Medicaid Primary Care Improvement Act
Sponsored By: Representative Crenshaw
Introduced
Summary
This bill would clarify that Medicaid may provide primary care through direct primary care arrangements. It defines a direct primary care arrangement as primary care services paid only by a fixed periodic fee and says states can include those arrangements in value-based care models.
Show full summary
- Families and beneficiaries: Could receive Medicaid primary care through fixed-fee direct primary care arrangements, and existing Medicaid cost-sharing rules under state plans remain unchanged.
- Primary care providers: Independent primary care clinicians and small practices could contract to furnish Medicaid primary care paid by a fixed periodic fee instead of traditional fee-for-service payments.
- States and Medicaid managed care organizations: Would be able to incorporate direct primary care into state plans or waivers and into value-based care arrangements.
- Federal oversight and reporting: The HHS Secretary would convene at least one virtual stakeholder meeting within 1 year and must report to Congress within 2 years on how states use direct primary care and on quality and cost outcomes.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Medicaid could pay for direct primary care
If enacted, states could let Medicaid pay for primary care through a direct primary care plan. You would get only primary care from primary care practitioners, and the provider would be paid a fixed periodic fee. States could do this through Medicaid managed care and value-based models. It would not change Medicaid cost-sharing rules or make direct primary care the only way to get care. This would apply only if your state chooses to use it.
Federal guidance for states on direct primary care
Within 1 year after enactment, HHS would hold at least one virtual meeting to get input from providers, states, and Medicaid plans. HHS would then issue guidance to states on using direct primary care in Medicaid. Within 2 years, HHS would report to Congress on state contracting and on quality and cost under Medicaid direct primary care models. This would not change who qualifies for Medicaid or add new funding.
Sponsors & CoSponsors
Sponsor
Crenshaw
TX • R
Cosponsors
Schrier
WA • D
Sponsored 2/10/2025
Smucker
PA • R
Sponsored 2/10/2025
Pettersen
CO • D
Sponsored 2/10/2025
Onder
MO • R
Sponsored 3/14/2025
Nunn (IA)
IA • R
Sponsored 5/5/2025
Gill (TX)
TX • R
Sponsored 12/16/2025
Auchincloss
MA • D
Sponsored 1/20/2026
Roll Call Votes
No roll call votes available for this bill.
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