The National Health Service Corps
Changes from January 4, 2022 to April 9, 2025
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The National Health Service Corps
Updated April 9, 2025 (R44970) Jump to Main Text of ReportContents
- Introduction
- Program Overview
- Federal Scholarship Program
- Federal Loan Repayment Program
- Main Loan Repayment Program
- Federal Students to Service (S2S) Loan Repayment Program
- Substance Use Disorder Repayment Program
- Rural Community Loan Repayment Program
- State Loan Repayment Program
- NHSC Funding
- Program Size
- Recruitment
- Field Strength
- Types of NHSC Providers
- NHSC Provider Locations
- Provider Retention
- Legislative Proposals Related to the NHSC
Figures
Summary
The National Health Service Corps (NHSC) provides scholarships and loan repayments to health The National Health Service Corps (NHSC) provides scholarships and loan repayments to healthcare providers in exchange for a period of service in a health professional shortage area (HPSA). care providers in exchange for a period of service in a health professional shortage area (HPSA).
Emergency Health Personnel Act of 1970 (P.L. 91-623), and its programs have been reauthorized and amended several times Emergency Health Personnel Act of 1970 (P.L. 91-623), and its programs have been reauthorized and amended several times
the ACA, the NHSC had been funded with discretionary appropriations. The ACA created a new mandatory funding source the ACA, the NHSC had been funded with discretionary appropriations. The ACA created a new mandatory funding source
for the NHSC, the Community Health Center Fund (CHCF), which was intended to supplement the programfor the NHSC, the Community Health Center Fund (CHCF), which was intended to supplement the program
appropriation. However, from FY2012 to FY2017, the CHCF entirely replaced the NHSCappropriation. However, from FY2012 to FY2017, the CHCF entirely replaced the NHSC
Beginning in FY2018, the program received discretionary appropriations again. These funds were appropriated for loan Beginning in FY2018, the program received discretionary appropriations again. These funds were appropriated for loan
repayment for substance use disorder treatment providers, with some funds reserved for loan repayment for providers placed repayment for substance use disorder treatment providers, with some funds reserved for loan repayment for providers placed
at rural facilities and at Indian Health Service facilities. In FY2021, the American Rescue Plan Act of 2021 (ARPA, P.L. 117-at rural facilities and at Indian Health Service facilities. In FY2021, the American Rescue Plan Act of 2021 (ARPA, P.L. 117-
program can make. ARPA also reserved $100 million for states to make loan repayment awards.program can make. ARPA also reserved $100 million for states to make loan repayment awards.
it has been extended several times, most recently through it has been extended several times, most recently through
individuals who have agreed to serve for a minimum of two years in a HPSAs. In individuals who have agreed to serve for a minimum of two years in a HPSAs. In
program size, because not all awardees are currently serving as NHSC providers; some are still completing their training program size, because not all awardees are currently serving as NHSC providers; some are still completing their training
(e.g., scholarship award recipients). As such, the NHSC also measures its field strength: the number of NHSC providers who (e.g., scholarship award recipients). As such, the NHSC also measures its field strength: the number of NHSC providers who
are fulfilling a service obligation in a HPSA in a given year. In are fulfilling a service obligation in a HPSA in a given year. In
providers are currently serving in a variety of settings throughout the entire United States and its territories. The majority of providers are currently serving in a variety of settings throughout the entire United States and its territories. The majority of
NHSC providers serve in outpatient settings, most commonly at federally qualified health centers.
Introduction
The National Health Service Corps (NHSC) is a clinician recruitment and retention program that The National Health Service Corps (NHSC) is a clinician recruitment and retention program thataims to reduce health workforce shortages in underserved areas. The NHSC has three aims to reduce health workforce shortages in underserved areas. The NHSC has three
components: (1) a federal scholarships program, (2) a federal loan repayment program, and (3) a components: (1) a federal scholarships program, (2) a federal loan repayment program, and (3) a
state-operated loan repayment program. Under each of these programs, health providers receive state-operated loan repayment program. Under each of these programs, health providers receive
either scholarships or loan repayments in exchange for a service commitment at an NHSC-either scholarships or loan repayments in exchange for a service commitment at an NHSC-
approved facility located in a federally designated health professional shortage area (HPSA, see approved facility located in a federally designated health professional shortage area (HPSA, see
text box).text box).
shortage areas; federal program participants may not. NHSC-approved facilities are generally shortage areas; federal program participants may not. NHSC-approved facilities are generally
nonprofit or government-operated (federal, state, local, or tribal) organizations that provide care nonprofit or government-operated (federal, state, local, or tribal) organizations that provide care
to patients without regard for the patientto patients without regard for the patient
to an estimated to an estimated
community health center, or a facility operated by the Indian Health Service) community health center, or a facility operated by the Indian Health Service)
patients for each primary care physician and has a population with high health patients for each primary care physician and has a population with high health
Source: Health Resources and Services Administration, Shortage Designation: Health Resources and Services Administration, Shortage Designation:
The three NHSC programs are managed by the Bureau of Health Workforce (BHW) in the Health Resources and Service Administration (HRSA), an agency in the Department of Health and Human Services (HHS). On March 27, 2025, HHS issued a press release and fact sheet announcing that HHS was being restructured.2 The fact sheet indicated that this restructuring would consolidate HRSA and other agencies into a new entity. At the time of this report's publication, the potential effect of this restructuring on NHSC and its administration are unknown.
The NHSC was created by the Emergency Health Personnel Act of 1970 to provide an adequate supply of trained health providers in federally designated HPSAs.3 Since the program's inception, Congress has reauthorized and revised the program several times, with the most recent reauthorization included in the Patient Protection and Affordable Care times, with the most recent reauthorization included in the Patient Protection and Affordable CareAct (P.L. 111-148, ACA). The ACA permanently reauthorized the NHSC, creating, among other Act (P.L. 111-148, ACA). The ACA permanently reauthorized the NHSC, creating, among other
things, a mandatory funding stream for the program and implementing a part-time option, which things, a mandatory funding stream for the program and implementing a part-time option, which
allows part-time service in exchange for an extended service commitment.allows part-time service in exchange for an extended service commitment.
types of providers the program supports, and the locations where they serve.types of providers the program supports, and the locations where they serve.
Program Overview
The NHSC consists of three programs: (1) a federal scholarship program; (2) a federal loan The NHSC consists of three programs: (1) a federal scholarship program; (2) a federal loan
repayment program, which includes several temporary component loan repayment programsrepayment program, which includes several temporary component loan repayment programs (the substance use disorder loan repayment program, the rural community workforce loan repayment program, and the Student to Service loan repayment program); and
(3) a state-operated loan repayment program. The federal scholarship program provides (3) a state-operated loan repayment program. The federal scholarship program provides
scholarships in exchange for a service commitment at the end of a recipientscholarships in exchange for a service commitment at the end of a recipient
including including after any training required before licensure. The loan repayment programs provide clinicians any training required before licensure. The loan repayment programs provide clinicians
with loan repayment in exchange for an immediate service commitment.with loan repayment in exchange for an immediate service commitment.
federal scholarship and loan repayment programs and provides funds to states. States match these federal scholarship and loan repayment programs and provides funds to states. States match these
funds to operate state loan repayment programs.funds to operate state loan repayment programs.
participants—is the federal loan repayment program, followed by the state loan repayment participants—is the federal loan repayment program, followed by the state loan repayment
program, and then the scholarship program.program, and then the scholarship program.
differences; however, the programs share a number of common elements. Specifically, the core differences; however, the programs share a number of common elements. Specifically, the core
programs generally require a minimum service commitment of two years in a HPSA.programs generally require a minimum service commitment of two years in a HPSA.
the component loan repayment programs require a three-year service commitment, including the the component loan repayment programs require a three-year service commitment, including the
substance use disorder loan repayment program, the rural community workforce loan repayment substance use disorder loan repayment program, the rural community workforce loan repayment
program, and the Student to Service loan repayment program (these programs are discussed program, and the Student to Service loan repayment program (these programs are discussed
below). All NHSC programs are restricted to U.S. citizens or U.S. nationals,below). All NHSC programs are restricted to U.S. citizens or U.S. nationals,
awards that are exempt from federal income and employment taxes. In addition, all three awards that are exempt from federal income and employment taxes. In addition, all three
programs allow physicians,programs allow physicians,
practitioners to participate, but the loan repayment programs also permit additional provider types practitioners to participate, but the loan repayment programs also permit additional provider types
to participate.to participate.
number of awards made under each of these programs.
