Provider Loan Repayment Programs · 2017. 10. 25. · Information provided by MDCH. 2. We are here to provide information about • Michigan State Loan Repayment Program (MSLRP) •

Healthcare Workforce

Provider Loan Repayment Programs

Presented by Ken Miller and Bob EsdaleMichigan Department of Community Health

January 23, 2007

Information provided by MDCH

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We are here to provide information about

• Michigan State Loan Repayment Program (MSLRP)

• National Health Service Corps (NHSC)

Government programs designed to increase the supply of health providers

These programs can complement provider recruitment incentives


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Encourage Providers to Apply to for Both Programs

• Providers can apply for both the NHSC and MSLRP at the same time.

• Providers cannot participate in both programs at the same time.

• MSLRP is especially advantageous for providers in HPSAs with low HPSA Scores– NHSC awards contracts to providers in HPSA with

highest scores– MSLRP doesn’t consider HPSA score

• Consecutive Participation Allowed– Best to participate in NHSC first, then in MSLRP– One-day contract overlap


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MSLRP Objective

• Provide Loan Repayment Assistance to:– Medical, Dental & Mental Health Care

Professionals– Committed to Providing– Full-Time (40/32 hours per week)– Primary Health Care Services– At a Not-For Profit Clinic– In a Health Professional Shortage Area

(HPSA)– For 2 or More Years


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How Can MSLRP Assist in Your Recruitment and Retention Efforts?

Maximum Contract Amounts:

• Primary Providers = – $50,000 Initial 2-Year Contract– Physicians, Dentists, PH.D MHC Providers

• Mid-Level Providers =– $30,000 Initial 2-Year Contract– PAs, NPs, CNM, MSWs & other Masters-Level

MHC Providers


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A Closer Look at Eligible Provider Types

Primary Providers ($50,000 Initial 2 Years)

• Dentists: DDS or DMD• Physicians: MD/DO

– Family Practice, Internal Medicine, OB/GYN, Pediatrics

• Psychiatrists• Clinical or Counseling Psychologists (Ph.D)• Licensed Professional Counselors (Ph.D.)• Marriage and Family Therapists (Ph.D.)


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A Closer Look at Eligible Provider Types

Mid-Level Providers: ($30,000 Initial 2 Years)

• Physician Assistants (Primary Care)

• Nurse Practitioners• Certified Nurse Midwives• Clinical Social Workers (Masters)

• Licensed Professional Counselors (Masters)

• Marriage & Family Therapists (Masters)

• Mental Health Counselors (Masters)

• Psychiatric Nurse Specialists (Masters)


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MSLRP Selection Criteria and Process

• Priority Providers

• Priority Practice Sites

• Non-Priority Status

• Single Priority Status

• Double Priority Status

• Triple Priority Status

• Lottery Numbers

• Waiting Lists


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Priority Providers

• Participants Applying to Re-Contract with MSLRP

• Dentists

• Psychiatrists

• Other Mental Health Care Providers


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Priority Practice Sites• Local Health Departments• State–Funded Institutions

– State Psychiatric Hospitals– Forensic Medicine Centers– CMH Agencies– State Correctional Facilities– State-Funded Primary Care Clinics

• Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes

• Critical Access Hospital (CAH)-Administered Primary Care Clinics

• Certified Rural Health Clinics (RHCs) Designated as Facility HPSAs


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Applicant Priority Status

• Non-Priority Status– Non-Priority Provider/Non-Priority Practice Site

• Single Priority Status– Priority Provider/Non-Priority Practice Site

– Non-Priority Provider/Priority Practice Site

• Double Priority Status– Priority Provider/Priority Practice Site

• Triple Priority Status– Participant Applying to Re-Contract with MSLRP


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Rank-Ordered MSLRP Applicant List

• Triple Priority (Re-Contracting for Third Year)– PA, L= 201– MD, L=456– Dentist, L=623

• Double Priority (Initial Applications)– Dentist, L= 198– Psychiatrist, L=376– Dentist, L=805

• Single Priority– DO, L=389– NP, L=662– PA, L=940

• Non-Priority– PA, L=143– DO, L=492– PA, L=725

• Withdrawn and Ineligible


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Rank-Ordered MSLRP Applicant List

• Withdrawn and Ineligible – Withdrawn, Accepted into NHSC- Good!– Ineligible Bad!!

