WASHINGTON, D.C. – Today, Congressman Dan Crenshaw (TX-02), Congresswoman Kim Schrier (WA-08), Congressman Lloyd Smucker (PA-11), and Congresswoman Brittany Pettersen (CO-07) 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.
“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.”
“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.”
Support from Health Care Organizations
Health care advocates and policy organizations have applauded the introduction of the bill, citing its potential to remove regulatory barriers and improve access to care for lower-income individuals.
Jay Keese, Executive Director of the Direct Primary Care Coalition:
“The Direct Primary Care Coalition applauds Reps. Crenshaw and Schrier for coming together on this bipartisan bill to bring the best possible primary care to Americans with lower incomes. This bill clears old federal regulatory roadblocks and encourages states to give Medicaid beneficiaries the option to choose a DPC practice for their primary care needs rather than seeking routine medical care in the ER. Studies have long shown that individuals who have a lasting relationship with a primary care doctor have far better health outcomes. This common-sense bill potentially saves states millions of dollars by cutting unneeded care delivered in more expensive acute care settings.
Jen Brull, MD, FAAFP, President, American Academy of Family Physicians:
“Direct primary care (DPC) provides a pathway to continuous, comprehensive, coordinated primary care for patients. 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.
Cliff Porter, MD, PhD, Texas Public Policy Foundation:
“Rep. Crenshaw and Rep. Schrier’s imaginative approach to Medicaid offers the opportunity to help those most in need with far better medical care at a fraction of the cost, rather than wasting resources in ineffective programs. Direct Primary Care provides the most important part of healthcare, often delayed or scarce, to prevent and treat chronic disease. This will help make America healthy again.”
Lawson Mansell, Health Policy Analyst, Niskanen Center:
“America's primary care shortage necessitates innovation in care models and state financing. The Medicaid Primary Care Improvement Act will facilitate easier access for Medicaid patients to receive consistent and reliable primary care, optimizing the safety net that Medicaid provides to low-income Americans with the potential to transform the healthcare options available to patients.”
How the Bill Works
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.
Click here to read the full bill text.