Lessons Learned From State-Based Efforts to Leverage Medicaid Funds for Graduate Medical Education
Erin P Fraher1, Jacob A Rains2, Thomas J Bacon3
1E.P. Fraher is professor, Department of Family Medicine, University of North Carolina at Chapel Hill, and deputy director for policy, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina.
Summary
States use Medicaid graduate medical education (GME) funding to address physician shortages and expand programs. Improved data and collaboration are needed to track GME investment outcomes and ensure accountability.
Area of Science:
- Health Policy
- Medical Education
- Public Health Funding
Background:
- Medicaid funding for graduate medical education (GME) has significantly increased.
- States possess flexibility in structuring Medicaid GME payments to align with population health objectives.
Purpose of the Study:
- To examine the motivations behind states' use of Medicaid GME funds.
- To analyze the structure of state Medicaid GME payments and advisory bodies.
- To assess the transparency and accountability of Medicaid GME investments in achieving workforce outcomes.
Main Methods:
- Conducted structured interviews with subject matter experts from 10 states.
- Analyzed interview transcripts thematically across six key areas related to Medicaid GME funding.
Main Results:
- Medicaid GME funds are utilized to address physician distribution, support program expansion, and offset funding losses.
- States employ modified state plan amendments and redesigned funding formulas to meet workforce needs.
- Advisory bodies play a role in educating legislators and guiding fund disbursement, though challenges in data systems and accountability metrics persist.
Conclusions:
- States can benefit from sharing best practices regarding Medicaid GME funding strategies.
- Developing learning collaboratives is recommended to facilitate the exchange of strategies for overcoming challenges in GME investment.
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