Expansion of HHS J-1 Waiver for Clinical Care Physicians

International medical graduates (IMG) enrolled in a graduate medical education or training program applying for a J-1 nonimmigrant visa are subject to a two-year home residency requirement.  This means the physician must return to his or her home country or country of last permanent residence for at least two-years in the aggregate prior to being eligible to apply for H-1 or L-1 nonimmigrant status or permanent residence.  This restriction is heavily burdensome, tricky to navigate from a career and timing perspective and sometimes difficult to waive.  J-1 visa holders who do not wish to return homecan apply for a waiver of the two-year home residency requirement typically by providing clinical care in underserved communities as designated by the Health Resources & Services Administration (HRSA). The most common is known as the Conrad 30 Waiver Program, administered by a state’s Department of Public Health.  Other waivers include those obtained through sponsorship by Department of Health and Human Services (HHS) as an interested government agency (IGA) for clinical care.J-1 physicians must agree to deliver health care services for three years in a mental health or primary care Health Professional Shortage Area (HPSA) in the U.S.  Previously, only Federally Qualified Community Health Centers (CHC), as designated by the government, were eligible to request clinical care waivers under the HHS program. Recently, HHS updated its guidelines so that any facility, such as a hospital or private practice, can apply for an HHS waiver as long as they have an HPSA score of at least 7 and the physician will provide primary care treatment. HPSA scores are developed by the National Health Service Corps to determine the areas in most need of assigned physicians. The higher the score, the greater the need. Primary care and mental health clinicians are scored between 1-25. The waiver is not available for specialists. Requirements for an HHS clinical care waiver request can be found under the Supplement B section here.

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