December 2, 2025
Mrs. Blackburn introduced the following bill; which was read twice and referred to the Committee on Finance
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.