DHSS Launches State Health Care Provider Loan Repayment Program

NEW CASTLE (May 4, 2022) – The Department of Health and Social Services (DHSS) has launched a state-sponsored Health Care Provider Loan Repayment Program (HCPLRP). Under the new loan repayment program, eligible clinicians may receive up to $50,000 per year in loan repayment for a maximum of four years of employment in Delaware.

Governor John Carney signed House Bill 48 with House Amendment 1 on Aug. 10, 2021, establishing the loan repayment program administered by the Delaware Health Care Commission (DHCC). The program is a valuable tool to incentivize providers to practice in Delaware, in addition to attracting more providers to the state’s primary care workforce.

“We are grateful to Governor Carney and to the General Assembly for their support of the Health Care Provider Loan Repayment Program,” said DHSS Secretary Molly Magarik. “It’s clear that we need to find ways to attract more primary care providers to practice in Delaware, and this state-sponsored program is a strategic way to do that.”

“When it comes to health care, Delawareans deserve to be treated by highly trained professionals at medical facilities statewide,” said Rep. David Bentz, the lead sponsor of House Bill 48. “However, we are facing a shortage of doctors as the demand for them grows. That’s why we passed HB 48, which offers an attractive incentive to Delaware students in residency programs here, as well as establishes an education loan repayment program for medical professionals who currently work in Delaware. With this law, we can work toward recruiting and retaining top primary care doctors. I’m grateful to the Delaware Health Care Commission for taking a leadership role in running the grant program and ensuring that we have more health care workers throughout the state, including in underserved communities.”

In Fiscal Year 2022, the General Assembly allocated $1 million in state funds to support the loan repayment program. The Delaware Health Care Commission also received, in December 2021, a $1 million one-time contribution from Highmark Blue Cross Blue Shield Delaware. For Fiscal Year 2023, beginning July 1, 2022, the Governor’s Recommended Budget has proposed an additional $1 million in state funds to support the program.

“The Delaware Health Care Commission is excited to be able to implement HB48 and offer health care providers, who are interested in practicing in Delaware, worked to address this crisis through the development of the Health Care Workforce Subcommittee; supporting education through Delaware Institute of Medical Education and Research (DIMER) and (Delaware Institute of Dental Education and Research (DIDER); providing practice sustainability through the Primary Care Reform Collaborative; and now incentivizing providers to practice in Delaware with the State Health Care Provider Loan Repayment Program,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission and a practicing OB/GYN. “We are excited to be able to implement HB48 and offer primary care providers, who will be practicing in Delaware, meaningful financial relief, so they can build a sustainable practice and increase access for our patients to quality, affordable care.”

Qualifying clinicians must be a new primary care provider in an ambulatory or outpatient setting and completed graduate education within six months of the application for HCPLRP being submitted. Eligible health care providers include physicians practicing family medicine, internal medicine, pediatrics, obstetrics/gynecology, geriatrics, and psychiatry as well as Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists, and Physicians Assistants practicing adult medicine, family medicine, pediatrics, psychiatry/mental health, geriatrics, and women’s health.

Employers may apply on behalf of their affiliated, qualifying clinicians for education loan repayment grants. These sites may include:
• Hospital primary care practices
• Private practices
• Federally Qualified Health Centers
• Community outpatient facilities
• Community mental health facilities
• Free medical clinics

For awards issued to practitioners employed by Delaware health care facilities, hospitals and health systems must provide a 50% match for loan repayment awards.

Priority consideration will be given to Delaware Institute of Medical Education and Research (DIMER)-participating students and participants in Delaware based residency programs. Delaware is one of four states that does not have its own medical school. To accommodate the growing demand for primary care physicians across the state, the General Assembly created DIMER to support affiliated agreements with two medical schools in Philadelphia: Philadelphia College of Osteopathic Medicine (PCOM) and Thomas Jefferson, Sidney Kimmel Medical College (SKMC). A minimum of 120 academic seats are reserved annually (80 at Sidney Kimmel and 40 at PCOM) for Delaware residents applying to an allopathic or osteopathic degree program. New DIMER graduates are eligible for HCPLRP.

Delaware’s Health Care Provider Loan Repayment Program application is available online.

Applications are now accepted on a rolling basis and will be reviewed on the following schedule:
June 1, 2022*
Aug. 1, 2022*
Oct. 1, 2022

* Applicants in the June 1 and August 1 review cycles must have completed their graduate medical education by July 2021 or sometime thereafter. Applicants in the Oct. 1 review cycle must complete their graduate education by 2022 or sometime thereafter.

In addition to the state-sponsored Health Care Provider Loan Repayment Program, Delaware has operated a federal state loan repayment program (SLRP) supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services. SLRP offers similar incentives: up to $200,000 for four-year contractual agreements to provide services in federally designated Health Professional Shortage Areas. Where SLRP differs from HCPLRP is in designated areas of need, eligible professional disciplines, types of health care employment facilities that qualify, and date of graduation in respective disciplines.

To learn more about Health Care Provider Loan Repayment Program and the federal state loan repayment program, visit the Health Care Commission’s website.

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.


Advances in Primary Care Reform Made Possible by Legislature

General Assembly sent key bill to the Governor

The Delaware General Assembly passed legislation to increase Delawareans’ access to high quality, affordable health care through a series of reforms that will refocus Delaware’s healthcare system on primary care and improvements in value.

