Loan Repayment and Behavioral Health Geriatric Workforce Initiatives

Congress and the Biden administration are paying significant attention to behavioral health workforce issues to address current provider shortages.

Historically, a key federal policy workforce lever has been federal loan repayment. Like many preceding administrations, the Biden administration has proposed to expand this central policy tool, including the National Health Service Corps and Behavioral Health Workforce Education and Training Programs, which trains a range of behavioral health clinicians and aims to specifically address areas with significant unmet need for providers. These proposals build on a growing appreciation for the capabilities of trained professionals without doctoral degrees.

Congress and the president have proposed to increase investment in the Minority Fellowship Program, which seeks to improve patient outcomes by increasing racial and ethnic minority representation in the behavioral health workforce and training practitioners to serve a diverse patient population. NBCC strongly supports increased funding in this program.

Currently, the National Health Service Corps (NHSC) recruits health care professionals to provide culturally competent interdisciplinary primary health, behavioral health, and oral health care to underserved populations. NHSC offers tax-free loan repayment assistance to support qualified health care providers who choose to take their skills where they’re most needed. Licensed health care providers may earn up to $50,000 toward student loans in exchange for a 2-year commitment at NHSC-approved sites. Eligible behavioral health providers include marriage and family therapists and licensed professional counselors. Key policymakers support expansion of this program. 

Of particular importance are strategies designed to provide financial incentives and support to professionals interested in pursuing a career related to geriatrics. For example, a bill in Congress, the Geriatricians Loan Forgiveness Act (H.R. 3046), would extend the National Health Service Corps Loan Repayment Program (NHSC LRP) to the fields of geriatric medicine and geriatric psychiatry. Many policymakers believe it is essential that loan repayment programs also be extended to master’s- and doctoral-level training programs for mental health professionals, such as counselors, who specialize in practice with older adults.  

Other relevant legislation pending in Congress includes the Mental Health Professionals Workforce Shortage Loan Repayment Act (S. 1578) to expand loan repayment. This bill requires the Health Resources and Services Administration (HRSA) to establish a loan repayment program for mental health professionals who work in designated workforce-shortage areas. As of May 2022, there are 6,229 geographic areas and population groups designated as mental health professional shortage areas.

The Department of Defense and the U.S. Public Health Service Partnership for Psychological Health initiative is another program that is designed to ensure that service members, their families, and veterans receive the resources they need by increasing the availability of behavioral health services such as counseling, family and group therapy, and preventive and resiliency-building services. The initiative has loan repayment potential.

The Substance Abuse and Mental Health Services Administration (SAMHSA) Prevention Fellowship Program (PFP) is a 2-year fellowship program that provides 10 participants with the education and training to build the needed skills for success in the substance abuse prevention and behavioral health fields. Fellows spend a required 32 hours each week during their fellowship building their skills in substance abuse prevention. They are supported by mentors from participating states and territories to establish or assess the performance of substance abuse prevention efforts.

State Initiatives

States also consider various policy options to recruit and retain a behavioral health workforce to provide necessary services. States including Colorado, Illinois, Maryland, Oregon, Pennsylvania, Texas, and Washington, have recently enacted legislation to study behavioral health trends and develop plans to address workforce challenges. Examples include:

• Illinois has required the Behavioral Health Workforce Education Center Task Force to study psychiatry residencies, behavioral health internships, and telehealth training in rural and underserved communities, as well as geographic and demographic trends. The Task Force recommended the creation of an Illinois Behavioral Health Workforce Education Center that would lead cross-agency and cross-sectoral statewide planning for the recruitment, education, and retention of the behavioral health workforce. The Center was created by the Illinois legislature in 2021 to leverage workforce and behavioral health resources across the state.
• Pennsylvania (2019) tasked the Joint State Government Commission to study provider shortages, projections, retention, and strategies to address disparities in rural communities, including telemedicine. The Commission recommended encouraging the use of integrated care models and developing additional behavioral health residency positions, increasing tuition repayment programs, encouraging the recruitment of underserved students, and expanding the use of telecounseling. Pennsylvania allocated $5 million in federal funding for loan repayment for behavioral health practitioners working in areas with high opioid use and workforce shortages.