Medicaid opens door to cheaper primary care—but at what cost?
S. 3298 — Medicaid Primary Care Improvement Act · Filed by Marsha Blackburn (R-TN) · Introduced Dec 2, 2025 · Referred to committee
Your members of Congress
Enter a ZIP to see where your representative and both senators stood on this bill.
Looked up on this device — your ZIP is never stored on our servers.
What it does
This bill clarifies that states can pay primary care doctors through direct primary care arrangements—where patients pay a fixed monthly fee for unlimited primary care services—and allows Medicaid to reimburse these fees. The bill requires HHS to issue guidance to states on how to set up these arrangements and report back on whether states are using them and whether they improve quality or reduce costs.
Why we flagged it
The bill's core function is to explicitly permit a specific payment arrangement (direct primary care) within Medicaid, removing regulatory ambiguity. It is not a major structural reform but a clarification that enables state experimentation with an alternative care model.
What the text implies
- States may use direct primary care arrangements to carve out primary care from comprehensive Medicaid benefits, potentially leaving patients responsible for specialist referrals, diagnostics, or preventive services not covered under the fixed fee.
- The bill's 'sole compensation is a fixed periodic fee' language may incentivize providers to minimize referrals and testing to protect margins, creating a financial conflict of interest in care decisions.
The full analysis lists 5 implications of this text.
Who stands to gain
independent primary care physicians and practices; Medicaid managed care organizations (cost reduction); health IT vendors (direct primary care platforms)