United StatesRequires states to score Medicaid managed care plans on performance
Changes how people are automatically assigned to Medicaid plans and may shift which plans gain members, affecting access, quality, and program costs.
What it does
Requires each State to establish a system to evaluate and score managed care entities participating in Medicaid.
Directs States to assign an annual performance score using cost, outcome, and individual satisfaction measures (State may determine appropriate measures).
Requires States to use those performance scores when making default enrollments into managed care entities (changes statutory enrollment rule).
Requires an annual public report comparing enrollments with and without using performance scores and estimating any expenditure reductions attributable to using scores.
Argument forUsing performance scores to guide default enrollments could steer enrollees toward higher-quality, lower-cost plans and create incentives for plans to reduce avoidable admissions and ED visits.
Argument againstDefault enrollment based on scores could reduce consumer choice and concentrate enrollments in a few high-scoring plans, potentially shrinking networks or options for some enrollees.
Where do you stand?
Choose your position
Tell your reps
Take a position to see your representatives and ways to contact them.
Where it stands
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 18Introduced in HouseLatest
- Jun 18Referred to the House Committee on Energy and Commerce.Introduced
HealthcareTaxes & BudgetConsumer Protection