State-Based Approaches to Leveraging Medicaid-Funded Graduate Medical Education

Principal Investigators: Erin Fraher, PhD, MPP; Jacob A. Rains MPH; Thomas J. Bacon DrPH; Julie Spero MSPH; Emily Hawes PharmD, BCPS, CPP

Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have considerable flexibility in designing Medicaid GME payments to address population health needs. The goal of this study was to use states as “policy laboratories” to understand states’ impetus for using Medicaid funds for GME, the structure of their investments, the composition and charge of advisory bodies that guide these investments, and the degree of transparency and accountability in place to track whether Medicaid GME investments achieved desired workforce outcomes. Two rounds of structured interviews were conducted in 2015-2016 and 2019-2020 with key stakeholders from 10 states. Interview transcripts were analyzed and coded in six thematic areas: impetus for change, payment, advisory bodies, transparency, accountability, and challenges. Findings from this study can inform individual state efforts and guide federal policy makers interested in convening learning collaboratives to share best practices and strategies to address common challenges encountered by states in designing Medicaid GME to meet their workforce needs.

• Fraher E, Rains J, Bacon T, Spero J, Hawes E. 2024 February 27. Lessons Learned from State-Based Efforts to Leverage Medicaid Funds for Graduate Medical Education. Academic Medicine.

• Fraher E, Rains J, Bacon T, Spero J, Hawes E. Lessons Learned from State Efforts to Leverage Medicaid Funds for Graduate Medical Education. Research Brief. 2023 October. Carolina Health Workforce Research Center. The University of North Carolina at Chapel Hill.
• Fraher E, Spero J, Bacon T. State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education. Carolina Health Workforce Research Center. Policy Brief. January 2017

• Fraher E, Rains J, Bacon T, Spero J, Hawes E. 2024 January 23. Lessons Learned from State Efforts to Leverage Medicaid Funds for Graduate Medical Education. Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, UNC-CH.

• Fraher E, Rodefeld L, Hawes E. 2024 June 18. Lessons Learned from State Efforts to Leverage Medicaid Funds and State Appropriations to Develop and Sustain GME Programs. Presentation to Medicaid Medical Directors. Virtual.
• Fraher, E. Lessons Learned from States Leveraging Medicaid Funds to Support Graduate Medical Education. NCSL Medicaid GME Webinar. May 12, 2023
• Fraher E. State-Based GME Reform: Lessons Learned from State Policy Laboratories. GME Initiative, November 2, 2021.
• Fraher E. 2019 March 20. A Copernican Revolution in Graduate Medical Education: Putting Patients’ Health Care Needs at the Center of GME Discussions. Robert Graham Center Primary Care Forum.