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From MSLRP to NHSC LRP: Exploring Loan Repayment Options for Michigan Healthcare Providers

MSLRP

The Michigan State Loan Repayment Program (MSLRP) awards medical, dental, and mental healthcare providers who are working in Health Professional Shortage Areas (HPSAs) with up to $300,000 to repay their educational debt over a period of 10 years. Like most of the other loan repayment programs, healthcare providers who participate in the MSLRP enter into two-year-long service obligations; to receive more repayment, MSLRP participants must participate in multiple two-year service obligations. However, unlike most loan repayment programs, the MSLRP requires employers to contribute 20% of their healthcare providers’ loan repayment agreement amounts. MSLRP is recognized as a State Loan Repayment Program (SLRP) by the Health Resources and Services Administration’s (HRSA) National Health Service Corps (NHSC).


The purpose of the MSLRP is to help employers in underserved areas recruit and retain medical, dental, and mental healthcare professionals, which increases healthcare access and improves the health of residents in those areas. In addition, the MSLRP specifies applicants who are a top priority for funding for each application period.


DECREASE OF MSLRP APPLICANTS

From 2020 to 2023, the number of MSLRP applicants decreased. However, on average, the number of MSLRP applicants increased over the past eleven years, according to MSLRP data. In 2019, the number of MSLRP applicants was at its peak, with the Michigan Department of Health and Human Services receiving 185 applications. But, this number decreased to 176 in 2020, 160 in 2021, 136 in 2022, and only 102 in 2023.



Furthermore, the average educational debt for MSLRP participants only increased during this time period (MDHHS, 2023). Why, then, could applications be decreasing if the need for loan repayment is increasing?


TEPSLF

One potential explanation for the decrease in applications is the Temporary Expanded Public Service Loan Forgiveness (TEPSLF). Public Service Loan Forgiveness (PSLF) allows individuals who work for a government or a non-profit organization to apply to have the remaining balance on their Federal Direct educational loans forgiven once those individuals have made 120 qualifying monthly payments toward their loans under specific repayment plans. However, under the Consolidated Appropriations Act of 2018, more individuals became eligible for loan forgiveness on their Federal Direct loans through TEPSLF if some or all of their payments were made on graduated repayment plans, extended repayment plans, standard repayment plans for direct consolidation loans and/or graduated repayment plans for direct consolidation loans. Congress appropriated $700 million for TEPSLF (U.S. Government Accountability Office, 2019) under the Act; once these funds run out, the TEPSLF opportunity will end. But, only about $287 million of the $700 million has been spent as of June 2023, helping approximately 6,500 individuals (Federal Student Aid, 2023). Therefore, TEPSLF is not a sufficient explanation for the decrease in applicants for MSLRP since 2020.


NHSC LRP

Another contributing factor to the decrease in applications to the MSLRP is the increased funding allocated to the National Health Service Corps Loan Repayment Program (NHSC LRP). The National Health Service Corps (NHSC) is a federal program under the Health Resources & Services Administration (HRSA) that currently “supports more than 20,000 primary care medical, dental, and behavioral providers through scholarships and loan repayment programs”. The NHSC LRP awards primary care, dental, mental health, and maternal health providers with up to $50,000 in educational loan repayment in exchange for a two-year, full-time service obligation at an approved site in a Health Professional Shortage Area (HPSA). Participants can enter into consecutive service obligations to receive additional loan repayment.


In FY2020, the NHSC had 8,318 total federal loan repayment agreements with healthcare providers, including 5,963 new agreements - both of these statistics are the highest number of agreements reported at least since FY2011. But, in FY2021, the American Rescue Plan Act of 2021 made a historic appropriation to the NHSC of $800 million, with the intention that the NHSC would expand the number of healthcare providers who were awarded loan repayment and scholarships (Heisler, 2022). In Michigan, as of September 30, 2022, the NHSC reported that 394 providers were participating in the NHSC LRP, the program that is most similar to the MSLRP, that year (HRSA, 2022). Participation in the NHSC LRP is nearly five times higher than the MSLRP during the same fiscal year.