Generally, NHSC awards are made competitively, with scholarships awarded based on eligibility and a set of selection factors (e.g., the participant's commitment to primary care practice and the likelihood of remaining in a shortage area after the NHSC service commitment has ended).11 Loan repayment awards are made based on the HPSA score of the site and on the loan repayment program's eligibility and selection factors. These include that the applicant (1) has a history of honoring their prior legal obligations (i.e., is not in default on a federal loan, among other things); (2) does not have a negative report to the National Practitioner Data Bank, which records actions taken on individual's clinical licenses and malpractice judgements; (3) has not breached another health service obligation; and (4) does not have another current service obligation.12
Federal Scholarship Program The NHSC Scholarship Program is established in Section 338A of the Public Health Service Act The NHSC Scholarship Program is established in Section 338A of the Public Health Service Act(PHSA).(PHSA).
monthly living stipend—to individuals enrolled full-time in specified education programs at a monthly living stipend—to individuals enrolled full-time in specified education programs at a
fully accredited U.S. school.fully accredited U.S. school.
osteopathic), physician assistant programs, dental schools, and advance practice nursing schools. osteopathic), physician assistant programs, dental schools, and advance practice nursing schools.
Individuals must agree to complete their training (including residency training or required clinical Individuals must agree to complete their training (including residency training or required clinical
hours, where applicable) in hours, where applicable) in primary care..
partial year after the first year), students must agree to provide a year of service in a HPSA. For partial year after the first year), students must agree to provide a year of service in a HPSA. For
example, if a full-time service scholar receives three years of scholarship support the scholar example, if a full-time service scholar receives three years of scholarship support the scholar
would owe three years of full-time service at an approved facility. Scholars incur a minimum would owe three years of full-time service at an approved facility. Scholars incur a minimum
service commitment of two years. The number of school years of NHSC scholarship support service commitment of two years. The number of school years of NHSC scholarship support
received by the scholar may not exceed four school years.received by the scholar may not exceed four school years.
program, the maximum required years of full-time service at an approved facility is four years.program, the maximum required years of full-time service at an approved facility is four years.
advance clinical training needed for licensure (e.g., primary care residency for physicians). advance clinical training needed for licensure (e.g., primary care residency for physicians).
Participants must also have obtained a professional license, certificate, or registration before Participants must also have obtained a professional license, certificate, or registration before
beginning their service commitment. NHSC scholars must fulfill their service commitment on a beginning their service commitment. NHSC scholars must fulfill their service commitment on a
full-time basis and are required to fulfill their service commitment in a HPSA of greatest need. full-time basis and are required to fulfill their service commitment in a HPSA of greatest need.
Each year HRSA determines the HPSA score indicative of greatest need. This varies by provider Each year HRSA determines the HPSA score indicative of greatest need. This varies by provider
type. For example, for class year type. For example, for class year
sites with a HPSA score of sites with a HPSA score of
above for primary care physician assistants, and above for primary care physician assistants, and
for mental health HPSAs and dental HPSA providers.for mental health HPSAs and dental HPSA providers.
loan repayment program may serve part-time and may serve in areas with lower HPSA scores, but loan repayment program may serve part-time and may serve in areas with lower HPSA scores, but
willing to continue service at an NHSC-approved facility. Generally, NHSC awards are made willing to continue service at an NHSC-approved facility. Generally, NHSC awards are made
competitively, with scholarships awarded based on a set of eligibility and selection factors (e.g., competitively, with scholarships awarded based on a set of eligibility and selection factors (e.g.,
the participantthe participant
shortage area after the NHSC service commitment has ended).shortage area after the NHSC service commitment has ended).
NHSC to Congress, the agency disclosed that there were more than 1,800 scholarship NHSC to Congress, the agency disclosed that there were more than 1,800 scholarship
applications for the 200 awards made.applications for the 200 awards made.
19 The selection rate decreased since then, as HRSA reported that in FY2024 it was able to award 5% of eligible scholarship applications.20 Federal Loan Repayment Program
The NHSC Federal Loan Repayment Program is authorized in PHSA Sections 331(i) and 338B.The NHSC Federal Loan Repayment Program is authorized in PHSA Sections 331(i) and 338B.
21 In addition to the list of providers who may participate in the scholarship program, dental In addition to the list of providers who may participate in the scholarship program, dental
hygienists and behavioral/mental health providers may also receive loan repayment.hygienists and behavioral/mental health providers may also receive loan repayment.
repayment recipients must have a license or certificate needed to practice and must be employed repayment recipients must have a license or certificate needed to practice and must be employed
or have accepted an offer to be employed at an NHSC-approved work site. Loan repayment is or have accepted an offer to be employed at an NHSC-approved work site. Loan repayment is
available only for available only for qualifying educational debt, which means principal, interest, and related , which means principal, interest, and related
expenses of outstanding government and private student loans obtained for undergraduate or expenses of outstanding government and private student loans obtained for undergraduate or
graduate education for tuition, along with reasonable educational and living expenses.graduate education for tuition, along with reasonable educational and living expenses.
section below discusses the main federal loan repayment program and additional specific loan section below discusses the main federal loan repayment program and additional specific loan
repayment programs.repayment programs.
Main Loan Repayment Program
two years or part-time for four. Continuation awards are awarded in one-year intervals, and two years or part-time for four. Continuation awards are awarded in one-year intervals, and
individuals may apply for and receive continuation awards as long as they have qualifying individuals may apply for and receive continuation awards as long as they have qualifying
educational debt and remain employed at an NHSC-approved site.educational debt and remain employed at an NHSC-approved site.
Federal Students to Service (S2S) Loan Repayment Program
At its outset, this program was for medical students (allopathic and osteopathic) in their final year At its outset, this program was for medical students (allopathic and osteopathic) in their final year
of medical school; however, the program has since expanded to include individuals in their last of medical school; however, the program has since expanded to include individuals in their last
year of dental school, nurse practitioner training, nurse midwifery training, and physician year of dental school, nurse practitioner training, nurse midwifery training, and physician
assistant training. In return, S2S program recipients must complete an approved primary care assistant training. In return, S2S program recipients must complete an approved primary care
residency (if applicable)residency (if applicable)
for at least three years (full-time) or six years (half-time).for at least three years (full-time) or six years (half-time).
certain fellowships that may be one or two years. These include one-year fellowships in geriatrics certain fellowships that may be one or two years. These include one-year fellowships in geriatrics
or obstetrics/gynecology, two-year child psychiatry fellowships, and one or two-year addiction or obstetrics/gynecology, two-year child psychiatry fellowships, and one or two-year addiction
On December 17, 2018, Congress enacted the Improving Access to Maternity Care Act (P.L. 115-320), which required HRSA to identify maternity care health professional target areas (abbreviated to MCTAs) within existing primary care health professional shortage areas (HPSA; see text box above). MCTAs are areas with a shortage of maternity health care professionals, which includes obstetrician/gynecologists and certified nurse midwives. HRSA designated these using criteria including
- population-to-provider ratio;
- travel time to the nearest source of care; and
- specified maternal health indicators (e.g., prevalence of certain pre-pregnancy health conditions, such as diabetes, and factors such as access to behavioral health care, among others).
