1. 1 Welcome Loan Repayment and Visa Waiver Opportunities and Assistance for Physicians in Texas

2. 2 Texas Primary Care Office  Increase access to care for underserved in Texas  Expand and increase the health care safety net for underserved populations  Measure access to medical, dental and mental healthcare (HPSAs & MUAs)  Improve access through incentives and benefits for providers in underserved areas

3. 3 Texas Primary Care Office  Administer/Assist the following programs:  Children’s Medicaid Loan Repayment Program (CMLRP)  National Health Service Corp/Scholarship and Loan Repayment  Physician Education Loan Repayment Program (PELRP)  Conrad 30 J-1 Visa Waiver Program  Health & Human Services J-1 Visa Waiver Program  Technical Assistance for H1-B Visa Holders

4. 4 Overview  Scholarship Opportunities  Loan repayment programs - close to 700 available loan repayment slots annually in Texas  Eligibility & Benefits  Service Obligations  Defaults & Penalties  Conrad 30 J-1 Visa Waiver Program  HHS J-1 Visa Waiver Program  National Interest Waiver  Job Search Options

5. 5 The Journey or the Destination? Houston Blanco

6. 6 Home Sweet Home Austin Mineola

7. 7

8. 8 After Residency

9. 9 Children’s Medicaid Loan Repayment Program  Eligibility Requirements:  Must be a U.S. citizen or a legal permanent resident  Have a license from the appropriate licensing board before applying  Subspecialists must have board certification or be eligible to sit for the applicable subspecialty board  Have a Medicaid number before applying  Not required to practice in a HPSA designated area or approved site  No concurrent service obligation  Must enroll as a Texas Health Steps provider

10. 10 Children’s Medicaid Loan Repayment Program  Eligible Loans:  Must be for undergrad, graduate or medical education at an accredited United States institution  Not be from relatives or the provider’s own insurance or pension plan  Not be consolidated with non-educational loans or loans held by a person other than the provider  Not be in default  Not have an existing service obligation  Loans made for residency are ineligible

11. 11 Children’s Medicaid Loan Repayment Program  Eligible Specialties:  Primary Care  Family Medicine  Ob/Gyn  General Internal Medicine  General Pediatrics  Dentists:  General and Pediatric

12. 12 Children’s Medicaid Loan Repayment Program  Selection Priority for Providers Who:  Practice in Texas Health Steps Lagging counties  Practice in service areas that have a HPSA designation  Type of Practice  Pediatrics  Family Practice  Internal Medicine  OB/GYN  Practice History-Newer Practice = Higher Score  Fill a vacancy at an FQHC or a RHC  Practice a sub-specialty determined by DSHS to be in critical demand

13. 13 Children’s Medicaid Loan Repayment Program  Service Obligations  Selection criteria may change to reflect the needs of the State  300 new applicants are selected each year  Four-year (4) commitment  A total of 1,200 slots will be available  Applications are accepted year round  Current application deadline is July 1, 2010  Must begin providing service by September 1st  Fiscal year runs from September to August  Must meet minimum monthly service requirements

14. 14 Children’s Medicaid Loan Repayment Program  Benefits:  $15,000 - $40,000 per year and $70,000 - $140,000 over the four-year service obligation depending on discipline and number of patient visits  Payments are made after the program year ends in August and service levels have been verified  Repayments received through this program are not considered taxable income bythe IRS

15. 15 Children’s Medicaid Loan Repayment Program Year Year 1Year 2Year 3Year 4 Loan Payout Amount by Year $20K$40K$15K$30K$20K$40K$15K$30K Specialty/ Subspecialty Monthly target number of Medicaid visits for children under 21 (Monthly average will be calculated over a 12-month period.) Family Physician, Internal Medicine & Ob/GYNs 255040807515075150 Pediatrician N/A50N/A80N/A150N/A150 Subspecialists N/A15N/A24N/A45N/A45 General Dentists 255037755010050100 Pediatric Dentists N/A50N/A75N/A100N/A100

16. 16 Children’s Medicaid Loan Repayment Program  Default Penalties:  Providers who do not meet the service requirements will:  Not receive any funds for the year in which service is not met  Be removed from the program  Be ineligible to apply for any other state loan repayment programs in Texas  Be ineligible to apply for any other federal loan repayment programs

17. 17 Physician Education Loan Repayment Program  Eligibility Requirements:  Must be a U.S. citizen or a legal permanent resident  Must hold a full physician license with no restrictions from the Texas Medical Board  Must provide care for Medicaid & CHIP enrollees  No concurrent service obligation  Must be Board Eligible in years 1 – 3 and Board Certified in a primary care specialty by year 4  Must practice in a HPSA  For subspecialists DSHS must determine there is a critical need in the service area where the practice is located

18. 18 Physician Education Loan Repayment Program  Eligible Loans:  Must be for undergrad, graduate or medical education at an accredited United States institution  Not be from relatives or the provider’s own insurance or pension plan  if consolidated with other loans, must document the portion that was originated to pay for the cost of education  not have an existing obligation  Not be in default  Loans made for residency are ineligible