Another benefit of the ARPA appropriation is that healthcare providers who work at NHSC-approved sites with lower HPSA scores have received loan repayment awards. One of the top funding priorities for NHSC LRP applications is that the higher the HPSA score, the more likely applicants are to receive funding. HPSA scores range from zero to 26 and are calculated based on the area’s population-to-provider ratio, the percent of the population below 100 percent of the Federal Poverty Level, the travel time to the nearest source of care outside the HPSA, and additional measures that differ for primary care, dental health, and mental health. Prior to the ARPA appropriation, healthcare providers working in HPSAs with a score of 14 or lower were unlikely to receive loan repayment since their scores were too low. However, in FY2021 and FY2022, providers at sites with HPSA scores as low as three were approved for loan repayment (Rural Health Information Hub, 2022; HRSA, 2022).


MICHIGAN DATA

MDHHS is working to bolster applications to the MSLRP, targeting behavioral and mental health providers. Over the past three fiscal years of MSLRP data, both the number and the percentage of behavioral health providers that comprise each cohort have decreased.


Breakdown of MSLRP Participants by Behavioral Health Profession from 2020 - 2022

Year

Total #

Total # BH Participants

% of BH Participants to Total

# Masters of Social Work (MSWs)

# Psychiatrists

# PhD/MA Clinical Psychologists

# Counselors

2020

107

30

28%

22

2

5

1

2021

110

22

20%

12

2

3

5

2022

80

13

16.3%

5

2

3

3


MHC Insight’s Take

The MSLRP is an important program to recruit and retain providers to areas in Michigan that have the greatest need. The general purpose of HRSA’s SLRP is so “each state and territory can design programs that address the most pressing health care needs of their residents”.


For Michigan healthcare providers deciding between applying to the MSLRP and the NHSC LRP, here are some things to consider:


Apply to the MSLRP if you are:

Apply to the NHSC LRP if you are:

  • A healthcare provider with a Masters of Social Work (MSW) providing autism services

  • A limited-licensed mental healthcare provider with a Masters degree

  • An obstetric service provider working in the northern Lower Peninsula or the Upper Peninsula

  • A Psychiatrist, Physician Assistant or Nurse Practitioner specializing in pediatrics at inpatient psychiatric units

  • Working at a practice site in Genesee County

  • Working at a non-priority practice site with a HPSA score of 8 or higher

  • A dental hygienist

  • Interested in serving in half-time clinical practice (at least 20 hours/week)

  • Working at a private practice

  • Working with an employer who cannot pay 20% of your loan repayment agreement


MDHHS’ current outreach efforts to promote the MSLRP include marketing the program to employers at eligible practice sites with HPSA designations and to high-demand healthcare providers, consulting with individuals who are interested in applying for the program, and using their organizational partners to promote MSLRP with their member and constituent practice sites (MDHHS, 2023). MDHHS might consider strengthening recruitment efforts to Masters programs preparing mental healthcare providers to increase the number of mental and behavioral healthcare providers in the program. Ultimately, Michigan stakeholders and MDHHS must continue to work together to make sure that more providers apply to the MSLRP in years to come.



References


Federal Student Aid. (2023). PSLF Portfolio Reporting Through 6/30/2023 [Data set]. https://studentaid.gov/data-center/student/loan-forgiveness/pslf-data


Health Resources and Services Administration. (2022, September 30). BHW Annual Field Strength Explorer [Interactive Dashboard]. https://data.hrsa.gov/topics/health-workforce/field-strength


Heisler, E. J. (2022, January 4). The National Health Service Corps (Report No. R44970). Congressional Research Service. https://crsreports.congress.gov/product/pdf/R/R44970/15



Michigan Department of Health and Human Services. (2023, July 1). Michigan Essential Health Provider Recruitment Strategy: FY 2020 - 2022 Report. https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Doing-Business-with-MDHHS/Health-Care-Providers/SLRP/2020-2022_MSLRP_Report.pdf?rev=98eb328f347145909d213a183741bd0b&hash=6883E703DEB4AFCDDBB1A88DAF5DE11C


Rural Health Information Hub. (2022, January 13). Expanded eligibility allows more rural clinicians to qualify for loan repayment [Webinar]. https://www.youtube.com/watch?v=sQibMwPzK2I&t=1438s


U.S. Government Accountability Office. (2019, September 5). Public Service Loan Forgiveness: Improving the Temporary Expanded Process Could Help Reduce Borrower Confusion (Report No. GAO-19-595). https://www.gao.gov/products/gao-19-595



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