T he Children's Hospitals Graduate Medical Education (CHGME) program provides direct financial support to children's hospitals—those that treat primarily patients below the age of 18—to train medical residents and fellows. The program is administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) and is authorized in Section 340E of the Public Health Service Act (PHSA). CHGME receives annual discretionary appropriations, which are authorized through FY2023. Because the Medicare program is used primarily by people who are over the age of 65, and children's hospitals treat primarily people below the age of 18, children's hospitals have low Medicare patient volume and receive few Medicare GME payments. Prior to the program's inception, advocates argued that the lack of direct federal support for GME in children's hospitals impeded the development of the pediatric workforce because children's hospitals, rather than general hospitals, are more likely to have the patient volume necessary to train pediatric subspecialists. Since the CHGME program began, the size of the pediatric subspecialty workforce has increased. HRSA data show that the program provided financial support to more than 7,100 medical residents and fellows in the 2015-2016 academic year (the last year of final data available). Finally, the program was most recently reauthorized from FY2019 through FY2023 in 2018 in the Dr. Benjy Frances Brooks Children's Hospital GME Support Reauthorization Act of 2018 ( P.L. 115-241 ), which increased the amount of funding authorized and extended the period of the program's authorization of appropriations to FY2023. The law reauthorizes the program appropriations through FY2023 and increases the amount authorized to $325 million, allocating $105 million for Direct Graduate Medical Education Payments (DGME) and $220 million for Indirect Graduate Medical Education Payments (IME). In FY2017, the most recent year of final data available, the program supported training at 58 free-standing children's hospitals located in 29 states, the District of Columbia, and Puerto Rico. Other Sources of GME Funding for Children's Hospitals

CHGME funds are one source of medical residency training support at children's hospitals. Concluding Observations

Appropriations for the CHGME program were reauthorized in 2018 through the end of FY2023. Though the reauthorization did not include substantive changes, policy changes to the program have been included in various policy proposals that would consolidate GME support (e.g., " FY2019 President's Budget Request ").
The Children's Hospitals Graduate Medical Education (CHGME) program provides direct financial support to children's hospitals to train medical residents and fellows. The program is administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) and is authorized in Section 340E of the Public Health Service Act (PHSA). CHGME receives annual discretionary appropriations, and its funding has increased in recent years. The program was funded at $315 million in FY2018 and will receive $325 million in FY2019.
Hospitals typically receive support for graduate medical education (GME) through Medicare, and those payments are provided to hospitals based on their Medicare patient volume. Because the Medicare program is used primarily by people who are over the age of 65, and children's hospitals treat primarily people below the age of 18, children's hospitals have low Medicare patient volume and receive few Medicare GME payments.
Prior to the CHGME program, advocates argued that the lack of direct federal support for GME in children's hospitals impeded the development of the pediatric workforce. Program proponents argued that children's hospitals, rather than general hospitals, are more likely to have the patient volume necessary to train pediatric subspecialists. Since the program was created in 1999, the size of the pediatric subspecialty workforce has increased. The CHGME program supports the training of nearly half of general pediatricians and more than half of all pediatric subspecialists. In the most recent year for which final training data are available (academic year 2016-2017), the program provided financial support to more than 7,100 medical residents and fellows. In FY2017, the program supported training at 58 free-standing children's hospitals located in 29 states, the District of Columbia, and Puerto Rico.
The program's appropriations were reauthorized in 2018 by P.L. 115-241, the Dr. Benjy Frances Brooks Children's Hospital GME Support Reauthorization Act of 2018, which extended the program's authorizations of appropriations until FY2023 and increased the amount authorized to $325 million. Under prior law, the program's authorization had been set to expire at the end of FY2018 and the amount authorized had been $300 million. The reauthorization did not include substantive changes to the program. The President's budget for FY2019 proposed to eliminate funding for this program; instead, it proposed that CHGME funds be combined with other sources of GME support, which would require new legislation.