The Future of Medicaid-Funded Graduate Medical Education as the Health Care System Shifts (2015-16)

Investigators: Erin P. Fraher PhD MPP and Julie Spero MSPH

Background: While Medicare is the dominant funding source for Graduate Medical Education (GME) in the United States, Medicaid investments in GME totaled nearly $4 billion in 2012.  Medicaid GME dollars are attractive to states because they can be matched by federal dollars, thereby increasing the total dollars available to train the future physician workforce.  The vast majority of states (40) make GME payments under Medicaid fee-for-service (FFS) programs, but in 36 states GME payments are also made under risk-based Medicaid managed care organizations (MCOs). As the nation moves from FFS to risk- and value-based payment models, there will be increasing interest at the state (and federal level) in understanding how to leverage Medicaid funds to shape the specialty and geographic distribution of the workforce needed to staff new models of care.

Study aims: This project will survey state Medicaid offices and workforce stakeholders to understand how states are reforming GME, including:

  • How they are shifting GME payment structures away from FFS payments attached to individual claims to capitated, value-based or other types of payments
  • Whether they are targeting Medicaid funds toward specific specialties and geographies (rural, HPSAs, etc)
  • If they are making changes in who receives GME training dollars (i.e. are they shifting payments from hospitals to ambulatory settings?)
  • Whether there are any mechanisms in place to track the return on investment for Medicaid dollars spent on GME
  • If non-physician providers such as Nurse Practitioners, Certified Nurse Midwives and Physician Assistants are eligible for state Medicaid GME funds
  • If Medicaid dollars are supporting innovations in training or practice such as implementation of population health approaches and team-based models of care.


Alignment with BHW priorities. Findings from this project will serve as a resource for states wishing to reform GME payments under value-based models of care. A similar project completed in 2012 (by the same investigators on this project) about Medicare funded GME has been of tremendous interest to states, the federal government, the Institute of Medicine (IOM) and other stakeholders to understand how state innovations in GME reform can serve as best practices and lessons learned (see


Project Products: 

Research Briefs