H.R.1433 - Kids’ Access to Primary Care Act of 2025 (119th Congress)
Summary
H.R.1433, the Kids' Access to Primary Care Act of 2025, aims to amend Title XIX of the Social Security Act, focusing on Medicaid. The primary goal is to renew and expand the application of Medicare payment rates to primary care services provided under Medicaid. This includes extending the payment floor to additional providers and improving the targeting of primary care services.
Expected Effects
The Act seeks to ensure that healthcare providers, particularly those specializing in family medicine, internal medicine, pediatrics, and obstetrics/gynecology, receive at least the Medicare payment rate for primary care services offered to Medicaid beneficiaries. It also mandates a study to assess the impact of these changes on enrollment, provider participation, and payment rates.
Potential Benefits
- Increased access to primary care for children enrolled in Medicaid.
- Improved payment rates for primary care providers, potentially incentivizing more providers to accept Medicaid patients.
- Enhanced targeting of primary care services by excluding emergency department services from the definition of primary care.
- A study to monitor the impact of the Act on enrollment, provider participation, and payment rates.
- Ensures managed care entities adhere to payment standards for primary care services.
Potential Disadvantages
- Potential increase in Medicaid costs due to higher payment rates.
- Administrative burden on states to ensure compliance with the new payment requirements.
- Possible unintended consequences from excluding emergency department services from primary care definitions.
- The study mandated by the Act may reveal unforeseen challenges or limitations.
- Increased complexity in Medicaid payment structures.
Most Disadvantaged Areas:
Constitutional Alignment
The bill aligns with the General Welfare Clause (Article I, Section 8) of the U.S. Constitution, as it aims to promote the health and well-being of children through improved access to primary care. By amending Title XIX of the Social Security Act, the bill falls under Congress's power to regulate spending for the general welfare. The Act does not appear to infringe upon any specific individual rights or liberties protected by the Constitution or its amendments.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).