In January of 2025, HRSA designated 7,629 locations as MCTAs with scores ranging from 0-25, with a higher score indicating greater shortages.
Sources: HRSA, HHS, "Criteria for Determining Maternity Care Health Professional Target Areas," 87 Federal Register 30501-30506, May 19, 2022 and "What is a Maternity Care Target Area," https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation#mcta and CRS analysis of HRSA data at https://data.hrsa.gov/tools/data-explorer. Substance Use Disorder Repayment ProgramBeginning in FY2018, HRSA received discretionary funding to provide loan repayments to behavioral health professionals who are providing substance use disorder treatment (SUD) in HPSAs. Language included in appropriations acts waives parts of the NHSC statute, which therefore permits a broader range of health professionals and service sites to be included in the program.30 This program is not permanently authorized in statute; as such, it may continue only if similar language is included in annual (or supplemental) appropriations laws.
The program's purpose is to expand evidence-based SUD treatment and counseling available in HPSAs. Under this program, HRSA makes loan repayment to behavioral health providers, some of whom are not otherwise eligible for the NHSC loan repayment program (e.g., pharmacists).31 It also permits program participants to fulfill their service commitment in behavioral health treatment sites. Generally, NHSC sites are primary care focused, and, as such, facilities that focus exclusively on substance use treatment, such as opioid use disorder treatment programs, would not otherwise be eligible to receive NHSC clinicians. The SUD workforce loan repayment program provides $75,000 in loan repayment in exchange for a three-year full-time service commitment in provides $75,000 in loan repayment in exchange for a three-year full-time service commitment ina designated mental health or primary medical care HPSA. It provides $37,500 in loan repayment a designated mental health or primary medical care HPSA. It provides $37,500 in loan repayment
for a three-year half-time service commitment.for a three-year half-time service commitment.
32 Rural Community Loan Repayment Program
with regard to eligible providers and sites. Like that program, the Rural Community Loan with regard to eligible providers and sites. Like that program, the Rural Community Loan
Repayment program focuses on increasing access to Repayment program focuses on increasing access to
FY2018, the program has been funded using a portion of the discretionary appropriations FY2018, the program has been funded using a portion of the discretionary appropriations
provided for SUD loan repayment. This program provides $100,000 for a three-year full-time provided for SUD loan repayment. This program provides $100,000 for a three-year full-time
service commitment for SUD treatment providers in rural areas.service commitment for SUD treatment providers in rural areas.
half-time clinical practice.half-time clinical practice.
34 State Loan Repayment Program
The state loan repayment program is authorized in PHSA Section 338I.The state loan repayment program is authorized in PHSA Section 338I.
to the Federal Loan Repayment Program, except that (1) it is a matching grant between the state to the Federal Loan Repayment Program, except that (1) it is a matching grant between the state
and the NHSC,and the NHSC,
eligible to participate in their program, and (3) states may require more than two years of service eligible to participate in their program, and (3) states may require more than two years of service
in exchange for loan repayment. For example, states have the option of addressing their unique in exchange for loan repayment. For example, states have the option of addressing their unique
workforce needs by making additional types of professionals eligible, such as registered nurses workforce needs by making additional types of professionals eligible, such as registered nurses
and pharmacists, although neither of these provider types are eligible to participate in the main and pharmacists, although neither of these provider types are eligible to participate in the main
federal loan repayment program. State loan repayors must provide care in a HPSA in exchange federal loan repayment program. State loan repayors must provide care in a HPSA in exchange
for their award, but states determine the approved service sites (i.e., facility types) for their for their award, but states determine the approved service sites (i.e., facility types) for their
programs. State loan repayment participants must also serve two years as an initial commitment, programs. State loan repayment participants must also serve two years as an initial commitment,
but states may require longer minimum service commitments or may vary the service but states may require longer minimum service commitments or may vary the service
commitment length by provider type. State loan repayment recipients may fulfill their service commitment length by provider type. State loan repayment recipients may fulfill their service
commitments on a full- or part-time basis. NHSC Funding The amount of total funds that the NHSC receives determines the number of awards that the The amount of total funds that the NHSC receives determines the number of awards that the
program can make. Historically, the NHSC had been exclusively funded as part of HRSAprogram can make. Historically, the NHSC had been exclusively funded as part of HRSA
's discretionary appropriation. However, that is no longer completely the case, as the program is discretionary appropriation. However, that is no longer completely the case, as the program is
now primarily funded by the mandatory Community Health Center Fund (CHCF).now primarily funded by the mandatory Community Health Center Fund (CHCF).
time-limited. At its outset, it was an appropriation from FY2011 through FY2015, but it has been time-limited. At its outset, it was an appropriation from FY2011 through FY2015, but it has been
extended several times, most recently extended several times, most recently
FY2017, the CHCF entirely replaced the NHSCFY2017, the CHCF entirely replaced the NHSC
FY2018, the program received discretionary appropriations again, though these funds have been FY2018, the program received discretionary appropriations again, though these funds have been
appropriated for loan repayment appropriated for loan repayment
reserved for loan repayment for providers placed at Indian Health Service reserved for loan repayment for providers placed at Indian Health Service (IHS) facilities. Though the facilities. Though the
NHSC has received discretionary appropriations in recent years, the CHCF represents more than NHSC has received discretionary appropriations in recent years, the CHCF represents more than
70% of the program70% of the program
(P.L. 117-2) provided a one-time appropriation of $800 million provided a one-time appropriation of $800 million
that the program the program
was able to make.38 Table 1 presents funding provided for the program between FY2011 and presents funding provided for the program between FY2011 and
shows the percentage of funding that comes from discretionary and mandatory sources.shows the percentage of funding that comes from discretionary and mandatory sources.
Table 1. National Health Service Corps (NHSC) Funding for FY2011-
FY2023
(dollars in millions)
Discretionary
__
__
__
__
__
__
Mandatory (CHCF)
$290
$295
Mandatory (ARPA)
__
__
__
__
__
__
__
__
__
__
__
__
Final
$315
$295
$285
$283
$287
$310
$289
$415
$430
$430
$414
$418
% Mandatory
92%
100%
100%
100%
100%
100%
100%
75%
72%
72%
71%
70%
Health Resources and Services Administration, Health Resources and Services Administration, Justification of Estimations for Appropriations Committees,
Rockville, MD, MD, volumes FY2013 through FY2013 through
148, as amended); ARPA148, as amended); ARPA = American Rescue Plan Act of 2021(P.L. 117-2); ARRA = American Recovery and = American Rescue Plan Act of 2021(P.L. 117-2); ARRA = American Recovery and
Reinvestment Act of 2009 (P.L. 111-5); BBA 2018 = Bipartisan Budget Act of 2018 (P.L. 115-123); BBEDCA = Reinvestment Act of 2009 (P.L. 111-5); BBA 2018 = Bipartisan Budget Act of 2018 (P.L. 115-123); BBEDCA =
Balanced Budget and Emergency Deficit Control Act of 1985( P.L. 112-25); CARES ActBalanced Budget and Emergency Deficit Control Act of 1985( P.L. 112-25); CARES Act
and Economic Security Act (P.L. 116-136); CHCF = Community Health Center Fund; FYand Economic Security Act (P.L. 116-136); CHCF = Community Health Center Fund; FY
National Health Service Corps; MACRA = Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10National Health Service Corps; MACRA = Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10);
as enacted or adjusted for sequestration, where applicable. For FY2022, the NHSC is receiving discretionary as enacted or adjusted for sequestration, where applicable. For FY2022, the NHSC is receiving discretionary
appropriations at the FY2021 level under continuing appropriations under P.L. 117-43 and P.L. 117-70. The appropriations at the FY2021 level under continuing appropriations under P.L. 117-43 and P.L. 117-70. The
Consolidated Appropriations Act, 2021 (P.L. 116-260), provided $310 Consolidated Appropriations Act, 2021 (P.L. 116-260), provided $310
budget. ARRA contributed $57 budget. ARRA contributed $57
of Estimations for Appropriations Committees,
Initiative administered by the Federal Office of Rural Health Policy in HRSA.Initiative administered by the Federal Office of Rural Health Policy in HRSA.
