Medicaid Primary Care Improvement Act

This bill makes it clear that states can let Medicaid patients get primary care through “direct primary care.” In this model, a patient’s primary care is covered by a regular flat fee paid to the doctor, instead of paying per visit. States can use this approach on its own or through Medicaid managed care plans and value-based care programs. It does not change Medicaid’s cost-sharing rules and does not limit people to only this type of care.

The federal health agency must hold at least one public virtual meeting to gather ideas and then give states guidance within one year on how to use direct primary care in Medicaid. Within two years, the agency must report to Congress on how often states contract with independent doctors and how quality and costs look when direct primary care is used through Medicaid managed care plans. In short, the bill authorizes states to offer primary care through flat-fee arrangements and sets deadlines for federal guidance and a follow-up report.

Key points

• Who is affected: Medicaid patients, primary care doctors, state Medicaid programs, and Medicaid managed care plans.
• What changes: States are clearly allowed to use flat-fee direct primary care for Medicaid primary care services; federal guidance and a study are required .
• When: Guidance due within 1 year of enactment; report due within 2 years of enactment.