The Bill to Let Medicaid Patients Join a DPC Practice Is Bipartisan in the House and a Solo Effort in the Senate

Legislation by DPC Insider
#Medicaid#legislation#Congress#bipartisan#rural health#federal policy#access
Sources: Kelly, Blackburn Introduce Bill to Increase Primary Care Access and Lower Costs for Medicaid Recipients in Rural Communities · Crenshaw, Schrier, Smucker, Pettersen Introduce Bipartisan Bill to Expand Access to Direct Primary Care Through Medicaid · Blackburn Introduces Bills to Support and Expand Tennessee's Medicaid Innovation · Can the US Senate Rescue Primary Care? · H.R.1162 – Medicaid Primary Care Improvement Act (119th Congress) · S.3298 – A bill to facilitate direct primary care arrangements under Medicaid (119th Congress)

In March 2024, Representatives Dan Crenshaw (R-TX) and Kim Schrier (D-WA) watched their Medicaid Primary Care Improvement Act clear the House by voice vote. Not a squeaker. Not a party-line fight. A voice vote — both sides saw no reason to object out loud.

Then the Senate didn’t act. The 118th Congress expired. The bill died without a Senate floor vote.

That bill is back. In February 2025, Crenshaw and Schrier reintroduced it as H.R. 1162 in the 119th Congress, joined at introduction by Representatives Lloyd Smucker (R-PA) and Brittany Pettersen (D-CO) — the same two who had cosponsored the version that passed. Four more members have signed on since, putting five Republicans and three Democrats on the House bill. In December 2025, Senator Marsha Blackburn (R-TN) introduced a Senate companion — S.3298 — as part of a three-bill Medicaid package. It has no cosponsors. Senator Mark Kelly (D-AZ) cosponsored Blackburn’s previous-Congress version in December 2024, but has not signed on to this one.

The question for 2026 is whether either chamber moves. A new Congress means starting over, so the House would have to pass the bill again — and the Senate has never brought it to a vote at all.

What the Bill Would Do

The Medicaid Primary Care Improvement Act is narrow by design.

It doesn’t restructure Medicaid, and it doesn’t require any state to do anything. What it does is clarify — explicitly — that nothing in Medicaid law should be read as barring a state from paying for primary care services through a direct primary care arrangement: the model where the sole compensation for defined primary care services is a fixed periodic fee, rather than a bill for each encounter through fee-for-service. The obligations the bill does create fall on the Secretary of Health and Human Services, not on states.

This might sound obvious, but it isn’t. Right now, the patchwork of CMS guidance, state Medicaid rules, and federal statutes creates enough ambiguity that most states haven’t tried. States that have looked at paying for DPC through Medicaid run into the same question: does a flat-fee payment structure actually qualify under existing Medicaid rules? Colorado’s 2026 attempt sidestepped it entirely. HB26-1096 wouldn’t have had Medicaid pay a DPC practice anything — it would have barred the state from denying Medicaid members the ability to buy a DPC membership with their own money, with the member signing an acknowledgment that the provider accepts no Medicaid payment for that care. Even that narrow version didn’t survive: it passed the House 40-22 in February before the Senate Health and Human Services Committee postponed it indefinitely on a 4-3 vote in April.

H.R. 1162 and S.3298 would answer that question with an explicit yes.

Those obligations are specific. Within a year of enactment, the Secretary would have to convene at least one virtual open door meeting with stakeholders — DPC physicians, state Medicaid agencies, Medicaid managed care organizations — and then issue guidance to states on how to implement these arrangements. Within two years, a report to Congress on the quality and cost of care paid for through DPC arrangements in Medicaid managed care. That’s a clarification for states alongside a reporting mandate on the federal side — useful infrastructure for advocates building the case for future expansion.

The Bipartisan Case in the House

The coalition behind H.R. 1162 is worth paying attention to because it isn’t the usual alignment.

