Exhibit 12.1
Centene Corporation
Computation of ratio of earnings to fixed charges
($ in millions)

| Year Ended December 31,
| 2017 |  | 2016 |  | 2015 |  | 2014 |  | 2013
Earnings: |  |  |  |  |  |  |  |  |
Pre-tax earnings from continuing operations | $ | 1,134 |  |  | $ | 1,157 |  |  | $ | 697 |  |  | $ | 457 |  |  | $ | 269 |
Addback: |  |  |  |  |  |  |  |  |
Fixed charges | 311 |  |  | 262 |  |  | 65 |  |  | 50 |  |  | 37 |
Add (Subtract): |  |  |  |  |  |  |  |  |
Noncontrolling interest | 20 |  |  | 1 |  |  | (2 | ) |  | 7 |  |  | (1 | )
Total earnings | $ | 1,465 |  |  | $ | 1,420 |  |  | $ | 760 |  |  | $ | 514 |  |  | $ | 305 |
Fixed Charges: |  |  |  |  |  |  |  |  |
Interest expense | $ | 255 |  |  | $ | 217 |  |  | $ | 43 |  |  | $ | 35 |  |  | $ | 27 |
Interest component of rental payments (1) | 56 |  |  | 45 |  |  | 22 |  |  | 15 |  |  | 10 |
Total fixed charges | $ | 311 |  |  | $ | 262 |  |  | $ | 65 |  |  | $ | 50 |  |  | $ | 37 |
Ratio of earnings to fixed charges | 4.7 |  |  | 5.4 |  |  | 11.7 |  |  | 10.3 |  |  | 8.2 |
(1) Estimated at 33% of rental expense as a reasonable approximation of the interest factor.