The "Better Care, Better Cost Act" amends the Social Security Act to require states to incorporate managed care entity performance into their Medicaid enrollment processes, shifting from purely equitable distribution to performance-based assignments. States must establish a system to evaluate and assign performance scores to managed care entities, utilizing a combination of cost and outcome measures , such as expenditures for medical assistance and rates of avoidable hospital readmissions or emergency department visits, alongside individual satisfaction measures like patient satisfaction scores and termination rates. The bill further mandates that states annually publish a report evaluating the impact of using performance scores on default enrollments and quantifying any estimated reduction in expenditures, with these provisions applying to enrollments beginning on or after January 1, 2028.