Medicaid Primary Care Improvement Act
Legislative Progress
In CommitteeMrs. Blackburn introduced the following bill; which was read twice …
Summary
What This Bill Does
The Medicaid Primary Care Improvement Act clarifies that states can pay for Medicaid primary care through "direct primary care" arrangements, where doctors receive a flat monthly fee per patient instead of billing for each individual service. The bill aims to give states more flexibility in how they deliver primary care to Medicaid beneficiaries while potentially improving care quality and reducing costs.
Who Benefits and How
Direct primary care physicians and medical practices gain access to a new patient population - Medicaid beneficiaries - who they can serve under their preferred payment model. Medicaid managed care organizations can now contract with these providers, expanding their network options. States get more flexibility to experiment with value-based care models that may reduce administrative costs and improve patient outcomes.
Who Bears the Burden and How
The Department of Health and Human Services must convene stakeholder meetings, issue guidance within one year, and submit a report to Congress within two years - adding new administrative workload. Traditional fee-for-service primary care providers may face increased competition from direct primary care practices for Medicaid patients. State Medicaid agencies must navigate new implementation complexities if they choose to adopt these arrangements.
Key Provisions
- Explicitly permits states to provide Medicaid primary care through direct primary care arrangements where providers receive a fixed periodic fee
- Allows Medicaid managed care organizations to contract with direct primary care providers
- Requires HHS to hold stakeholder meetings and issue implementation guidance within 1 year
- Mandates HHS to submit a report to Congress within 2 years analyzing adoption rates and quality/cost outcomes
- Preserves existing Medicaid requirements regarding cost-sharing and scope of medical assistance
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Clarifies that states can provide Medicaid primary care services through direct primary care arrangements, where providers receive a fixed periodic fee instead of fee-for-service payments.
Policy Domains
Legislative Strategy
"Enable alternative payment models in Medicaid by explicitly authorizing direct primary care arrangements, promoting value-based care and potentially reducing costs while maintaining quality."
Likely Beneficiaries
- Direct primary care physicians and practices
- Independent primary care practitioners
- States seeking flexibility in Medicaid payment models
- Medicaid managed care organizations
- Medicaid beneficiaries who may receive more consistent primary care
Likely Burden Bearers
- Secretary of Health and Human Services (reporting and guidance requirements)
- State Medicaid agencies (implementation complexity)
- Traditional fee-for-service primary care providers (competitive pressure)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
An arrangement under which an 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.
Has the meaning given that term in section 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 1396b(m)(1)(A)).
The Secretary of Health and Human Services.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology