Federal appropriations package holds primary care payment, workforce wins

Feb. 9, 2026

By David Tully
Vice President, Government Relations

Following a partial federal shutdown, Congress last week passed the Consolidated Appropriations Act (CAA) of 2026, funding most of the government—and including several wins for family medicine physicians and patients.

The AAFP has published a summary of what’s in the law. To unpack that information, I’m sharing this space with my colleague Natalie Williams, senior manager of legislative affairs.

David Tully: Natalie, let’s start with some significant good news regarding the primary care workforce.

Natalie Williams: Right, this is big: The legislation answers a longtime AAFP advocacy priority by reauthorizing the Teaching Health Center Graduate Medical Education (THCGME) program—and doing it through September 2029, an improvement over the more piecemeal actions we’ve seen lately. It also funds community health centers and the National Health Service Corps at higher levels through September of this year.

Tully: That’s an important reinforcement of the primary care workforce pathway. And there’s also a funding increase for THCGME?

Williams: The program is set to receive $250 million for fiscal year 2027 and then $25 million more each of the next two fiscal years.

Another long-term win for clinicians is the CAA’s reauthorization and expansion, through fiscal year 2030, of the Dr. Lorna Breen Health Care Provider Protection Act. On our own and in broad coalition with other medical associations, we’ve strongly endorsed this first and only federal law aimed at preventing suicide, reducing occupational burnout, and addressing mental health conditions and stress among health care professionals. Its extension includes broader grant eligibility to address administrative burden.

Tully: The CAA extends Medicare telehealth flexibilities. What are the terms?

Williams: The extension runs through Dec. 31, 2027, and is in line with our advocacy. We’re obviously pleased by this and will keep pressing to make these Medicare flexibilities permanent.

Beyond that, the law directs HHS (in consultation with stakeholders such as the Academy) to issue guidance on how best to expand access to telehealth services for patients with limited English proficiency, an important step toward patient equity. It borrows language from the SPEAK Act, which the AAFP endorsed.

Tully: What else, in terms of payment?

Williams: The law responds to our advocacy around alternative payment models (APM) in a couple of key ways.

• It reinstates incentive payments for advanced APM participants at 3.1% for the 2026 performance year, which is the 2028 payment year.
• It also freezes the Qualifying Participant threshold.

After last year’s expiration of APM bonuses, this is good news for physician-led value-based care.

The CAA also extends the physician work geographic practice cost index floor of 1.0 through the end of this year, as we’ve called for.

Our advocacy to stem the effects of health care consolidation gets a nod in the law. In a move toward fairer payment across settings that provide the same service, off-campus hospital outpatient departments will have to use a separate NPI from their hospital or other parent facility when billing Medicare.

And it further delays planned decreases to Medicare clinical lab payments, as the Academy and numerous other stakeholders have urged. This action prevents, through the end of 2026, payment cuts of up to 15%.

Tully: What about Medicaid and the Children’s Health Insurance Program (CHIP)?

Williams: The law calls for a streamlined enrollment process for eligible out-of-state clinicians under Medicaidand CHIP, meaning that

• states will be required to implement a process for out-of-state clinicians to enroll in and provide services without screening or enrollment requirements beyond what is necessary to pay them, and
• these clinicians can be enrolled for five years without having to go through the process again.

Tully: The CAA reauthorizes the Preventing Maternal Deaths Act, which expired in 2023. This is another win we’ve sought for a while. What does the law do?

Williams: The most basic thing it does is to make sure maternal mortality review committees keep up their work. That sounds bureaucratic, but there’s real impact. Much of what we know about the maternal health crisis in this country—including the maternal health deserts where family physicians are making a difference—comes from these committees. This is how we know that two-thirds of pregnancy deaths occur during the postpartum year and that 84% of pregnancy-related deaths were preventable. And the CAA pushes funding for this to $100 million annually through 2030.

Under the law, HHS must identify and inform clinicians and stakeholders of best practices for preventing maternal morbidity and mortality, and update that data set at least once every fiscal year. Especially in a policy climate in which federal data has gotten harder to get, that’s good news.

Tully: There’s another piece of legislation in the CAA that the AAFP has endorsed.

Williams: Yes, the CAA contains the PREEMIE Reauthorization Act, which we backed. It authorizes research relating to preterm labor and delivery, and to the care, treatment and outcomes of preterm and low-birthweight infants.

Under this law, HHS must establish an interagency working group to conduct this research and contract with the National Academies of Science, Engineering and Medicine to convene an expert committee to report on the findings.

Tully: What else is good for patients as well as family doctors in the CAA?

Williams: It enacts parts of the Innovation in Pediatric Drugs Act, legislation the AAFP has endorsed, including a mandate that Pediatric Research Equity Act studies of certain new drugs for children are completed.

Another AAFP win related to prescription drugs is that pharmacy benefit managers will have to submit regular reports to sponsors of group health plans about drugs covered by the plan, such as a list of drugs for which a claim was filed and the contracted compensation paid by the plan.

Tully: What’s happening next in Congress?

Williams: There’s more to be done with this year’s budget. This package, signed into law Feb. 3, funds most of the government but not all of it. A separate continuing resolution is funding the Department of Homeland Security for two weeks while Congress continues to negotiate potential reforms to that agency’s spending and activities.

Tully: What about the enhanced premium tax credits for Patient Protection and Affordable Care Act enrollees that expired Dec. 31?

Williams: When H.R. 1 did not extend those credits, we ramped up our push for legislation to fix the problem. Negotiations in Congress seem now to have stalled out along partisan lines, but members can still use our Speak Out tool to let their representatives know what a substantial disruption to patient care this change is already causing.

We’re going to keep calling for an extension. The Academy is part of Keep Americans Covered coalition, a single-issue stakeholder coalition that remains active on this front.