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8-K - FORM 8-K - CENTENE CORPform8k.htm


Exhibit 99.1
N E W S R E L E A S E                                
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 2012 THIRD QUARTER RESULTS -

ST. LOUIS, MISSOURI (October 23, 2012) -- Centene Corporation (NYSE: CNC) today announced its financial results for the quarter ended September 30, 2012
During the third quarter of 2012, we recorded net earnings of $0.07 per diluted share reflecting the following:
Earnings excluding Kentucky operations
$
0.78

Third quarter loss from Kentucky operations
(0.31
)
Subtotal
0.47

Kentucky premium deficiency reserve
(0.69
)
Gains on sales of investments
0.21

State tax benefit
0.08

Net earnings per diluted share
$
0.07

During the third quarter of 2012, we recorded a $63.0 million pre-tax premium deficiency reserve for our Kentucky health plan contract covering the period from October 1, 2012 through July 5, 2013, or $0.69 per diluted share. We recorded a $17.9 million pre-tax gain on the sale of an investment in a convertible note and $1.5 million in gains on the sale of investments in our Georgia health plan, or $0.21 per diluted share during the third quarter of 2012. We also recorded a $4.6 million tax benefit, or $0.08 per diluted share, associated with the clarification by a state regarding the items included in the state income tax calculation.
Third Quarter Highlights
Quarter-end at-risk managed care membership of 2,503,000, an increase of 887,300 members, or 55% year over year.
Premium and service revenues of $2.2 billion, representing 75% growth year over year.
Health Benefits Ratio of 93.3%, compared to 85.0% in 2011. Excluding our Kentucky operations, the HBR was 88.7% for the third quarter of 2012.
General and Administrative expense ratio of 8.2%, compared to 11.3% in 2011.
Operating cash flow of $317.2 million for the third quarter of 2012.
Other Events
In July 2012, the Company began operating under a new contract with the Washington Health Care Authority to serve Medicaid beneficiaries in the state, initially operating as Coordinated Care. 
In July 2012, the Company's subsidiary, Home State Health Plan, began operating under a new contract with the Office of Administration for Missouri to serve Medicaid beneficiaries in the Eastern, Central, and Western Managed Care Regions of the state.

1



In August 2012, we were notified by the Ohio Department of Job and Family Services that Buckeye Community Health Plan, our Ohio subsidiary, was selected to serve Medicaid members in a dual-eligible demonstration program in three of Ohio's pre-determined seven regions: Northeast (Cleveland), Northwest (Toledo) and West Central (Dayton). This three-year program, which is part of the state of Ohio's Integrated Care Delivery System expansion, will serve those who have both Medicare and Medicaid eligibility. Enrollment is expected to begin in the second half of 2013.
In October 2012, we announced that our subsidiary, Kentucky Spirit Health Plan (Kentucky Spirit), notified the Cabinet for Health and Family Services that it is exercising a contractual right that it believes allows Kentucky Spirit to terminate its Medicaid managed care contract with the Commonwealth of Kentucky effective July 5, 2013. We have also filed a formal dispute with the Cabinet for damages incurred under the contract. In addition, we have filed a lawsuit in Franklin Circuit Court against the Commonwealth of Kentucky seeking declaratory relief as a result of the Commonwealth's failure to completely and accurately disclose material information.
Michael F. Neidorff, Centene's Chairman and Chief Executive Officer, stated, “The third quarter results demonstrate our commitment to addressing issues identified in the second quarter.  While progress has been made, there is more work to be done to achieve and sustain our targeted margins.”
The following table sets forth the Company's membership by state for its managed care organizations:
 
September 30,
 
2012
 
2011
Arizona
23,800

 
22,800

Florida
209,600

 
188,600

Georgia
312,400

 
298,000

Illinois
17,900

 
13,600

Indiana
205,400

 
205,300

Kentucky
145,400

 

Louisiana
167,200

 

Massachusetts
28,000

 
34,700

Mississippi
30,600

 
30,600

Missouri
53,900

 

