# Plain Language Summary: Kids' Access to Primary Care Act of 2025

This bill makes it easier and more affordable for children on Medicaid to see primary care doctors by guaranteeing that these doctors get paid at least as much through Medicaid as they would through Medicare. Right now, many states pay primary care doctors significantly less through Medicaid than Medicare does, which can discourage doctors from accepting Medicaid patients. This bill fixes that problem by requiring states to pay family doctors, pediatricians, and internal medicine doctors at Medicare rates when they treat Medicaid patients. The bill also expands this requirement to include obstetricians and gynecologists, nurse practitioners, physician assistants, and certified nurse-midwives who provide primary care services.

The bill goes further by making sure that nurse practitioners, physician assistants, and midwives working in rural health clinics and community health centers also receive adequate payment for primary care. It also requires managed care insurance plans (the HMOs and other insurance companies that many Medicaid patients use) to pay these providers fairly and to prove they're doing so. This matters because if insurance companies don't pay enough, doctors and clinics might stop accepting Medicaid patients, leaving families with fewer places to go for care.

The bill also clarifies that primary care services don't include emergency room visits, so states can't count expensive emergency room care as a substitute for regular doctor visits. Additionally, Congress is expressing its support for pediatricians following the "Bright Futures" guidelines, which are evidence-based recommendations for preventive health screenings and care for children. Finally, the bill requires the federal government to study whether these changes actually help—looking at whether more children enroll in Medicaid, whether more doctors accept Medicaid patients, and how payment rates compare across different states.

Kids’ Access to Primary Care Act of 2025

Schrier, Kim

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 &amp; 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.