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The Affordable Care Act (ACA) raised Medicaid fees for primary care physicians to Medicare levels in 2013 and 2014, but most states now have returned to lower fee levels. This study examines the impact of these fee changes on appointment availability for new Medicaid patients. Data was from an audit study, in which trained staff requested the earliest appointment available from randomly selected primary care physicians in 10 states. The four states with large increases in Medicaid fees—Illinois, New Jersey, Pennsylvania, and Texas—all experienced substantial increases in appointment availability when Medicaid fees increased; New Jersey and Texas also experienced substantial decreases in appointment availability when Medicaid fees decreased.