• HPSA Status Not Confirmed– Medical, Dental, Mental Health, Facility HPSA

• Not Providing Primary Care– ER, Trauma Center, Orthopedics, Hospitalist

– Incomplete/Illegible Application Package Ugly!!!• Provider Application, Part A• Provider Application, Part B• Practice Site Application & Declaration of Intent• W9 (Provider’s Address/Signature)• Payee Registration Form (Provider’s

Address/Signature)• Faxed Application Package


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Waiting Lists

• Applicants Not Initially Selected Remain on Rank-Ordered List.

• Offered Contracts as Candidates Already Selected Withdraw their Application, or are Determined Ineligible.


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MSLRP Contract Provisions

• Qualifying Educational Loans

• MSLRP Payments

• Tax Treatment of MSLRP Payments

• Contract Start Dates

• Service Obligation

• Default Provisions


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MSLRP Contract ProvisionsQualifying Educational Loans• Undergraduate and Graduate Loans through

Government Agencies and Commercial Lenders• Private Loans from Individuals Ineligible• Loans Must Have Been:

– Used for Education Leading to a Degree in the Health Profession in which the Participant will Satisfy their Service Obligation

• Provider Application, Part B– Long Lead Time (start 1 month before begin of

application period)– Provider (fax) Lender(s) (fax) Provider

Include in Application Package w/Required Postmark Mail to MSLRP Office (no faxes)


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MSLRP Payments:• Start 6 Months after Contract Start Date• Each 6 Months during Contract • Provider Initiates Each Payment Cycle

– Work Verification Form: Provider Employer MSLRP Office Check Provider’s Home Address (W9/Payee Registration Form)

• Example:– Physician, $50,000 Contract, 4/1/08 – 3/31/10


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Physician Contract $50,000

4/1/08 – 3/31/10

WVF Payment Amount

9/08 10/08 $12,500

3/09 4/09 $12,500

9/09 10/09 $12,500

3/10 4/10 $12,500


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Tax Treatment of MSLRP Payments• Information for Providers’ Tax Professionals• Public Law 108-357• All NHSC and State Loan Repayment Program

Funds Received on or after January 1, 2004 are: – Exempt from Gross Income and Employment Taxes– Excluded from Wages in Determining Benefits under

the Social Security Act.• State of Michigan has Exempted NHSC and MSLRP

Payments from State and Local Taxes


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MSLRP Contract ProvisionsService Obligation

• Each Provider Entering into a MSLRP Contract– Agrees to Complete a Service Obligation, which– Runs the Length of their Contract

• Legal Responsibility• Shouldn’t be taken Lightly• Providers: Read Carefully Before Signing• Providers Who Fail to

– Complete Service Obligation, or – Meet any Contractual Service Obligation,Face Significant Default Provision included in their Contracts


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MSLRP Contract ProvisionsDefault Provisions

• Severe Federal Penalties Mandated by the Federal State Loan Repayment Program

• Apply to all Providers who default on their MSLRP Contract:– Don’t Complete Service Obligation– Fail to Meet any Contractual Service

Requirements


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A Provider Who Breaches the MSLRP Contract:

• Receives no future MSLRP payments, and owes the Department an amount equal to the sum of:

1. The total of the amounts paid by the Department to the Contractor for loan repayment for any period of obligated service not served; and,

2. An amount equal to the number of months of obligated service not completed, multiplied by $7,500; except that:

3. The amount the Department is entitled to recover shall not be less than $31,000


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Limited Flexibility in Dealing with Provider Issues