Ohio
173,800

 
162,200

South Carolina
89,400

 
86,500

Texas
930,700

 
494,500

Washington
42,000

 

Wisconsin
72,900

 
78,900

Total at-risk membership
2,503,000

 
1,615,700

Non-risk membership

 
10,600

Total
2,503,000

 
1,626,300


The following table sets forth our membership by line of business:
 
September 30,
 
2012
 
2011
Medicaid
1,939,400

 
1,189,900
CHIP & Foster Care
229,600

 
210,600
ABD & Medicare
289,800

 
171,700
Hybrid Programs
35,700

 
38,400
Long-term Care
8,500

 
5,100
Total at-risk membership
2,503,000

 
1,615,700
Non-risk membership

 
10,600
Total
2,503,000

 
1,626,300


2



The following table identifies the Company's dual eligible membership by line of business. The membership tables above include these members.
 
September 30,
 
2012
 
2011
ABD
76,900

 
34,000
Long-term Care
7,800

 
4,700
Medicare
4,000

 
3,100
Total
88,700

 
41,800

Statement of Operations: Three Months Ended September 30, 2012
 
For the third quarter of 2012, Premium and Service Revenues increased 75% to $2.2 billion from $1.3 billion in the third quarter of 2011. The increase was primarily driven by the Texas and Arizona expansions, pharmacy carve-ins in Texas and Ohio, the additions between years of Kentucky, Louisiana, Missouri and Washington contracts and membership growth.  

Consolidated HBR of 93.3% for the third quarter of 2012 represents an increase from 85.0% in the comparable period in 2011 and 92.9% from the second quarter of 2012. The increase compared to last year primarily reflects the recognition of a $63.0 million premium deficiency reserve for our Kentucky contract as well as increased medical costs in Kentucky. Excluding the Kentucky health plan operations, the third quarter 2012 HBR was 88.7%.

Consolidated G&A expense ratio for the third quarter of 2012 was 8.2%, compared to 11.3% in the prior year. The year over year decrease reflects the leveraging of expenses over higher revenues and a reduction in performance based compensation expense which lowered the ratio by 50 basis points.  

Earnings from operations were $(27.6) million in the third quarter 2012 compared to $48.5 million in the third quarter 2011. Net earnings attributable to Centene Corporation were $3.8 million in the third quarter 2012, compared to $29.0 million in the third quarter of 2011.

Earnings per diluted share were $0.07 in the third quarter of 2012 compared to $0.55 in the prior year.

Balance Sheet and Cash Flow

At September 30, 2012, the Company had cash, investments and restricted deposits of $1,529.8 million, including $36.0 million held by its unregulated entities. Medical claims liabilities totaled $919.0 million, representing 42.8 days in claims payable excluding the expense and liability for the Kentucky premium deficiency reserve. Total debt was $395.3 million which includes $40.0 million drawn on the $350 million revolving credit facility at quarter end. Debt to capitalization was 25.0% at September 30, 2012, excluding the $76.0 million non-recourse mortgage note. Cash flow from operations for the three months ended September 30, 2012 was $317.2 million.

A reconciliation of the Company's change in days in claims payable from the immediately preceding quarter-end is presented below:
Days in claims payable, June 30, 2012
41.4

 
Timing of claim payments
0.9

 
Impact of new business
0.5

 
Days in claims payable, September 30, 2012
42.8

 
 


3



Outlook
The table below depicts the Company's annual guidance for 2012.
 
 
Full Year 2012
 
 
 
Low
 
High 
 
Premium and Service Revenues (in millions)
 
$
8,100

 
$
8,300

 
Diluted EPS
 
$
0.56

 
$
0.66

 
Consolidated Health Benefits Ratio
 
90.0
%
 
91.0
%
 
General & Administrative expense ratio
 
8.5
%
 
8.8
%
 
Diluted Shares Outstanding (in thousands)
 
53,600

 
53,800

 
 
 
 

 
 

