Introduction

Health care provider shortages create challenges for patients and plans nationwide. These shortages increase wait times for patients and create network challenges for plans. The difficulties are compounded by new, more rigorous access standards for managed care, inadequate capitation payments, looming cuts to federal funding from the recent reconciliation package, and recent guidance that the Centers for Medicare & Medicaid Services (CMS) will not extend or approve 1115 workforce development waivers.^[1] These headwinds combine to form a looming crisis for the Medicaid and CHIP programs. Federal and state actors need to start now to build and retain the safety net workforce necessary to meet patient needs.

The current provider shortage is expected to worsen over the next decade, with the most acute scarcities among primary care physicians^[2] and behavioral health providers.^[3] The uneven geographic distribution of clinicians makes these challenges even greater for rural and frontier areas.^[4]

In managed care, the predominant payment system in Medicaid,^[5] new wait time standards in Medicaid will take effect in July 2027, including a maximum of 15 business days for primary care and OB/GYN appointments, and 10 business days for behavioral health appointments.^[6]

However, providers are less likely to accept new Medicaid patients due to the program’s low payment rates and administrative burdens.^[7] Plans seeking to increase provider payments are often limited by low capitation rates paid by state agencies coupled with rising drug costs and utilization.

ACAP compiled this fact sheet to highlight innovative methods our plans have developed for their own communities and to provide Insights for future policy development. ACAP is ready to work with federal policymakers on solutions to meet the upcoming workforce challenges.

 

Safety Net Health Plans and Training Initiatives

Safety Net Health Plans (SNHP) are mission-driven, not-for-profit organizations with deep roots in the communities they serve. SNHPs are dedicated to meeting the unique needs of their communities with equitable, affordable, and high-quality care. More than 30 million individuals in Medicaid, Marketplace, and Medicare D-SNP plans are covered by SNHPs that are members of ACAP.

Many Safety Net Health Plans are nurturing the provider pipeline in their own communities by partnering with academic institutions to launch career pathway programs.

• Kern Family Health Care (Calif.) has committed $10 million to the Healthcare Workforce Expansion Initiative, an effort aimed at boosting the local health care workforce. The program enhances the training of nursing and medical professionals through partnerships with contracted health care providers and local educational institutions.

The funding, disbursed between 2023 and 2025, supports nine educational entities and providers working collaboratively to expand nursing and residency programs, increasing the health care workforce in Kern County. Local hospitals will concentrate on expanding Internal Medicine and Specialty Care Residency Programs, while educational institutions will introduce a Doctor of Nursing Practice (DNP) program and community colleges will launch an Associate Degree in Nursing Program.

• Similarly, Vaya Health in North Carolina launched a two-year program funded by a Dogwood Health Trust grant^[8] to strengthen the behavioral health workforce. The initiative includes $5,000 stipend-based internships for students in behavioral health and social work, offered in collaboration with Western Carolina University.
• In Arizona, with support from private philanthropies, Banner Health integrated workforce pipelines under Arizona’s Medicaid Workforce development framework, including K-12 engagement through school-based career technical education groups and heath care camps.^[9] These initiatives build early interest in health care among students of diverse backgrounds. Additionally, Banner Health’s Career Pathways program, launched in 2022 with a $1.2 million grant from Maricopa County’s Employer Services Initiative,^[10] helps address workforce shortages by equipping current employees to transition into health and allied health roles. The program supports workers across the Banner Health System with tools, training, and financial assistance to move into careers such as Radiology Technologist, Surgical Technologist, and Certified Nursing Assistant.

 

Direct Assistance

Grants and financial assistance programs for providers form the backbone of many SNHP workforce development strategies, supporting provider recruitment and reducing attrition.

