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Congressional Research Service
Version 00 · Introduced in House · Feb 18, 2025
Kids' Access to Primary Care Act of 2025
This bill modifies payments for Medicaid primary care services. Specifically, the bill applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill and extends the payment rate to additional types of practitioners (e.g., obstetricians).
The Centers for Medicare & Medicaid Services must conduct a study on the number of children enrolled in Medicaid, the number of providers receiving payment for primary care services, and associated payment rates before and after the bill's implementation.
People & committees
Rep. Schrier, Kim [D-WA-8] · D–WA
Legislative record
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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.
Source last updated: Sep 19, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-18 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 Kids’ Access to Primary Care Act of 2025 would renew minimum Medicaid payments for eligible primary care services, using Medicare payment rates as a benchmark. It would cover specified physicians, other clinicians, and qualifying clinics, affecting payments for the care they provide. Hospital emergency-department services would be excluded. Medicaid managed-care contracts would also have to include requirements supporting the payment rules.
This Act may be cited as the Kids’ Access to Primary Care Act of 2025.
Renewal of application of Medicare payment rate floor to primary care services furnished under Medicaid and inclusion of additional providers
payment for primary care services (as defined in subsection (jj)) at a rate that is not less than 100 percent of the payment rate that applies to such services and physician under part B of title XVIII
Such term does not include any services described in subparagraph (A) or (B) of paragraph (1) if such services are provided in an emergency department of a hospital.
such contract provides that (I) payments to health care providers specified in section 1902(a)(13)(C) for furnishing primary care services defined in section 1902(jj) during a year or period specified in section 1902(a)(13)(C) are at least equal to the amounts set forth and required by the Secretary by regulation
The proposed payment minimum would be at least the applicable Medicare Part B rate, or a higher Medicare rate calculated using the 2009 conversion factor—a number used in the payment calculation. Payments also could not fall below the Medicaid rate that would otherwise apply without this provision.
at a rate that is not less than 100 percent of the payment rate that applies to such services and physician under part B of title XVIII (or, if greater, the payment rate that would be applicable under such part if the conversion factor under section 1848(d) for the year involved were the conversion factor under such section for 2009), and that is not less than the rate that would otherwise apply to such services under this title if the rate were determined without regard to this subparagraph
The replacement language would retain coverage for specified physician services furnished in 2013 and 2014. The renewed payment period would begin on the first day of the first month after enactment; the supplied language specifies no ending date for that period.
(i) furnished in 2013 and 2014, by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine; or (ii) furnished during the period beginning on the first day of the first month beginning after the date of the enactment of the Kids’ Access to Primary Care Act of 2025
Eligible physicians in the renewed period would include those designated in family medicine, general internal medicine, pediatric medicine, or obstetrics and gynecology who attest that they are board-certified in the corresponding field. Physicians designated in related subspecialties would also qualify if they attest to board certification in that subspecialty, regardless of which board offers the designation.
(I) by a physician with a primary specialty designation of family medicine, general internal medicine, pediatric medicine, or obstetrics and gynecology, but only if the physician self-attests that the physician is board-certified in family medicine, general internal medicine, pediatric medicine, or obstetrics and gynecology, respectively; (II) by a physician with a primary specialty designation of a family medicine subspecialty, an internal medicine subspecialty, a pediatric subspecialty, or a subspecialty of obstetrics and gynecology, without regard to the board that offers the designation for such a subspecialty, but only if the physician self-attests that the physician is board-certified in such a subspecialty
Advanced practice clinicians, whose definition would be set by the Secretary of Health and Human Services, could qualify when supervised by an eligible physician or by a qualifying nurse practitioner, physician assistant, or certified nurse-midwife working under state law.
(III) by an advanced practice clinician, as defined by the Secretary, that works under the supervision of— (aa) a physician described in subclause (I) or (II); or (bb) a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)(2)) who is working in accordance with State law
Rural health clinics, federally qualified health centers, and other health clinics could qualify if paid under a fee schedule applicable to the listed professionals. Covered services would have to be furnished by the specified professionals or advanced practice clinicians under their supervision.
(IV) by a rural health clinic, Federally-qualified health center, or other health clinic that receives reimbursement on a fee schedule applicable to a physician described in subclause (I) or (II), an advanced practice clinician described in subclause (III), or a nurse practitioner, physician assistant, or certified nurse-midwife described in subclause (III)(bb), for services furnished by— (aa) such a physician, nurse practitioner, physician assistant, or certified nurse-midwife, respectively; or (bb) an advanced practice clinician supervised by such a physician, nurse practitioner, physician assistant, or certified nurse-midwife
Qualifying nurse practitioners, physician assistants, and certified nurse-midwives working under state law would also be covered directly. Procedures would have to ensure that the portion of payment they receive is at least what they would receive for the services under Medicare Part B.
(V) by a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife described in subclause (III)(bb) who is working in accordance with State law, in accordance with procedures that ensure that the portion of the payment for such services that the nurse practitioner, physician assistant, or certified nurse-midwife is paid is not less than the amount that the nurse practitioner, physician assistant, or certified nurse-midwife would be paid if the services were provided under part B of title XVIII
The bill would amend Social Security Act section 1905(dd) to add services furnished during an additional period beginning on the first day of the first month after enactment. The underlying provision is not reproduced, so the supplied text does not establish its complete financing effect.