• Informed Employer and Provider– Reading/understanding MSLRP Contract– Frank pre-contract provider/MSLRP Office

discussion

• Good Employer/Provider/MSLRP Office Communications– Notify MSLRP Office and discuss changes in

employment situation that affects contract

• Suspension• Transfer to New Practice Site


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Dealing with Provider Issues:Suspension

• Stops the clock on provider’s service obligation

• Allows time away from practice site in excess of 7 week/35 workday limit per contract year for:– Personal health issues– Caregiving for child, spouse or relative

• MSLRP Contract is amended– Contract end date is extended to recapture period of

unfulfilled service obligation

• Completion of service obligation can be postponed, but not cancelled


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Dealing with Provider Issues:Transfer to New Practice Site

• Allows provider to complete service obligation and avoid breach of contract, when:– Current practice site is closed– Irreconcilable problems in employer/provider

relationship

• Provider’s responsibility to find new practice site of a different employer– New practice site must be located in a HPSA

corresponding to provider’s discipline

• MSLRP Office assists, but resources limited


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Recent MSLRP Developments & Current Opportunities

• Expansion of Mental Health Care Provider Policy

• Notification of Current MSLRP Opportunities

• Development of Marketing Partners

• First Come, First-Served Application Period, Started January 1, 2008

• Looking to the Future


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Expansion of Mental Health Care Provider Policy

• Attempt to increase participation of MHC providers in MSLRP

• Old Policy: Eligible Practice Sites:– State Psychiatric Hospitals– Forensic Medicine Centers– CMH Agencies– State Correctional Facilities


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• New Policy: Eligible Practice Sites:– Local Health Departments– State–Funded Institutions

• State Psychiatric Hospitals• Forensic Medicine Centers• CMH Agencies• State Correctional Facilities• State-Funded Primary Care Clinics

– Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes

– Critical Access Hospital (CAH)-Administered Primary Care Clinics

– Certified Rural Health Clinics (RHCs) Designated as Facility HPSAs


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• Old Policy: Employer/Community Matching Contributions had to be from:– Community Mental Health funds, or– Department of Corrections funds

• New Policy: Employer/Community Matching Contributions May be from:– Any verifiable non-federal source


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Notification of Current MSLRP Opportunities

• MSRLP Opportunity Notification List– Current and future MSLRP employers– Organizations concerned about access to

primary care• MSLRP Opportunity Notification E-Mails

– Upcoming application periods– Changes in MSLRP policy

• MSLRP Marketing Partners– Organizations representing segments of our

target markets– Forward opportunities to their constituencies– Provide opportunities for MSLRP staff speak to

their members about the program


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Getting on the List• Interested in:

– Receiving MSLRP Opportunity Notifications?– Becoming a MSLRP Marketing Partner?

• To get on the list:– Give me your card today– Mail me your card, or – Send me an e-mail with your contact

information

• Feel free to call me about MSLRP opportunities any time


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Contact InformationKen MillerMSLRP AnalystHealth Planning and Access to Care SectionMichigan Department of Community HealthCapitol View Building, 7th Floor201 TownsendLansing, MI 48913

571 [email protected]/mislrp

mailto:[email protected]


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“First Come, First Served” MSLRP Application Period

• Current MSLRP Opportunity• Started January 1, 2008• First come, first served, regardless of

priority status• Will continue until all funds are committed• Close will be posted on the MSLRP Website• Employer/Community Contribution

Contracts:– Allow employers and communities to double the

impact of their recruitment and retention funds– Each employer/community contribution dollar is

matched with available federal dollars to fund loan repayment contracts for needed medical, dental and MHC providers.


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Looking to the Future• Objectives:

– Increase application volume– Expand employer/community contribution (local

match) contract segment of program– Increase number of providers serving in Health

Professional Shortage Areas.– Increase federal funding and sustain state funding

• Employer/Community Contribution Segment is Growing– Current competitive grant allows for increases in

federal funding over the next two years– Use it, or lose it.– Means we need additional employers, communities

and organizations to sponsor medical, dental or mental health care providers


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Employer, Community, Organizational Sponsorship

• Do you know a provider committed to working in a HPSA worthy of your sponsorship?

