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Medicaid Primary Care Improvement Act
To facilitate direct primary care arrangements under Medicaid.
Summary
This bill clarifies that States may provide Medicaid assistance through direct primary care arrangements, where individuals receive primary care services from practitioners for a fixed periodic fee. The bill allows this arrangement to be implemented through State Medicaid plans, waivers, or medicaid managed care organizations. The Secretary of Health and Human Services must hold stakeholder meetings and issue guidance to States on implementing these arrangements within one year of enactment. Within two years, the Secretary must report to Congress on the extent States are using direct primary care arrangements and the quality and costs of care provided under such arrangements. The bill does not alter other existing Medicaid requirements regarding cost-sharing and the scope of covered services.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
Actions (2)
- Dec 2, 2025 Read twice and referred to the Committee on Finance. · senate
- Dec 2, 2025 Introduced in Senate
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Full text
IN THE SENATE OF THE UNITED STATES
December 2, 2025
Mrs. Blackburn introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To facilitate direct primary care arrangements under Medicaid.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Medicaid Primary Care Improvement Act”.
SEC. 2. CLARIFYING THAT CERTAIN PAYMENT ARRANGEMENTS ARE ALLOWABLE UNDER THE MEDICAID PROGRAM.
(a) In General.—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), 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.
(b) Definitions.—In this Act:
(1) Direct primary care arrangement.—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.
(2) Medicaid managed care organization.—The term “medicaid managed care organization” 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)).
(3) Secretary.—The term “Secretary” means the Secretary of Health and Human Services.
(c) Guidance.—Not later than 1 year after the date of enactment of this Act, the Secretary shall—
(1) convene at least 1 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 under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(d) Report.—Not later than 2 years after the date of enactment of this Act, the Secretary 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.) through direct primary care arrangements; 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 through a medicaid managed care organization.
(e) Rule of Construction.—Nothing in this section shall be construed to alter statutory requirements applicable to State plans (or waivers of such plans) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), including requirements relating to cost-sharing and requirements relating to the amount, duration, and scope of medical assistance that is required to be made available to individuals who are eligible for such assistance under such a plan or waiver. <all>
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