NOTES
1http://www.kff.org/kcmu (The Kaiser Commission on Medicaid and the Uninsured, supported by the Kaiser Family Foundation, Washington, DC: 2002)
2MSNBC
News, “Uninsured on the Rise,”
http://msnbc.com, February 10, 2003.
3Jay Greene, “California Laws to Address Physician
Shortages,” American Medical News (Washington, DC: American Medical Association,
December 3, 2001): 18.
4http://www.ncsl.org/programs/insur/medmal.htm
5Massachusetts
Medical Society, The MMS Physician Practice Environment Index Report–March
2002,
http://www.massmed.org. Accessed March
26, 2002.
6http://www.ncsl.org/programs/insur/medmal.htm
7State Budget Update: April 2003 (Denver, CO: Office of Publications, National Conference of State Legislatures, April 2003).
8Health Policy Tracking Service Analysis of 2002-2003 Budget Change (Denver, CO: Office of Publications, National Council of State Legislatures, September 2003).
9National Journal, American Health Line, National Journal’s Daily Briefing (Washington, DC: The Advisory Board Company, May 16, 2003).
10Tim Henderson, Training Nurse Practitioners and Physician Assistants: How Important is State Financing? (Denver, CO: Office of Publications, National Conference of State Legislatures, November 1997).
11Richard A. Cooper, “There’s a Shortage of Specialists. Is Anyone Listening?” Academic Medicine, 22, No. 8 (August 2002): 763.
12The Association of Directors of Geriatric Academic Programs, Geriatric Medicine Training and Practice in the United States at the Beginning of the 21st Century (July 2002).
13Tim Henderson, Practice Location of Physician Graduates: Do States Function as Markets? (Denver, CO: Office of Publications, National Conference of State Legislatures, January 2003).
15Tim Henderson, Practice Location of Physician Graduates: Do States Function as Markets? (Denver, CO: Office of Publications, National Conference of State Legislatures, January 2003).
16Tim Henderson, Medicaid Direct and Indirect Graduate Medical Education Payments: A 50-State Survey (Washington, DC: Association of American Medical Colleges, December 2003).
17Association of American Medical Colleges, 2002, http://www.aamc.org/data/finance.
18Tim
Henderson, Medicaid Direct and Indirect Graduate Medical Education Payments:
A 50-State Survey (Washington, DC: Association of American Medical Colleges,
December 2003).
19Ibid.
21Tim Henderson, Medicaid Direct and Indirect Graduate Medical Education Payments: A 50-State Survey (Washington, DC: Association of American Medical Colleges, December 2003).
22www.aafp.org, American Academy of Family Physicians, State Legislation and Funding for Family Practice Programs, 1995-1996, 1996.
23In general, all residency programs are financed through a mix of patient fees, grants, and medical education reimbursements.
24http://www.cms.gov/medicaid/
25Medicare began “carving out” GME payments from MCO rates effective with the 1997 Balanced Budget Act of Congress.
26Tim Henderson, Medicaid Direct and Indirect Graduate Medical Education Payments: A 50-State Survey (Washington, DC: Association of American Medical Colleges, December 2003).
27Although GME payments under managed care in most States now are carved out from MCO rates, there is often an inadequate accounting of the exact amount of these funds.
28Duplicative
payments refer to reimbursements made more than once for the same service. In
the situation of GME, such payments would include those made to a teaching hospital
for the same GME costs—both as a separate direct payment and as part of
capitation to MCOs that contract with such hospitals.
29Federal Register, Vol. 67, No. 115, Rules and
Regulations, 41023; 41103, June 14, 2002.
30Lynn Barker, telephone conversation with Tim Henderson, OIG, DHHS, Indianapolis, IN, February 10, 2003.
31Tim Henderson, Medicaid Direct and Indirect Graduate Medical Education Payments: A 50-State Survey (Washington, DC: Association of American Medical Colleges, December 2003).
32Utah’s original waiver application also proposed to include pooling Medicaid GME payments.
33Medicaid’s Federal-State matching payments rely on a formula that is tied to State per-capita income. States with per-capita incomes above the national average have a lower Federal matching rate, and those with incomes below the national average have a higher rate. States have a fiscal and political incentive to minimize the amount of their own funds spent on Medicaid and to maximize the amount of Federal matching funds that they draw down under their formulas.
34In 2003, Texas eliminated Medicaid support for GME because of budgetary shortfalls, but observers widely expect the State to consider reinstating some form of GME funding in the near future.
35These dollars were matched with approximately $9.3 million in Federal Medicaid funds for 1 year only. A new assessment of private payers was considered, but was rejected because the assessment could not include self-funded plans. Such plans were excluded because of restrictions under the Federal Employee Retirement Income Security Act (ERISA), which prevents States from regulating the health plans of large employers that self-insure.
36New York is the only other State that supports GME through an all-payer fund.
37Alicia Tyler and other officials with the West Virginia Higher Education Policy Commission, telephone conversation with Tim Henderson, National Conference of State Legislatures, May 12, 2003.
38National Journal, “HMOs: Hospitals Canceling Contracts at ‘Surprising Rate,’ “American Health Line, National Journal’s Daily Briefing (Washington, DC: The Advisory Board Company, July 5, 2000).
39PQE’s funding of primary care resident education in managed care settings was launched in 1996 with a grant from The Pew Charitable Trusts.
40Under phase 1, PQE also awarded 66 partnership grants with support from The Pew Charitable Trusts.
41http://www.pqe.org and Elizabeth March, personal e-mail communication with Tim Henderson, National Conference of State Legislatures, March 11, 2003.
43The Commission is also charged with using State of California census tracts to identify geographic areas where health care professionals are in short supply and where the population has a substantial unmet need for health care.