• In 2024, CareOregon invested more than $5.9 million in grants to 28 organizations across the state, supporting behavioral health workforce development, substance use treatment and education infrastructure.^[11] The grants provide staffing support, training, and programming expansion for providers serving Medicaid beneficiaries. Some grants funded capacity expansion at addiction recovery centers. Others underwrote a Community Health Worker certification program, and new scholarship and faculty positions in nursing.
• CenCal Health, in Santa Barbara, Calif., committed $6 million to workforce development through its Medi-Cal Capacity, Access and Workforce Development Grant Program for primary care, and behavioral health and specialty care services.^[12] Eligible applicants include Federally Qualified Health Centers, private provider practices, and local collaboratives, reflecting CenCal Health’s emphasis on building and expanding sustainable workforce partnerships.
• CalOptima Health (Calif.) awarded nearly $30 million in grants in 2024 to expand Orange County’s provider workforce as part of its ongoing $50 million Provider Workforce Development Initiative. The grants went to seven educational institutions that train nurses, physician assistants and others, and six organizations that focus on behavioral health workforce development. The goal of the grants is to ease workforce shortages, boost training and education, and improve access to care for Medi-Cal members.^[13]
• To help extend provider capacity and meet patient needs, Inland Empire Health Plan (IEHP) in California piloted a Provider Medical Interpretation program, offering qualification in bilingual medical interpretation and training to providers and administrative staff. The initiative was aimed at improving patient-provider communication and meeting linguistic access needs across its provider network. 55 individuals completed the program and 18 achieved qualified interpreter requirements. The pilot has concluded, and the plan is not accepting new participants currently.^[14]
• Kern Family Health Care’s $3 million Provider Recruitment and Retention Grant will help enhance access to primary care, specialty care, and behavioral health services. This grant will support 20 Kern County providers across a large and mostly rural region, and aims to expand medical services, increase provider capacity, and improve appointment availability, ensuring better access to care for all of Kern County.

 

Tuition Aid

Through scholarship programs, plans are working to eliminate financial barriers to health care education.

• A. Care’s flagship Elevating the Safety Net initiative represents a $255 million multi-pronged investment to bolster the primary care workforce serving in the Los Angeles County safety net. The initiative includes eight annual full-ride medical scholarships for students at the David Geffen School of Medicine at UCLA and the Charles R. Drew University of Medicine and Science, $5,000 monthly loan repayments for physicians who commit to three years in safety net settings, and $125,000 salary subsidies to incentivize practice in high-need clinics.^[15],[16] The initiative has already awarded 64 full medical school scholarships and includes a multilingual caregiver training program offering CPR, infection control, and first aid in six languages.
• Kern Family Health Care supplemented its training investments with scholarship programs at CSU Bakersfield, Bakersfield College, Cerro Coso College, and Taft College funding ten nursing, two MSW, four Public Health, and eighteen students enrolled in health care studies annually. These scholarships are designed to help underrepresented students’ complete degrees and stay in the local workforce. Additionally, Kern is funding a Doctor of Nursing Practice (DNP) program to meet the national shift toward doctorate-level education for nurse practitioners and to ensure the availability of qualified clinical faculty.
• Since its founding, AlohaCare (Hawaii) has awarded approximately $400,000 in educational scholarships to students pursuing degrees in health and social care, directly investing in local workforce development in rural and underserved areas in the state of Hawai’i. AlohaCare’s scholarship program creates structured educational opportunities that support long-term retention and upward mobility within the Medicaid and safety net workforce for the island community.
• Cook County Health’s Provident Scholarship Fund supports students from or those committed to serving underrepresented communities. The goal of this program is to remove barriers for students from communities that have faced historical challenges to their education, economic opportunities, transportation, food, or medical care. The Health Professionals Scholarship provides scholarships for medical students and graduate students in health-related academic programs, and the Allied Health Scholarship offers scholarships for students training in nursing, respiratory therapy, radiology, EMT, and behavioral health programs.^[17],[18] Funding for this scholarship comes from the Cook County Health Foundation, the Cook County President’s office and CountyCare (IL) – Cook County Health’s Medicaid managed care plan.
• Each year, ACAP’s Sylvia B. Kelly Medical Scholarship for Health Equity provides $25,000 towards tuition for a fourth-year medical student with a demonstrated interest in reducing Black maternal mortality.^[19]

 

Community-Based Investment

SNHPs are embedding workforce strategies in broader efforts to improve social conditions and build provider-community trust.

