The Regulator

Medicare is ending coverage for enrollees outside four immigration groups, with terminations starting no earlier than February 1, 2027, CMS told providers today. The Centers for Medicare & Medicaid Services (CMS) says the “Working Families Tax Cut legislation” now limits Medicare eligibility to U.S. citizens and nationals, lawful permanent residents (green card holders), Cuban and Haitian entrants, and Compact of Free Association migrants, who must also meet every other eligibility requirement. Who it hits: enrollees outside those groups, plus the physician practices, hospitals and Medicare Advantage plans that will see their patients’ coverage change. So what: the Social Security Administration (SSA) will mail termination notices with each person’s end date, providers can check status in the HIPAA Eligibility Transaction System (HETS), and Medicare Advantage plans will tell their providers about their own enrollees. CMS also warns that anyone ineligible for Medicare because of immigration status will not qualify for premium help on a Marketplace plan. CMS gives no headcount and cites no statute section in the item. Confidence: High on the eligibility groups and the February 1 floor, which come from CMS’s own newsletter; Low on scale, which CMS does not state. Source: CMS MLN Connects Newsletter, November 12, 2026.

UPDATE: CMS has told Minnesota it will not reimburse $112,752,702 in Medicaid claims over fraud concerns, local reporting says, a roughly $113 million disallowance. The letter went to state officials Friday, November 6, per the Grand Forks Herald, covering claims Minnesota had already submitted for services CMS deemed high risk for fraud. Who it hits: Minnesota’s Medicaid program and its taxpayers, who must now cover the gap or appeal. So what: Minnesota’s temporary human services commissioner says CMS used 78 claims totaling $112,000 to justify a disallowance about 1,000 times larger, and says CMS has not answered requests for a path to resolution. The Herald puts the funds the federal government has withheld from Minnesota at about $350 million in total, after earlier actions of $259 million in February and $91 million in April; the state is still awaiting decisions on the rest. No appeal deadline has been reported. Confidence: Med; the amount, date and state response come from one news report, and we could not find CMS’s letter or a CMS statement posted. Source: Grand Forks Herald, November 11, 2026.

A Queens adult day care director pleaded guilty to a roughly $127 million Medicare and Medicaid fraud, with a maximum sentence of 30 years. The Justice Department (DOJ) announced Tuesday that Daniel Lee, 57, of Flushing, New York, pleaded guilty Monday to conspiracy to commit health care fraud and conspiracy to commit money laundering. Who it hits: New York Medicaid and Medicare, and any social adult day care operator billing for attendance. So what: DOJ says that over about ten years two Flushing centers, Happy Life Inc. and Z&W Empire Enterprise Inc., paid cash kickbacks to Medicaid recipients to enroll and billed for services never provided, including on days recipients were hospitalized. A related pharmacy paid kickbacks to Medicare beneficiaries and Medicaid recipients and billed for unnecessary drugs. Investigators seized about $900,000 from bank accounts and found over $100,000 in cash in a search. Sentencing is set for March 2, 2027. Confidence: High; the facts come from DOJ’s release, and a plea is not a sentence. Source: DOJ press release 26-1341.

CMS awarded the last 200 of 1,000 Medicare-funded residency slots created by a 2021 law. CMS announced the Round 5 awards under section 126 of the Consolidated Appropriations Act, 2021, partially Medicare-funded positions aimed at hospitals serving underserved communities. Who it hits: hospitals that won slots and the training programs and communities they serve. So what: this closes out the 1,000-slot program, and the award list is posted as a downloadable file on CMS’s direct graduate medical education page. CMS’s item gives no dollar figure and no hospital-by-hospital summary. Confidence: High on the 200 and the statute cited; we did not open the award list. Source: CMS MLN Connects Newsletter, November 12, 2026.

Federal employees and retirees are in open season for 2027 health plans through December 14, with 45 FEHB carriers and 118 plan options. The Office of Personnel Management (OPM) says the open season began Monday, November 9, covering the Federal Employees Health Benefits (FEHB) program, the Postal Service Health Benefits (PSHB) program and dental and vision plans. Who it hits: federal workers, postal workers and annuitants choosing 2027 coverage. So what: OPM lists 17 PSHB carriers with 65 plan options, 11 dental carriers with 21 plans and five vision carriers with 10 plans, and says average premium increases slowed for a second year, but its release gives no percentage, so we cannot size the change. Employees can also choose a FSAFEDS Visa card for 2027. Confidence: High on dates and plan counts, which come from OPM; Low on premium size, which OPM’s release does not state. Source: OPM open season announcement.

Quiet note: we found no new same-day Federal Register rule from the Centers for Medicare & Medicaid Services or the Food and Drug Administration beyond items we covered yesterday, so today leans on agency announcements.