Federal Student Loan Repayment Programs for Behavioral Health Service Providers

Federal Student Loan Repayment Programs for Behavioral Health Service Providers

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August 4, 2022
Federal Student Loan Repayment Programs for Behavioral
Health Service Providers
Many policymakers have longstanding concerns about the
more information, see CRS Infographic IG10015, Health
availability of behavioral health (i.e., mental health and
Professional Shortage Areas (HPSAs)). Providers may also
substance use) treatment services overall and in specific
serve half-time (i.e., 20 hours per week for two years) in
geographic areas. One option pursued to increase the
exchange for up to $25,000. Providers may extend their
availability of these services has been to provide student
service in one-year increments in exchange for additional
loan repayment benefits to individuals in specified
loan repayment benefits. NHSC LRP is available to the
behavioral health professions in exchange for providing
following types of behavioral health providers:
health services in specific locations, as licensed behavioral
psychiatrists, health service psychologists, licensed clinical
health providers may have borrowed student loans to pursue
social workers, psychiatric nurse specialists, marriage and
the advanced training required of their profession. The
family therapists, licensed professional counselors, and
eligible types of behavioral health providers vary by loan
nurse practitioners and physician assistants who focus on
repayment program, but generally include psychiatrists,
mental health or psychiatry. NHSC service sites are
psychologists, nurses (who specialize in mental health),
primarily outpatient primary-care focused facilities,
social workers, and counselors (licensed professional and
although Indian Health Service facilities and small rural
marriage and family). These professionals provide a range
hospitals are also eligible. For more information, see CRS
of services, from outpatient mental health counseling and
Report R44970, The National Health Service Corps.
medication management to coordinated inpatient care. In
recent years, programs have focused on recruiting providers
NHSC Substance Use Disorder (SUD)
who are able to provide access to medication-assisted
Workforce LRP
treatment, which is used to treat opioid use disorders.
NHSC SUD Workforce LRP is a subset of NHSC LRP that
This In Focus discusses student loan repayment programs
provides up to $75,000 in student loan repayment benefits
specifically available to behavioral health providers and for
in exchange for an individual providing three years of full-
which Congress appropriated funds in FY2022 (Table 1),
time service at an NHSC-approved SUD treatment facility
along with selected policy issues. All of the programs
in a mental health or primary medical care HPSA. Providers
discussed are administered by the Health Resources and
may serve half-time for three years in exchange for up to
Services Administration (HRSA) within the Department of
$37,500 in benefits. NHSC SUD Workforce LRP is
Health and Human Services (HHS) and are authorized by
available to individuals who serve in NHSC disciplines, but
the Public Health Service Act. In general, loan repayment
also to physicians who provide opioid use disorder
benefits provided under these programs are subject to the
treatment (who may not be psychiatrists), SUD counselors,
availability of funds.
pharmacists, and registered nurses. Providers may fulfill
Student loan repayment and forgiveness programs that are
their service commitment at SUD treatment sites, which
not discussed in this In Focus, but for which behavioral
may include facilities that may not be eligible for NHSC
health providers may be eligible, include those operated by
LRP because they are behavioral health focused.
federal agencies that seek to recruit and retain health
NHSC Rural Community LRP
providers at federal facilities—such as military treatment
facilities, Veterans Affairs health facilities, and facilities
NHSC Rural Community LRP is a subset of NHSC LRP
operated or funded by the Indian Health Service—and those
that provides up to $100,000 in student loan repayment
that are available to a broader class of individuals (i.e., not
benefits in exchange for an individual providing three years
specific to behavioral health professions), such as the
of full-time service. Providers may serve half-time over
Public Service Loan Forgiveness (PSLF) program. More
three years for up to $50,000 in benefits. Health
information about these and other programs can be found in
professionals and service sites are generally the same as
CRS Report R43571, Federal Student Loan Forgiveness
under the NHSC SUD Workforce LRP; however, service
and Loan Repayment Programs.
sites must be located in rural mental health or primary care
HPSAs.
National Health Service Corps (NHSC)
Loan Repayment Program (LRP)
Substance Use Disorder Treatment and
Recovery (STAR) LRP
The NHSC LRP is the largest health-focused student loan
repayment program. It provides up to $50,000 in loan
STAR LRP provides up to $250,000 in student loan
repayment benefits in exchange for an individual providing
repayment benefits in exchange for six years of service in a
two years of full-time service in an eligible discipline or
STAR LRP-approved facility located either within a mental
specialty at an NHSC-approved service site in a federally
health HPSA or a county where the drug-related overdose
designated health professional shortage area (HPSA; for
death rate for the past three years exceeds the national
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average. Health provider types are the same as under the
center. Restrictions on LRP eligibility to individuals serving
NHSC SUD program, but also include psychology doctoral
only in healthcare facilities may limit the utility of the
interns, certified nursing assistants, licensed practical
increased BSCA funding for school healthcare, as
nurses, occupational therapists, medical assistants, and
behavioral health providers may choose to work in LRP
behavioral health paraprofessionals (e.g., community health
eligible facilities rather than in schools.
workers and peer recovery specialists). Each recipient must
Overlapping Benefits Across Programs
provide direct treatment or recovery support of SUD
patients. STAR LRP-approved sites include inpatient sites,
Multiple LRPs may be available to the same group of
detox facilities, recovery centers, and office-based opioid
individuals and may serve the same or similar purposes.
treatment facilities that are generally not NHSC-approved
Also, some current proposals in Congress would authorize
service sites.
new LRPs to provide benefits to similarly situated
individuals and to support similar purposes. Such overlap
Pediatric Subspecialist LRP
may lead to confusion among potential recipients and may
The Pediatric Subspecialist LRP Program was first
lead to the government funding administrative costs for
authorized in 2010 by the Patient Protection and Affordable
multiple programs when only one may be sufficient.
Care Act (P.L. 111-148), but first received an appropriation
Within the current array of all federally authorized student
in FY2022. As such, it has not yet been fully implemented.
loan forgiveness and repayment programs, the same
The program is to provide up to $35,000 of student loan
borrower could receive benefits from multiple programs for
repayment benefits per year to individuals who provide
the same service performed. Such overlap may bolster the
pediatric care in a shortage area. Individuals must agree to
desirability of entering into and remaining in a chosen
serve for a minimum of two years and may serve up to three
profession but may also result in confusion among
years. Pediatricians and qualified health professionals who
recipients regarding interactions among programs. The
have received specialized training in child and adolescent
latter may hamper an individual’s ability to make rational
mental health in psychiatry, psychology, school
choices and maximize available benefits. From the
psychology, behavioral pediatrics, psychiatric nursing,
government’s perspective, such overlap may result in the
school social work, SUD prevention and treatment,
federal government expending funds from more than one
marriage and family therapy, school counseling, or
source for the same service.
professional counseling are eligible for this program.
Specific service sites have not yet been determined.
Income Tax Consequences
In general, student loan debt that is repaid on a borrower’s
Table 1. FY2022 Appropriations for LRPs for
behalf is included as part of an individual’s gross income
Behavioral Health Providers
for the purposes of federal income taxation. Benefits under
(dol ars in mil ions)
NHSC LRP and its subsets are specifically excluded from
Program
FY2022 Funding
federal income taxation. STAR-LRP and Pediatric
Subspecialist LRP are not excluded from federal income
NHSC LRP
$292a
taxation. An individual who received loan repayment
NHSC SUD Workforce LRP and
benefits under these programs would be subject to federal
$120b
NHCS Rural Community LRP
income tax liability associated with those benefits.
Congress might consider whether to grant similar income
STAR-LRP
$28
tax treatment to similar programs.
Pediatric Subspecialist LRP
$5
Funding Considerations
Source: Health Resources and Services Administration Budget
Loan repayment benefits provided under these programs are
Documents, https://www.hrsa.gov/about/budget/index.html.
available subject to the availability of funds. With the
a. Funding not exclusive to behavioral health providers.
exception of Pediatric Subspecialist LRP, all programs
b.
discussed in this In Focus have consistently received some