• Amida Care developed the Consumer Workforce Initiative with $200,000 in funding from the New York City Council in 2016. This program trains peer workers—many of whom are living with HIV/AIDS or complex conditions—and supports their transition into full-time, living wage jobs. Amida Care’s Workforce Initiative Network offers free peer workforce training to health plan members, helping them leverage lived experience to enter roles in health navigation and outreach. In collaboration with Housing Works and ASCNYC, the plan offers multi-week training cohorts multiple times a year, preparing participants for employment in community health support roles. Its research has shown that engagement with peers helps members lower their viral load, underscoring the program’s positive impact on health outcomes.
• UPMC for You (Pa.) is meeting community workforce needs by expanding health care career development opportunities for its members and communities. Its Freedom House 2.0 program — a six-week training program that provides the foundational knowledge necessary to become a medical assistant, patient care technician, or community health worker — has graduated over 200 students since 2021.^[20] New partnerships with Partner4Work and UPMC Senior Communities are investing over $1.2 million in paid apprenticeships and support services, graduating its first class of Certified Nurse Assistants in 2023.^[21]
• In collaboration with its Provider Advisory Committee, Vaya Health used its grant funding from Dogwood Health Trust to hire a full-time Workforce Development Coordinator whose sole focus is to help small providers recruit and retain staff, using updated recruitment pipelines and modernized retention strategies.^[22] The grant funds one full-time staff position to coordinate with providers and community partners to address workforce gaps, and also supports paid clinical internships and provider training on recruiting and engaging Peer Support and Direct Support Professionals. This tailored approach is crucial to rural North Carolina, where providers are often too small to maintain robust HR departments and face fierce competition. The initiative also includes training for provider HR staff on peer workforce integration, a growing priority in behavioral health systems.
• To address housing shortages affecting health care providers and other community members, CareOregon purchased a Red Lion Inn hotel and converted the Seaside, OR space into residences for health care workers and supportive housing for plan members with behavioral health needs. Columbia Pacific, a local Coordinated Care Organization and CareOregon subsidiary, operates the location, which will help to attract new health care providers to the area as well as address a vital gap in affordable housing for some of its members with complex needs.^[23]

 

Future Workforce Development

Policy discussions on developing and retaining the provider workforce should prioritize solutions that increase supply for the health care safety net—with special focus on primary and behavioral health providers who treat enrollees of Medicaid and CHIP. The crisis is urgent and demands an “all-of-the-above” approach that incentivizes the training of more doctors, nurses, and allied health workers, with attention to reducing barriers to practicing providers from participating in Medicaid programs.

Key Areas for Consideration

• Leverage Safety Net Health Plans: With deep community ties, SNHPs are well-positioned to inform policy and deliver solutions. State and federal leaders should work to align funding streams with locally tailored initiatives, developed in collaboration with SNHPs.
• Reimbursement Rates and Network Adequacy: New federal restrictions on state-directed payments (SDPs) will reduce flexibility and threaten network adequacy^[24]—despite SDPs being critical for maintaining provider networks under new 2024 access standards. Adequate reimbursement in the program is a perennial concern, and a deterrent for increased provider participation. Further, current Medicaid payment structures struggle to reflect the acuity of the post-pandemic population and rising drug costs.^[25] Actuarial soundness standards should be examined to ensure capitation rates are sufficient to meet the statutory intent of coverage that “payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.”^[26]
• Medicaid GME: Medicaid-funded GME programs should be expanded, particularly in underserved areas, and targeted to meet geographic needs. States that already use Medicaid GME funding to support community-based training programs, FQHCs, and underserved specialties should serve as models as should successful SNHP programs.^[27] Expanded funding and technical assistance to states and interested providers should be explored as a tool for safety net development.
• Support for Allied Health: Build off successful initiatives from SNHP plans and consider further methods of supporting training of allied health professionals, which include the wide range of professions outside of doctors, nurses or dentists involved in health care delivery – like paramedics, dieticians and speech language pathologists. These roles enhance provider capacity and accessibility. Invest in allied health training and culturally competent care to broaden capacity and improve access.
• Underserved Area Incentives: Incentives for practice in underserved areas and methods to expand should all be explored. This should be part of an all-of-the-above approach: Expanded loan forgiveness (e.g., NHSC), additional Medicare GME slots to build on local efforts to expand the provider pipeline, and continuation of programs like the Teaching Health Center Graduate Medical Education (THCGME) program to encourage practice in shortage areas. Consider expanding graduate medical training in settings that see a disproportionate share of Medicaid and CHIP patients, for example at FQHCs and rural and community-based clinics.

