H.R. 9336

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9336 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 9336

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.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

June 18, 2026

Mr. Goldman of Texas (for himself and Mr. Pfluger) introduced the 
following bill; which was referred to the Committee on Energy and 
Commerce

_______________________________________________________________________

A BILL

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.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Better Care, Better Cost Act''.

SEC. 2. REQUIRING STATES TO TAKE INTO ACCOUNT PERFORMANCE WHEN 
ASSIGNING INDIVIDUALS TO MANAGED CARE ENTITIES UNDER THE 
MEDICAID PROGRAM.

(a) In General.--Section 1932(a)(4) of the Social Security Act (42 
U.S.C. 1396u-2(a)(4)) is amended---
(1) in subparagraph (D)(ii)(II), by striking ``the 
equitable'' and all that follows through the period and 
inserting ``the performance score of such entities, as 
determined under the system established by the State under 
subparagraph (E).''; and
(2) by adding at the end the following new subparagraph:
``(E) Performance.--
``(i) In general.--A State shall--
``(I) establish a system to 
evaluate the performance of managed 
care entities participating under the 
State plan (or wavier of such plan) of 
such State; and
``(II) on an annual basis, publish 
a report--
``(aa) evaluating the 
differences in default 
enrollments made taking into 
account the performance scores 
of managed care entities under 
this subparagraph compared to 
such enrollments that would 
have been made had such scores 
not been taken into account; 
and
``(bb) quantifying any 
estimated reduction in 
expenditures under such plan 
(or waiver) attributable to 
taking into account such scores 
in default enrollments.
``(ii) Score.--Under the system established 
by a State under clause (i), the State shall 
assign a performance score for each managed 
care entity described in such clause based on 
such cost and outcome measures and such 
individual satisfaction measures as determined 
appropriate by the State. Measures used under 
such system may include, with respect to 
individuals enrolled under such entity, 
measures of the performance of such entity 
(compared to the risk-adjusted expected 
performance of such entity) with respect to the 
following:
``(I) Expenditures for medical 
assistance.
``(II) Potentially avoidable 
hospital readmissions.
``(III) Potentially avoidable 
emergency department visits.
``(IV) Potentially avoidable 
hospital admissions.
``(V) Satisfaction scores from such 
individuals and the rate at which such 
individuals elect to terminate 
enrollment with such entity.''.
(b) Effective Date.--The amendments made by this section shall 
apply with respect to the enrollment of individuals in managed care 
entities under a State plan under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), or under a waiver of such plan, on or after 
January 1, 2028.
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