PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the House Committee on Energy and Commerce.
Congressional Research Service
Version 00 · Introduced in House · Feb 10, 2025
Medicaid Primary Care Improvement Act
This bill specifies that state Medicaid programs are authorized to provide primary care services through direct primary care arrangements (i.e., arrangements in which primary care providers receive a fixed periodic fee for their services).
The Centers for Medicare & Medicaid Services must (1) convene at least one virtual stakeholder meeting and issue related guidance on how state Medicaid programs may implement direct primary care arrangements, and (2) report on the extent to which state Medicaid programs contract with independent providers and on the quality and cost of care under direct primary care arrangements that are offered through Medicaid managed care organizations.
People & committees
Rep. Crenshaw, Dan [R-TX-2] · R–TX
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
Referred to the House Committee on Energy and Commerce.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Jan 21, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-10 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Medicaid Primary Care Improvement Act would clarify that states may arrange Medicaid primary care through providers paid a fixed recurring fee as their only compensation for that care. States could use this approach but would not have to. The bill would preserve existing statutory requirements for patients’ share of costs and would not limit Medicaid assistance to services covered by these arrangements.
This Act may be cited as the Medicaid Primary Care Improvement Act.
Nothing in title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) shall be construed as prohibiting a State, under its State plan (or waiver of such plan) under such title (including through a medicaid managed care organization (as defined in section 1903(m)(1)(A) of such Act)), from providing medical assistance consisting of primary care services through a direct primary care arrangement with a health care provider, including as part of a value-based care arrangement established by the State.
if the sole compensation for such care is a fixed periodic fee.
Nothing in this section shall be construed to alter statutory requirements under the State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for cost-sharing requirements or be construed to limit medical assistance solely to those provided under a direct primary care arrangement.
Section 2(a) would clarify that Medicaid law does not prohibit these arrangements under a state’s Medicaid plan or a waiver of that plan. States could also use them through Medicaid managed care organizations or as part of a state-established value-based care arrangement.
Nothing in title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) shall be construed as prohibiting a State, under its State plan (or waiver of such plan) under such title (including through a medicaid managed care organization (as defined in section 1903(m)(1)(A) of such Act)), from providing medical assistance consisting of primary care services through a direct primary care arrangement with a health care provider, including as part of a value-based care arrangement established by the State.
A qualifying “direct primary care arrangement” would cover only primary care services supplied by primary care practitioners. A fixed recurring fee would have to be the only compensation for that care.
the term direct primary care arrangement means, with respect to any individual, an arrangement under which such individual is provided medical assistance consisting solely of primary care services provided by primary care practitioners, if the sole compensation for such care is a fixed periodic fee.
Within one year after enactment, the Secretary of Health and Human Services would have to convene at least one virtual open door meeting to seek stakeholder input and issue guidance explaining how states may implement these arrangements. The meeting would have to seek input from stakeholders including direct primary care providers, state Medicaid agencies, and Medicaid managed care organizations. The guidance would have to take that input into account.
(b) Guidance Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall— (1) convene at least one virtual open door meeting to seek input from stakeholders, including primary care providers who practice under the direct primary care model, state Medicaid agencies, and Medicaid managed care organizations; and (2) taking into account such input, issue guidance to States on how a State may implement direct primary care arrangements (as defined in subsection (a)) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
Within two years after enactment, the Secretary would have to report to Congress on how extensively states contract with independent physicians, independent physician practices, and primary care practices to provide Medicaid care. The report would also analyze care quality and costs for Medicaid enrollees whose care is paid for under direct primary care arrangements through Medicaid managed care organizations.
(c) Report Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report containing— (1) an analysis of the extent to which States are contracting with independent physicians, independent physician practices, and primary care practices for purposes of furnishing medical assistance under State plans (or waivers of such plans) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and (2) an analysis of quality of care and cost of care furnished to individuals enrolled under such title where such care is paid for under a direct primary care arrangement (as defined in subsection (a)) through a medicaid managed care organization (as so defined).
Section 2(d) would preserve statutory cost-sharing requirements—the rules governing patients’ share of costs. It would also prevent this section from being interpreted to restrict Medicaid assistance to services provided under a direct primary care arrangement.
(d) Rule of construction Nothing in this section shall be construed to alter statutory requirements under the State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for cost-sharing requirements or be construed to limit medical assistance solely to those provided under a direct primary care arrangement.
The supplied official-actions snapshot, updated January 21, 2026, records introduction in the House and referral to the House Committee on Energy and Commerce on February 10, 2025.
Source snapshot updated 2026-01-21T09:05:19Z. 2025-02-10: Referred to the House Committee on Energy and Commerce. 2025-02-10: Introduced in House
A closer look
Reviewed version: Introduced in House · 2025-02-10. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials. Member requests, earmark disclosures, and committee or conference materials were not supplied, so formal earmark status cannot be independently established from those materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow carve-out, special exemption, or preferential treatment warranting a finding was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Jan 21, 2026. How PlainBill uses AI