WeVote
Log In

Bill

Bill

HR 9336

Better Care, Better Cost Act

119th Congress Introduced by August Pfluger

Medicaid goes to performance-based assignment of beneficiaries to managed care entities, using quality and outcomes metrics to guide which MCE serves each enrollee.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 9336

Summary of HR 9336 (119th Congress)

Purpose and intent

  • HR 9336 seeks to amend title XIX of the Social Security Act (Medicaid) to modify how states assign individuals to managed care entities (MCEs) under Medicaid.
  • The core objective is to require states to consider performance metrics when determining which MCEs serve particular beneficiaries, with the aim of incentivizing higher-quality care and better outcomes.

Key provisions and changes

  • Requirement to incorporate performance in assignment: States would be obligated to take into account specified performance measures when allocating or reassigning Medicaid beneficiaries to managed care entities. This represents a shift from assignment decisions based primarily on contract terms, network adequacy, or enrollment capacity to include performance outcomes as a criterion.
  • Potential performance metrics (illustrative, as defined by the bill or subsequent guidance): The bill would authorize the use of performance data to guide assignment decisions. While exact metrics may be detailed in the statutory text or accompanying regulations, typical measures in this space include quality of care, member health outcomes, access to services, patient satisfaction, and cost efficiency.
  • Federal program compliance: The amendment would prescribe how states must implement performance-based assignment within the existing Medicaid managed care framework, ensuring alignment with federal requirements under title XIX.
  • Administrative and data requirements: States would likely need to establish data collection, reporting, and monitoring systems to track performance metrics, ensure data accuracy, and apply the metrics consistently across MCEs.
  • Effective date and phased implementation: The bill would specify when states must begin applying performance-based assignment (e.g., a statutory effective date) and may outline transitional provisions or waivers to facilitate gradual implementation.

Who would be affected

  • Medicaid beneficiaries enrolled in managed care programs: Their assignment to MCEs would be influenced by performance-based considerations, potentially affecting which MCE they are enrolled with.
  • Managed care entities (MCEs): MCEs would be subject to performance evaluation and could experience changes in enrollment patterns based on performance outcomes and resulting assignment decisions.
  • State Medicaid agencies: Responsible for implementing the policy, collecting performance data, and adjusting assignment processes in accordance with the new requirements.
  • Federal Department/Agency administering Medicaid: Oversees compliance, provides guidance, and ensures consistency with federal law.

Procedural and timeline aspects

  • Introduction and referral: The bill was introduced in the House and referred to the House Committee on Energy and Commerce on June 18, 2026.
  • Legislative process status: As of the provided information, the bill has not yet advanced beyond committee consideration. Committee action, potential amendments, and floor debate would determine its progression toward passage.
  • Sponsorship: Co-sponsored by Representative August Pfluger (along with the primary sponsor indicated by the bill).

Potential impact and considerations

  • Quality improvement: By tying assignment to performance, the bill aims to promote higher-quality care and better outcomes for Medicaid beneficiaries in managed care.
  • Administrative burden: States would face new data collection, reporting, and analysis requirements to implement performance-based assignments, potentially increasing administrative workload and infrastructure needs.
  • Equity and access: Policymakers may consider how performance-based assignments affect beneficiary access, provider networks, and continuity of care, particularly in rural or underserved areas where MCE options may be limited.
  • Federal-state dynamics: The change would reorient state Medicaid administration within the existing federal framework, necessitating coordination with federal guidance and potential impacts on federal funding or compliance standards.

If you’d like, I can tailor this summary to specific sections of the bill (text-based provisions, definitions, or anticipated regulatory guidance) or compare it to similar existing Medicaid reforms.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.