Sponsors (7)
The bill raises Medicaid primary care payments to improve access and provider compensation, especially in safety‑net and rural settings, but does so at increased state cost and with risks of cost‑control responses and limited near‑term policy guidance from a modestly funded study.
Medicaid beneficiaries will have broader access to primary care because Medicaid must pay at least Medicare Part B rates for a wider set of primary care providers during the covered period.
Nurse practitioners, physician assistants, and certified nurse‑midwives will receive at least Medicare-equivalent pay when covered, improving compensation and likely increasing provider participation in Medicaid.
Rural health clinics and federally qualified health centers (FQHCs) reimbursed on a physician fee schedule may receive higher payments, helping sustain safety‑net providers in underserved and rural communities.
States will face higher Medicaid costs because Medicaid must pay higher rates (at least Medicare rates) for many primary care services, potentially increasing state budgets or requiring offsets.
Some managed‑care organizations and states may respond to higher mandated rates by restricting provider participation, narrowing covered services, or increasing administrative barriers, which could reduce patient access.
Providers must self‑attest board certification or meet state scope‑of‑practice rules to qualify for the payment floor, which may exclude some clinicians (especially advanced practice clinicians) from higher payments.
Based on analysis of 3 sections of legislative text.
Expands and extends a Medicare‑equivalent Medicaid payment floor to more primary care provider types, excludes ED services from the primary care definition, and requires managed‑care contract compliance and an HHS study.
Official title: Amend title XIX of the Social Security Act to renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid program, and for other purposes.
Introduced February 26, 2025 by Patty Murray · Last progress February 26, 2025
Requires Medicaid to pay at least Medicare-equivalent rates for a broader set of primary care providers for a defined “additional period,” expands which provider types are covered by that payment floor, narrows the statutory definition of primary care to exclude services provided in hospital emergency departments, and directs managed-care contracts to ensure compliance and documentation. Directs HHS to study changes in child enrollment, numbers of providers paid for primary care, and cross‑State payment comparisons and provides $200,000 for that study.