 
The Company's updated guidance reflect business expansion costs of $0.12 to $0.15 per diluted share in the fourth quarter, including business expansion costs for Kansas which is expected to commence in January 2013.
Conference Call
As previously announced, the Company will host a conference call Tuesday, October 23, 2012, at 8:30 A.M. (Eastern Time) to review the financial results for the third quarter ended September 30, 2012, and to discuss its 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 1-877-270-2148 in the U.S. and Canada; +1-412-902-6510 from abroad; or via a live, audio webcast on the Company's website at www.centene.com, under the Investors section. A webcast replay will be available for on-demand listening shortly after the completion of the call for the next twelve months or until 11:59 p.m. (Eastern Time) on Tuesday, October 22, 2013, at the aforementioned URL. In addition, a digital audio playback will be available until 9:00 a.m. (Eastern Time) on Tuesday, October 30, 2012, by dialing 1-877-344-7529 in the U.S. and Canada, or +1-412-317-0088 from abroad, and entering access code 10018806.
Non-GAAP Financial Presentation
The Company is providing certain non-GAAP financial measures in this release as the Company believes that these figures are helpful in allowing individuals to more accurately assess the ongoing nature of the Company's operations and measure the Company's performance more consistently.  The Company uses the presented non-GAAP financial measures internally to allow management to focus on period-to-period changes in the Company's core business operations.  Therefore, the Company believes that this information is meaningful in addition to the information contained in the GAAP presentation of financial information.  The presentation of this additional non-GAAP financial information is not intended to be considered in isolation or as a substitute for the financial information prepared and presented in accordance with GAAP.
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/hybrid 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 and reserves, competition, membership and revenue projections, timing of regulatory contract approval, changes in healthcare practices, changes in federal or state laws or regulations, changes in expected contract start dates, inflation, provider and state 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, as well as those factors disclosed in the Company's publicly filed documents. The expiration, cancellation or suspension of Centene's Medicaid

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Managed Care contracts, or the loss of any appeal of or protest to any such expiration, cancellation or suspension, by state governments would also negatively affect Centene.
[Tables Follow]


5



CENTENE CORPORATION AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
(In thousands, except share data)
(Unaudited)

 
September 30,
2012
 
December 31,
2011
ASSETS
 
 
 
Current assets:
 
 
 
Cash and cash equivalents
$
796,621

 
$
573,698

Premium and related receivables
316,123

 
157,450

Short-term investments
139,920

 
130,499

Other current assets
123,841

 
78,363

Total current assets
1,376,505

 
940,010

Long-term investments
559,714

 
506,140

Restricted deposits
33,509

 
26,818

Property, software and equipment, net
381,781

 
349,622

Goodwill
256,288

 
281,981

Intangible assets, net
21,375

 
27,430

Other long-term assets
61,764

 
58,335

Total assets
$
2,690,936

 
$
2,190,336

LIABILITIES AND STOCKHOLDERS’ EQUITY
 

 
 

Current liabilities:
 

 
 

Medical claims liability
$
919,032

 
$
607,985

Premium deficiency reserve
63,000

 

Accounts payable and accrued expenses
162,778

 
216,504

Unearned revenue
131,967

 
9,890

Current portion of long-term debt
3,337

 
3,234

Total current liabilities
1,280,114

 
837,613

Long-term debt
391,973

 
348,344

Other long-term liabilities
61,785

 
67,960

Total liabilities
1,733,872

 
1,253,917

Commitments and contingencies
 
 
 
Stockholders’ equity:
 

 
 

Common stock, $.001 par value; authorized 100,000,000 shares; 54,405,296 issued and 51,632,704 outstanding at September 30, 2012, and 53,586,726 issued and 50,864,618 outstanding at December 31, 2011
54

 
54

Additional paid-in capital
458,741

 
421,981

Accumulated other comprehensive income:
 
 
 
Unrealized gain on investments, net of tax
6,702

 
5,761

Retained earnings
557,759

 
564,961

Treasury stock, at cost (2,772,592 and 2,722,108 shares, respectively)
(59,277
)
 
(57,123
)
Total Centene stockholders’ equity
963,979

 
935,634

Noncontrolling interest
(6,915
)
 