Crenshaw (R-TX) is a fiscal conservative whose healthcare advocacy centers on competition and patient choice. Schrier (D-WA) is a pediatrician-turned-congresswoman whose DPC support comes from clinical experience. Smucker (R-PA) and Pettersen (D-CO), the bill’s two other original cosponsors, stretch the group from conservative Pennsylvania to progressive Colorado.

The Senate side is thinner. Blackburn’s name is the only one on S.3298. When she and Kelly introduced the previous version in December 2024, the case they made rested on the rural access gap: rural areas nationally average 39.8 physicians per 100,000 people versus 53.3 in urban areas — a gap that DPC’s lower overhead model could help close if states can pay for it through Medicaid.

Blackburn framed it as a state flexibility issue rather than a federal mandate: “The Medicaid Primary Care Improvement Act would address disproportionate health care coverage in rural areas by providing states with greater flexibility to address primary care challenges within Medicaid populations.”

Kelly’s language at the time captured the access argument: “By expanding care options for patients, this bill will allow providers to meaningfully address health needs and improve preventive care.”

The DPC Coalition put it in cost terms: giving Medicaid beneficiaries access to DPC means “low-income Americans can improve their health with great primary care for a fraction of the cost of the same care delivered in the hospital or ER.”

Why the Senate Is the Harder Chamber

The House proved the politics were workable once: a voice vote in March 2024, in a Congress that has since expired. No recorded tally exists, and the House hasn’t taken up H.R. 1162 since, so the bill would have to clear that chamber again. But the Senate doesn’t move the same way, and several factors are working against quick action.

Legislative bandwidth. The 119th Congress has been focused on implementing and defending the One Big Beautiful Bill Act, including Medicaid provisions that are generating significant advocacy pressure from multiple directions. A targeted DPC access bill competes for floor time against much louder fights.

Medicaid’s structure. Even if Congress clarifies that DPC is authorized, states have to build the administrative infrastructure to pay flat monthly fees rather than per-encounter claims. That’s not a minor lift for Medicaid managed care organizations accustomed to the fee-for-service billing cycle. Guidance from HHS — which the bill would require — helps, but it doesn’t do the implementation work.

The equity design problem. DPC works when patients can reliably pay a monthly membership. For Medicaid beneficiaries on fixed or low incomes, even a $40-$50 monthly fee can be a barrier without a well-designed subsidy structure. The goal isn’t to extend DPC to people who can already afford to pay — it’s to reach the patients for whom rural fee-for-service is actively failing. Getting that design right requires state-level work that federal authorization alone doesn’t solve.

None of these are arguments against the bill. But they explain why voice-vote popularity in the House hasn’t translated to Senate action.

As a February 2026 Medscape analysis of the legislation noted, the political conditions for Senate action are as favorable as they’ve been — bipartisan sponsors, a prior House passage to point to, state-level DPC legislation building a track record — but “legislative bandwidth being consumed by the rollout of the One Big Beautiful Bill Act” remains the core obstacle.

What This Means

If you’re a DPC physician practicing in a rural county, this legislation matters directly to your panel composition. A meaningful share of your surrounding community is likely on Medicaid. Under current rules, those patients either can’t join your practice or do so by paying out of pocket — which limits who you can realistically serve and constrains your panel to the commercially insured working-age population. In many rural counties, that’s a thin demographic to build a practice around.

H.R. 1162 and S.3298 would open a federally sanctioned pathway for states to change that. A physician shortage projected to reach up to 55,200 primary care doctors by 2032 is concentrated precisely in the rural and underserved areas where DPC’s economics are most sustainable — if the payment pathway exists.

The OBBBA established a template: Congress can use federal law to expand who has access to DPC, and the HSA provisions effective January 1, 2026 show the approach works. The Medicaid bill asks for the next step in the same direction. Some of the political infrastructure is in place: a bipartisan House coalition, a prior House passage to point to, a Senate companion filed. What isn’t in place is a Democratic cosponsor in the Senate, or a scheduled vote in either chamber.

What’s left is committee time in both chambers. For DPC physicians and advocates watching this space, the Senate Finance Committee is the room to watch — that’s where S.3298 sits, and where the House-passed version landed when it reached the Senate in 2024.