Sponsors (7)
The bill increases Medicaid payment rates for primary care—boosting provider pay and likely improving access for beneficiaries—while creating meaningful new costs for States and risking unintended access limits or administrative complications, with a modestly funded study intended to inform future policy.
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 services/providers during the covered period.
Nurse practitioners, physician assistants, and certified nurse‑midwives (and other eligible primary care clinicians) 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 reimbursed on a physician fee schedule may receive higher payments, helping sustain safety‑net providers in rural and underserved communities.
State governments and ultimately taxpayers will face higher Medicaid costs because Medicaid is required to pay higher rates (at least Medicare rates) for many primary care services.
Some managed‑care organizations or States may respond to higher mandated payments by restricting which providers participate or narrowing covered services to control costs, which could reduce patient access and increase administrative burdens.
Providers who cannot self‑attest board certification or who are limited by state scope‑of‑practice rules may be excluded from the higher payment floor, leaving some clinicians (and their patients) without the intended pay/participation benefits.
Based on analysis of 3 sections of legislative text.
Raises Medicaid minimum payments for primary care to at least 100% of Medicare Part B rates for more provider types and requires managed-care contract compliance; directs an HHS study.
Requires Medicaid to pay a Medicare-equivalent rate for primary care delivered to Medicaid enrollees during a newly defined additional period starting the first day of the first month after enactment. The minimum payment must be at least 100% of the Medicare Part B rate (or a higher 2009-adjusted conversion-factor rate) and cannot be lower than the otherwise-applicable Medicaid rate; the floor is extended to more provider types (including OB/GYNs, subspecialists, advanced practice clinicians, rural health clinics, FQHCs reimbursed on a physician fee schedule, nurse practitioners, physician assistants, and certified nurse‑midwives) with certain scope-of-practice or self-attestation conditions. Also narrows the legal definition of "primary care services" by excluding services provided in hospital emergency departments, requires managed-care contracts to ensure MCOs and other managed-care entities pay providers at least the specified amounts and document compliance (while allowing approved capitation or value-based arrangements that meet methodology requirements), and directs HHS to complete a study within 13 months comparing child Medicaid enrollment and provider payment changes before and after the start date, with $200,000 authorized for the study in FY2026.
Introduced February 26, 2025 by Patty Murray · Last progress February 26, 2025