785

Total stockholders’ equity
957,064

 
936,419

Total liabilities and stockholders’ equity
$
2,690,936

 
$
2,190,336






6



CENTENE CORPORATION AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except share data)
(Unaudited)

 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
2012
 
2011
 
2012
 
2011
Revenues:
 
 
 
 
 
 
 
Premium
$
2,184,061

 
$
1,239,464

 
$
5,853,469

 
$
3,640,829

Service
28,403

 
25,817

 
84,062

 
81,629

Premium and service revenues
2,212,464

 
1,265,281

 
5,937,531

 
3,722,458

Premium tax
235,657

 
36,754

 
333,484

 
110,948

Total revenues
2,448,121

 
1,302,035

 
6,271,015

 
3,833,406

Expenses:
 
 
 
 
 
 
 
Medical costs
2,036,999

 
1,053,320

 
5,370,080

 
3,091,007

Cost of services
21,744

 
20,229

 
66,897

 
60,717

General and administrative expenses
181,073

 
142,934

 
512,322

 
427,067

Premium tax expense
235,946

 
37,005

 
333,872

 
111,668

Impairment loss

 

 
28,033

 

Total operating expenses
2,475,762

 
1,253,488

 
6,311,204

 
3,690,459

Earnings (loss) from operations
(27,641
)
 
48,547

 
(40,189
)
 
142,947

Other income (expense):
 
 
 
 
 
 
 
Investment and other income
23,244

 
2,697

 
32,580

 
9,379

Debt extinguishment costs

 

 

 
(8,488
)
Interest expense
(4,855
)
 
(4,572
)
 
(14,393
)
 
(15,523
)
Earnings (loss) from operations, before income tax expense
(9,252
)
 
46,672

 
(22,002
)
 
128,315

Income tax expense (benefit)
(9,547
)
 
18,459

 
(6,068
)
 
49,216

Net earnings (loss)
295

 
28,213

 
(15,934
)
 
79,099

Noncontrolling interest
(3,524
)
 
(774
)
 
(8,732
)
 
(2,007
)
Net earnings (loss) attributable to Centene Corporation
$
3,819

 
$
28,987

 
$
(7,202
)
 
$
81,106

 
 
 
 
 
 
 
 
Net earnings (loss) per common share attributable to Centene Corporation:
Basic earnings (loss) per common share
$
0.07

 
$
0.58

 
$
(0.14
)
 
$
1.62

Diluted earnings (loss) per common share
$
0.07

 
$
0.55

 
$
(0.14
)
 
$
1.55

 
 
 
 
 
 
 
 
Weighted average number of common shares outstanding:
 
 
 
 
 
 
 
Basic
51,584,860

 
50,345,512

 
51,393,345

 
50,089,845

Diluted
53,806,197

 
52,620,350

 
51,393,345

 
52,320,906





7



CENTENE CORPORATION AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
(Unaudited)
 
Nine Months Ended September 30,
 
2012
 
2011
Cash flows from operating activities:
 
 
 
Net earnings (loss)
$
(15,934
)
 
$
79,099

Adjustments to reconcile net earnings (loss) to net cash provided by operating activities
 

 
 

Depreciation and amortization
49,892

 
43,055

Stock compensation expense
18,417

 
13,263

Impairment loss
28,033

 

Gain on sale of investment in convertible note
(17,880
)
 

Gain on sale of investments, net
(1,460
)
 
(213
)
Debt extinguishment costs

 
8,488

Deferred income taxes
(19,318
)
 
(223
)
Changes in assets and liabilities
 

 
 

Premium and related receivables
(139,414
)
 
(13,306
)
Other current assets
(23,487
)
 
(6,667
)
Other assets
1,918

 
(1,230
)
Medical claims liabilities
374,046

 
40,476

Unearned revenue
122,077

 
(65,183
)
Accounts payable and accrued expenses
(59,872
)
 
(11,414
)
Other operating activities
(9,736
)
 
3,528

Net cash provided by operating activities
307,282

 
89,673

Cash flows from investing activities:
 