Funds appropriated for SUD treatment providers in general;
HRSA determines the specific amount al ocated for NHSC Rural
amount of funding, although amounts available have varied
Community LRP from this appropriated amount.
over time. Limitations to program funding may cut against
efforts to recruit and retain individuals in the fields targeted
Selected Issues
by these programs, as funding amounts may not be
commensurate with need.
This section highlights selected policy issues with respect to
student loan repayment programs for behavioral health
In response to the COVID-19 pandemic, the American
providers that may be of interest to Congress.
Rescue Plan Act of 2021 (P.L. 117-2) appropriated $800
million, available until expended, to HHS to carry out
Providers in Schools vs. Healthcare Facilities
NHSC LRP (as well as the NHSC scholarship and state
The Bipartisan Safer Communities Act (BSCA; P.L. 117-
loan repayment programs). This may ultimately result in
159), enacted in June 2022, authorized funds to increase
scenarios in which behavioral health providers and their
healthcare services in schools. Funds may be used to
employers rely on a large, one-time infusion of funds that
support, for example, school-based mental health services.
may not be available going forward.
However, the current federal student loan repayment
programs that are specifically for behavioral health
Alexandra Hegji, Analyst in Social Policy
providers are not available to individuals serving in schools,
Elayne J. Heisler, Specialist in Health Services
unless an individual is serving in a school-based health
IF12184
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Federal Student Loan Repayment Programs for Behavioral Health Service Providers

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