The Kids’ Access to Primary Care Act of 2025 would renew the Medicare payment rate floor for primary care services furnished under Medicaid and expand which providers can qualify for that floor. It broadens eligibility to include physician specialties in family medicine, internal medicine, pediatrics, and related subspecialties, as well as advanced practice clinicians (NPs, PAs, CNMs) working under supervision and in certain clinic settings such as rural health clinics and federally qualified health centers.
The bill also tightens targeting of payments and requires managed care contracts to ensure minimum payments, while funding a formal study to compare enrollment, provider counts, and payment rates across states. It concludes with a Sense of Congress urging use of Bright Futures guidelines for preventive pediatric care.
At a Glance
What It Does
Renews the Medicare payment rate floor for Medicaid primary care services at no less than 100% of the Medicare rate, with specific expansion to additional provider types and practice settings.
Who It Affects
Primary care providers (physicians in family medicine, internal medicine, pediatrics and subspecialties), advanced practice clinicians (NPs, PAs, CNMs), and clinics serving Medicaid patients (RHCs, FQHCs). States administer Medicaid and will implement the new payment floor.
Why It Matters
Sets a guaranteed, Medicare-aligned floor for Medicaid primary care payments and broadens who can receive it, aiming to improve access for children and stabilize primary care delivery in undercompensated settings.
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What This Bill Actually Does
The bill amends the Social Security Act to renew a floor under Medicaid that ensures primary care services are paid at rates at least equal to Medicare’s rate. It expands who can qualify for the floor by including physicians with primary care designations (family medicine, internal medicine, pediatrics and related subspecialties) and by allowing advanced practice clinicians (NPs, PAs, CNMs) to receive the floor under supervision or state-law-based arrangements.
It also extends the floor to rural health clinics and federally qualified health centers when they bill for primary care services, and to scenarios where non-physician clinicians are paid under supervision or under standard fee arrangements that mimic physician payments. The bill makes targeted changes to exclude certain emergency department services from the floor and aligns payment determinations with the current Medicare framework, including an effective date tied to enactment.
It also requires managed care arrangements to ensure that payments to primary care providers meet set minimums and adds documentation requirements to verify compliance. In addition to the payment provisions, the bill authorizes a study to compare Medicaid enrollment, provider counts, and payment rates across states, and it includes a Sense of Congress favoring Bright Futures guidelines for pediatric preventive services.
Finally, the legislation authorizes $200,000 for a study in fiscal year 2026, to be used for report generation and data collection. This package is designed to strengthen pediatric access to primary care through steadier, Medicare-level funding and broader provider participation, while maintaining oversight and policy evaluation.
The Five Things You Need to Know
The bill renews the Medicare payment rate floor for Medicaid primary care at not less than 100% of the Medicare rate.
It expands eligible providers to include physicians with primary care designations and certified advanced practice clinicians.
Rural Health Clinics and Federally Qualified Health Centers are explicitly covered for the floor.
Managed care contracts must ensure minimum payments and document compliance for providers under the floor.
A formal study, funded at $200,000 for FY2026, will map enrollment, provider counts, and payment rates across states.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short Title
This act may be cited as the Kids’ Access to Primary Care Act of 2025. It establishes the naming convention for the bill and sets the stage for the substantive provisions to follow.
Renewal of payment floor for primary care; additional providers
Section 2 amends section 1902(a)(13) to replace the prior subparagraph with a new requirement: primary care payments must be not less than 100% of the Medicare rate, and not less than the rate that would apply if the conversion factor rules from Medicare Part B were applied. This applies to physicians with designated primary care specialties and, beginning after enactment, to a broader set of providers (including those self-attesting board-certification or subspecialty qualifications, and advanced practice clinicians supervised under state law). The section also covers rural health clinics and FQHCs, and adds conditions for nurse practitioners, physician assistants, and certified nurse-midwives to receive payments at levels comparable to those providers would receive under Part B when providing primary care services.
Improved targeting of primary care
Section 2(b) tightens the definition of who counts as primary care for payment purposes and clarifies exclusions, such as certain emergency department services. It restructures the payment framework to ensure that primary care payments reflect actual service delivery, while preserving safeguards around appropriate settings and supervision. The date of applicability aligns with the first day of the period described for 1902(a)(13).
Ensuring payment by managed care entities
Section 2(c) expands the requirement for managed care contracts to ensure that payments to designated primary care providers meet minimum levels. It adds new subclauses to guarantee that contracts can substantiate compliance, require documentation, and allow for payment arrangements (including capitation or value-based models) that satisfy the minimum payment standard for primary care services.
Study
Section 3 authorizes a study within roughly 14 months of enactment to compare (a) Medicaid enrollment in the relevant state plans, (b) the number of providers receiving primary care payments, and (c) payment rates across states using specific Medicaid-to-Medicare indices. The study includes a defined appropriation of $200,000 for FY2026 and directs that results be reported after data collection across states.
Bright Futures guideline guidance
Section 4 states the Sense of Congress that providers should follow Bright Futures guidelines for early periodic screening, diagnostic, and treatment services in pediatric care, aligning preventive services with established pediatric supervision guidelines.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Pediatricians, family medicine and internal medicine physicians who meet board-certification or state-attestation criteria and provide primary care to Medicaid patients, gaining payment parity with Medicare for eligible services.
- Advanced practice clinicians (nurse practitioners, physician assistants, and certified nurse-midwives) practicing primary care, especially where supervision arrangements meet statutory criteria.
- Rural Health Clinics and Federally Qualified Health Centers serving Medicaid patients, receiving higher, Medicare-aligned reimbursement for primary care services.
- Children enrolled in Medicaid, who benefit from more predictable and potentially higher primary care payments that support access to timely care.
- State Medicaid agencies and Medicaid programs that implement the payment floor and related provider requirements, potentially improving network stability and payment uniformity.
Who Bears the Cost
- State Medicaid programs that may face higher ongoing payments for primary care services under the floor.
- Managed care organizations (MCOs) burdened with ensuring minimum payments and maintaining documentation for compliance.
- Providers may incur costs related to attestation and ongoing credentialing for board-certification or subspecialty qualifications.
- The federal government bears a one-time study cost of $200,000 for FY2026 to evaluate cross-state effects and provider access.
Key Issues
The Core Tension
The central tension is balancing higher, Medicare-aligned payments to broaden primary care access with Medicaid’s budgetary constraints and administrative burden. Expanding eligibility to non-physician clinicians and clinic types improves access potential but increases costs and oversight complexity, raising questions about sustainment, oversight, and how to measure success.
The bill’s main policy lever—raising the payment floor for Medicaid primary care to Medicare-like rates—inevitably increases short-term Medicaid expenditures. While the expanded provider groups and settings improve access prospects, states that administer Medicaid will need to bear higher payments and associated administrative costs, particularly for supervision arrangements and documentation in managed care contracts.
The study in Section 3 is a critical evaluation tool, but its effectiveness depends on robust data collection across states, which can be uneven. In addition, the reliance on attestation of board-certification and the inclusion of various clinician types raise questions about credentialing standards, scope of practice, and monitoring.
The Bright Futures guidance in Section 4 aligns pediatric care with recognized standards, but its implementation will require coordination with state guidelines and payer policies.
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