The House Passed a Medicaid Direct Primary Care Bill by Voice Vote in 2024. Neither 2025 Successor Has Left Committee.

Legislation by DPC Insider — Policy Desk
#medicaid#federal-legislation#congress#dpc-policy#direct-primary-care
Sources: S.3298 - 119th Congress (2025-2026): A bill to facilitate direct primary care arrangements under Medicaid. · H.R.1162 - 119th Congress (2025-2026): Medicaid Primary Care Improvement Act · H.R.3836 - 118th Congress (2023-2024): Medicaid Primary Care Improvement Act · House Report 118-170, Medicaid Primary Care Improvement Act · HB26-1096 CO Medicaid Access to Primary Care Services · Concierge Medical Care Comes To the Middle Class · Qliance healthcare startup cites lender fraud for sudden shutdown as patients are left in the lurch · Direct Primary Care (DPC), Institute for Research on Poverty, University of Wisconsin-Madison · Congressional Bill H.R. 6500 Signed into Law

A bill letting state Medicaid programs buy direct primary care has already passed the House of Representatives. No objection went on the record. H.R. 3836 cleared the chamber on a motion to suspend the rules in March 2024, agreed to by voice vote, and it never became law.

The idea has now been filed in two consecutive Congresses. Two versions are live right now. Neither has left committee.

What the bill would actually authorize

The Medicaid Primary Care Improvement Act does one structural thing. It says a state Medicaid program is authorized to provide primary care services through a direct primary care arrangement, meaning an arrangement where the provider is paid a fixed periodic fee rather than billed encounters.

Read the verb carefully. Authorized, not required. No state has to do anything, no money is appropriated and no existing payment rule is repealed. What the bill hands out is federal permission.

The rest is paperwork, and the paperwork is the interesting part. The Secretary of Health and Human Services would have to hold at least one virtual open-door meeting to take outside input, issue guidance to states on how a state may implement these arrangements, then report back to Congress on how far state programs contract with independent providers and on the cost and quality of care delivered under arrangements offered through Medicaid managed care organizations.

That last clause is the part of the bill that would produce evidence rather than permission.

Two bills, two committees, no floor action

H.R. 1162 is the House version this Congress. Representative Dan Crenshaw filed it on February 10, 2025 with Kim Schrier, Lloyd Smucker and Brittany Pettersen, two Republicans and two Democrats. It went to the Committee on Energy and Commerce and has not come out.

S. 3298 is the Senate version. Senator Marsha Blackburn introduced it on December 2, 2025, and the introduced text records no cosponsors at all. It was read twice and referred to the Committee on Finance, where it has sat since.

Colorado tried the narrow version and killed it anyway

States have not been waiting quietly. Colorado ran its own version this year, and Colorado’s was far smaller than the federal one.

HB26-1096 would have barred the state’s Department of Health Care Policy and Financing from denying a Medicaid member the ability to buy primary care services or enter a direct primary care agreement. Medicaid would not have paid for any of it. The member would sign an acknowledgment that the DPC provider takes no Medicaid payment, that no claim can be submitted for reimbursement and that the member keeps the right to see an enrolled provider instead.

It passed the Colorado House 40 to 22 in February. On April 2 the Senate Health and Human Services Committee postponed it indefinitely on a 4 to 3 vote.

So a bill that spends no Medicaid dollars and only declines to stand between an enrollee and a cash-pay doctor died in a state Senate committee. The federal bill asks for something larger: the authority for the program itself to pay the fee.

The Qliance contract ended without a published result

There is a real-world test, and it is nearly a decade old.

Qliance, a Seattle group that ran flat-fee primary care clinics, took Medicaid patients under a contract with Centene’s Washington Medicaid plan. NPR reported in January 2016 that the contract paid the monthly fee covering primary and preventive care while the insurer covered specialty and emergency services. The company’s own projection at the time was that participants would cost Washington 15 to 20 percent less than traditional Medicaid.

The company did not last long enough to find out. Qliance was serving roughly 35,000 patients across several clinics in 2015 and had shrunk to about 13,000 by early 2017 after losing large employer accounts. The clinics closed abruptly that May, ahead of a June 15 date set for winding the company down, and the company’s chief executive told GeekWire that a lender had made an unauthorized withdrawal of about $200,000 from a company account on May 12.

Read the reported causes honestly. What the coverage describes is a lost employer book and a lender draw. What never arrived is an independent read on the money. A 2019 University of Wisconsin review of the DPC evidence found that Qliance’s own savings analysis had not been independently evaluated or peer reviewed, and that the literature held no independent evaluations of the company’s performance. The projection stayed a projection.

What Changes Tomorrow

Nothing, and that is the useful answer.

Neither federal bill moved this week, so nothing changed at the federal level. What a Medicaid enrollee can actually do with your membership still turns on your state, and worth knowing before you ask: the House committee report on the 2024 bill treats current law as already permitting Medicaid payment for these arrangements. That is part of why the bill reads as a clarification plus a reporting mandate rather than a new benefit. If you run a practice where part of the panel is covered by Medicaid, your operating reality in October is the one you had in September.

The dates worth writing down are short-term. The continuing resolution signed September 2 funds federal agencies through December 11, which makes whatever moves in December the last realistic vehicle of this Congress. The 119th ends in January. If S. 3298 does not get attached to something by then, the bill gets refiled in the 120th, the third consecutive Congress to receive an idea the House already passed without a single recorded objection.

Permission is the cheapest thing Congress can hand out. This one has taken two and a half years and is still in a committee drawer.