Kids’ Access to Primary Care Act of 2025
HB1433, titled the Kids’ Access to Primary Care Act of 2025, would renew and expand a Medicaid payment floor for primary care services so that Medicaid payments for certain primary care services are generally no less than 100 percent of the Medicare payment rate, or in some cases a higher Medicare-based amount tied to the 2009 conversion factor. The bill is aimed at increasing reimbursement for primary care and broadening the categories of providers and settings covered, including certain physicians in family medicine, internal medicine, pediatrics, and obstetrics and gynecology, as well as advanced practice clinicians, nurse practitioners, physician assistants, certified nurse-midwives, rural health clinics, federally qualified health centers, and other clinics that pay on a physician fee schedule.
The bill also updates Medicaid managed care rules to require contracts to ensure these higher primary care payments are passed through and documented, including in capitation and value-based payment arrangements. It narrows the definition of primary care services for this payment floor by excluding services furnished in hospital emergency departments. In addition, it directs the Secretary of Health and Human Services to conduct a study on changes in child enrollment, provider participation, and state-by-state payment rates after implementation, and it includes a sense of Congress encouraging use of the American Academy of Pediatrics’ Bright Futures guidelines for pediatric screening and preventive care.
If enacted, the bill would amend Title XIX of the Social Security Act, changing Medicaid payment rules for primary care and related managed care contracting requirements. It would extend a Medicare-linked payment floor that previously applied only to a limited period and set of providers, while also adding new provider categories and clarifying how payments must be handled through managed care organizations. The bill would affect state Medicaid agencies, Medicaid managed care plans, primary care physicians, advanced practice clinicians, community health centers, rural health clinics, and other providers furnishing primary care services to Medicaid beneficiaries.
The bill appears to have a broadly supportive framing, reflected in its bipartisan and cross-party list of House sponsors and its child-access-focused title. The text and accompanying context suggest the measure is intended to strengthen access to primary care for children and Medicaid enrollees by improving provider reimbursement and encouraging participation. No committee debate or recorded votes were provided, so there is no evidence in the supplied materials of formal opposition or amendment activity.
The main policy issues embedded in the bill are how far to extend the Medicaid payment floor, which provider types should qualify, and how to verify that managed care entities actually pass through the required payment levels. The inclusion of advanced practice clinicians, nurse practitioners, physician assistants, certified nurse-midwives, and clinics may be supported by access advocates but could raise concerns among payers or states about administrative complexity and cost. Another likely point of contention is the exclusion of emergency department services from the primary care definition, as well as the requirement for physician self-attestation of board certification and the study’s focus on measuring effects on child enrollment and provider participation.