This bill mandates that states consider the performance of managed care entities when automatically enrolling individuals in Medicaid managed care plans.
Craig Goldman
Representative
TX-12
The Better Care, Better Cost Act mandates that states must use performance data when automatically enrolling individuals into Medicaid managed care plans, replacing simple equitable distribution. States are required to develop a system to score managed care entities based on cost, outcomes, and satisfaction measures. This aims to ensure individuals are placed into higher-performing plans by default, with results reported annually starting in 2028.
Better Care, Better Cost Act Mandates Performance-Based Medicaid Assignments Starting in 2028
The Better Care, Better Cost Act changes how states handle Medicaid enrollment for people who don't pick their own plan. Currently, if you are eligible for Medicaid but don't choose a specific managed care provider, states often just distribute those 'default' enrollments evenly among available companies. This bill requires states to stop the even-split approach and instead steer people toward the plans that actually deliver better results. Starting January 1, 2028, states must use a performance-based scoring system to decide where these individuals go, effectively rewarding high-performing insurance entities with more members.
Scoring the System
Under the new rules, states have to build a report card for every managed care entity they work with. While the bill gives states some flexibility, it suggests they look at the metrics that actually impact your life and the taxpayer's wallet. We're talking about tracking how often people end up back in the hospital after being discharged, how many unnecessary ER visits occur, and—most importantly for the average user—individual satisfaction scores. If a plan is losing members left and right (the 'disenrollment rate'), the state will now have to factor that 'voting with your feet' into the plan's overall score. For a single parent or a trade worker who doesn't have time to research every insurance network, this means the 'default' option is more likely to be one that other people actually like and that keeps them out of the hospital.
The Bottom Line on Savings
This isn't just about better service; it’s a push for government efficiency. The bill (specifically Section 2) requires states to publish an annual report that does the math on two things: how enrollment changed because of these scores, and exactly how much money the Medicaid program saved as a result. By prioritizing plans that manage chronic conditions well enough to avoid expensive emergency room bills, the goal is to drive down the overall cost of the program. For the average person, this could mean a more stable Medicaid system that focuses on quality rather than just filling quotas.
Flexibility and Implementation Gaps
Because the bill gives states the power to determine which measures are 'appropriate' for their scoring system, the actual experience might look different depending on where you live. One state might lean heavily on cost-cutting, while another might prioritize patient satisfaction. There is also a lead time built in; the changes don't take effect until 2028, giving state agencies and insurance companies a few years to get their data systems in order. While this delay might feel slow, it ensures that the performance scores are based on actual data rather than guesses, aiming for a smoother transition for the millions of people who rely on these plans for their daily healthcare.