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HR 1433
Recent Bills/HR 1433

Kids’ Access to Primary Care Act of 2025

IntroducedFebruary 18, 2025
In Senate10 months ago
Intro
House
Senate
Pres
Reported to Senate
HealthGovernment studies and investigationsHealth promotion and preventive careChild healthHealth personnelMedicaidMedical tests and diagnostic methodsMedicareNursingWomen's health
Why This Matters

This bill renews a rule that Medicaid must pay primary care services at least at Medicare rates and expands the types of providers covered. It also requires managed care plans to follow the rule and orders a study on its effects.

Who this affects
Children covered by Medicaid · Doctors · Nurses · Clinics
What changes is this bill making?
  1. 1Requires Medicaid to pay for primary care services at least 100 percent of the Medicare Part B rate or the higher 2009-based rate.
  2. 2Extends the payment floor beyond 2015 and applies it from the first full month after enactment.
  3. 3Adds providers eligible for the higher rates: board-certified obstetricians and gynecologists, family medicine subspecialists, internal medicine subspecialists, pediatric subspecialists, advanced practice clinicians working under supervision, nurse practitioners, physician assistants, certified nurse-midwives, rural health clinics, Federally-qualified health centers (FQHC), and similar clinics.
  4. 4Excludes services provided in a hospital emergency department (ED) from the primary care definition.
  5. 5Requires Medicaid managed care contracts to ensure payments meet the floor, to document compliance, and to allow review by states and HHS (Department of Health and Human Services).
  6. 6Directs the Secretary of HHS to study child enrollment, provider participation, and payment rates for primary care in Medicaid, comparing fees across states using specified indexes.
  7. 7States a sense of Congress that providers should follow the American Academy of Pediatrics’ “Bright Futures” guidelines for child health services.
Read the detailed summary

Kids' Access to Primary Care Act of 2025This 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.

Read full document
Bill Progress3 of 4
Bills must pass the House, Senate, and be signed by the President to become law.
Intro
House
Senate
Pres
IntroducedFeb 18, 2025
Sponsors
See all 12 sponsors
House
SenateCurrent

Reported to Senate

President

The President

Donald Trump
President
Awaiting Vote
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