Sponsors (4)
Official title: To amend title XIX of the Social Security Act to require States to take into account performance when assigning individuals to managed care entities under the Medicaid program.
Introduced June 18, 2026 by Craig A. Goldman · Last progress June 18, 2026
The bill aims to improve Medicaid plan performance, transparency, and long‑term cost efficiency, but risks reduced access for complex patients and imposes administrative and measurement challenges for states and beneficiaries.
Medicaid beneficiaries could be steered to higher‑performing managed care plans, potentially improving health outcomes and patient satisfaction.
Taxpayers and Medicaid beneficiaries may see lower Medicaid costs over time if emphasis on avoidable utilization reduces unnecessary hospital readmissions and emergency department visits.
States and the public gain more transparency through a required annual statewide evaluation and public report on plan performance, improving oversight and informing choices.
Medicaid beneficiaries—especially people with complex needs or disabilities—could face reduced access if managed care entities limit services or avoid high‑cost enrollees to boost performance scores.
If measures or weighting are poorly designed, reported scores could misrepresent plan quality and mislead beneficiaries and policymakers.
States and taxpayers will incur administrative costs to design, implement, and report new performance systems, which could strain state budgets.
Based on analysis of 2 sections of legislative text.
Requires states to score Medicaid managed care plans on cost, outcomes, and satisfaction, publish annual reports, and use scores when assigning beneficiaries starting Jan 1, 2028.
Requires states to establish a system that evaluates and scores Medicaid managed care entities on cost, outcomes, and enrollee experience and to use those scores when assigning beneficiaries to managed care plans. States must publish an annual statewide performance report with entity-level scores and must begin using the scores for assignments for enrollments on or after January 1, 2028. The measure defines example performance metrics (expenditures for medical assistance, potentially avoidable readmissions, avoidable emergency department visits, avoidable hospital admissions, enrollee satisfaction, and disenrollment rates) and replaces broader "equitable" assignment language so that performance scores must be considered in assignment decisions.