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UnitedHealthcare and Humana are canceling Medicare Advantage plans, a move that will affect nearly one million people. The companies are the two largest private health insurance companies for older adults in the U.S. and are ending plans in specific areas where they are making less money, a shift that comes as Medicare enrollment season starts. The decision was made to protect corporate profits, Fortune reported. (Whiteside, 10/22)

The US Justice Department said it filed charges against 15 people in a massive health-care fraud scheme that allegedly resulted in $2 billion in bogus claims to both government and private health-care programs. The alleged scheme, which included six medical professionals, involved luring vulnerable individuals to California for the fake treatments, the Justice Department said in a statement Thursday that called the bust “the largest case of its type ever prosecuted by the Department.” (Larson, 10/22)

Gilead Sciences agreed to pay $45 million to settle allegations of paying kickbacks that improperly influenced prescriptions paid for by the Texas Medicaid program, the latest pharmaceutical company to reach a deal with the state over marketing practices. (Silverman, 10/22)

Julia Feinberg feels like she’s living in a sinister version of Groundhog Day. For the second year in a row California lawmakers have made it tougher for seniors and people with disabilities to qualify for state-funded health benefits. Feinberg, 37, who has a degenerative neuromuscular disorder, said without Medi-Cal she would be confined to a nursing home rather than living and working as a therapist in Oakland. (Hwang, 10/22)

Six states are giving Molina Healthcare raises next year to account for the expected impact of Medicaid work requirements and more frequent eligibility verifications, Chief Financial Officer Mark Keim said Thursday. Across the company’s Medicaid portfolio, states are proposing an average 7% increase to Molina Healthcare’s Medicaid pay next year, CEO Joe Zubretsky told investor analysts on the company’s third-quarter earnings call on Thursday. This represents a break from precedent. Traditionally, states rely on historical medical cost data to determine what Medicaid insurance companies are paid. (Tepper, 10/22)

�Թϲ�����: GOP Congressman In California Swing-District Race Defends Vote For Medicaid Cuts

Ulises Hernandez has had health coverage through Medicaid for as long as he can remember. But he had never waited as long for care as he did in September after a dental crown slipped down his throat during a procedure. He spent eight hours in an emergency room waiting for care and more than two days without food. Sitting in his wheelchair to protest looming federal Medicaid cuts outside Republican U.S. Rep. David Valadao’s Bakersfield office, Hernandez described his wait as a foreshadowing of what’s ahead. (Fortiér, 10/23)

�Թϲ�����: Medicaid At Risk For Hundreds Of Thousands Of Lawfully Present Immigrants

Refugees. Sex-trafficking victims. People fleeing war. They’re among the hundreds of thousands of immigrants living in the country legally who no longer qualify for Medicaid. The change, in effect since Oct. 1, is part of the 2025 Republican tax law, which cuts Medicaid spending by an estimated $900 billion through 2034. (Jones, 10/23)

�Թϲ�����: Medicaid Is Now A Campaign Issue

Republicans tried to backload Medicaid cuts in 2025’s One Big Beautiful Bill Act so they would take effect after this year’s elections, but that’s not stopping Democrats from using them to hammer their opponents. Meanwhile, the Trump administration ramps up its war on fraud. Alice Miranda Ollstein of Politico, Amanda Seitz of �Թϲ�����, and Liz Essley Whyte of The Wall Street Journal join �Թϲ�����’ Julie Rovner to discuss these stories and more. Also, Rovner speaks with Ollstein about her new book, “Side Effects.” (10/22)

A federal freeze on new insurance agents and brokers registering to serve health insurance exchange customers faces a new legal challenge. The trade group Health Agents for America sued the Health and Human Services Department and the Centers for Medicare and Medicaid Services in the U.S. District Court for the District of Maryland on Wednesday. The plaintiff claims the federal government violated the Administrative Procedure Act of 1946 and exceeded its statutory authority. (Tong, 10/22)

�Թϲ�����: Shopping For An ACA Plan This Year? Here’s What You Need To Know

Consumers who buy Affordable Care Act health insurance are going to see changes both big and small as open enrollment for 2027 coverage kicks off. These include premium increases, possible additional identity checks, potential delays in working with a broker, and new limits on which immigrants can get subsidies. Shoppers need to plan accordingly. Open enrollment starts Nov. 1 in most states. Idaho, Connecticut, and Massachusetts start earlier, and some states are already allowing “window shopping” to check premium rates. (Appleby, 10/23)