 
 

Capital expenditures
(70,601
)
 
(56,938
)
Purchases of investments
(501,958
)
 
(201,145
)
Sales and maturities of investments
434,009

 
180,124

Investments in acquisitions, net of cash acquired

 
(3,192
)
Net cash used in investing activities
(138,550
)
 
(81,151
)
Cash flows from financing activities:
 

 
 

Proceeds from exercise of stock options
11,686

 
13,582

Proceeds from borrowings
215,000

 
419,183

Payment of long-term debt
(177,422
)
 
(415,475
)
Excess tax benefits from stock compensation
6,049

 
1,632

Common stock repurchases
(2,154
)
 
(1,280
)
Contribution from noncontrolling interest
1,032

 
569

Debt issue costs

 
(9,242
)
Net cash provided by financing activities
54,191

 
8,969

Net increase in cash and cash equivalents
222,923

 
17,491

Cash and cash equivalents, beginning of period
573,698

 
434,166

Cash and cash equivalents, end of period
$
796,621

 
$
451,657

Supplemental disclosures of cash flow information:
 

 
 

Interest paid
$
12,127

 
$
16,097

Income taxes paid
$
34,001

 
$
49,996






8



CENTENE CORPORATION
SUPPLEMENTAL FINANCIAL DATA
 
Q3
 
Q2
 
Q1
 
Q4
 
Q3
 
2012
 
2012
 
2012
 
2011
 
2011
MEMBERSHIP
 
 
 
 
 
 
 
 
 
Managed Care:
 
 
 
 
 
 
 
 
 
Arizona
23,800

 
24,000

 
23,100

 
23,700

 
22,800

Florida
209,600

 
204,100

 
199,500

 
198,300

 
188,600

Georgia
312,400

 
313,300

 
306,000

 
298,200

 
298,000

Illinois
17,900

 
17,800

 
17,400

 
16,300

 
13,600

Indiana
205,400

 
205,000

 
206,300

 
206,900

 
205,300

Kentucky
145,400

 
143,500

 
145,700

 
180,700

 

Louisiana
167,200

 
168,700

 
51,300

 

 

Massachusetts
28,000

 
41,400

 
36,000

 
35,700

 
34,700

Mississippi
30,600

 
30,100

 
29,500

 
31,600

 
30,600

Missouri
53,900

 

 

 

 

Ohio
173,800

 
166,800

 
161,000

 
159,900

 
162,200

South Carolina
89,400

 
87,800

 
86,700

 
82,900

 
86,500

Texas
930,700

 
919,200

 
811,000

 
503,800

 
494,500

Washington
42,000

 

 

 

 

Wisconsin
72,900

 
75,800

 
76,000

 
78,000

 
78,900

Total at-risk membership
2,503,000

 
2,397,500

 
2,149,500

 
1,816,000

 
1,615,700

Non-risk membership

 

 

 
4,900

 
10,600

TOTAL
2,503,000

 
2,397,500

 
2,149,500

 
1,820,900

 
1,626,300

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicaid
1,939,400

 
1,848,500

 
1,634,800

 
1,336,800

 
1,189,900

CHIP & Foster Care
229,600

 
222,600

 
218,800

 
213,900

 
210,600

ABD & Medicare
289,800

 
269,900

 
247,400

 
218,000

 
171,700

Hybrid Programs
35,700

 
48,100

 
41,500

 
40,500

 
38,400

Long-term Care
8,500

 
8,400

 
7,000

 
6,800

 
5,100

Total at-risk membership
2,503,000

 
2,397,500

 
2,149,500

 
1,816,000

 
1,615,700

Non-risk membership

 

 

 
4,900

 
10,600

TOTAL
2,503,000

 
2,397,500

 
2,149,500

 
1,820,900

 
1,626,300

 
 
 
 
 
 
 
 
 
 
Specialty Services(a):
 
 
 
 
 
 
 
 
 
Cenpatico Behavioral Health
 
 
 
 
 
 
 
 
 
