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House Bill 1433HR 1433

Kids’ Access to Primary Care Act of 2025

Health

12 pages

house
senate
president

Introduced February 18, 2025 by Kim Schrier · Last progress February 18, 2025

Bill Summary

Summary

Extends and broadens a Medicaid rule that requires minimum payment rates for primary care so certain primary-care services are paid at least at Medicare Part B levels and adds more provider types covered. It also tightens managed-care contract requirements to ensure those payments are made and documented, orders an HHS study comparing child enrollment, provider counts, and Medicaid primary-care payments before and after the extension, and expresses a nonbinding preference that EPSDT care follow the American Academy of Pediatrics Bright Futures guidance.

Key Points

Renews a Medicaid rule requiring primary-care payments be at least 100% of Medicare Part B for a renewed period beginning the first month after enactment.
Expands the covered provider types to include more physician specialties, advanced practice clinicians, RHCs, FQHCs, and nonphysician primary-care clinicians.
Excludes hospital emergency department services from the definition of primary-care services for the payment floor.
Requires Medicaid managed-care contracts (new contracts after enactment) to ensure the payment floor is met and to provide documentation to States and HHS.
Directs HHS to approve capitated or value-based payment arrangements that meet reasonable methodology and documentation requirements.
Orders an HHS study (completed within 13 months) comparing child enrollment, provider counts, and Medicaid primary-care payment rates before and after the renewed period.
Authorizes $200,000 for FY2026, available until expended, to carry out the HHS study.
Includes a nonbinding Sense of Congress encouraging EPSDT services to follow the AAP Bright Futures guidance; this creates no new legal requirements or funding.

Pros & Cons

The bill raises primary care Medicaid payment rates and increases monitoring and guidance to improve access and quality—helping providers and Medicaid enrollees—while raising Medicaid costs and administrative burdens for states and payers and offering limited funding/enforcement for implementation.

Potential Benefits

6

Primary care clinicians (physicians, NPs, PAs, CNMs, APRNs) will receive at least 100% of Medicare Part B rates for covered primary care services during the statute period, increasing provider reimbursement and revenue.
Medicaid beneficiaries, especially in underserved areas, may gain improved access to primary care as higher payment rates make more providers willing to accept Medicaid patients.
Rural health clinics and federally qualified health centers (FQHCs) may strengthen service capacity in underserved and rural communities because higher Medicaid payments improve financial stability.

Potential Drawbacks

6

Taxpayers and state budgets will face higher federal and state Medicaid spending to support the higher payment floor, potentially forcing states to reallocate funds, raise taxes, or cut other services.
State Medicaid agencies and managed-care organizations will face additional administrative burdens and compliance requirements to document contract modifications and compile payment/enrollment data for HHS, increasing paperwork and operational costs.
Hospitals and Medicaid patients may see reduced or more complex higher-rate payments for some emergency department care because ED services are excluded from the primary care definition, complicating billing and reimbursement for ED-based primary care services.

AI Insights

Analyzed 4 of 4 sections

Categories & Tags

Agencies

HHS

Centers for Medicare & Medicaid Services

Subjects

Maternal & Child Health

Medicaid & CHIP

Health Insurance Coverage

Medicare

Healthcare Workforce

Public Health Preparedness

+2 more

Affected Groups

Children & Youth

Healthcare Workers

Medicaid Beneficiaries

State Governments

+1 more

Sponsors (11)

Bill Summary

Summary

Extends and broadens a Medicaid rule that requires minimum payment rates for primary care so certain primary-care services are paid at least at Medicare Part B levels and adds more provider types covered. It also tightens managed-care contract requirements to ensure those payments are made and documented, orders an HHS study comparing child enrollment, provider counts, and Medicaid primary-care payments before and after the extension, and expresses a nonbinding preference that EPSDT care follow the American Academy of Pediatrics Bright Futures guidance.

Key Points

Renews a Medicaid rule requiring primary-care payments be at least 100% of Medicare Part B for a renewed period beginning the first month after enactment.
Expands the covered provider types to include more physician specialties, advanced practice clinicians, RHCs, FQHCs, and nonphysician primary-care clinicians.
Excludes hospital emergency department services from the definition of primary-care services for the payment floor.
Requires Medicaid managed-care contracts (new contracts after enactment) to ensure the payment floor is met and to provide documentation to States and HHS.
Directs HHS to approve capitated or value-based payment arrangements that meet reasonable methodology and documentation requirements.
Orders an HHS study (completed within 13 months) comparing child enrollment, provider counts, and Medicaid primary-care payment rates before and after the renewed period.
Authorizes $200,000 for FY2026, available until expended, to carry out the HHS study.
Includes a nonbinding Sense of Congress encouraging EPSDT services to follow the AAP Bright Futures guidance; this creates no new legal requirements or funding.

Pros & Cons

The bill raises primary care Medicaid payment rates and increases monitoring and guidance to improve access and quality—helping providers and Medicaid enrollees—while raising Medicaid costs and administrative burdens for states and payers and offering limited funding/enforcement for implementation.

Potential Benefits

6

Primary care clinicians (physicians, NPs, PAs, CNMs, APRNs) will receive at least 100% of Medicare Part B rates for covered primary care services during the statute period, increasing provider reimbursement and revenue.
Medicaid beneficiaries, especially in underserved areas, may gain improved access to primary care as higher payment rates make more providers willing to accept Medicaid patients.
Rural health clinics and federally qualified health centers (FQHCs) may strengthen service capacity in underserved and rural communities because higher Medicaid payments improve financial stability.

Potential Drawbacks

6

Taxpayers and state budgets will face higher federal and state Medicaid spending to support the higher payment floor, potentially forcing states to reallocate funds, raise taxes, or cut other services.
State Medicaid agencies and managed-care organizations will face additional administrative burdens and compliance requirements to document contract modifications and compile payment/enrollment data for HHS, increasing paperwork and operational costs.
Hospitals and Medicaid patients may see reduced or more complex higher-rate payments for some emergency department care because ED services are excluded from the primary care definition, complicating billing and reimbursement for ED-based primary care services.

AI Insights

Analyzed 4 of 4 sections

Categories & Tags

Agencies

HHS

Centers for Medicare & Medicaid Services

Subjects

Maternal & Child Health

Medicaid & CHIP

Health Insurance Coverage

Medicare

Healthcare Workforce

Public Health Preparedness

+2 more

Affected Groups

Children & Youth

Healthcare Workers

Medicaid Beneficiaries

State Governments

+1 more

Sponsors (11)

All Legislation

House Bill 1433HR 1433

Kids’ Access to Primary Care Act of 2025

Health

12 pages

house
senate
president

Introduced February 18, 2025 by Kim Schrier · Last progress February 18, 2025

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