Indian organization facilities.Indian organization facilities.
e. P.L. 117-103 included $121.6 million for loan repayment for substance use disorder providers and reserved $15.6 million of that amount to place these providers at Indian Health Service, tribally operated, and Urban Indian organization facilities.
f. P.L. 117-328 included $125.6 million for loan repayment for substance use disorder providers and reserved $15.6 million of that amount to place these providers at Indian Health Service, tribally operated, and Urban Indian organization facilities.
g. ACA appropriated $300 million in mandatory funding for the NHSC to be used in FY2013. However, thisFY2013. The sequestration order was issued pursuant to the BBEDCA, as amended.FY2013. The sequestration order was issued pursuant to the BBEDCA, as amended.
amount was subject to the 7.2% mandatory spending sequestration, resulting in $283 amount was subject to the 7.2% mandatory spending sequestration, resulting in $283
mandatory spending sequester for FY2016 was calculated by OMB. As a consequence, OMB did not include mandatory spending sequester for FY2016 was calculated by OMB. As a consequence, OMB did not include
the FY2016 funding in the sequester calculation, and thus no sequester was ordered for the NHSC funding the FY2016 funding in the sequester calculation, and thus no sequester was ordered for the NHSC funding
in FY2016. (See in FY2016. (See OMB Report to Congress on the Joint Committee Reductions for Fiscal Year 2016, February 2, , February 2,
2015, available at https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/legislative_reports/2015, available at https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/legislative_reports/
sequestration/2016_jc_sequestration_report_speaker.pdf.). P.L. 114-223 provided $6 sequestration/2016_jc_sequestration_report_speaker.pdf.). P.L. 114-223 provided $6
supplemental NHSC funding for Zika response. See discussion in CRS Report R44460, supplemental NHSC funding for Zika response. See discussion in CRS Report R44460, Zika Response
Funding: Request and Congressional Action..
this amount is subject to the 6.9% mandatory spending sequestration, resulting in $289 this amount is subject to the 6.9% mandatory spending sequestration, resulting in $289
These funds were appropriated after OMB had calculated the mandatory amounts to be sequestered in These funds were appropriated after OMB had calculated the mandatory amounts to be sequestered in
these fiscal years. As a result, no sequestration was applied to these mandatory NHSC funds.these fiscal years. As a result, no sequestration was applied to these mandatory NHSC funds.
that states use no more than 10% of the ARPA funds they receive to administer their state loan repayment that states use no more than 10% of the ARPA funds they receive to administer their state loan repayment
programs.programs.
years. As a result, no sequestration was applied to these mandatory NHSC funds.years. As a result, no sequestration was applied to these mandatory NHSC funds.
Program Size NHSC program size is measured in three ways: (1) funding, discussed above; (2) recruitmentNHSC program size is measured in three ways: (1) funding, discussed above; (2) recruitment,
which is the number of awards in different categories; and (3) fieldwhich is the number of awards in different categories; and (3) field strength, which is the number strength, which is the number
of NHSC clinicians currently fulfilling their service commitments. Recruitment in a given year is of NHSC clinicians currently fulfilling their service commitments. Recruitment in a given year is
generally smaller than the programgenerally smaller than the program
are currently fulfilling their service commitments, including those who are fulfilling a second are currently fulfilling their service commitments, including those who are fulfilling a second
year of their service commitment, and individuals who received scholarships or S2S agreements year of their service commitment, and individuals who received scholarships or S2S agreements
in earlier years who have completed their required training and are currently fulfilling their in earlier years who have completed their required training and are currently fulfilling their
service commitments. The section below discusses recruitment and field strength.service commitments. The section below discusses recruitment and field strength.
Recruitment
From FY2011 through From FY2011 through
more than more than
agreed to serve for a minimum of two years in a HPSA. The resumption of discretionary agreed to serve for a minimum of two years in a HPSA. The resumption of discretionary
appropriations for loan repayments in FY2018 increased the number of loan repayment awards appropriations for loan repayments in FY2018 increased the number of loan repayment awards
that the program was able to that the program was able to
FY2023. Table 2. National Health Service Corps (NHSC) Recruitment, FY2011-
Program
Scholarship Awards (New)
253
212
180
190
196
205
181
222
200
251
1,199
180
180
9
10
16
7
11
8
7
7
11
12
7
25
48
Total Scholarship Awards (New and Continuing)
262
222
196
197
207
213
188
229
211
263
1,206
205
228
Federal Loan Repayment Agreements (New)
4,113
2,342
2,106
2,775
2,934
3,079
2,554
Agreements (Agreements (
Continuing)
1,305
1,925
2,399
2,105
1,841
2,111
2,259
2,384
2,385
2,355
2,277
2,476
3,129
Total Federal Loan Repayment (New and Continuing)
5,418
4,267
4,505
4,880
4,775
5,190
4,813
5,646
6,397
8,318
8,646
7,705
7,302
Total Students to Service Loan Repayment Agreements
69
78
79
96
92
175
162
127
148
257
368
157
394
281
447
464
620
634
535
625
812
712
855
656
1,047
6,074
4,839
5,226
5,620
5,698
6,129
5,801
6,662
7,547
9,441
10,964
8,934
8,734
and Services Administration, and Services Administration, Justification of Estimations for Appropriations Committees,
Field Strength
The number of awards the NHSC makes at any point in time is only one component of program The number of awards the NHSC makes at any point in time is only one component of program
size, as not all awardees are currently serving as NHSC providers. Specifically, NHSC scholars size, as not all awardees are currently serving as NHSC providers. Specifically, NHSC scholars
and S2S program participants are still completing their training. As such, the NHSC also and S2S program participants are still completing their training. As such, the NHSC also
measures its field strength, which is the number of NHSC providers who are fulfilling a service measures its field strength, which is the number of NHSC providers who are fulfilling a service
obligation in a HPSA in a given year.obligation in a HPSA in a given year.
strength is a measure of both the NHSC appropriation, which affects the number of awards that strength is a measure of both the NHSC appropriation, which affects the number of awards that
can be made, and the relative balance between scholarships and loan repayment, both in the can be made, and the relative balance between scholarships and loan repayment, both in the
current fiscal year and in the past.current fiscal year and in the past.
number of awards made has increased (number of awards made has increased (
14,450) were in the main loan repayment program, which reflects the NHSCwere in the main loan repayment program, which reflects the NHSC
who will undertake their service commitment immediately in HPSAs.who will undertake their service commitment immediately in HPSAs.
scholarship awards in an earlier year, so the funding investment is not realized until after the scholarship awards in an earlier year, so the funding investment is not realized until after the
scholars complete their schooling and required training.scholars complete their schooling and required training.
are NHSC providers. Specifically, are NHSC providers. Specifically,
Figure 1. Trends in National Health Service Corps (NHSC) Field Strength (FY2011-FY2023, by number of providers who are fulfilling a service obligationin a HPSA in a given year) Source: Prepared by CRS, based on data in
Estimations for Appropriations Committees,
and Services Administration, and Services Administration, Justification of Estimations for Appropriations Committees,
FY2018, p. 74. Note: NHSC field strength is the number of NHSC clinicians or providers who are NHSC field strength is the number of NHSC clinicians or providers who are
in a Health Professional Shortage Area (HPSA) in exchange for a scholarship or loan repayment agreement.in a Health Professional Shortage Area (HPSA) in exchange for a scholarship or loan repayment agreement.
