The NCSL Blog


By Margaret Wile

This legislative session, the Idaho Legislature put the state’s rural physician loan repayment program under the knife.

Nurse Celeste Parsons treats patient Mimi Rosenkrance, 58, as she recovers from being trampled by a mother cow protecting her calf. Photo by M. Scott Mahaskey/PoliticoAnd the results?

An astounding $640,000 per year appropriated for the state’s rural physician loan repayment program. The Legislature enacted and the governor signed HB 472, which appropriates funding to bring about six additional physicians to their state each year, which more than doubles the current number.

So, go ahead and eat your apples but it won’t keep those doctors away.

States use loan repayment programs as a strategy to increase provider recruitment and retention. These programs typically provide loan repayment or forgiveness to students in health professions in exchange for their future service. For example, the students commit to practice in a medically underserved area/population, health professional shortage area (HPSA) or rural region for a specified period of time, often at least two years.

Many rural states face health provider shortages, including Idaho. Health provider shortage areas are defined as, “having shortages of primary care, dental care, or mental health providers"; may be defined by a geographic area, such as a county or service area; a population that is, for example, low income or Medicaid eligible; or facilities, such as federally qualified health centers, or state or federal prisons.

According to the Kaiser Family Foundation, as of December 2017, Idaho needed an additional 88 primary care physicians to meet the needs of its population. HB 472 is a step to address this unmet need of roughly 351,793 Idahoans.

NCSL has been working with a multidisciplinary team from Idaho over the last year on improving rural health in their state, through a federal cooperative agreement called the National Organizations for State and Local Officials funded through the U.S. Health Resources and Services Administration. The Idaho team was made up of legislators, legislative staff, and representatives from Medicaid, the Office of Rural Health and Primary Care and the Department of Health.

The team was one of eight states invited to participate in a kickoff meeting in June 2017. Over the course of the three-day conference the teams listened to a variety of experts who spoke on topics related to rural health.

The key focus areas of the meeting were:

  • Emerging health system changes.
  • State strategies to address the health workforce in rural areas.
  • Innovations for sustainable rural health facilities.
  • Using data to drive change.

The state teams had time to discuss these topics during breakout sessions throughout the conference and constructed team action plans based on what they learned and knew about their own states. During the breakout sessions, the Idaho state team identified loan repayment programs as an effort they wanted to address in their action plan. During the following nine months, NCSL facilitated monthly phone calls with the team where team members worked to move the goals of their action plan forward.

Through this group’s hard work, they were able enact legislation to improve their state’s rural physician loan forgiveness efforts. I guess you could say the team’s action plan now has a clean bill of health.

Margaret Wile is a policy specialist in NCSL's Health program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.