State and federal policymakers should leverage the expertise of their local SNHPs and look to ways to marry federal funding streams with locally tailored initiatives. SNHPs are uniquely positioned to understand their communities’ health care needs — the challenges, strengths and solutions — and to help shape a provider infrastructure that meets those needs. Building on their successes offers the best path to meeting future access and network demands and safeguarding the health of Medicaid members.

 

 

[1] “Letter to State Medicaid Directors on Medicaid and CHIP Workforce Initiatives,” Centers for Medicare & Medicaid Services, April 23, 2024, https://www.medicaid.gov/resources-for-states/downloads/workforc-ltr-to-states.pdf.

[2] “Physician Workforce: Projections, 2022-2037,” National Center for Health Workforce Analysis, November 2024, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/physicians-projections-factsheet-10-23.pdf.

[3] “Projecting Health Workforce Supply and Demand,” Bureau of Health Workforce, Health Resources and Services Administration, accessed July 2025, https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand.

[4] “Health Professional Shortage Areas: Primary Care, By County,” Rural Health Information Hub, April 2025, https://www.ruralhealthinfo.org/charts/5.

[5] Elizabeth Hinton and Jada Raphael, “10 Things to Know About Medicaid Managed Care,” KFF Health News, February, 2025, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/.

[6] “Medicaid & Children’s Health Insurance Program (Managed Care Access, Finance, and Quality) Final Rule,” Centers for Medicare & Medicaid Services, April 22, 2024, https://www.cms.gov/newsroom/fact-sheets/medicaid-and-childrens-health-insurance-program-managed-care-access-finance-and-quality-final-rule.

[7] “Physician Acceptance of New Medicaid Patients: Findings from the National Electronic Health Records Survey,” Medicaid and CHIP Payment and Access Commission, June, 2021, https://www.macpac.gov/wp-content/uploads/2021/06/Physician-Acceptance-of-New-Medicaid-Patients-Findings-from-the-National-Electronic-Health-Records-Survey.pdf.

[8] Zola Simon, “Vaya Health receives $300,000 grant to address workforce shortages in N.C.,” ABC 13 News, September 5, 2024, https://wlos.com/news/local/vaya-health-awarded-grant-to-address-healthcare-workforce-challenges .

[9] “Workforce Development Offers New Beginnings at Banner Health,” Banner Health Foundation, April 2024, https://www.bannerhealthfoundation.org/news-information/articles/workforce-development-offers-new-beginnings-at-banner-health.

[10] “Movin’ On Up: Innovative Program Helps Banner Employees Grow and Improves Patient Care,” Banner Health Foundation, February 2024, https://www.bannerhealthfoundation.org/news-information/articles/movin-on-up-innovative-program-helps-banner-employees-grow-and-improves-patient-care.

[11] “CareOregon awards grants to 28 organizations across Oregon to address most critical health care needs,” CareOregon, October 16, 2024, https://careoregon.org/about-us/news-and-press-releases/2024/10/16/careoregon-awards-grants-to-28-organizations-across-oregon-to-address-most-critical-health-care-needs.

