Section 126 of the Consolidated Appropriations Act, 2021 (CAA-2021) and Section 4122 of the Consolidated Appropriations Act, 2023 (CAA-2023) represent a major policy effort to expand graduate medical education (GME) capacity:
- CAA-2021 Section 126 authorized 1,000 new Medicare-funded residency positions to be distributed over five annual rounds, with priority given to hospitals serving Health Professional Shortage Areas (HPSAs). Awarded hospitals must begin training residents in these positions within five years of the effective date.
- CAA-2023 Section 4122 added 200 additional residency positions, with half mandated for psychiatry or psychiatry subspecialty programs, using similar eligibility and prioritization rules.
How Have Section 126 & 4122 Residency Slots Been Awarded to Date?
Four of the five annual rounds of Section 126 residency positions have already been awarded. Key award trends include:
- Applicants & awardees: There were approximately 200 applicants with approximately 100 awardees each round.
- High‑need areas dominate: Most awardees meet or exceed the average HPSA score of 16, with most scores in the mid‑to‑high teens.
- Geographic concentration:
- New York consistently received 13 to 19% of awards per round.
- Florida, Illinois, Arizona, and Georgia repeatedly appear among the top recipients.
- Specialty distribution: Awards varied across primary care, surgery, and subspecialty programs.
Section 4122 had a high award rate of nearly 90%, reflecting the smaller applicant pool relative to available positions and its focus on psychiatry and psychiatry subspecialty programs. Section 4122 was a one-time opportunity.
Additional details and award data are available on the CMS DGME webpage.
What Is the Deadline for the Final Round of Section 126 Residency Slots?
The fifth and final application round for Section 126 residency positions will close on March 31, 2026. Applications must be submitted through the CMS MEARIS website. Hospitals interested in pursuing the remaining 200 Medicare‑funded slots should begin preparing now by:
- Validating their HPSA score as of November 1, 2025.
- Confirming community and workforce needs.
- Prioritizing accreditation readiness.
How Forvis Mazars Can Help
Our team has extensive experience providing strategic reimbursement and operational support for GME programs at academic medical centers, teaching hospitals, and other provider organizations. If you have questions or would like assistance with your application for the final round of Section 126 residency positions, please reach out to a professional at Forvis Mazars.