by Laura Grangaard, MPH
Loan repayment/forgiveness programs can be an optimal way to attract needed healthcare professionals. In exchange for varying levels of loan repayment/forgiveness from the federal and/or state government, providers work at an approved site in an underserved area for a certain amount of time (often subject to increase, if desired). Rural areas that are underserved are often host to sites that are approved or are able to become approved.
Options to Consider
Before considering these recruitment programs and options, it is useful to understand if your site is in a Health Professional Shortage Area (HPSA), which is required to participate in most programs, and if your site is an approved site type.
The Health Resources and Services Administration (HRSA) offers a searchable online database of HPSAs by state and county, with the corresponding HPSA score.
Depending on the program, the federal HPSA designation may not be a requirement, and the program may also be open in locations that are designated as a Medically Underserved Area (MUA) or provide healthcare services to Medically Underserved Populations (MUP). HRSA provides an online search tool to determine if a location is in an MUA/P.
The National Health Service Corps has an online list of approved site types. Some programs have slightly different criteria (noted below), when applicable.
Types of repayment/forgiveness programs
The following information is framed for a potential site seeking to recruit a new provider. Note that most of these programs offer a yearly application cycle, although this may be dependent upon funding streams.
National Health Service Corps (NHSC) loan repayment Licensed health care providers are offered loan repayment assistance in exchange for working in facilities in HPSAs.
Approved site types: NHSC Types of Sites
Additional Information: Become an NHSC Site
Professions: Licensed primary care medical, dental, and mental/behavioral health providers
Length of time for service: 2 years of full-time service, or 4 years of half-time service
For more information: NHSC Loan Repayment Program Fact sheet
Money available per applicant: Funds are not taxable.
- For sites with HPSA scores of 14 and above:
- $50,000 for 2 years of full-time or 4 years of half-time
- $25,000 for 2 years of half-time
- For sites with HPSA scores of 13 and below:
- $25,000 for 2 years of full-time or 4 years of half-time
- $15,000 for 2 years of half-time
National Health Service Corps (NHSC) Students to Service Loan Repayment Program (S2S LRP) Medical students (MD and DO) in their last year of school are given loan repayment assistance in exchange for a commitment to provide primary care services in HPSAs.
Approved site types: NHSC-approved sites
Additional information: Become an NHSC Site
Professions: Medical students (MD and DO)
Length of time for service: 3 years of full-time service, or 6 years of half-time service.
Money available per applicant: Up to $120,000, payable in annual installments for 3 years full-time or 6 years half-time service. Funds are not taxable.
HRSA NURSE Corps Loan Repayment Program
Loan repayment to registered nurses and advanced practice registered nurses working in a public or private nonprofit Critical Shortage Facility.
Approved site types: Public or private nonprofit Critical Shortage Facilities, listed in the fact sheet.
Professions: Licensed registered nurses, advanced practice nurses, nursing faculty, or nurse practitioners
Length of time for service: 2-year minimum (optional third year)
For more information: NURSE Corps Loan Repayment Program Fact sheet
Money available per applicant: Repays 60 percent of a qualifying educational loan balance in exchange for two years of service at a critical shortage facility. Participants may be eligible to work a third year and receive an additional 25 percent of the qualifying loan balance. Funds are taxable.
HRSA NURSE Corps Scholarship Program
Nursing students (accepted or enrolled) receive scholarships for education in exchange for working at an eligible Critical Shortage Facility after completion of education.
Approved site types: Public or private nonprofit Critical Shortage Facilities
Professions: Students accepted or enrolled in a diploma, associate, baccalaureate or graduate nursing programs (including Nursing Bridge Programs: RN to BSN; RN to NP and non-nursing Bachelor’s to NP)
Length of time for service: 2-year minimum (4-year maximum conditional support)
For more information: Application and Program Guidance
Money available per applicant: Scholarships include tuition, fees, reasonable costs, and a monthly living stipend while in school. Scholarships are taxable.
Indian Health Service Loan Repayment Program
A wide range of health care providers are offered loan repayment assistance in exchange for serving at least 2 years full-time at an Indian health program site.
Approved site types: Indian Health Programs
Professions: See Eligibility Criteria
Length of time for service: 2-year minimum. Extension possible on a year-to-year basis.
Application cycle: Application cycle is yearly, but on a rolling basis until funds are exhausted.
Money available per applicant: Up to $20,000 per year.
State-based Loan Repayment Programs (SLRP) Federally funded grant program that provides cost-sharing grants to states help them operate their own state loan repayment programs for primary care providers in HPSAs.
Funding: State and federal
Who to contact: Not all states host a State-based Loan Repayment Program, but an interactive map of State Loan Repayment Programs is available on the National Health Service Corps website.
Approved site types: Varies, but site must be in a Health Professional Shortage Area (HPSA). Contact state office for specifics.
Professions: Vary by state. May include physicians (MD or DO), Nurse Practitioners, and Physician Assistants in primary care or mental health capacities; dental professionals; mental health professionals; Registered Nurses; and/or pharmacists. Contact state office for specifics.
Length of time for service: In most cases, 2 or 3 years. Extension usually possible on a year-to-year basis
For more information: State Loan Repayment Program Fact sheet
Money available per applicant: Variable. Some examples follow:
- Colorado: $105,000 for 3-years of full-time for physicians, $60,000 for 3 years of full-time for physician assistants, advanced practice nurses, and mental health providers, or $22,500 for dental hygienists
- Louisiana: $90,000 for 3 years of full-time for physicians, $45,000 for 3 years of full-time for some other professions
- Minnesota: $40,000 for 2 years of full-time, or $20,000 for 2 years of half-time
- Ohio: $50,000 for 2 years of full-time for physicians
Other State-based programs
Many states offer additional state-appropriated funds for health professions loan repayment or forgiveness programs. To find more information about these programs, contacting the State Office of Rural Health, Primary Care, Workforce, or related offices (the location of these programs varies by state) would be a good first step. The Rural Health Information Hub (RHIhub) offers a state-by-state listing of State Offices of Rural Health.
RHIhub also offers lists of Loan Repayment Programs currently accepting applications and Loan Repayment programs which may offer funding in the future.
Laura Grangaard is a Research Analyst for Stratis Health. This guide was compiled as part of a team project for Rural Health System Analysis and Technical Assistance (RHSATA), a cooperative agreement between the Federal Office of Rural Health Policy, the RUPRI Center for Rural Health Policy Analysis (RUPRI Center) and Stratis Health. Grangaard can be reached at: LGRANGAARD@stratishealth.org.
Back to: Winter 2014 Issue