Kids' Access to Primary Care Act

Summary#

This bill would renew a rule that requires Medicaid to pay at least the Medicare payment rate for certain primary care services for a new period after the bill becomes law. It expands the kinds of providers covered. The rule would apply to physicians in family medicine, general internal medicine, pediatrics, and obstetrics/gynecology (with self-attestation), subspecialists in those fields, advanced practice clinicians who work under supervision, nurse practitioners, physician assistants, certified nurse-midwives, rural health clinics, and Federally Qualified Health Centers when those clinics are reimbursed on a physician fee schedule.

The bill also adds a rule for Medicaid managed care contracts. Contracts would have to require payments to primary care providers that meet the required minimum rates, let states and HHS check documentation, and allow value-based payment arrangements if they use a reasonable method and provide documentation.

The Secretary of Health and Human Services must study changes in child Medicaid enrollment, the number of providers paid for primary care, and state payment rates. The study uses three indexes: a Medicaid fee index, a Medicaid-to-Medicare fee index, and a Medicaid fee change index. The bill includes a small appropriation for that study and expresses that providers should follow the American Academy of Pediatrics Bright Futures guidelines for child screening and care.

What it means for you#

  • If you are a child on Medicaid, the bill directs higher minimum payment rates for many primary care services paid to providers in Medicaid. The minimum is at least equal to the Medicare rate or the otherwise applicable Medicaid rate, whichever is higher.
  • More types of clinicians and clinics can receive those payment rates, including obstetrician-gynecologists, subspecialists, nurse practitioners, physician assistants, certified nurse-midwives, rural health clinics, and Federally Qualified Health Centers under the listed conditions.
  • States and their Medicaid managed care plans must include contract terms to show they pay the required amounts and must give documentation when asked. Value-based or capitation payments can qualify if the method is reasonable and documented.
  • HHS will study enrollment, provider counts, and payment rates across states and report findings using several fee indexes.

Expenses#

  • The bill authorizes $200,000 for fiscal year 2026 for the HHS study, to remain available until spent.
  • No publicly available information on other costs, savings, or budgetary effects is provided in the bill text or metadata.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.