The increase in FY2022 represents clinicians receiving awards funded under the American Rescue Plan Act in FY2021. Types of NHSC Providers The NHSC is made up of an increasingly diverse set of health professionals. In FY2009, The NHSC is made up of an increasingly diverse set of health professionals. In FY2009,
physicians accounted for nearly 35% of providers and were the largest group of providers in the physicians accounted for nearly 35% of providers and were the largest group of providers in the
NHSC. In contrast, in FY2016, they made up 21%, and behavioral/mental health providers had NHSC. In contrast, in FY2016, they made up 21%, and behavioral/mental health providers had
become the largest provider typebecome the largest provider type
workforce loan repayment program began, further increasing the number and type of workforce loan repayment program began, further increasing the number and type of
behavioral/mental health providers in the program. In behavioral/mental health providers in the program. In
behavioral/mental health providers.behavioral/mental health providers.
largest groups of providers. Combined with behavioral/mental health providers, these three largest groups of providers. Combined with behavioral/mental health providers, these three
provider types made up provider types made up
2023. Figure 2 shows the NHSCshows the NHSC
which complete data are available.
Figure 2. National Health Service Corps (NHSC) Field Strength, by Discipline
2023) Source: Prepared by CRS, based on data in U.S. Department of Health and Human Services, Health Resources Prepared by CRS, based on data in U.S. Department of Health and Human Services, Health Resources
and Services Administration, and Services Administration, Justification of Estimations for Appropriations Committees,
FY2025, Rockville, MD, p. 90. Notes: Total providers = Total providers =
(MD) degree and osteopathic physicians who hold a Doctor of Osteopathic Medicine (DO) degree. (MD) degree and osteopathic physicians who hold a Doctor of Osteopathic Medicine (DO) degree.
Loan Repayment CliniciansLoan Repayment Clinicians
NHSC providers may serve at a number of facility types that generally focus on providing NHSC providers may serve at a number of facility types that generally focus on providing
outpatient primary care to patients regardless of their ability to pay. In addition, some NHSC outpatient primary care to patients regardless of their ability to pay. In addition, some NHSC
provider sites generally focus on primary care, such as federal health centers, while others may provider sites generally focus on primary care, such as federal health centers, while others may
target behavioral health, such as community mental health centers. As mentioned, these facilities target behavioral health, such as community mental health centers. As mentioned, these facilities
must be located in HPSAs. NHSC eligible sites must be located in HPSAs. NHSC eligible sites
government entities (including state, local, tribal, and federally operated facilities). In addition, government entities (including state, local, tribal, and federally operated facilities). In addition,
HRSA requires that NHSC sites are part of a system of care (e.g., have referral arrangements for HRSA requires that NHSC sites are part of a system of care (e.g., have referral arrangements for
specialty care and after-hours arrangements for patient care); have a documented record of sound specialty care and after-hours arrangements for patient care); have a documented record of sound
fiscal management; have a history of using NHSC providers appropriately and efficiently; accept fiscal management; have a history of using NHSC providers appropriately and efficiently; accept
beneficiaries from Medicare, Medicaid, and CHIP; have a sliding scale discount schedule; and beneficiaries from Medicare, Medicaid, and CHIP; have a sliding scale discount schedule; and
have general community support for assigning NHSC providers to the facility.have general community support for assigning NHSC providers to the facility.
outpatient Opioid Treatment Programs (OTPs) certified by the Substance Abuse and Mental outpatient Opioid Treatment Programs (OTPs) certified by the Substance Abuse and Mental
Health Services Administration (SAMHSA)Health Services Administration (SAMHSA)
provide outpatient—generally primary and behavioral—health care to disadvantaged populations provide outpatient—generally primary and behavioral—health care to disadvantaged populations
regardless of patientsregardless of patients
funded by the funded by the
this is particularly true with funds appropriated in FY2019-this is particularly true with funds appropriated in FY2019-
IHS-funded facilities.IHS-funded facilities.
in outpatient settings. However, some may serve at IHS-funded hospitals, and in recent years, in outpatient settings. However, some may serve at IHS-funded hospitals, and in recent years,
some have fulfilled part of their service commitment (up to 24 hours per week) at critical access some have fulfilled part of their service commitment (up to 24 hours per week) at critical access
hospitals (CAHs), which are small hospitals located in rural areas. hospitals (CAHs), which are small hospitals located in rural areas.
between inpatient services at the CAH (up to 24 hours per week) and outpatient services at CAH between inpatient services at the CAH (up to 24 hours per week) and outpatient services at CAH
affiliated-outpatient clinics (not less than 16 hours per week).affiliated-outpatient clinics (not less than 16 hours per week).
NHSC providers are located at HPSAs throughout the United States and its territories (see NHSC providers are located at HPSAs throughout the United States and its territories (see Figure
3). According to . According to
Figure 3. National Health Service Corps (NHSC) Providers by State, Territory
(FY2023)
Source: CRS Analysis of https://data.hrsa.gov/topics/health-workforce/field-strength.Note: FTE = Full Time Employee.
Provider RetentionThe NHSC collects data on the retention of NHSC clinicians. HRSA modernized its data systems to better track its alumni starting in FY2019, which may provide additional insights into the program. In the FY2022 report on the NHSC, HRSA reported that 86% of those who had finished their service commitment in FY2020 remained in service in a HPSA. In addition, they found that 87% of those who had fulfilled their service commitments between 2012 and 2021 are either still working in a HPSA or remained in the community where they fulfilled their service commitment, even if it no longer qualified as a HPSA.55
Legislative Proposals Related to the NHSC
This section discusses some common types of legislative proposals that would amend the NHSC This section discusses some common types of legislative proposals that would amend the NHSC
and discusses how the new NHSC SUD loan repayment program (including the rural component) and discusses how the new NHSC SUD loan repayment program (including the rural component)
legislation.legislation.
service locations that are eligible for the program. For example, legislation in the service locations that are eligible for the program. For example, legislation in the
Secretary has some authority to add disciplines without new laws being enacted.Secretary has some authority to add disciplines without new laws being enacted.
in prior requests from appropriations committees about including pharmacists in the program, the in prior requests from appropriations committees about including pharmacists in the program, the
HHS Secretary has declined to do so based on an interpretation that pharmacy and chiropractor HHS Secretary has declined to do so based on an interpretation that pharmacy and chiropractor
services would be outside of the core intent of the NHSC to provide services would be outside of the core intent of the NHSC to provide
"58 Similar conversations have occurred between HHS and the House Appropriations Committee Similar conversations have occurred between HHS and the House Appropriations Committee
regarding optometry.regarding optometry.
