The Trump administration is investigating Medicaid spending in at least six Democratic-led states that provide comprehensive health coverage to poor and disabled immigrants living in the U.S. without permanent legal status. Public records obtained by KFF Health News and The Associated Press show the Centers for Medicare and Medicaid Services is looking for waste, fraud or abuse. The federal letters to state health agencies in California, Colorado, Illinois, Minnesota, Oregon and Washington say CMS is reviewing federal and state payments for services like prescription drugs and specialty care. California is the biggest target after the state self-reported overcharging the government more than $500 million, spurring the threat of a lawsuit.

Pricey prescriptions and nagging medical costs are swamping some insurers and employers, which means patients may start paying more next year. Health insurance will grow more expensive in many corners of the market in 2026, and some coverage may shrink. That could leave patients exposed to more costs for doctor visits and prescription coverage changes. Price changes could be especially stark in individual coverage marketplaces, where insurers also are predicting the end of some government support that helps people buy coverage. Expensive gene therapies and diabetes and obesity treatments are pressuring prescription coverage.