Centene CEO Sarah London battles Trump-driven Medicaid cuts while steering tech-focused overhaul

At 41, Sarah London became the youngest female chief executive of a Fortune 500 company when she succeeded Michael Neidorff at Centene, the nation’s largest Medicaid managed-care provider. The St. Louis-based insurer reported almost 20% revenue growth to $194.8 billion last year but recorded a $6.7 billion loss largely due to a write-down tied to the One Big Beautiful Bill Act, which trims federal Medicaid spending by more than $900 billion over a decade and tightens ACA Marketplace eligibility.

With Medicaid accounting for over half of Centene’s income, London pulled earnings guidance in July, sending the stock down 40% to an eight-year low. She is now reshaping the company through technology, predictive analytics, and community initiatives, including a plan unveiled at the Fortune Brainstorm Health conference to fund $900 million of affordable housing across eight states. London’s strategy emphasizes preventive health, fraud detection, and partnerships that aim to keep vulnerable populations healthier and reduce long-term costs.