Sponsors (8)
The bill makes it easier for Medicaid to fund direct primary care—likely improving access and giving states and Congress better implementation data—while risking displacement of specialty care, higher state costs, and added administrative complexity.
Medicaid enrollees (low-income Americans on Medicaid) may gain expanded access to primary care because States and MCOs can pay primary care providers through direct primary care arrangements (DPCAs), increasing availability of routine primary care.
States, Medicaid managed care organizations, and Congress will receive clearer federal guidance, stakeholder input within a year, and a required 2-year report on cost and quality outcomes — improving implementation decisions and future policymaking for DPCAs.
Independent primary care practitioners may get more contracting opportunities with Medicaid and managed care organizations as DPCAs are authorized, potentially improving practice viability and small-practice revenue streams.
Medicaid beneficiaries could face gaps in specialty or episodic care if State payment shifts toward fixed periodic DPC fees that emphasize primary care but displace other needed services.
Shifting to fixed periodic payments for DPC providers could alter cost distribution and increase State Medicaid expenditures if enrollees' use of other services does not fall, creating fiscal pressure on state budgets and possibly taxpayers.
Transitioning to and contracting for DPCAs could raise administrative complexity and contracting burden for State Medicaid agencies, managed care organizations, and health systems during implementation.
Based on analysis of 2 sections of legislative text.
Clarifies states may provide Medicaid primary care via fixed-fee direct primary care arrangements and requires HHS guidance and a report to Congress.
Allows states to offer primary care to Medicaid enrollees through direct primary care arrangements (DPCAs) — agreements in which a patient pays a fixed periodic fee for only primary care services — by clarifying that nothing in Medicaid law bars such arrangements. The measure requires the HHS Secretary to hold at least one virtual stakeholder meeting within a year and to issue guidance to states on implementing DPCAs in Medicaid, and to report to Congress within two years on state contracting and outcomes when DPCAs are used in Medicaid managed care. The bill does not change Medicaid cost-sharing rules or require states to use DPCAs; it only affirms they are permitted and asks HHS to study and advise on implementation and outcomes.
Introduced February 10, 2025 by Daniel Crenshaw · Last progress February 10, 2025