Senate Substitute 1 for Senate Bill 120 requires commercial health insurance companies to make meaningful increases in their primary care investment, limits price increases for hospital and other non-professional services, and compels health insurance companies and health systems to work together to improve healthcare value. By implementing these reforms simultaneously, models show that the increases in primary care investment do not result in unsustainable increases in total cost of care.

“Informed by data and the perspectives of Delaware consumers, physicians, employers, health insurance companies and hospitals, the Delaware Department of Insurance created a road map aimed at ensuring residents have access to high-quality, affordable health care, and that the primary care provider community would be strengthened in the process,” stated Insurance Commissioner Trinidad Navarro. “Through this legislation, the General Assembly has put these plans into action. We look forward to working with those stakeholders and the General Assembly to implement this important legislation that will improve the health and wellbeing of Delawareans while bending the healthcare cost curve.”

The types of reforms included in SS 1 for SB 120 were first contemplated in a report by the Delaware Department of Insurance and its Office of Value-Based Health Care Delivery, which was created by the General Assembly in 2019. Those same agencies would be tasked with implementing the legislation, creating necessary regulations, and enforcing its measures. To inform this work, the Office of Value-Based Healthcare Delivery embarked on an extensive data collection and stakeholder engagement process in 2020, which included data from Delaware health insurers, the Delaware Health Information Network Health Care Claims Database, publicly available sources, and perspectives shared during more than two dozen stakeholder interviews.

Research by the Office of Value-Based Health Care Delivery found that primary care spending in Delaware is low relative to the national average and about half of what is spent in leading states. This low investment in primary care services has likely contributed to declining numbers of primary care providers and poor access to primary care statewide. Increased numbers of primary care providers have been associated with improvements in health and decreases in mortality, as well as lower rates of emergency department visits and hospital admissions. Though many states face similar trends, the research also found primary care access problem in Delaware is particularly acute. The state’s population is among the oldest in the nation, a trend that will continue to grow.

“With one in five Delawareans are over the age of 65 and two in five of our neighbors living in an area with a shortage of primary care doctors, we have to do more to ensure our communities have access to the frontline providers they need to improve the quality of their health and keep them out of the hospital,” said Senate Majority Leader Bryan Townsend, the prime sponsor of SS 1 for SB 102. “Even as costs continue to rise for us all, the current system is simply providing positive results for too few Delawareans,” he said. “After three years of careful study and consideration, I am confident the legislation that Rep. David Bentz and I passed through the General Assembly will result in more primary care providers serving our state and better healthcare outcomes for our neighbors.”

“The primary care industry in Delaware is facing substantial challenges. Physicians are retiring or leaving the state, creating a shortage that means poor access to care for residents. Factor in the low levels of investment and we have an unsustainable system. We need to tackle this crisis head-on immediately,” said Rep. David Bentz, the bill’s lead House sponsor. “SS 1 for SB 120 will modernize and enhance primary care services in Delaware by directing the Health Care Commission to monitor and promote compliance with alternative payment models that promote value-based care. Primary care is critical in our efforts to improve public health outcomes and reduce long-term costs. It is, without question, where we get the best return on investment with our healthcare spend both financially and in-terms of the health of our population. I look forward to Governor Carney signing this bill into law to reverse the losses we’ve seen in recent years.”


New Report Outlines Plan for Strengthening Primary Care in Delaware

Provisional Affordability Standards aim to strengthen primary care in Delaware through increased investment

Insurance Commissioner Trinidad Navarro announced the release of the Office of Value-Based Health Care Delivery’s initial provisional Affordability Standards as part of a new report, Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality and Value, which includes plans to more than double primary care spending in the commercial fully-insured market by 2025.

The Affordability Standards announced today also include decreasing price growth for certain healthcare services and expanding the use of payment models that aim to improve healthcare value. The Affordability Standards and targets were informed by data from Delaware health insurers, the Delaware Health Information Network Health Care Claims Database, publicly available sources, and the perspectives shared during more than two dozen stakeholder interviews.

“An effective healthcare environment requires a strong primary care system, but it also requires shared standards that define success and progress. The multi-pronged approach announced today aims to increase primary care investment without increasing the total cost of healthcare or health insurance premiums,” Commissioner Navarro said. “We are grateful to our many partners who shared their data and experience during the process of building these guidelines. Now we ask the public as a whole to share their feedback on this report.”

The department will be accepting public comment on the report until January 25, 2021. Anyone may submit comments via email to DOI-legal@delaware.gov.

The Office of Value-Based Health Care Delivery was created through the passage of Senate Substitute 1 for Senate Bill 116 in 2019. The General Assembly recognized the importance of a strong system of primary care and the need to help bend the healthcare cost growth curve, directing the department to establish the office in order to “reduce health-care costs by increasing the availability of high quality, cost-efficient health insurance products with stable, predictable, and affordable rates,” and charged the office with three tasks:

1. Establish Affordability Standards for health insurance premiums based on recommendations from the Primary Care Reform Collaborative and annually monitor and evaluate these standards;
2. Establish targets for carrier investment in primary care to support a robust system of primary care by January 1, 2025; and
3. Collect data and develop annual reports regarding carrier investments in health care, including commercial reimbursement rates for primary and chronic care services.

The Office is meeting these directives by conducting extensive research on Delaware’s healthcare market, and used that research to inform the development of the interim Affordability Standards, including targets for increased investment in primary care.