Press Releases

WASHINGTON — Today, U.S. Representatives Brittany Pettersen (CO-07), Dan Crenshaw (TX-02), Kim Schrier (WA-08), and Lloyd Smucker (PA-11) introduced the Medicaid Primary Care Improvement Act, bipartisan legislation that clarifies state Medicaid programs’ authority to expand healthcare access through direct primary care (DPC). This model allows Medicaid beneficiaries to access primary care services at a flat, monthly fee, improving health outcomes while reducing emergency room visits and unnecessary medical costs.

“As a mom, I know how important it is for families to have access to reliable primary care,” said Congresswoman Pettersen. “When families have a long-term relationship with a primary care physician, they are able to catch illness and health challenges earlier, improve outcomes, and reduce costly emergency room visits. I’m glad to work on this bipartisan solution to break down barriers that prevent Medicaid patients from receiving direct primary care and ensure families can access the care they need.”

“This bill incentivizes a form of healthcare that is better for patients and for the American taxpayer,” said Congressman Crenshaw. “We can address cost and workforce challenges by allowing state Medicaid programs to innovate so that patients can access direct primary physicians. We need every available healthcare provider to improve preventative care and confront the provider shortage that is impacting too many communities across America.”

“As a doctor, I know what a crucial role primary care plays in keeping people healthy, preventing chronic disease, catching medical conditions earlier, and avoiding trips to the emergency department,” said Congresswoman Schrier. “I’m proud to introduce this bipartisan legislation, which will make it clear that Medicaid can participate in direct primary care arrangements that help expand access to primary care and achieve better health outcomes.”

“Direct primary care keeps patients out of the emergency room, improves health outcomes, and will yield savings to the Medicaid program,” said Congressman Smucker. “When state Medicaid programs innovate on behalf of their patients, especially by leveraging value-based care delivery models like direct primary care, patients and taxpayers are the winners. I look forward to working together to advance this legislation.” 

“Direct primary care (DPC) provides a pathway to continuous, comprehensive, coordinated primary care for patients,” said Jen Brull, MD, FAAFP, President, American Academy of Family Physicians. “However, too many physicians face legal and financial obstacles to fully embrace this model. The AAFP supports the Medicaid Primary Care Improvement Act, which will help remove existing barriers to expand affordable access to DPC. Addressing this barrier will help improve access to primary care for some of the nation’s most vulnerable and underserved populations.” 

Background:

The Medicaid Primary Care Improvement Act ensures that states can offer direct primary care arrangements as part of Medicaid without unnecessary federal restrictions. Under this model: 

• Medicaid patients can receive unlimited primary care visits for a flat, monthly fee.
• Doctors can spend more time with patients rather than navigating excessive paperwork.
• States will have flexibility to adopt value-based care models, leading to better health outcomes and lower costs for taxpayers.
  

The bill also requires the Department of Health and Human Services (HHS) to: 

• Issue guidance to states on implementing DPC models under Medicaid.
• Conduct stakeholder meetings with primary care providers, Medicaid agencies, and managed care organizations.
• Submit a report to Congress within two years analyzing the impact of direct primary care arrangements on cost and quality of care.