Summary
There are several federal health programs designed to expand access to primary care services, such as the National Health Service Corps (NHSC), Community Health Centers (CHCs), and the Teaching Health Center Graduate Medical Education (THCGME) Program. ACP has long-standing policy supporting adequate funding for these programs.
Community Health Centers (CHC): There are over 1,400 CHCs all across the country, in both rural and urban settings, serving nearly 30 million people. These community-based centers enjoy longstanding bipartisan support by Administrations and policymakers at all levels, as well as in both the private and public sectors.
CHCs receive a combination of both discretionary and mandatory funding from the federal government totaling approximately $5.682 billion for fiscal year 2021. Of that total, $4 billion is in mandatory funding, which Congress also authorized for fiscal years 2022 and 2023 in the FY2021 Omnibus and COVID Relief and Response Act, H.R. 133. The $1.682 billion in discretionary funding will have to go through the annual appropriations process for FY2022 and beyond. CHC mandatory funding will expire in October 2023 if Congress does not act to authorize mandatory funding for CHCs for FY2024 and beyond. In October 2017, federal funding for these centers temporarily lapsed because Congress did not pass legislation to extend their funding.
In March 2021, the American Rescue Plan (ARP) Act of 2021 (H.R. 1319) was signed into law, which included $7.6 billion for CHCs to use for COVID-19-related activities such as testing, contact tracing, surveillance, mitigation, and treatment; purchase COVID-19 equipment and supplies; support for the health care workforce; expand health care services and infrastructure; and conduct COVID-19 community outreach and education activities.
Learn more about Community Health Centers here at the HRSA Bureau of Primary Health Care’s (BPHC) Health Center Program webpage.
National Health Service Corps (NHSC): The NHSC was established in 1972 within the Public Health Service Act to provide support to medical, mental, and dental health professionals in exchange for service in areas identified as experiencing a health professions shortage. From within the Health Resources and Services Administration (HRSA), NHSC helps provide primary health care through direct support of health professionals across the country. The NHSC provides support to qualified medical professionals in the way of scholarships and loan repayment.
The NHSC also receives a combination of both discretionary and mandatory funding from the federal government totaling $430 million for fiscal year 2021. Of that total, $310 million is in mandatory funding, which Congress also authorized for fiscal years 2022 and 2023 in the FY2021 Omnibus and COVID Relief and Response Act, H.R. 133. The $120 million in discretionary funding, which is directed to substance-use disorder services, will have to go through the annual appropriations process for FY2022 and beyond. NHSC mandatory funding will expire in October 2023 if Congress does not act to authorize mandatory funding for the NHSC for FY2024 and beyond.
The American Rescue Plan (ARP) Act of 2021 (H.R. 1319) included $800 million for the NHSC to help contend with the COVID-19 pandemic by increasing loan repayments and scholarships.
Loan Repayment: For medical students, the Students to Service Loan Repayment Program (S2S LRP) can provide up to $120,000 in their final year of school in exchange for serving at least three years at an approved NHSC site in a Health Professional Shortage Area of greatest need. Find out more about the program here, including a webinar about the program.
While the 2020 S2S LRP application process is now closed, one can sign up here for email reminders for the 2021 application process which is expected to begin in the fall.
For already licensed physicians, the NHSC Loan Repayment Program (NHSC LRP) can offer up to $50,000 of forgiveness in exchange for a two-year commitment at an NHSC-approved site. After the initial two-year service commitment, one can apply to extend one’s service and receive additional loan repayment assistance. The level of repayment one receives depends on his/her job site's shortage score and whether one chooses to work full-time or half-time. Learn more here about the NHSC LRP:
While the 2020 NHSC LRP application process is now closed, one can sign up here for email reminders for the 2021 application process which is expected to begin early in the year.
Scholarships: Medical students who have committed to primary care and are accepted to or enrolled in an accredited U.S. medical school can be eligible for tuition, fees, other educational costs, as well as a living stipend. In exchange, the medical student agrees to a commitment to work at least two years at an NHSC-approved site in a medically underserved community. For each year of financial support (up to four years), the student agrees to serve one year (minimum two years) at an NHSC-approved site. The service commitment begins upon graduation (and completion of primary care residency training for doctors). Learn more here.
While the CY 2020-2021 scholarship application process is now closed, one can sign up here for email reminders for the next year application process.
Teaching Health Center Graduate Medical Education (THCGME) Program: The THCGME program provides funding to train medical residents in primary care, thereby increasing the overall number of primary care physicians. THCGME funding trains medical residents in primary care in community settings, including CHCs, with a focus on areas where there are health provider shortages. Over half (59 percent) of THCGME program training sites are in medically underserved areas. In the current academic year (2020-2021), the THCGME program supports the training of 769 residents in 60 primary care residency programs, across 25 states in Federally Qualified Health Centers, Rural Health Clinics, and Tribal health centers. THCGME is also administered by the BHW within HRSA and was established by the ACA.
The THCGME program is solely funded through mandatory appropriations of $126.5 million for fiscal year 2021, which Congress also authorized for fiscal years 2022 and 2023 in the FY2021 Omnibus and COVID Relief and Response Act, H.R. 133. THCGME mandatory funding will expire in October 2023 if Congress does not act to authorize mandatory funding for the THCGME program for FY2024 and beyond.
In March 2021, Congress passed American Rescue Plan (ARP) Act of 2021, H.R. 1319, which included $330 million for the THCGME program to help contend with the COVID-19 pandemic by expanding the number of sites nationwide and increase the per resident allocation.
Read more about the THCGME program here.
For questions, please contact Jared Frost at jfrost@acponline.org.