UnitedHealth also tightened its forecast when it reported third-quarter results Tuesday. Insurers typically act conservatively with forecasts this late in the year and focus on signaling to investors how the coming year will play out. With more than 8.9 million people enrolled, Elevance is one of the country's biggest insurers in Medicaid, which pays for health care for people with low incomes. States hire insurers to manage their Medicaid programs. Elevance said Thursday its Medicaid enrollment tumbled 19% from 11 million people in last year's third quarter. States have been going through a process to redetermine Medicaid eligibility after enrollment in the program swelled during the COVID-19 pandemic. That process led to an unfavorable shift in Medicaid membership, Elevance said, which hurt the operating gain for its health benefits business. "We have not had an environment like this before in Medicaid," CEO Gail Boudreaux told analysts during a call to discuss the company's third quarter.