19. 19 Physician Education Loan Repayment Program  Eligible Specialties:  Family Practice  Osteopathic Family Practice  Obstetrics/Gynecology  General Internal Medicine  General Pediatrics  Psychiatry  Geriatrics  Subspecialties are eligible based on determination of critical need

20. 20 Physician Education Loan Repayment Program  Selection Priority:  Renewal Applicants  first priority given to primary care physicians  New applications from primary care physicians:  practicing in rural geographic whole county HPSAs  practicing in FQHC’s  practice sites that accept payments on a sliding fee scale and follow a policy of providing health care to all who present for care  HPSA score for applicant’s practice location

21. 21 Physician Education Loan Repayment Program  Service Obligations  Must already practice in a HPSA  Four-year commitment  Projected to be 225 slots available annually  Applications are accepted year-round  Deadline is June 15, 2010  Must begin providing services by July 1 st  Fiscal year runs from July to June

22. 22 Physician Education Loan Repayment Program  Benefits: Debt $160K & above * Debt below $160K* Year 1 $25,00016% of total debt Year 2 $35,00022% of total debt Year 3 $45,00028% of total debt Year 4 $55,00034% of total debt  Physicians may receive prorated loan repayment assistance based on the percentage of full time service if providing direct patient care for a minimum of 20 hours per week  Repayments received through this program are not considered taxable income by the IRS

23. 23 Physician Education Loan Repayment Program  Default Penalties:  Providers who do not meet the service requirements will:  Not receive any funds for the year in which service is not met  Be removed from the program  Be ineligible to apply for any other state loan repayment programs in Texas  Be ineligible to apply for any other federal loan repayment programs

24. 24 Dental Education Loan Repayment Program The purpose of the program is to recruit and retain qualified dentists to provide dental care in areas of Texas that are under-served with respect to dental care.

25. 25 Eligibility Requirements The dentist must: Have a current license with no disciplinary action from the Texas State Board of Dental Examiners; Practice general or pediatric dentistry; Work at an approved practice site; Accept Medicaid assignments as full payment for services, and not deny services based on a patient’s ability to pay;

26. 26 Approved Practice Sites Federally designated Dental Care Health Professional Shortage Areas (DHPSA) in Texas; and Federally funded Community Health Centers

27. 27 Service Period The dentist must provide eligible services for at least 12 consecutive months at an approved practice site. To qualify for federal matching funds applicants must provide eligible services for at least 24 consecutive months at an approved practice site and 12 months of continuous service for subsequent years. The first year of service is for 12 consecutive months from the date the application is received or the date eligible service began, whichever is later. Subsequent years begin at the end of the previous service period. Repayments are contingent on availability of funds.

28. 28 Annual Loan Amounts The maximum annual state funded loan repayment for an eligible dentist providing full-time service is $10,000. Applicants qualifying for federal matching funds may receive up to $20,000 after 24 months of consecutive service and $10,000 for each 12 months of continuous service for subsequent years. Payment from state funds for part-time service can be pro-rated based on the hours provided. Repayments are contingent upon availability of funds.

29. 29 Texas Primary Care Office Can:  Answer your questions about available loan repayment programs in Texas  Help you determine if loan repayment is right for you and which program meets your needs  Provide assistance on completing loan repayment and waiver applications  Find a practice site that meets your personal needs, specific program requirements and /or priority selection criteria  Provide assistance to ensure you continue meet program requirements and stay enrolled

30. 30 Texas Primary Care Office Can:  Find resources to support your practice in underserved areas  Help you navigate the 589 HPSA designations and 281 MUA designations that we analyze and update  Assist a facility in becoming an NHSC approved practice site  Provide J-1 visa waiver recommendations  Assist H-1Bs with identifying jobs in shortage areas  Provide NIW support letters

31. 31 Job Search Assistance National Health Service Corps Job Opportunities http://nhscjobs.hrsa.gov/ http://nhscjobs.hrsa.gov/ Job seekers can search for positions by state, county, and type of position and do not need to be an NHSC participant. http://nhscjobs.hrsa.gov/http://nhscjobs.hrsa.gov/ Texas Health Match http://www.texashealthmatch.com/ http://www.texashealthmatch.com/ A free service to both facilities in Texas and medical professionals seeking employment in a medical facility in Texas. http://www.texashealthmatch.com/http://www.texashealthmatch.com/

32. 32 Job Search Assistance TX Association of Community Health Centers (TACHC) TACHC member facilities can post vacancies. Job seekers search for free. http://www.tachc.org/Careers/Opportunities.asp 3RNet http://www.3rnet.org/ http://www.3rnet.org/ 3RNet member facilities can post vacancies. Job seekers search for free. http://www.3rnet.org/http://www.3rnet.org/

33. 33 Job Search Assistance Texas Dept of Rural Affairs (TDRA) TDRA can assist recent graduates in locating employment in rural health clinics, hospitals and other health care http://www.orca.state.tx.us/ http://www.orca.state.tx.us/ facilities. http://www.orca.state.tx.us/http://www.orca.state.tx.us/

34. 34 For Additional Information/Q&A Jim Conditt TX Primary Care Office PO Box 149347, Mail Code 1937 Austin, TX 78714-9347 (512) 458-7518 TexasPCO@dshs.state.tx.us http://www.dshs.state.tx.us/chpr/default.shtm