The Association of American Medical Colleges (AAMC) recently released the report, Medicaid Graduate Medical Education Payments: A 50-State Survey, which updates previous reports on state Medicaid GME policies.
According to the report, Medicaid is the second-largest source of funding for graduate medical education (GME), behind Medicare, as Medicaid programs in most states help offset a portion of GME costs incurred by teaching hospitals and other entities. However, unlike Medicare, the federal government has no explicit guidelines for states on whether or how their Medicaid programs should or could make GME payments. Most states historically have made such payments under their Medicaid fee-for-service (FFS) programs.
The report indicates that as of 2015, 42 states and the District of Columbia (D.C.) provided GME payments under their Medicaid program. The states that did not were Alaska, California, Massachusetts, New Hampshire, North Carolina, North Dakota, Rhode Island, and Wyoming.
The report also states that the amount of payments for Medicaid GME funding is difficult to quantify precisely, in part because teaching programs also may receive Medicaid disproportionate share hospital (DSH) payments, which can be difficult to differentiate from GME payments. However, the report suggests that total Medicaid support for GME nationwide continued to rise last year. Total Medicaid GME payments in 2015 by the 42 states and D.C. were estimated to be $4.26 billion, which was up from $3.87 billion in 2012.
GME payments reflect the following:
- Payments made under Medicaid FFS ($1.35 billion),
- Payments (explicit) made directly to teaching programs under managed care ($1.92 billion)
- Payments (implicit) recognized and included in capitated rates ($213.4 million).
In addition, the report includes results from a survey that asked states whether they linked Medicaid GME payments to a state policy goal of increasing the size of the physician workforce. Thirty-two states reported that they made Medicaid GME payments with the expectation of producing more physicians, which was up from 22 states in 2012.
The AAMC will be discussing these results with its state chapters. The objective is to better equip their representatives when they have GME conversations with their state legislators and policymakers. The AASM will be in contact with the AAMC regarding this issue and will communicate advocacy strategies to our members.