Arizona
162,000

 
159,900

 
162,100

 
168,900

 
175,500

Kansas
48,500

 
44,300

 
46,000

 
46,200

 
45,600

TOTAL
210,500

 
204,200

 
208,100

 
215,100

 
221,100

 
 
 
 
 
 
 
 
 
 
(a) Includes external membership only.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
REVENUE PER MEMBER PER MONTH(b)
$
283

 
$
279

 
$
269

 
$
262

 
$
245

 
 
 
 
 
 
 
 
 
 
CLAIMS(b)
 
 
 
 
 
 
 
 
 
Period-end inventory
826,804

 
1,195,000

 
735,000

 
495,500

 
482,900

Average inventory
547,393

 
640,600

 
457,400

 
367,590

 
312,400

Period-end inventory per member
0.33

 
0.50

 
0.34

 
0.27

 
0.30

(b) Revenue per member and claims information are presented for the Managed Care at-risk members.
 
 
 
 
 
 
 
 
 
 
NUMBER OF EMPLOYEES
6,400

 
6,200

 
5,700

 
5,300

 
5,000





9



 
Q3
 
Q2
 
Q1
 
Q4
 
Q3
 
2012
 
2012
 
2012
 
2011
 
2011
 
 
 
 
 
 
 
 
 
 
DAYS IN CLAIMS PAYABLE (c)
42.8

 
41.4

 
44.7

 
45.3

 
43.6

(c) 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, excluding the Kentucky premium deficiency reserve expense and liability.
 
 
 
 
 
 
 
 
 
 
CASH AND INVESTMENTS (in millions)
 
 
 
 
 
 
 
Regulated
$
1,493.8

 
$
1,198.2

 
$
1,166.9

 
$
1,198.9

 
$
1,079.3

Unregulated
$
36.0

 
$
40.6

 
$
35.5

 
$
38.2

 
$
35.9

TOTAL
$
1,529.7

 
$
1,238.8

 
$
1,202.4

 
$
1,237.1

 
$
1,115.2

 
 
 
 
 
 
 
 
 
 
DEBT TO CAPITALIZATION
29.2
%
 
30.1
%
 
26.4
%
 
27.3
%
 
28.0
%
DEBT TO CAPITALIZATION EXCLUDING NON-RECOURSE DEBT(d)
25.0
%
 
25.9
%
 
21.8
%
 
22.6
%
 
23.2
%
Debt to Capitalization is calculated as follows: total debt divided by (total debt + total equity).
(d) The non-recourse debt represents the Company's mortgage note payable ($76.0 million at September 30, 2012.)
Operating Ratios:
 
Three Months Ended September 30,
 
Nine Months Ended
September 30,
 
2012
 
2011
 
2012
 
2011
Health Benefits Ratios:
 
 
 
 
 
 
 
  Medicaid and CHIP
91.8
%
 
81.5
%
 
90.8
%
 
82.3
%
  ABD and Medicare
97.3

 
92.0

 
93.4

 
90.3

  Specialty Services
89.5

 
87.9

 
92.5

 
87.4

  Total
93.3

 
85.0

 
91.7

 
84.9

 
 
 
 
 
 
 
 
Total General & Administrative Expense Ratio
8.2
%
 
11.3
%
 
8.6
%
 
11.5
%
MEDICAL CLAIMS LIABILITY (In thousands)
The changes in medical claims liability are summarized as follows:

Balance, September 30, 2011
 
$
498,705

Incurred related to:
 
 
Current period
 
6,659,744

Prior period
 
(55,925
)
Total incurred
 
6,603,819

Paid related to:
 
 
Current period
 
5,684,404

Prior period
 
436,088

Total paid
 
6,120,492

Less: Premium Deficiency Reserve
 
$
63,000

Balance, September 30, 2012
 
$
919,032


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 represents favorable development and includes the effects of reserving under moderately adverse conditions, new markets where we use a conservative approach in setting reserves during the initial periods of operations, receipts from other third party payors related to coordination of benefits and lower medical utilization and cost trends for dates of service prior to September 30, 2011.

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