The White House tried to zero out the program that trains half the nation's pediatricians

Medicare is the country's largest funder of physician training, but it was built to pay hospitals based on how many Medicare patients they treat — and Medicare beneficiaries are, by definition, people over 65 or with a qualifying disability.▸ Children's hospitals don't have those patients. A freestanding children's hospital can run a full pediatric residency program and receive almost nothing from Medicare's graduate medical education (GME) payments for it. Congress patched that gap in 1999 with a separate, discretionary program: the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. It has never been funded like Medicare's version, and this year Washington argued openly about whether to fund it at all.

CHGME pays 59 freestanding children's hospitals — about 1% of all U.S. hospitals — to train resident physicians and dentists, using a Medicare-style formula (a per-resident amount times a hospital's funded FTE count, plus an indirect-cost add-on) that Congress modeled directly on Medicare's GME payment system.▸ But Medicare GME is mandatory spending, paid automatically out of the Part A Trust Fund. CHGME is discretionary — Congress has to appropriate it fresh every year, and its own authorizing statute has not been renewed since authorizations lapsed after FY2023, according to the Congressional Research Service. Congress has kept funding it anyway, but slowly: $375 million in FY2022, $385 million in FY2023, then flat at $390 million through FY2024 and FY2025, before rising $5 million to $395 million for FY2026.

The flat years weren't an accident.▸ The Administration's FY2026 budget request — filed under a proposed restructuring of HHS into an "Administration for a Healthy America" — asked Congress to eliminate CHGME entirely and provide no funding for FY2026, per the Congressional Research Service's reading of that budget justification. Congress didn't go along with it: the Further Consolidated Appropriations Act, 2026 (P.L. 119-75), signed Feb. 3, 2026, funded the program at $395 million — a small increase, not a cut. Now a 21-organization coalition, including the American Hospital Association, the Children's Hospital Association, the American Academy of Pediatrics, the Association of American Medical Colleges and the American Medical Association, is asking House and Senate appropriators for $1.02 billion in FY2027 — more than double the level the White House tried to zero out a year earlier.

The coalition's case rests on a specific number: what CHGME pays per resident versus what Medicare pays.▸ A 2022 analysis by Dobson DaVanzo & Associates, commissioned by the Children's Hospital Association and cited in the CRS's 2025 review of federal GME spending, put the average CHGME per-resident payment at $79,813 in FY2022, against an average Medicare GME per-resident payment of $156,128 the same year — CHGME pays about 51 cents for every training dollar Medicare pays elsewhere. The same coalition's 2025 letter to appropriators puts it more simply: CHGME per-resident funding runs "about one-half" of what other federal training programs pay.

That gap exists despite the volume of training the program supports.▸ Across the 59 CHGME hospitals, HRSA's own FY2025 budget justification — cited in the same CRS report — counts 15,860 individual medical residents, fellows and dentistry trainees during academic year 2022–2023, spread across five specialty categories. That figure isn't the same as the smaller, formula-weighted "full-time-equivalent" count HRSA uses to cap payments (8,390 FTE slots across the same hospitals) — CHGME funds partial time for many rotators, so the headcount of people who train there runs well above the payment-formula FTE count.

The coalition argues that volume is exactly why the per-resident gap matters for children specifically.▸ Their letters say CHGME-funded hospitals train more than 55% of the nation's pediatricians and pediatric subspecialists, more than half of the country's developmental-behavioral pediatricians, and over 40% of child and adolescent psychiatrists — all funded through a program that represents just 1.7% of total federal GME spending, according to the same letter.

Appropriation figures are federal fiscal years as enacted (FY2022–FY2026) or requested (FY2027, not yet enacted at publication). The $79,813 vs. $156,128 per-resident comparison is FY2022 data from a Children's Hospital Association-commissioned study, the most recent per-resident comparison found in Congressional Research Service reporting; trainee counts are academic year 2022–2023, the most recent full breakdown in HRSA's public budget justification.