Expand eligibility for loan repayment programs
Recommendation
Congress should expand funding the eligibility criteria for national and state loan repayment programs to include bachelor-level social workers, health and human services providers, and certified drug and alcohol counselors, while also expanding service delivery location sites to include more home, school, and community-based settings.[1]
Background/summary
Certified drug and alcohol counselors, social workers, and other health professionals work in different capacities to provide mental health and substance use disorder (MH/SUD) care.[1][2] Serious workforce shortages exist among MH/SUD clinicians nationwide.[2]
HRSA’s student loan repayment programs have been leveraged to encourage providers to practice in communities facing behavioral health staff shortages.[3] For instance, the National Health Service Corps (NHSC) Loan Repayment Program (LRP) offers student loan forgiveness for primary behavioral health care clinicians who agree to provide two years of service in areas where communities face limited access to care.[5] Additionally, the State Loan Repayment Program provides grants to states who administer loan forgiveness programs for health professionals who work in shortage areas for two years, including MH/SUD clinicians.[6] Congress should increase funding for both the NHSC and the State Loan Repayment Program.
Unfortunately, the current eligibility criteria for national and state repayment programs typically exclude some bachelor-level health professionals who may play an essential role in expanding access to treatment and recovery services, such as social workers and certified drug and alcohol counselors.[1][4][5][6][7] Furthermore, NHSC does not provide assistance to peer support specialists, which are an integral part of the continuum of care and often better mirrors the communities they serve. Loan repayment programs should be expanded to include a greater range of professionals and peer support specialists degrees to quickly expand the capacity of our nation’s MH/SUD workforce.
Finally, loan repayment programs should also expand the types of sites in which health professionals may work in order to be eligible to receive loan forgiveness.[1] For instance, HRSA’s Substance Use Disorder Workforce Loan Repayment Program allows loan recipients to work at community mental health centers, private practices, and school-based clinics.[7] However, there are no approved home-based settings or sites.[7] Additionally, NHSC programs do not currently specify that crisis programs be eligible sites. HRSA should align eligibility with Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines for crisis services, which include a range of facilities such as call centers, mobile crisis response teams, and crisis receiving and stabilization facilities.[8]
citations
1. National Rural Health Association. National Rural Health Association Policy Brief: Mental Health in Rural Areas. Last Accessed February 2022.
2. Nathaniel Counts, “Understanding the U.S. Behavioral Health Workforce Shortage.” The Commonwealth Fund, Last Accessed May 18, 2023.
3. National Board of Certified Counselors. Loan Repayment and Behavioral Health Geriatric Workforce Initiatives. Last Accessed June 22, 2022.
4. Health Resources and Services Administration, National Health Service Corps. Apply Today for One of Our NHSC Loan Repayment Programs. Last Accessed April 2023.
5. U.S. Department of Health and Human Services, Health Resources and Services Administration, National Health Service Corps. National Health Service Corps Loan Repayment Program. Last Accessed January 2023.
6. U.S. Department of Health and Human Services, Health Resources and Services Administration. Clinicians’ Eligibility and Application Requirements for the State Loan Repayment Program. Last Accessed September 2021.
7. U.S. Department of Health and Human Services, Health Resources and Services Administration, National Health Services Corps Substance Use Disorder Workforce Loan Repayment Program. Fiscal Year 2023 Application & Program Guidance. Last Accessed February 2023.
8. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). National Guidelines for Behavioral Health Crisis Care. Last Accessed February 2024.