468,500  
Proceeds from stock offering
    104,534        
Payment of long-term debt
    (97,467 )     (456,059 )
Distributions (to) from noncontrolling interest
    (7,387 )     4,324  
Excess tax benefits from stock compensation
    424       43  
Common stock repurchases
    (714 )     (5,539 )
Debt issuance costs
          (405 )
Net cash provided by financing activities
    55,596       12,581  
Net (decrease) increase in cash and cash equivalents
    (6,086     14,883  
Cash and cash equivalents, beginning of period
    403,752       379,099  
Cash and cash equivalents, end of period
  $ 397,666     $ 393,982  
                 
Supplemental disclosures of cash flow information:
               
Interest paid
  $ 9,501     $ 8,556  
Income taxes paid
  $ 44,407     $ 43,308  
                 
Supplemental disclosure of non-cash investing and financing activities:
               
Contribution from noncontrolling interest
  $ 306     $ 5,491  
Capital expenditures
  $ 15,291     $ 10,106  
 
 
 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 8
 
CENTENE CORPORATION

CONTINUING OPERATIONS SUPPLEMENTAL FINANCIAL DATA

      Q3       Q2       Q1       Q4       Q3  
      2010       2010       2010       2009       2009  
MEMBERSHIP
                                       
Managed Care:
                                       
Arizona                                              
    19,300       19,300       19,000       18,100       17,400  
Florida                                              
    116,300       113,100       105,900       102,600       84,400  
Georgia                                              
    300,900       295,600       301,000       309,700       303,400  
Indiana                                              
    213,300       212,700       211,400       208,100       200,700  
Massachusetts                                              
    34,400       30,100       26,900       27,800       500  
Ohio                                              
    161,800       159,300       156,000       150,800       151,200  
South Carolina                                              
    90,600       92,600       53,900       48,600       46,100  
Texas                                              
    428,100       475,500       459,600       455,100       450,200  
Wisconsin                                              
    106,100       133,600       134,900       134,800       132,500  
Total at-risk membership
    1,470,800       1,531,800       1,468,600       1,455,600       1,386,400  
Non-risk membership                                              
    35,900       50,900       62,200       63,700       63,200  
TOTAL                                      
    1,506,700       1,582,700       1,530,800       1,519,300       1,449,600  
                                         
Medicaid                                              
    1,122,800       1,135,500       1,088,300       1,081,400       1,040,000  
CHIP & Foster Care                                              
    219,100       272,400       266,300       263,600       263,400  
ABD & Medicare                                              
    94,500       93,800       87,100       82,800       82,500  
Other State programs                                              
    34,400       30,100       26,900       27,800       500  
Total at-risk membership
    1,470,800       1,531,800       1,468,600       1,455,600       1,386,400  
Non-risk membership                                              
    35,900       50,900       62,200       63,700       63,200  
TOTAL                                      
    1,506,700       1,582,700       1,530,800       1,519,300       1,449,600  
                                         
Specialty Services(a):
                                       
Cenpatico Behavioral Health
                                       
Arizona                                              
    121,300       119,700       119,300       120,100       117,300  
Kansas                                              
    39,800       39,100       39,800       41,400       41,000  
Bridgeway Health Solutions
                                       
Long-term Care                                              
    3,000       2,800       2,700       2,600       2,500  
TOTAL                                      
    164,100       161,600       161,800       164,100       160,800  
                                         
(a) Includes external membership only.
                                 
                                         
REVENUE PER MEMBER PER MONTH(b)
  $ 216.96     $ 208.58     $ 215.95 (c)   $ 226.42     $ 222.77  
                                         
CLAIMS(b)
                                       
Period-end inventory                                              
    469,000       480,400       341,400       423,400       414,900  
Average inventory                                              
    307,500       306,900       283,900       279,000       227,100  
Period-end inventory per member
    0.32       0.31       0.23       0.29       0.30  
(b) Revenue per member and claims information are presented for the Managed Care at-risk members.
 
(c) Reduction in revenue per member per month is a result of the pharmacy carve-outs in 2010.
 

 
 
 

Centene Corporation Reports 2010 Third Quarter Results October 26, 2010 / Page 9

 
 
Q3
 
Q2
 
Q1
 
Q4
 
Q3
 
2010
 
2010
 
2010
 
2009
 
2009
                   
DAYS IN CLAIMS PAYABLE
                 
Medical                                              
46.0
 
47.2
 
46.6
 
48.1
 
47.1
Pharmacy                                              
1.1
 
1.0
 
1.1
 
2.0
 
1.8
TOTAL                                      
47.1
 
48.2
 
47.7
 
50.1
 
48.9
Days in Claims Payable is a calculation of Medical Claims Liabilities at the end of the period divided by average claims expense per calendar day for such period.
                   
CASH AND INVESTMENTS (in millions)
               
Regulated                                              
$
895.4
 
$
813.0
 
$
917.9
 
$
949.9
 
$
911.4
Unregulated                                              
 
32.7
   
39.4
   
51.3
   
36.2
   
27.6
TOTAL                                      
$
928.1
 
$
852.4
 
$
969.2
 
$
986.1
 
$
939.0
                   
DEBT TO CAPITALIZATION
24.7%
 
24.5%
 
23.7%
 
33.2%
 
31.9%
Debt to Capitalization is calculated as follows: total debt divided by (total debt + total equity).

OPERATING RATIOS:

   
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
Health Benefits Ratios:
 
2010
 
2009
 
2010
 
2009
 
  Medicaid and CHIP
      83.2%       84.7%      84.0%        84.4%  
  ABD and Medicare
  85.9   81.1   84.3    81.7  
  Specialty Services
  87.9   80.5   83.4    79.6  
  Total
  84.2   83.7   84.0    83.4  
                   
Total General & Administrative Expense Ratio
     12.2%      13.2%      12.7%       13.5%  

 

MEDICAL CLAIMS LIABILITY (In thousands)
The changes in medical claims liability are summarized as follows:

Balance, September 30, 2009
  $ 426,700  
Incurred related to:
       
Current period
    3,518,220  
Prior period
    (60,481 )
Total incurred
    3,457,739  
Paid related to:
       
Current period
    3,069,850  
Prior period
    357,504  
Total paid
    3,427,354  
Balance, September 30, 2010
  $ 457,085  

Centene’s claims reserving process utilizes a consistent actuarial methodology to estimate Centene’s ultimate liability.  Any reduction in the “Incurred related to:  Prior period” amount may be offset as Centene actuarially determines “Incurred related to: Current period.”  As such, only in the absence of a consistent reserving methodology would favorable development of prior period claims liability estimates reduce medical costs.  Centene believes it has consistently applied its claims reserving methodology in each of the periods presented.

The amount of the “Incurred related to: Prior period” above includes the effects of reserving under moderately adverse conditions, new markets where we use a conservative approach in setting reserves during the initial periods of operations, increased receipts from other third party payors related to coordination of benefits and lower medical utilization and cost trends for dates of service prior to September 30, 2009.