The "Kids Access to Primary Care Act of 2025" aims to improve children's access to primary care by increasing Medicaid payments to primary care providers, including OB/GYNs, and encouraging the use of Bright Futures guidelines.
Kim Schrier
Representative
WA-8
The "Kids Access to Primary Care Act of 2025" aims to improve children's healthcare access by increasing Medicaid payments for primary care services to match Medicare rates, expanding the types of providers eligible for these payments, and mandating compliance from Medicaid managed care plans. It also requires a study on the impact of these changes on enrollment and provider payment rates. Additionally, the Act encourages healthcare providers to utilize the Bright Futures guidelines for pediatric care.
Medicaid Pay Bump for Kid's Primary Care: 'Kids' Access to Primary Care Act of 2025' Boosts Rates and Expands Provider List
The "Kids' Access to Primary Care Act of 2025" aims to make it easier for kids on Medicaid to see a doctor. The core of the bill is pretty straightforward: it boosts the amount Medicaid pays primary care providers to match what Medicare pays. This isn't just for doctors, it includes nurse practitioners, physician assistants, and certified nurse-midwives, plus specialists in obstetrics and gynecology (Section 2). Think of it like this: if a family doctor normally gets $X for a check-up under Medicare, Medicaid in every state will now have to pay at least that much, and potentially more.
Leveling the Payment Playing Field
The law renews and expands a previous rule that bumped up Medicaid payments. Now, it's not just about family doctors and pediatricians. OB/GYNs are in the mix, too. This is important because access to consistent women's healthcare can directly impact children's well-being. The bill also makes sure that clinics outside of big hospitals, like rural health clinics and Federally Qualified Health Centers, get the same payment boost (Section 2).
Real-World Ripple Effects
Imagine a single mom in a rural area. Her local clinic might have struggled to keep doctors because Medicaid payments were too low. This bill could mean that clinic can now afford to hire more staff or retain the providers they have. For that mom, it means less travel time and more appointment slots for her kids. Or consider a family practice in a busy city. Higher Medicaid rates could allow them to accept more Medicaid patients, reducing wait times for everyone.
However, there's a catch. Services provided in a hospital emergency room don't get this pay increase (Section 2). This is likely to encourage families to use regular check-ups and preventative care, rather than relying on the ER for routine issues. The bill also requires managed care organizations (the companies that often run Medicaid plans) to prove they're following the new payment rules. This is important because it aims to ensure the money actually gets to the providers.
Tracking the Impact
Within a year of the law's enactment, the Secretary of Health and Human Services has to do a deep-dive study (Section 3). They'll compare how many kids were enrolled in Medicaid before and after this change, how many providers were participating, and how the payment rates actually changed across different states. This will give us hard data on whether the bill is working as intended. The study will cost $200,000 in 2026. Finally, the bill encourages providers to use the "Bright Futures" guidelines (Section 4) – basically, a best-practices checklist for kids' health, from infancy through adolescence. This promotes consistent, high-quality care across the board.