• Do you know of employers, organizations or community-based funding sources wanting to double the impact of their recruitment and retention dollars?

• If so, call me to discuss how we can bring another provider to an underserved area.


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MSLRP Questions?


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Addressing the Shortageof Health Care Providers

The National Health Service Corps

• Started in 1972 as a scholarship program

• The NHSC is committed to:- Uniting communities in need with caring

health professionals

- Supporting communities' efforts to build better systems of health care


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National Health Service Corps: Recruitment Programs

• NHSC Scholarship Program

• NHSC Loan Repayment Program (LRP)• NHSC Campus Based Ambassador Program

• NHSC Ready Responder Program

• NHSC SEARCH (Student/Resident Experiences And Rotations in Community Health) Program

• NHSC State Loan Repayment Program


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NHSC Scholarship Program

• Scholarships to students who commit to practicing primary care in Health Professional Shortage Areas (HPSAs) of greatest need upon completion of education or training

• Period of service is 2-4 years based on number of years of scholarship support.

• Students choose their practice site from a list of approved sites located in areas of greatest need across the country.


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NHSC Loan Repayment Program: Clinician Incentive

• Repayment of educational loans for clinicians who are providing full-time clinical services

• 2-year service commitment with options for additional years

• Maximum repayment during the required initial 2-year contract is $50,000

• Clinician obtains employment at eligible/approved site and then applies for NHSC-LRP


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Recruit These Disciplines for NHSC Loan Repayment

Primary Health Care

MentalHealth

Oral Health Care

Primary Care Physicians (FP, IM, PED, & OB/GYN)

Primary Care Nurse Practitioners

Physician Assistants

Certified Nurse Midwives

Psychiatrists

Psychiatric Nurse Practitioners

Clinical Psychologists

Clinical Social Workers

Licensed Professional Counselors

Marriage and Family Therapists

Dentists

Dental Hygienists


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Site Eligibility-Type of Sites

• Public or private entity

• Community Health Centers

• Rural Health Clinics

• Hospital affiliated practices

• Private practices

• Indian Health Service

• Prisons - State and Federal

• Community Mental Health Centers


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What Can You Do to Maximize Your Opportunities with the NHSC?

• Apply to NHSC to be included on the NHSC Opportunity List

• Market your site

• Recruit potential loan repayors

• If eligible, recruit scholars


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Site Eligibility-Type of Sites• Provide comprehensive primary care, primary

mental health/substance abuse or dental services in an ambulatory setting

• Ensure access to ancillary, inpatient and specialty referrals

• Requirements pertain to entire site, not just NHSC clinician

• Must be in compliance at time of application and maintain compliance throughout term of NHSC clinician's service commitment

• Each location must apply and be approved by State and by NHSC-SIAB


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Site Eligibility-Health Professional Shortage Area (HPSA)

Must be located in and providing service to a federally designated Health Professional Shortage Area (HPSA)

HPSAs– Primary care - shortage of primary care providers – Mental health - shortage of mental health providers – Dental - shortage of oral health providers

Contact the Primary Care Office (PCO) at (517) 241- 2966


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Primary Care HPSAs


Updated: December 2007


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Updated: December 2007

Dental Health HPSAs


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Mental Health HPSAs


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Site Eligibility- Health Professional Shortage Area (HPSA)

• All Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes have an Automatic HPSA designation

• Certified Rural Health Clinics eligible for Automatic HPSA but must apply and meet NHSC Charges for Services Requirements

• Native American populations and sites also have Automatic HPSA opportunities


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All approved sites in HPSAs eligible for LRP

Sites in a HPSA with a score of 17 or higher receive priority (funded first and early - as soon as clinician application determined to be complete and eligible)

Sites in a HPSA with a score of 16 or below will be funded after deadline (last Friday in March) by decreasing HPSA score, as funds are available

FY 2007-08 Primary Care LRP applications funded with scores as low as 6

Sites Eligible for NHSC LRP


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Site Eligibility- Charges for Services

