S. 760 — Kids’ Access to Primary Care Act of 2025

This section renews the Medicaid requirement that state payment rates for primary care services (as defined in section 1902(jj) of the Social Security Act) be at least 100% of the Medicare Part B rate applicable to such services and physician (or the rate using the 2009 Medicare conversion factor if greater, whichever is higher) during a new open-ended period beginning the first month after enactment of the Kids’ Access to Primary Care Act of 2025 (previously applicable to services furnished in 2013-2014 by family medicine, general internal medicine, or pediatric physicians and extended through 2015 via enhanced federal matching payments). It expands eligible providers during the new period to include (1) board-certified physicians in family medicine, general internal medicine, pediatric medicine, or obstetrics/gynecology and their subspecialties (based on self-attestation); (2) advanced practice clinicians supervised by such physicians, nurse practitioners, physician assistants, or certified nurse-midwives working per state law; (3) rural health clinics, federally qualified health centers, or other clinics reimbursed on a physician fee schedule for services by the above providers; and (4) such nurse practitioners, physician assistants, or certified nurse-midwives working per state law (with payments ensuring they receive no less than the Medicare Part B amount). (As background, the primary care payment floor—originally enacted in the Affordable Care Act—increases Medicaid reimbursement to Medicare levels to improve access for low-income beneficiaries served by state Medicaid programs.) The section further (1) excludes primary care services furnished in hospital emergency departments from this payment floor; (2) extends enhanced federal matching payments under section 1905(dd) for the amount by which qualifying payments exceed prior Medicaid rates during the new period; and (3) requires Medicaid managed care contracts to ensure payments to specified providers meet the floor, with documentation provided to states and the Secretary upon request.

This section directs the Secretary of Health and Human Services to conduct a study of the Medicaid program (i.e., title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)), to be completed not later than one year and one month after enactment, that (1) compares child enrollment in state Medicaid plans (or waivers) during the 12-month period preceding the first day of the period described in section 1902(a)(13)(C)(ii) (as amended by section 2) to enrollment during the subsequent 12-month period; (2) makes a similar comparison for the number of health care providers receiving Medicaid payments for primary care services; and (3) compares primary care payment rates across states during the subsequent 12-month period using three specified indexes—a Medicaid fee index (state average fee for primary care services vs. national average), a Medicaid-to-Medicare fee index (state average vs. Medicare fees under title XVIII), and a Medicaid fee change index (pre-period fees vs. subsequent-period fees). This section authorizes $200,000 for FY2026, to remain available until expended.