(including the rural component) and states can elect to include them in their loan repayment (including the rural component) and states can elect to include them in their loan repayment
programs. Optometrists programs. Optometrists and clinical lab personnel are not eligible for the federal NHSC loan repayment programs.are not eligible for the federal NHSC loan repayment programs.
provider types out of concern that doing so would shift the program away from its traditional provider types out of concern that doing so would shift the program away from its traditional
focus of providing primary care to underserved populations.focus of providing primary care to underserved populations.
program is currently competitive and that adding new eligible disciplines could redirect NHSC program is currently competitive and that adding new eligible disciplines could redirect NHSC
funds away from already identified clinical shortage areas (and thus potentially create new funds away from already identified clinical shortage areas (and thus potentially create new
ones).ones).
individuals served by the NHSC, because the new provider types (e.g., physical therapists) individuals served by the NHSC, because the new provider types (e.g., physical therapists)
generally serve a narrower subset of the population than do primary care providers.generally serve a narrower subset of the population than do primary care providers.
clarified the range of eligible providers. For example, in 2016, the clarified the range of eligible providers. For example, in 2016, the
114-255) clarified that adolescent and child psychiatrists are eligible to participate in the federal 114-255) clarified that adolescent and child psychiatrists are eligible to participate in the federal
loan repayment program.loan repayment program.
were eligible. This law, however, did not expand the list of NHSC providers. Instead, it sought to were eligible. This law, however, did not expand the list of NHSC providers. Instead, it sought to
clarify that, within the existing group of NHSC-eligible psychiatrists, those who specialize in clarify that, within the existing group of NHSC-eligible psychiatrists, those who specialize in
child and adolescent psychiatry are eligible to participate in the NHSC.child and adolescent psychiatry are eligible to participate in the NHSC.
The SUD loan repayment program was first enacted in the Consolidated Appropriations Act, 2018 The SUD loan repayment program was first enacted in the Consolidated Appropriations Act, 2018
for the NHSC loan repayment program to substance use disorder counselors and pharmacists, for the NHSC loan repayment program to substance use disorder counselors and pharmacists,
among others. These laws also increased NHSC funding and specified that this funding among others. These laws also increased NHSC funding and specified that this funding must be used to be used to
support awards to substance use disorder providers. These specifications in the law increased the support awards to substance use disorder providers. These specifications in the law increased the
overall size of the NHSC and added provider types with these additional funds. Adding additional overall size of the NHSC and added provider types with these additional funds. Adding additional
funding, and not drawing from the NHSC funding otherwise available, may have averted a funding, and not drawing from the NHSC funding otherwise available, may have averted a
number of the displacement concerns that HHS has noted in prior efforts to expand the NHSC number of the displacement concerns that HHS has noted in prior efforts to expand the NHSC
(i.e., that new providers added to the program have not reduced the number of primary care (i.e., that new providers added to the program have not reduced the number of primary care
providers participating the in the program).providers participating the in the program).
providers.providers.
primary care practice (where a patient pays a fee to access the practice) as eligible for NHSC primary care practice (where a patient pays a fee to access the practice) as eligible for NHSC
scholarships or loan repayment if the practice is located in a HPSA. In the scholarships or loan repayment if the practice is located in a HPSA. In the
6979 would have added facilities operated by the Department of Veterans Affairs as eligible for 6979 would have added facilities operated by the Department of Veterans Affairs as eligible for
NHSC clinicians. Adding addition facility types raises a number of the same displacement NHSC clinicians. Adding addition facility types raises a number of the same displacement
concerns as does adding additional provider types. Currently, the number of sites eligible for the concerns as does adding additional provider types. Currently, the number of sites eligible for the
NHSC exceeds the number of clinicians that the program can fund. Adding new site types could NHSC exceeds the number of clinicians that the program can fund. Adding new site types could
increase the number of sites with unfilled positions and could create more competition between increase the number of sites with unfilled positions and could create more competition between
sites for providers. For the VA example, the agency has its own scholarship and loan repayment sites for providers. For the VA example, the agency has its own scholarship and loan repayment
programs to recruit and retain providers. Should VA facilities be added as eligible for the NHSC, programs to recruit and retain providers. Should VA facilities be added as eligible for the NHSC,
there may be a need for coordination across these programs.there may be a need for coordination across these programs.
to create new demonstration programs within the NHSC. For example, H.R. 2130 and to create new demonstration programs within the NHSC. For example, H.R. 2130 and S. 924 in the 117th Congress would have created
year service commitment in a rural HPSA. NHSC loan repayment is a two-year service year service commitment in a rural HPSA. NHSC loan repayment is a two-year service
commitment in exchange for a one-time payment amount. In contrast, this program would require commitment in exchange for a one-time payment amount. In contrast, this program would require
a five-year commitment and would pay one-fifth of a cliniciana five-year commitment and would pay one-fifth of a clinician
each year of service. each year of service.
NHSC had a rural community loan repayment program as a component of the SUD loan NHSC had a rural community loan repayment program as a component of the SUD loan
repayment program in recent years. In addition, the NHSC does place providers in rural areas repayment program in recent years. In addition, the NHSC does place providers in rural areas
under the current program. Specifically, under the current program. Specifically,
its clinicians served in rural areas. This percentage is higher than the overall size of the U.S. its clinicians served in rural areas. This percentage is higher than the overall size of the U.S.
population that resides in rural areas (20%) but is lower than the percentage of HPSAs that are population that resides in rural areas (20%) but is lower than the percentage of HPSAs that are
considered to be rural (approximately 60% of all considered to be rural (approximately 60% of all
also been proposed in also been proposed in
increasing provider stability in HPSAs.increasing provider stability in HPSAs.
and Treatment for Patients and Communities Act (P.L. 115-271and Treatment for Patients and Communities Act (P.L. 115-271, the SUPPORT Act). Specifically, Section 7701 enacted a new loan repayment program that was set up in FY2021
program (or STAR LRP).program (or STAR LRP).
repayment balance per year for a six-year full-time service commitment at a qualified facility, repayment balance per year for a six-year full-time service commitment at a qualified facility,
including a number of inpatient facilities that are not eligible sites for the NHSC.including a number of inpatient facilities that are not eligible sites for the NHSC.
commitment will be a barrier to recruitment or retention. This program also permits a broader set commitment will be a barrier to recruitment or retention. This program also permits a broader set
of facilities to be eligible as service sites (e.g., inpatient psychiatric treatment facilities). A longer of facilities to be eligible as service sites (e.g., inpatient psychiatric treatment facilities). A longer
loan repayment period may be challenging because it could increase participants defaulting on loan repayment period may be challenging because it could increase participants defaulting on
their service commitment. This new program may be a way of determining whether some of the their service commitment. This new program may be a way of determining whether some of the
proposed demonstration projects within the NHSC (e.g., longer loan repayment, additional proposed demonstration projects within the NHSC (e.g., longer loan repayment, additional
providers, and additional sites) are feasible.providers, and additional sites) are feasible.
workforce in emergencies. The Coronavirus Disease 2019 (COVID-19) pandemic raised issues workforce in emergencies. The Coronavirus Disease 2019 (COVID-19) pandemic raised issues
related to health workforce availability. related to health workforce availability.
to S. 4055 in the to S. 4055 in the
NHSC clinicians to be deployed in emergency circumstances as part of the National Disaster NHSC clinicians to be deployed in emergency circumstances as part of the National Disaster
Medical System (NDMS) in exchange for additional loan repayment. The NDMS includes Medical System (NDMS) in exchange for additional loan repayment. The NDMS includes
volunteer medical personnel who may be deployed temporarily, at a statevolunteer medical personnel who may be deployed temporarily, at a state
a disaster. The a disaster. The demonstration program would also program would also
loan repayment. This bill would loan repayment. This bill would
removing concerns that it would reduce the number of awards that the NHSC could make. However, NHSC concerns that it would reduce the number of awards that the NHSC could make. However, NHSC
clinicians provide care in HPSAs, which by definition have a shortage of providers that the clinicians provide care in HPSAs, which by definition have a shortage of providers that the
program seeks to ameliorate. Deploying active NHSC clinicians may create concerns about health program seeks to ameliorate. Deploying active NHSC clinicians may create concerns about health
care availability in HPSAs. The bill also care availability in HPSAs. The bill also
which may entail fewer concerns about provider availability in HPSAs.which may entail fewer concerns about provider availability in HPSAs.
Calvin C. DeSouza, CRS Geographic Information Specialist, prepared the map included in this report, and Brion Long, CRS Visual Information Specialist, prepared the graphics included in this report. Joe Angert, CRS Research Assistant, contributed to this report.
