Bipartisan Bill Could Bring Reliable, Relationship-Based Primary Care To Medicaid Enrollees

The Medicaid Primary Care Improvement Act, reintroduced this month by Sens. Marsha Blackburn (R‑Tenn.) and Mark Kelly (D‑Ariz.), would allow states to contract directly with direct primary care (DPC) practices — membership-style clinics organized around continuous, relationship-based preventive care. Proponents say the change could give Medicaid enrollees dependable access to personal physicians and reduce reliance on costly, episodic emergency care.

What Direct Primary Care Offers

Direct primary care simplifies the primary care relationship: patients (or a payer such as Medicaid) pay a flat monthly membership fee — commonly cited around $75 — for comprehensive primary care services, including walk-in or same‑day visits. Because many DPC practices do not bill fee‑for‑service insurance for routine visits, clinicians avoid much of the administrative workload that shortens patient visits in traditional settings and can spend more time on prevention, care coordination, and chronic disease management.

Key advantages reported for DPC practices include: very high same‑day availability (survey data indicate roughly 98% of DPC practices offer same‑day appointments), visit times often two to three times longer than typical primary care encounters, and reduced administrative overhead for clinicians. By comparison, the average wait for a conventional primary care appointment is roughly 20 days.

Why Congress Is Considering This Change

Primary care utilization in the United States has fallen in recent years, with primary care visits declining about 6% between 2021 and 2022 and longer-term trends showing larger per‑person reductions in some surveys since 2008. As routine needs shift into emergency departments, specialists and urgent care centers, costs rise and outcomes often worsen because those settings are not designed for continuous prevention or long‑term chronic care.

Supporters argue that letting states contract directly with DPC clinics could rebalance care toward continuous primary care, reducing avoidable emergency visits and hospitalizations and improving health outcomes. Evidence from employer and commercial DPC arrangements suggests potential downstream savings, and lawmakers hope Medicaid could realize comparable benefits.

How The Bill Works

The legislation would clarify federal law so states would not need a Section 1115 Medicaid waiver to contract with DPC practices. Participating states would retain full authority over reimbursement levels and the terms of participation, including how DPC clinics integrate with care coordination, behavioral health, and specialty referrals in their Medicaid programs. The bill is structured as a flexible option for states, not a federal mandate.

For patients: Near‑unlimited access to an identified primary care team, shorter waits, and fewer surprise bills. For clinicians: A sustainable model to serve Medicaid patients without onerous paperwork. For taxpayers: A modest fixed monthly payment could replace some of Medicaid’s most expensive crisis‑driven spending.

Scale, Interest, And Caveats

The DPC sector has grown rapidly: memberships rose about 241% between 2017 and 2021, and more than 2,000 clinics operate nationwide. Several state officials have already expressed interest in piloting DPC contracts under the clarification proposed by this bill.

That said, the approach is not a cure‑all. Critics raise questions about continuity when patients frequently change plans or move between Medicaid and other coverage, oversight and quality measurement in nontraditional payment arrangements, and how care for complex needs (behavioral health, specialty care, social supports) will be integrated. States would need to design contracts carefully to preserve network adequacy, ensure data sharing, and measure outcomes.

The bill previously passed the House unanimously last year; it must clear the Senate and be signed by the president to take effect. If enacted, states could begin contracting with DPC clinics as provider capacity allows, offering a pragmatic, state‑driven pathway to strengthen primary care for Medicaid populations.

Lawson Mansell is a health policy analyst at the Niskanen Center.