(Bloomberg) — In the first major overhaul in more than a decade, the United States has proposed new rules for private health insurers who run Medicaid plans covering millions of poor people and children.

The proposed rules, issued Tuesday, call for plans to report what portion of the money they collect to care for patients actually gets spent on benefits. They would attempt to broaden access to doctors and hospitals by having states set standards on access to care. The rules would also create a performance-based ratings system for plans.

Big health insurers like Aetna Inc., Humana Inc., Anthem Inc., and UnitedHealth Group Inc. offer the Medicaid plans, as do specialized firms such as Molina Healthcare Inc., Centene Corp., WellCare Health Plans Inc. and Health Net Inc.