Footnotes
National Health Service Corps (NHSC) providers supported by the federal programs must serve at an NHSC-approved service site; time spent at an unapproved site, even if that site is within a health professional shortage area (HPSA), does not count toward the clinician's service commitment. See U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), National Health Service Corps Loan Repayment Program, Fiscal Year 2025, Application & Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/lrp-application-guidance.pdf, p. 43.
U.S. Department of Health and Human Services, "HHS Announces Transformation to Make America Healthy Again," press release, March 27, 2025, https://www.hhs.gov/press-room/hhs-restructuring-doge.html.
P.L. 91-623 was enacted on December 31, 1970. The NHSC is authorized in Sections 331-338 of the Public Health Service Act (PHSA) (42 U.S.C. §254d et. seq.). The federal regulation states the purpose of the loan repayment (42 C.F.R. §62.21) and the scholarship program (42 C.F.R. §62.1).
For additional changes included in the Affordable Care Act, see CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions in ACA: Summary and Timeline.
PHSA Section 338G authorizes a fourth program that would provide a $25,000 loan to an NHSC member in exchange for two-years of service in a HPSA in private practice. This program has never been implemented.
Funding included in the American Rescue Plan Act (ARPA) for the state loan repayment program waived the state matching requirement.
U.S. nationals are individuals born in certain U.S. territories.
Physicians include individuals who have graduated from allopathic medical schools, which award Medical Doctor (MD) degrees and osteopathic medical schools which grant Doctors of Osteopathy (DO) degrees. Graduates of foreign medical schools are not eligible for the NHSC.
For example, the federal loan repayment program permits mental and behavioral health providers and dental hygienists to participate. The state loan repayment program allows these additional providers and permits states to designate additional provider types as eligible based on the state's workforce needs.
See HHS, HRSA, National Health Service Corps Loan Repayment Program, Fiscal Year 2025, Application & Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/lrp-application-guidance.pdf, pp. 33-35. (Hereinafter, HRSA, NHSC Loan Repayment Program.)
42 U.S.C. §254l.
Individuals who attend foreign medical schools are not eligible for the NHSC scholarship program. HRSA, NHSC Scholarship Program defines reasonable educational costs on p. 17-18.
For physicians, this is defined as family medicine, general internal medicine, general pediatrics, obstetrics/gynecology, general psychiatry, and joint programs in a combination of these specialties (e.g., internal medicine/pediatrics). For nurses, this is defined as adult medicine, family medicine, geriatrics, primary care pediatrics, psychiatric-mental health, or women's health. For dentists, this is defined as general practice dentistry, advanced education in general dentistry, pediatric dentistry, and public health dentistry.
HRSA, NHSC Scholarship Program, p. 4.
HRSA, NHSC, "Review Site HPSA Score and Job Search Requirements for NHSC Scholars," https://nhsc.hrsa.gov/scholarships/requirements-compliance/jobs-and-site-search .
HRSA, NHSC Scholarship Program, p. 8-9.
HHS/HRSA, Report to Congress, National Health Service Corps for the Year 2019, Rockville, MD, 2019, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/about-us/reports-to-congress/nhsc-report-congress-2019.pdf, p. 10.
HHS, HRSA, "Growing the Health Workforce and the Biden-Harris Administration: The National Health Service Corps," https://nhsc.hrsa.gov/sites/default/files/nhsc/about-us/nhsc-roundtable-handout-2024.pdf .
42 U.S.C. §254d(i), as amended, and 42 U.S.C. §254l-1, as amended, and respectively.
A behavioral/mental health worker in the NHSC may be a licensed clinical social worker, licensed professional counselor, health service psychologist, marriage and family therapist, physician (e.g., a psychiatrist, including child and adolescent psychiatrists), nurse practitioner (i.e., a psychiatric nurse specialist), or physician assistant (e.g., mental health and psychiatry). See HRSA, NHSC Loan Repayment Program, pp. 20-25.
HRSA, NHSC Loan Repayment Program, p.11.
HRSA, NHSC Loan Repayment Program. pp. 49-50. The FY2025 application included a bonus of up to $5,000 for health professionals with Spanish language proficiency.
In FY2024, for the S2S Program, sites with HPSAs scores of 14 or above are determined to be of high-need. See HRSA NHSC Student to Service, p. 26.
HRSA, NHSC Student to Service, pp. 19-20.
See HRSA, NHSC Student to Service, p. 7. The calculations of Maternity Care Target Areas do not include family medicine physicians; however, they would be eligible by the Maternity Care Target Area Supplemental Award under HRSA's FY2025 application and program guidance.
For example, the language appropriating FY2024 funds in P.L. 118-47, was as follows: "That $128,600,000 shall remain available until expended for the purposes of providing primary health services, assigning National Health Service Corps ("NHSC") participants to expand the delivery of substance use disorder treatment services, notwithstanding the assignment priorities and limitations under Sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of the PHS Act, and making payments under the NHSC Loan Repayment Program under Section 338B of such act." For FY2025, the federal government is operating under a full-year continuing resolution as enacted in P.L. 119-4. Amounts allocated to specific programs have not, as of the date of this report's publication, been publicly released.
HHS, HRSA, National Health Service Corps, Substance Use Disorder Workforce Loan Repayment Program, FY2025, Application and Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/sud-lrp-application-guidance.pdf, p. 12-13. The Substance Use Disorder (SUD) Loan Repayment Program provides $75,000 in loan repayment for a three-year service commitment. In FY2024, the amount for the main loan repayment (see "Main Loan Repayment Program" section in this report) program increased from $50,000 to $75,000 in exchange for a two-year service commitment. Some providers may be eligible for both programs, which may make the main loan repayment program more attractive. Some types of behavioral health providers may be eligible for the SUD program but not the main loan repayment program. Some health facilities that focus on SUD treatment may not be eligible sites under the main loan repayment program, but may be eligible sites for the SUD program.
HHS, HRSA, National Health Service Corps, Substance Use Disorder Workforce Loan Repayment Program, FY2025, Application and Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/sud-lrp-application-guidance.pdf, p. 12-13. The FY2025 application included a bonus of up to $5,000 for health professionals with Spanish language proficiency. The program also provides loan repayment for maternity care health professionals providing care in a maternity care target area (MCTA; see text box).
HHS, HRSA, National Health Service Corps, Rural Community Loan Repayment Program, FY2025, Application and Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/rural-community-lrp-application-guidance.pdf.
HHS, HRSA, National Health Service Corps, Rural Community Loan Repayment Program, FY2025, Application and Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/rural-community-lrp-application-guidance.pdf, p. 3. FY2025 application included a bonus of up to $5,000 for health professionals with Spanish language proficiency. The program also provides loan repayment for maternity care health professionals providing care in a maternity care target area (MCTA, see text box).
PHSA Section 338I(a)(2) (42 U.S.C. §254q–1) authorizes the Secretary to make grants to states for the NHSC State Loan Repayment program provided that a state agency agrees to administer the program. Within 42 C.F.R. §62.54, the state agencies administering the State Loan Repayment Program must comply with regulations to ensure that their health workforce meets requirements for training, placement in medically underserved areas, and comparability to the NHSC Federal Loan Repayment Program, among other things. For program guidance, see HHS, State Loan Repayment Contacts, http://nhsc.hrsa.gov/loanrepayment/stateloanrepaymentprogram/contacts.html.
Funding included in the American Rescue Plan Act of 2021 for the state loan repayment program waived the state matching requirement.
The Community Health Center Fund was created in Section 10503 of the Affordable Care Act (P.L. 111-148, as amended) and provided time-limited mandatory funding for the health center program and the NHSC (in Section 10503(b)(2)).
