H.R. 9336 – Better Care, Better Cost Act

AI-Generated Summary

Updated June 25, 2026 at 2:21 PM UTC

The Better Care, Better Cost Act would change Medicaid rules so that states must factor in how well managed‑care entities perform when assigning beneficiaries to them. States would have to develop a scoring system that looks at costs, avoidable hospital use, and enrollee satisfaction, and they must report each year on the impact of using those scores, including any savings. The changes apply to Medicaid enrollment starting January 1 2028.

Key Provisions

Amends the Medicaid enrollment rule (Section 1932(a)(4)) to replace the “equitable” factor with a requirement that states consider each managed‑care entity’s performance score when assigning individuals.
Requires each state to create a system that rates the performance of its Medicaid managed‑care entities using cost, outcome, and satisfaction measures the state deems appropriate.
Mandates that states publish an annual report showing how default enrollments differ when performance scores are used versus not used, and estimating any cost savings from using those scores.
Specifies that performance scores may be based on measures such as Medicaid expenditures, potentially avoidable hospital readmissions, emergency‑department visits, hospital admissions, and enrollee satisfaction or termination rates.
Sets the new requirements to take effect for enrollments made on or after January 1 2028.

Legislative Activity

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1 earlier action

HouseIntro Referral Latest Action

Referred to the House Committee on Energy and Commerce.

Energy and Commerce Committee

June 18, 2026

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HouseIntro Referral

Introduced in House

June 18, 2026

HouseIntro Referral

Referred to the House Committee on Energy and Commerce.

Energy and Commerce Committee

June 18, 2026

Floor Debate

1 member

What members said about H.R. 9336 on the floor

1 Republican

Rep. Craig A. GoldmanR-TX-12 · Jul 21, 2026

Mr. Speaker, I ask unanimous consent to remove the gentleman from California (Mr. Panetta) and the gentleman from New Jersey (Mr. Norcross) as cosponsors of H.R. 9336.

Bill Text

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Introduced in HouseIssued June 18, 2026

I

119th CONGRESS

2d Session

H. R. 9336

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.

1.

Short title

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

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.