Health and Human Services increases loan forgiveness for OBs, midwives who practice in rural areas

Photo: Unsplash // Hush Naidoo Jade Photography

Policy change comes amid increase in so-called ‘maternal care deserts’

By: Kelcie Moseley-Morris, Utah News Dispatch

The U.S. Department of Health and Human Services announced Thursday a $25,000 increase in loan forgiveness available to primary care providers in designated underserved areas. That means qualifying individuals are eligible for up to $75,000 in forgiveness if they commit to two full-time years of service.

The amount is available to medical and osteopathic doctors, including OB-GYNs, pediatricians, nurse practitioners and midwives, and physician assistants who practice in areas with shortages of primary care providers. The move is meant to help rural and historically underserved communities provide primary care services. It could also help areas that have been deemed “maternal care deserts” after clinics closed because adequate staffing levels could not be maintained, leaving care limited or completely absent and forcing people to travel long distances for standard appointments.

This has especially been a problem in states with abortion bans since 2022, including Idaho, Mississippi and South Dakota. Idaho has lost 22% of its practicing OB-GYNs since a near-total abortion ban went into effect in late 2022, along with half of the state’s maternal-fetal medicine specialists, and three clinics across the state closed their labor and delivery units in the same time frame. Doctors have said it has been difficult to recruit new physicians to fill those positions — one doctor said Wednesday that out-of-state applications for openings have dropped significantly.

According to March of Dimes, nearly 7 million people of reproductive age live in a county that is considered a maternity care desert as of 2022, or about 35%. That number has reportedly grown in the past two years. About 2.2 million of those people live in an area with no hospital providing obstetric care, no birth center and no obstetrics providers. The 2022 report showed more than 97,000 Ohioans were affected by reductions in access to maternity care, the highest of any state.

Another 11.4%, according to the report, live in an area considered to have low access to maternity care, meaning fewer than two hospitals or birth centers providing maternity services and fewer than 60 OB-GYN providers. Research also notes challenges finding care in rural and medically underserved communities disproportionately affect people of color, particularly Black patients.

Medical school costs have grown, and associated debt has increased four-fold over the past 30 years, according to HHS, but the maximum loan forgiveness had remained at $50,000 until now. The Health Resources and Services Administration division of HHS is responsible for the program.

An additional maximum of $5,000 in loan repayment will be available for those who pass an oral exam showing they are fluent in Spanish and practice in high need areas with patients who have limited proficiency in English. Research from the American Medical Association has shown those patients have worse health outcomes and provider experiences.

HHS is also working to create new primary care residency programs in rural communities, which would provide 540 openings for physicians in specialty care, once operational, according to the release. It is also conducting more than 25,000 training sessions for practicing primary care providers, including OB-GYNs, nurse midwives and other maternal care providers to diagnose and treat mental health conditions among pregnant patients, new moms, children and adolescents.

The National Health Service Corps Loan Repayment Program is accepting applications until May 9.