Ontario’s FHO+ model introduced a significant increase in funding for Family Health Organization (FHO) leadership effective April 1, 2026.
The existing Group Management Leadership Payment (GMLP) continues, while the new Enhanced Group Management Leadership Payment (eGMLP) provides additional compensation for the responsibilities involved in leading and managing an FHO.
Together, these payments provide $5 per enrolled patient annually, with a minimum of $25,000 and a maximum of $125,000 per FHO group.
But who actually receives this money? How is it calculated, and who decides how it should be distributed?
This guide explains the new payments and their practical implications for FHO physicians and group leaders.
1. What are GMLP and eGMLP?
The Group Management Leadership Payment (GMLP) is an administrative payment intended to compensate FHO leadership for responsibilities associated with operating the group and ensuring compliance with its contractual obligations.
Before April 1, 2026, the GMLP provided $1 per enrolled patient annually, to a maximum of $25,000 per group.
Under the updated FHO agreement, an Enhanced GMLP was introduced, adding another $4 per enrolled patient annually.
| Payment | Annual rate per patient | Annual maximum |
|---|---|---|
| Existing GMLP | $1 | $25,000 |
| Enhanced GMLP | $4 | $100,000 |
| Combined | $5 | $125,000 |
The combined payments are subject to an annual minimum of $25,000 per FHO group.
The payments are based on patient enrolment, prorated daily according to the duration of enrolment during the fiscal year.
2. How much will your FHO receive?
The amount depends primarily on the number of patients enrolled with the group.
Consider the following examples:
| FHO enrolled patients | Estimated annual payment |
|---|---|
| 3,000 | $25,000 |
| 5,000 | $25,000 |
| 7,500 | $37,500 |
| 10,000 | $50,000 |
| 15,000 | $75,000 |
| 20,000 | $100,000 |
| 25,000 | $125,000 |
| 30,000 | $125,000 |
These illustrative calculations assume a stable roster throughout a full fiscal year and apply the combined minimum and maximum. Actual payments may vary because enrolment is prorated.
For example, an FHO with 12,000 enrolled patients throughout the fiscal year would receive approximately $60,000 annually in combined GMLP and eGMLP payments.
This represents a substantial increase over the former GMLP arrangement.
3. Who receives the GMLP and eGMLP?
This is one of the most important aspects of the program.
Both the GMLP and eGMLP are paid to the FHO group, not directly to the individual lead physician.
The Ministry deposits the payments into the FHO group’s designated account.
Although the funding is intended to recognize FHO leadership responsibilities, the FHO determines how to allocate the money internally.
The fact that a physician is designated as the FHO lead does not automatically establish an individual entitlement to the full payment.
The Ontario Medical Association recommends that FHO groups establish clear provisions in their governance agreements explaining how leadership payments will be distributed.
4. What responsibilities are these payments intended to compensate?
FHO leadership involves important responsibilities that extend beyond individual patient care.
The Ministry and OMA identify leadership responsibilities related to compliance with the FHO agreement, including appropriate after-hours availability and care.
Practical examples include:
- After-hours organization: Coordinating appropriate after-hours access and physician coverage.
- Ministry communication: Acting as the primary contact between the FHO and the Ministry of Health.
- Physician enrolment: Coordinating required documentation when physicians or locums join the group.
- Governance: Organizing group meetings and reviewing governance arrangements.
- Contractual compliance: Helping ensure the group meets its obligations under the FHO agreement.
- Physician support: Assisting new physicians and coordinating group responsibilities.
- Administrative coordination: Maintaining relevant FHO documentation and ensuring necessary information is communicated to members.
The group may share many of these responsibilities among the lead, associate lead and other physicians.
However, the FHO lead retains specific responsibilities relating to official communication and documentation with the Ministry.
The OMA also distinguishes FHO clinical leadership from general third-party administrative management. The GMLP is intended to compensate leadership within the FHO, rather than automatically provide compensation to external management companies.
5. Can the FHO lead keep all the GMLP money?
There is no universal rule requiring the GMLP and eGMLP to be divided equally among all physicians.
