Kids’ Access to Primary Care Act of 2025
Sponsored By: Representative Schrier
Introduced
Summary
This bill renews and expands a Medicare-based minimum payment floor for Medicaid primary care, making sure primary care services under Medicaid are paid at least the Medicare Part B rate and widening which providers qualify. It also tightens what counts as primary care, extends the rule into managed care contracts, and requires a federal study of enrollment, provider participation, and payment changes.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Higher Medicaid pay for primary care
This bill would set a payment floor for Medicaid primary care. States would have to pay at least the highest of three amounts: the state’s Medicaid rate, the Medicare Part B rate, or the Medicare Part B rate recalculated with the 2009 conversion factor. Services in a hospital emergency department would not count as primary care for this floor. More providers could qualify, including board‑certified family, internal, pediatric, and OB‑GYN doctors, certain subspecialists, nurse practitioners, physician assistants, certified nurse‑midwives, and qualifying clinics. When an NP, PA, or CNM provides the service, their share of the payment would be no less than what Medicare Part B would pay them. These changes would start the first month after enactment. New Medicaid managed care contracts signed after enactment would also need to meet the primary care payment amounts set by HHS and share documents to prove it. The Secretary could approve capitation or value‑based payments only if the method is reasonable and documented.
Congress urges Bright Futures child checkups
Congress would state that providers should follow the American Academy of Pediatrics’ Bright Futures guidelines for kids’ checkups under Medicaid. This is a recommendation only. It would not create new legal duties or change payments.
HHS study on kids' Medicaid access
HHS would run a one‑time study due within 13 months of enactment. It would compare child enrollment, the number of providers paid for primary care, and state payment rates before and after the change. The study would use three indexes to compare fees across states and over time. Congress would authorize $200,000 for fiscal year 2026 to pay for the study, available until spent.
Sponsors & CoSponsors
Sponsor
Schrier
WA • D
Cosponsors
Fitzpatrick
PA • R
Sponsored 2/18/2025
Castor (FL)
FL • D
Sponsored 2/18/2025
DelBene
WA • D
Sponsored 2/18/2025
Cohen
TN • D
Sponsored 2/18/2025
Tonko
NY • D
Sponsored 2/18/2025
Meng
NY • D
Sponsored 2/18/2025
Sewell
AL • D
Sponsored 2/18/2025
Davis (NC)
NC • D
Sponsored 2/18/2025
Strickland
WA • D
Sponsored 2/18/2025
Magaziner
RI • D
Sponsored 2/18/2025
Roll Call Votes
No roll call votes available for this bill.
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