HHS, "HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities," press release, November 22, 2021, https://www.hhs.gov/about/news/2021/11/22/hhs-announces-record-health-care-workforce-awards-in-rural-underserved-communities.html.
U.S. Department of Health and Human Services, Health Resources and Services Administration, Justification of Estimations for Appropriations Committees, FY2025, Rockville, MD, https://www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-justification-fy2025.pdf https://web.archive.org/web/20250308124649/https://www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-justification-fy2025.pdf, p. 93. Hereinafter, HHS, HRSA, Justification of Estimates for Appropriations Committees, FY2025.
National Advisory Council on the National Health Service Corps, Meeting Minutes Summary, HHS, Rockville, MD, 2012, p. 2, https://nhsc.hrsa.gov/corpsexperience/aboutus/nationaladvisorycouncil/meetingsummaries/011912minutes.pdf.
HHS, HRSA, Justification of Estimations for Appropriations Committees, FY2025, Rockville, MD, p. 94. In addition to currently obligated NHSC clinicians, some NHSC alumni may remain as providers in a HPSA. These individuals are not included in NHSC field strength data. For more information on NHSC alumni, see the "Provider Retention" section in this report.
See section on "NHSC Funding" for a detailed discussion of NHSC funding sources.
HHS, HRSA, Justification of Estimations for Appropriations Committees, FY2025, Rockville, MD, p. 94. The FY2023 total includes individuals who received one-year continuation contracts after having previously received a two-year award using American Rescue Plan Act (P.L. 117-2) funding.
HHS, HRSA, Justification of Estimations for Appropriations Committees, FY2025, Rockville, MD, p. 88.
HHS, HRSA, Justification of Estimates for Appropriations Committees, FY2011, p. 69.
HHS, HRSA, Justification of Estimates for Appropriations Committees, FY2025, p. 90.
Under limited circumstances, NHSC providers may also fulfill their service commitment by working in a private practice in a HPSA. For more information about these facility types, see CRS Report R43937, Federal Health Centers: An Overview for description of health centers and Appendix A for description of other NHSC eligible facility types. Indian Health Service facilities are also described in CRS Report R43330, The Indian Health Service (IHS): An Overview.
HHS/HRSA, Report to Congress, National Health Service Corps for the Year 2022, Rockville, MD, 2022,https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/about-us/reports-to-congress/nhsc-report-congress-2022.pdf, p. 14-15.
HHS, Substance Abuse and Mental Health Services Administration, "Become an Approved OTP Accreditation Body," https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/become-otp. These are facilities that are permitted to administer and dispense medication assisted treatment (MAT) for treatment of opioid use disorders.
HHS, HRSA, National Health Service Corps, Substance Use Disorder Workforce Loan Repayment Program, FY2025, Application and Program Guidance, https://nhsc.hrsa.gov/sites/default/files/nhsc/loan-repayment/sud-lrp-application-guidance.pdf, p. 25-26.
For more information, see CRS Report R43937, Federal Health Centers: An Overview. For information on where NHSC providers serve, see HHS/HRSA, Report to Congress, National Health Service Corps for the Year 2022, Rockville, MD, 2019, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/about-us/reports-to-congress/nhsc-report-congress-2022.pdf, p. i.
For more information, see CRS Report R43330, The Indian Health Service (IHS): An Overview.
See HRSA, NHSC Loan Repayment Program, p. 18.
For information on where NHSC providers serve, see HHS/HRSA, Report to Congress, National Health Service Corps for the Year 2022, Rockville, MD, 2022, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/about-us/reports-to-congress/nhsc-report-congress-2022.pdf, p. 3. Information on the percentage rural, were drawn from https://data.hrsa.gov/topics/health-workforce/field-strength. In its FY2025 report on HPSA designations approximately 67% of primary care HPSAs were rural (similar percentages of dental HPSAs were considered rural and 63% of mental health HPSAs were also considered rural). See Bureau of Health Workforce, HRSA, HHS, Designated Health Professional Shortage Areas, First Quarter of Fiscal Year 2025 Designated HPSA Quarterly Summary, Rockville, MD, December 31, 2024, https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport.
HHS/HRSA, Report to Congress, National Health Service Corps for the Year 2022, Rockville, MD, 2022, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/about-us/reports-to-congress/nhsc-report-congress-2019.pdf; https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/about-us/reports-to-congress/nhsc-report-congress-2022.pdf, p. 2-3.
Other bills in the 117th and 116th Congresses also propose adding additional types of providers to the program. See, for example, H.R. 3912 and S. 1676 in the 116th Congress, which would have added nephrologists to the program.
For information on prior types of health provider expansions considered, see U.S. Congress, Senate Committee on Appropriations, Subcommittee on Departments of Labor, Health and Human Services, and Education, and Related Agencies, Departments Labor, Health and Human Services, and Education, and Related Agencies Appropriation Bill, 2012, To Accompany S. 1599, 112th Cong., 1st sess., September 22, 2011, S.Rept. 112-84 (Washington: GPO, 2012), p. 40.
Primary health services are defined as health services regarding family medicine, internal medicine, pediatrics, obstetrics and gynecology, dentistry, or mental health that are provided by physicians or other health professionals. HHS, HRSA, Justification of Estimates for Appropriations Committees, FY2013, p. 371, http://www.hrsa.gov/about/budget/budgetjustification2013.pdf. In P.L. 107-251, Health Care Safety Net Amendments of 2001 (enacted on October 26, 2002), Congress required the Secretary to implement a "Chiropractic/Pharmacist Demonstration Project" under Section 338B of the PHSA (or the NHSC's Federal Loan Repayment Program). Following a general notice (68 Federal Register 112; 34981; June 11, 2003), the Secretary implemented the program but discontinued it after initial demonstrations were completed. Source: CRS email communication HHS, Office of Legislative Affairs, August 2016.
H.Rept. 114-699, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2017, to accompany H.R. 5926, p. 28.
HHS, HRSA, Justification of Estimates for Appropriations Committees, FY2017, p. 427, http://www.hrsa.gov/about/budget/budgetjustification2017.pdf. In the 2018 Budget Justification, HRSA also declined to broaden the eligible disciplines for the NHSC. See Department of Health and Human Services, Health Resources and Services Administration, Justification of Estimations for Appropriations Committees, FY2018, Rockville, MD, p. 331.
See discussion of Section 9023 in CRS Report R44718, The Helping Families in Mental Health Crisis Reform Act of 2016 (Division B of P.L. 114-255).
See also S. 1688 in the 116th Congress, which would have added pediatric inpatient mental health facilities as eligible NHSC sites.
For information on the Department of Veterans Affairs program, see Department of Veteran Affairs, "Health Care Professionals: Hiring Incentives," https://www.vacareers.va.gov/Benefits/HiringProgramsInitiatives/#professionals.
See "Field Strength Dashboard" at https://data.hrsa.gov/topics/health-workforce/field-strength. In its FY2025 report on HPSA designations approximately 67% of primary care HPSAs were rural (similar percentages of dental HPSAs were considered rural and 63% of mental health HPSAs were also considered rural). See Bureau of Health Workforce, HRSA, HHS, Designated Health Professional Shortage Areas, First Quarter of Fiscal Year 2025 Designated HPSA Quarterly Summary, Rockville, MD, December 31, 2024, https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport.
CRS Report R45423, Public Health and Other Related Provisions in P.L 115-271, the SUPPORT for Patients and Communities Act.
HHS, HRSA, "Substance Use Disorder Treatment and Recovery Loan Repayment Program," https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp.
The section of the SUPPORT Act enacting this program required a report to specified committees five years after enactment (i.e., October 2023); however, that report is not included within HRSA's list of reports to Congress. CRS cannot determine whether this report was not completed or was completed and is not publicly available.