Section 1905(dd) of the Social Security Act (42 U.S.C. 1396d(dd)) is amended
by inserting or furnished during the additional period specified in paragraph (2), after 2015,
For purposes of paragraph (1), the additional period specified in this paragraph is the period beginning on the first day of the first month beginning after the date of the enactment of the Kids’ Access to Primary Care Act of 2025.
Services furnished in a hospital emergency department would be excluded from the primary care definition used for the payment minimum. This exclusion would apply starting on the first day of the renewed payment period.
Such term does not include any services described in subparagraph (A) or (B) of paragraph (1) if such services are provided in an emergency department of a hospital.
The amendments made by paragraph (1) shall apply with respect to primary care services provided on or after the first day of the period described in subparagraph (C)(ii) of section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396a(a)(13)), as amended by section 2.
Medicaid managed-care contracts would have to require payments to eligible providers at least equal to amounts required by the Secretary through regulations. On request, the managed-care entity would have to give the state documentation sufficient for the state and Secretary to check compliance.
(xiv) such contract provides that (I) payments to health care providers specified in section 1902(a)(13)(C) for furnishing primary care services defined in section 1902(jj) during a year or period specified in section 1902(a)(13)(C) are at least equal to the amounts set forth and required by the Secretary by regulation, (II) the entity shall, upon request, provide documentation to the State that is sufficient to enable the State and the Secretary to ensure compliance with subclause (I)
The Secretary would have to approve qualifying payments through agreed-upon capitation, partial capitation, or other value-based arrangements—alternatives to paying separately for each service. Approval would require a reasonable calculation method and documentation sufficient to check compliance with the required payment amounts.
(III) the Secretary shall approve payments described in subclause (I) that are furnished through an agreed-upon capitation, partial capitation, or other value-based payment arrangement if the agreed-upon capitation, partial capitation, or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the State that is sufficient to enable the State and the Secretary to ensure compliance with subclause (I).
The managed-care amendments would apply to contracts entered into on or after enactment. The bill would also add a reference to the new contract requirement in Social Security Act section 1932(f), whose existing text is not supplied.
Section 1932(f) of the Social Security Act (42 U.S.C. 1396u–2(f)) is amended by inserting and clause (xiv) of section 1903(m)(2)(A) before the period.
The amendments made by this subsection shall apply with respect to contracts entered into on or after the date of the enactment of this Act.
Within one year and one month after enactment, the Secretary of Health and Human Services would have to conduct a study comparing children's Medicaid enrollment and the number of providers receiving Medicaid primary care payments. Each comparison would cover the 12 months before the renewed payment period and the 12 months beginning with that period.
Not later than the date that is one year and one month after the date of the enactment of this Act, the Secretary of Health and Human Services shall conduct a study
(1) comparing the number of children enrolled in a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan) during the 12-month period preceding the first day of the period described in subparagraph (C)(ii) of section 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), as amended by section 2, to the number of children so enrolled during the 12-month period beginning on such first day
(2) comparing the number of health care providers receiving payments for primary care services under the Medicaid program under such title during the 12-month period preceding the first day of the period described in subparagraph (C)(ii) of section 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), as amended by section 2, to the number of health care providers receiving such payments during the 12-month period beginning on such first day
The study would also compare Medicaid primary care payment rates across states during the first 12 months of the renewed period. Required measures would compare state Medicaid fees with the national average, with Medicare fees, and with Medicaid fees during the preceding 12 months.
(3) comparing health care provider payment rates for primary care services under the Medicaid program under such title during the 12-month period beginning on the first day of the period described in subparagraph (C)(ii) of section 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), as amended by section 2, across States, using the indexes described in subsection (b).
(1) A Medicaid fee index, comparing each State’s average fee for primary care services under the Medicaid program under such title to the national average for such services. (2) A Medicaid-to-Medicare fee index, comparing each State’s average fee for primary care services under the Medicaid program under such title to the fee for such services under the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.). (3) A Medicaid fee change index, comparing fees for primary care services under the Medicaid program under such title during the 12-month period preceding the first day of the period described in subparagraph (C)(ii) of section 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), as amended by section 2, to the fees for such services during the 12-month period beginning on such first day.
The bill would authorize Congress to appropriate $200,000 for the study for fiscal year 2026, with any appropriated funds available until spent. This authorization would not itself provide the money.
For purposes of this section, there is authorized to be appropriated $200,000 for fiscal year 2026, to be available until expended.
The bill would express Congress's nonbinding view that providers should follow the American Academy of Pediatrics’ Bright Futures guidelines when providing the referenced early and periodic screening, diagnostic, and treatment services. This section expresses a recommendation rather than imposing a provider requirement.
It is the sense of Congress that health care providers should provide early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act (42 U.S.C. 1396d(r))) in accordance with the guidelines of the American Academy of Pediatrics entitled, Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
The supplied official-actions snapshot, updated September 19, 2026, records introduction in the House and referral to the House Committee on Energy and Commerce on February 18, 2025. It does not establish what happened after those recorded actions.
Source snapshot updated 2026-09-19T23:20:45Z. 2025-02-18: Referred to the House Committee on Energy and Commerce. 2025-02-18: Introduced in House
A closer look
Reviewed version: Introduced in House · 2025-02-18. 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 attached to appropriations was identified in the supplied complete introduced text. This conclusion 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 supplied complete introduced text. This text-only conclusion does not establish formal earmark status or absence in other versions or accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow special exemption, carve-out, or preferential treatment was identified beyond the main policy's provider eligibility and payment rules in the supplied complete introduced text. This conclusion is limited to that version and does not cover other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Sep 19, 2026. How PlainBill uses AI