Kids’ Access to Primary Care Act of 2025
Sponsored By: Senator Patty Murray
Introduced
Summary
Applies a Medicare payment rate floor to Medicaid primary care services. The Kids' Access to Primary Care Act of 2025 would extend that floor to more clinician types and tighten how managed care pays for primary care, aiming to keep more providers in Medicaid networks.
Show full summary
- Children and families: Medicaid primary care for eligible services would be paid at a floor equal to 100 percent of Medicare Part B rates, which is meant to support access to pediatric and family care.
- Providers: The floor would cover more clinicians, including family medicine, general internal medicine, pediatrics, certain obstetricians who self-attest board certification, advanced practice clinicians practicing under state law, nurse-midwives, Federally Qualified Health Centers, and rural health clinics.
- Managed care and States: Medicaid managed-care contracts would need to ensure payments meet HHS-set amounts, let States obtain documentation to verify compliance, and allow HHS to approve capitation or value-based arrangements with adequate documentation.
- Data and oversight: HHS must study changes in Medicaid enrollment, the number of providers receiving primary care payments, and state payment rates before and after the change within about a year.
*Authorizes $200,000 for fiscal year 2026 for the required HHS study, available until expended.*
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Higher Medicaid pay for primary care
If enacted, Medicaid would have to pay at least 100% of the Medicare Part B physician rate for defined primary care services. The floor would also use a higher historical Medicare conversion factor if that gives a larger rate. The rule would apply retroactively for 2013 and 2014 for certain family, internal medicine, and pediatric physicians. Starting the first day of the first month after enactment, the floor would cover more provider types (including some OB/GYNs who self-attest board certification, covered subspecialists, advanced practice clinicians under specified supervision, rural clinics, and FQHCs). Hospital emergency department care would not count as primary care. Managed-care contracts entered into or renewed on or after enactment would have to show payments meet the floor or an HHS‑approved value-based equivalent and provide documentation for State and HHS review.
Study of Medicaid primary care rates
If enacted, HHS would study and report within 13 months on enrollment, provider counts, and Medicaid primary care payment levels before and after the new payment floor. The report would compare 12-month pre- and post-periods using three indexes (a Medicaid fee index, a Medicaid‑to‑Medicare fee index, and a Medicaid fee change index). The bill would authorize $200,000 for fiscal year 2026, available until expended, to carry out the study.
Sponsors & CoSponsors
Sponsor
Patty Murray
WA • D
Cosponsors
Raphael Warnock
GA • D
Sponsored 2/26/2025
Cory Booker
NJ • D
Sponsored 2/26/2025
Richard Blumenthal
CT • D
Sponsored 2/26/2025
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 2/26/2025
Jeff Merkley
OR • D
Sponsored 2/26/2025
Peter Welch
VT • D
Sponsored 2/26/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in