Ensure no financial barriers to care exist – Fees for service consistent with prevailing

rates in area – Discounts or waives fees for individuals at or

below 200% of the Federal poverty level – Accepts assignments for Medicare

beneficiaries; and enters into agreements with Medicaid and State Children's Health Insurance programs

– Prominently posts signage


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Site Eligibility - Hiring NHSC Clinicians

When hiring NHSC Clinicians, sites agree:– Full-time clinical – No reduction in salary because of NHSC – Communicate changes in employment – Only allow practice at approved site(s) – Make available personnel/practice records – Not restrict communication between clinician

and NHSC


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Monitoring Site Compliance

• Information from State Partners

• The State Primary Care Office involved and often are aware of issues sooner than the NHSC

• Required to pass along information regarding site or NHSC clinician’s compliance

• NHSC also involved in site/clinician monitoring and are doing 6-month service verifications


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NHSC Assistance to Communities

In addition to the programs the NHSC offers to students and clinicians, the NHSC works with communities to recruit and retain primary care clinicians by:

– Providing technical assistance to become an NHSC Site.

– Developing academic and community partnerships for student experiences and rotations in underserved areas.


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Technical Assistance

• Site development

• Planning and development; type of services

• Development of fee schedules; practice management

• Retain NHSC clinicians

• Recruitment of NHSC clinicians


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What Happens When . . .

• No new NHSC clinicians can be placed at the site

• All vacancies are removed

• NHSC Clinicians currently serving can continue to serve, but no loan repayors can amend their LRP contracts at that site

• If eligible for auto HPSA, site can switch vacancies to that HPSA and NHSC Loan Repayors can amend under that auto HPSA

HPSA is withdrawn or “No New Data”


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• If the vacancy was on the NHSC list in the discipline and specialty for that Scholar, and the Scholar visited the site (and was approved for the site visit by NHSC) we would honor the original score

• If however, the vacancy was on the list but the Scholar had not interviewed and was now asking to visit/interview or match, it would not be approved.

HPSA Score Changes


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• Depends on areas of non-compliance

• If of a serious nature (i.e., does not use a discount fee policy; does not provide full-time clinical hours; site moved to non-HPSA) and site is unwilling to resolve, current NHSC clinicians serving may be moved

• If the area of non-compliance is not as serious and can be resolved, NHSC clinicians currently serving would be allowed to stay, however no new NHSC clinicians would be approved until the site is brought back into compliance

Site Visit Reveals Site Non-Compliance


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• All vacancies are removed from the list

• Site visit scheduled unless CHC

• If CHC, phone TA may be provided

• Determination made if site should continue to be eligible for NHSC

• Would not affect current NHSC clinicians who continue to serve at the site

Site Terminates a NHSC Provider


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To Learn More

• For more information on NHSC and its programs:

– Call HHS toll-free helpline at 1-800-221-9393

– Visit the NHSC Web site at: http://nhsc.bhpr.hrsa.gov

– Call the Primary Care Office in Michigan at (517) 421-2966 or email

[email protected]


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Program Comparison

Open to: primary care MDs & DOs, primary care nurse practitioners, nurse-midwives, physician assistants, Dentists, dental hygienists, clinical psychologists, clinical social workers, licensed professional counselors, family therapists, psychiatric NP

Requires: Minimum two year commitment, practice in shortage area

Provides: Up to $50,000 for two years

Open to: primary care MDs & DOs, primary care nurse practitioners, nurse-midwives, physician assistants, Dentists, clinical psychologists, clinical social workers, licensed professional counselors, family therapists, psychiatric NP

Requires: Minimum two year commitment, practice in shortage area

Provides: Up to $25,000 a year, up to three years

NHSC LRP MSLRP

Still have loans? Complete one program and apply for the other

Documents

Provider Loan Repayment Programs · 2017. 10. 25. · Information provided by MDCH. 2. We are here to provide information about • Michigan State Loan Repayment Program (MSLRP) •