Similarly, the payment is not automatically the personal income of the FHO lead.
The FHO group determines the appropriate allocation through its governance arrangements.
For example, a group might decide to compensate the lead physician for substantial leadership responsibilities and provide additional compensation to the associate lead or other physicians who undertake specific duties.
Alternatively, a group may adopt another arrangement agreed upon through its governance process.
The important considerations are transparency, fairness, clearly defined responsibilities and compliance with the group’s agreements.
Ideally, an FHO governance agreement should specify:
- Which leadership roles are eligible for compensation.
- How the payment allocation is determined.
- When leadership compensation will be distributed.
- How changes in leadership or responsibilities affect the allocation.
- How disagreements regarding distribution will be resolved.
Clearly documenting these arrangements helps protect both the FHO leadership team and the group as a whole.
6. When and how are GMLP and eGMLP paid?
The existing GMLP continues to be paid monthly.
The enhanced GMLP became effective April 1, 2026.
According to the OMA’s updated guidance, the enhanced payment is issued quarterly during its first year of implementation, with the first payment expected in August 2026 for April through June. Monthly enhanced payments are scheduled to begin April 1, 2027.
Important implementation note: The Ministry’s original April 1, 2026 INFOBulletin indicated monthly eGMLP payments beginning with the May 2026 Remittance Advice. This differs from the OMA’s later payment-frequency guidance. Groups should verify actual payments against their RA and any subsequent Ministry instructions.
The enhanced payment should appear in the accounting transactions section of the FHO group’s Remittance Advice (RA), identified as:
Enhanced Group Management Leadership
FHO leads or administrators should periodically reconcile these amounts against the group’s deposits.
7. Frequently asked questions
Does an FHO need to apply for eGMLP?
No. According to the OMA, eligible FHOs are automatically entitled to the enhanced payment under the updated FHO agreement.
Does every physician in the FHO receive a share?
Not necessarily. The payment is made to the FHO group, which determines its internal allocation through its governance arrangements.
Is eGMLP available to Family Health Networks (FHNs)?
No. The enhanced payment is available to FHOs. The original GMLP also applies to certain other primary-care group models, including FHNs and RNPGA physician groups.
Does the FHO lead need to document the hours spent on leadership duties?
The OMA states that activity documentation is not required specifically for GMLP. However, maintaining appropriate governance and financial records remains good administrative practice.
Is eGMLP separate from the FHO+ hourly rate?
Yes. The GMLP and eGMLP are group leadership payments, distinct from compensation associated with individual physicians’ eligible FHO+ hourly activities.
Does eGMLP replace the Office Practice Administration (OPA) payment?
No. The OPA payment remains a separate component of FHO compensation.
8. What should FHO groups do now?
The introduction of eGMLP creates an opportunity for FHO groups to review how leadership responsibilities are organized and compensated.
Groups should consider reviewing their governance agreements, clarifying leadership roles, confirming the distribution arrangement, and reconciling actual Ministry payments.
For larger FHOs, where combined leadership payments can reach $125,000 annually, these arrangements are particularly important.
Good FHO governance requires both accountability and fair recognition of leadership responsibilities.
Key takeaway
GMLP and eGMLP recognize the important work required to lead and administer Ontario Family Health Organizations.
Effective April 1, 2026, combined funding increased to $5 per enrolled patient annually, with a $25,000 minimum and $125,000 maximum per group.
However, the money belongs to the FHO group, and individual distribution is determined through the group’s governance arrangements.
Understanding these rules can help FHO physicians make informed decisions about leadership responsibilities, financial transparency and group operations.
Official references
- Ontario Ministry of Health — INFOBulletin 260308: FHO+ Implementations for April 2026
- Ontario Medical Association — FHO+ Group Management Leadership Payment
- Ontario Medical Association — FHO+ Frequently Asked Questions
Disclaimer: This article is intended for general educational purposes. It does not replace official Ministry guidance, contractual advice, accounting advice or the terms of an FHO’s governance agreement. Funding arrangements may change.
Published by Dr. Plus Physician Services Inc.