[12] ”CenCal Health to Invest $6M in Workforce Development on Central Coast,” CenCal Health, October 15, 2024, https://www.cencalhealth.org/news/2024/10/cencal-health-to-invest-6m-in-workforce-development-on-central-coast/.

[13] “CalOptima Health Gives $25M to Bolster Safety Net, Reduce Health Disparities, Ease Workforce Shortages,” CalOptima Health, April 9, 2024, https://www.caloptima.org/en/about-us/press-releases/caloptima-health-gives-25m-to-bolster-safety-net-reduce-health-disparities-ease-workforce-shortages.

[14] Rancho Cucamonga, ”Inland Empire Health Plan launches program to improve patient, provider communication,“ Global Viv-Media, January 31, 2025, http://www.viv-media.com/infozx-359447-Inland-Empire-Health-Plan-launches-program-to-improve-patient–provider-communication-.html.

[15] “Elevating the Safety Net 2024 Scholarship Recipients,” L.A. Care Health Plan https://www.lacare.org/providers/elevating-safety-net/2024-scholarships..

[16] “Elevating the Safety Net,” L.A. Care Health Plan, https://www.lacare.org/providers/elevating-safety-net,

[17] “Cook County Celebrates Award of More Than $1.5 Million in Scholarships to Students Pursuing Careers in Medicine,” Cook County Health, https://cookcountyhealth.org/press-release/cook-county-celebrates-award-of-more-than-1-5-million-in-scholarships-to-students-pursuing-careers-in-medicine/.

[18] “Provident Scholarship Fund,” Cook County Health, https://cookcountyhealth.org/provident-scholarship-fund/.

[19] Association for Community Affiliated Plans, “The Sylvia B. Kelly Medical Scholarship for Health Equity,” https://www.communityplans.net/the-sylvia-b-kelly-medical-scholarship-for-health-equity/.

[20] “Pathways to Work: Health Care Workforce Development at UPMC,” UPMC, 2024, https://upmc.widen.net/s/wnrwfb5pjp/24isd4913630-upmc-ptw-fact-sht.

[21] “Apprenticeship Initiative to Connect People to Career Pathways,” Partner4Work, March 2023, https://www.partner4work.org/news/apprenticeship-initiative-to-connect-people-to-career-pathways.

[22] Zola Simon, “Vaya Health receives $300,000 grant to address workforce shortages in N.C.,” ABC 13 News, September 5, 2024, https://wlos.com/news/local/vaya-health-awarded-grant-to-address-healthcare-workforce-challenges.

[23] Jasmine Lewin, “Hawk’s Eye Apartments in Seaside looks to fill housing gap,” The Astorian, August 14, 2024, https://dailyastorian.com/2024/08/14/hawks-eye-apartments-in-seaside-looks-to-fill-housing-gap/.

[24] Letter to House Energy and Commerce Committee on Medicaid Funding Proposals,” Association for Community Affiliated Plans, May 2025, https://communityplans.wpenginepowered.com/wp-content/uploads/2025/05/2505-House-EC-reconciliation-letter.pdf.

[25] “Joint Letter to CMS, HHS, and Biden Administration on Adjusting Medicaid Capitation Rates to Reflect Post-Unwinding Population Acuity and Utilization,” Association for Community Affiliated Plans, June 2024, https://www.communityplans.net/policy/joint-letter-cms-hhs-and-biden-administration-on-adjusting-medicaid-capitation-rates-to-reflect-post-unwinding-population-acuity-and-utilization/.

[26] “Social Security Act § 1902(a)(30)(A) – Payment for Services,” Social Security Administration, accessed July 2025, https://www.ssa.gov/OP_Home/ssact/title19/1902.htm.

[27] “Medicaid Graduate Medical Education Payments: A 50-State Review,” Association of American Medical Colleges, July 2021, https://store.aamc.org/downloadable/download/sample/sample_id/590/.