Kids’ Access to Primary Care Act of 2025

This bill would raise what Medicaid pays for primary care to at least the Medicare level. It also expands who can get these higher payments to include more types of providers, such as obstetrician–gynecologists, certain subspecialists, nurse practitioners, physician assistants, certified nurse-midwives, and clinics like rural health clinics and federally qualified health centers, when they deliver primary care. Emergency room services do not count as primary care for this rule .

Medicaid health plans must also pay at least these amounts and show proof they are meeting the requirement; states can use capitation or other value-based payments if they still meet the floor. The higher rates start the first day of the first month after the bill becomes law, and the health plan requirement applies to contracts signed on or after that date. The federal government must study the impact about a year later, looking at children’s Medicaid enrollment, how many providers are getting paid for primary care, and how payment levels compare across states. The study is funded at $200,000 for fiscal year 2026 .

• Who is affected: People on Medicaid (including children), primary care doctors, OB-GYNs and some subspecialists, nurse practitioners, physician assistants, certified nurse-midwives, rural health clinics, and federally qualified health centers; Medicaid health plans must comply too .
• What changes: Medicaid pays at least Medicare rates for primary care; more provider types qualify; emergency room visits are excluded; managed care must pass through the required pay and document it .
• When: Starts the first day of the first month after enactment; managed-care contract rules apply to contracts entered into on or after enactment; study due one year and one month after enactment .