Sponsors (2)
The bill aims to improve Medicaid plan quality and transparency and reduce avoidable costs by assigning enrollees toward higher-performing plans, but it creates administrative burdens, transition disruption, and incentives that could limit access for high‑need patients if measures or implementation are flawed.
Medicaid beneficiaries could be steered into higher-performing managed care plans, which may improve continuity of care, health outcomes, and patient satisfaction.
State governments and the public will get a required annual statewide evaluation and public report on plan performance, increasing transparency for consumers and policymakers.
Taxpayers and Medicaid beneficiaries may see reduced unnecessary hospital readmissions and emergency department visits over time, lowering Medicaid spending through emphasis on cost and avoidable utilization measures.
Medicaid beneficiaries—particularly people with complex needs or disabilities—may face reduced access if managed care plans limit services or avoid enrolling high‑cost patients to improve performance scores.
State governments (and ultimately taxpayers) will incur administrative costs to design, implement, and report on the new performance system, straining state budgets especially during the transition.
Medicaid beneficiaries and state officials could be misled if measures or weighting are poorly designed, producing scores that misrepresent true quality and prompting bad decisions.
Based on analysis of 2 sections of legislative text.
Requires States to score Medicaid managed care entities annually, use those scores when assigning enrollees, and publish an annual statewide performance report.
Requires states to use annual performance scores for Medicaid managed care entities when assigning enrollees to plans, and to create and publish a statewide performance-evaluation system that rates managed care entities on cost, clinical outcomes, avoidable utilization, enrollee satisfaction, and disenrollment. The change replaces more subjective assignment criteria with a requirement that states establish, score, and publicly report on managed care performance for enrollments on or after January 1, 2028. The law directs each State Medicaid program to design the evaluation system, specify the measures (including expenditures per enrollee, potentially avoidable readmissions, avoidable ED visits and admissions, and enrollee satisfaction and disenrollment), calculate an annual score for each managed care entity, and publish an annual report. This creates new state reporting and scoring responsibilities intended to steer enrollments toward higher-performing plans and improve transparency for beneficiaries and regulators.
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