IHS Loan Repayment Program (LRP)
The IHS Loan Repayment Program (LRP), authorized under Section 108 of the IHCIA, offers health care professionals the opportunity to ease the burden of qualified health profession-related student loans and help Indian health programs meet the staffing needs of priority sites. Applicants agree to serve two years at an Indian health program in exchange for up to $20,000 per year (up to $40,000 for the initial two-year contract) in loan repayment funding (and up to an additional $4,000 per year to offset the tax liability). Loan repayment recipients with more than $40,000 in loan debt can extend their initial two-year contract and receive up to an additional $20,000 per year (plus up to $4,000 for taxes) until their original qualifying educational loan debt is paid.
Determining Loan Repayment Discipline Needs
Before the start of the FY 2015 LRP cycle, the IHS LRP requested the help of Tribal health programs and IHS Area leadership to assist in identifying specific health professional discipline priorities by providing a recommended list for LRP disciplines. The priority disciplines for FY 2015 funding were behavioral/mental health, dentists, nurses, optometrists, pharmacists and physicians. It’s important to identify priorities as there is insufficient funding to provide loan repayment to all qualified applicants.
Qualifying Loan Debt
Many health professionals have significant health profession-related educational loan debt. Health professionals receiving IHS loan repayment tend to request loan repayment until their loan debt is repaid. For many health disciplines (physicians, dentists, podiatrists and optometrists), the average applicant’s loan debt exceeds $140,000 (requiring more than seven years of loan repayment support). While the need for continued LRP support helps with health care professional retention and provides much needed health care services to Indian communities, the additional years of contract extension reduce the number of new awards that are available to new LRP applicants.
Loan Repayment Application Process
In October of each year, recruiters at IHS HQ work with IHS Discipline Leads to create a discipline-specific site score list for all Indian health facilities. LRP contracts are awarded based on site scores. The site scores themselves, which range from 0 to 100, are based on Health Professional Shortage Area (HPSA) scores, current vacancies and other factors. Once funding becomes available, on a monthly basis, LRP staff review all completed applications in each discipline. Starting at the top of the Site Score List for each discipline, they work their way down, giving awards until all completed applications are awarded or funding is exhausted. To help ensure that clinicians working at sites with the greatest need are funded, applications from health professionals working at sites with a HPSA score of less than 70 points are not eligible for funding consideration until January. This award process encourages health professionals needing loan repayment to apply for jobs at sites with a higher site score.
Loan Program Repayment Awards
In FY 2015, 1,435 health care professionals requested IHS loan repayment funding and 1,211 health care professionals received IHS loan repayment funding. This included 437 new two-year contracts, 395 one-year extension contracts and 379 health professionals starting the second year of their FY 2014 two-year contract. Not all health care professionals who applied for loan repayment in FY 2015 could be funded. There are two categories of applicants who are not funded.
The first of these is known as "Matched Unfunded" applicants. These are applicants who accepted a job and are working for an Indian health program but were denied an award due to lack of funds. In FY 2015, there were 200 “Matched Unfunded” LRP applicants. It is estimated that an additional $10.3 million would be needed to fund the 200 "Matched Unfunded" health professional applicants from FY 2015.
The second type of unfunded applicant is known "Unmatched Unfunded." These include applicants who applied for the LRP but were either not licensed, could not find a suitable assignment or who had found an assignment but for specific reasons were not awarded loan repayment and declined a job offer. These applicants are referred to as "Unmatched Unfunded" because they are not currently working at an Indian health program.
In FY 2015, there were 413 "Unmatched Unfunded" health professionals (including 17 physicians, 53 behavioral health providers, 23 dentists and 147 nurses). The inability to fund these 413 health professional applicants is a significant challenge for agency recruitment efforts. It is estimated that an additional $21.1 million would be needed to fund the 413 "Unmatched Unfunded" health professional applicants from FY 2015.
Loan Repayment Program Awards FY 2015
|Awards by Profession||Total Awards||New Awards||Contract Extensions||Matched Not Awarded|
|Physician Assistants/ Advanced Practice Nurses||83||56||27||20|
*Includes Dentists, Dental Hygienists and Dental Assistants.
|Other Professions||Total Awards||Matched Unfunded||By Pay System||Awards|
|Certified Professional Coder||2||0||Civil Service||266|
|Engineering||4||5||Urban Health Employees||14|
|Medical Laboratory Scientist||5||8||Total||832|
Of the LRP awards given in FY 2015, 144 (or 19 percent) were given to American Indians and Alaska Natives (AI/AN). Of the 832 LRP awards in FY 2015, 382 went to federal employees (266 to civil service and 116 to Commissioned Corps officers), 436 to Tribal employees and 14 to Urban Indian Program employees.
More LRP awards go to Areas of greatest need and Areas with larger numbers of health professionals.
To learn more, visit the IHS Loan Repayment Program.