S. 2954

119 S2954 IS: Health Care Workforce Expansion Act of 2025
 U.S. Senate
 2025-09-30
 text/xml
 EN
 Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
 II  119th CONGRESS  1st Session  S. 2954  IN THE SENATE OF THE UNITED STATES   September 30, 2025   Mr. Sanders  (for himself and  Mr. Merkley ) introduced the following bill; which was read twice and referred to the  Committee on Health, Education, Labor, and Pensions    A BILL
To establish grant programs for health professional schools, and for other purposes.
1.
Short title
This Act may be cited as the   Health Care Workforce Expansion Act of 2025  .
2.
Grant programs for health professional schools
(a)
MED, DENTAL, and NURSE Grants
Part A of title IV of the Higher Education Act of 1965 ( 20 U.S.C. 1070 ) is amended by adding at the end the following:
11
MED Grants
420S.
Definitions
For the purposes of this subpart:
(1)
Eligible institution
The term  eligible institution  means an institution of higher education, as defined in section 101, that is a school of medicine or school of osteopathic medicine as defined in section 799B of the Public Health Service Act ( 42 U.S.C. 295p ).
(2)
Medical school candidate
The term  medical school candidate  means a student in attendance at an eligible institution pursuing a professional doctor of medicine or doctor of osteopathic medicine degree.
420T.
Program established
(a)
Program authority
(1)
Payments required
The Secretary shall pay to each eligible institution such sums as may be necessary to pay to each medical school candidate who files an application and agreement in accordance with section 420U, and who qualifies under such section, a MED Grant in the amount of tuition and required fees for each year during which that medical school candidate is in attendance at the institution.
(2)
References
Grants made under paragraph (1) shall be known as  MED Grants .
(b)
Payment methodology
(1)
Prepayment
Not less than 85 percent of any funds provided to an eligible institution under subsection (a) shall be advanced to the eligible institution prior to the start of each payment period and shall be based upon an amount requested by the institution as needed to pay medical school candidates until such time as the Secretary determines and publishes in the Federal Register with an opportunity for comment, an alternative payment system that provides payments to institutions in an accurate and timely manner, except that this sentence shall not be construed to limit the authority of the Secretary to place an institution on a reimbursement system of payment.
(2)
Direct payment
Nothing in this section shall be interpreted to prohibit the Secretary from paying directly to medical school candidates, in advance of the beginning of the academic term, an amount for which medical school candidates are eligible, in cases where the eligible institution elects not to participate in the disbursement system required by paragraph (1).
(c)
No exceeding cost
The amount of a grant awarded under this subpart, in combination with Federal assistance, shall not exceed the cost of attendance (as defined in section 472) at the eligible institution at which that medical school candidate is in attendance.
(d)
Period of eligibility for grants
The period during which a medical school candidate may receive a MED grant under this subpart shall be the period required for the completion of the professional medical degree being pursued by the medical school candidate at the eligible institution at which the medical school candidate is in attendance, except that the period during which a medical school candidate may receive a MED Grant under this subpart shall not exceed 8 years.
420U.
Application; award
(a)
Application; award
(1)
Application
The Secretary shall periodically set dates by which medical school candidates shall file applications for grants under this subpart. Each medical school candidate desiring a grant under this subpart for any year shall file an application containing such information as is necessary to demonstrate that the medical school candidate—
(A)
is an eligible student for purposes of section 484;
(B)
has completed a FAFSA;
(C)
would like to receive a MED grant; and
(D)
understands and agrees to the terms and conditions of the agreement to serve described in subparagraph (b).
(2)
Award
The Secretary shall award a MED grant to each eligible medical school candidate who meets the requirements described in paragraph (1) for each year that the application under such paragraph is submitted and such requirements are met.
(b)
Agreements To serve
Each application under subsection (a) shall contain or be accompanied by an agreement by the applicant that—
(1)
the applicant will—
(A)
practice primary care, as defined in section 1886 of the Social Security Act ( 42 U.S.C. 1395ww ), as a physician for at least 10 years after their related training is completed (including residency or fellowship programs) within 15 years after completing the degree for which the applicant received a MED Grant under this subpart or such related training (referred to in this section as the  service obligation window ); and
(B)
annually submit an employment certification, for each year of service, showing that the requirement under subparagraph (A) is being met;
(2)
in the event that the applicant is determined to have failed or refused to carry out such service obligation, a specified amount of any MED Grants received by such applicant will be treated as a loan and collected from the applicant in accordance with subsection (c) and the regulations thereunder; and
(3)
contains, or is accompanied by, a plain-language disclosure form developed by the Secretary that clearly describes the nature of the MED Grant award, the service obligation, and the loan repayment requirements that are the consequence of the failure to complete the service obligation.
(c)
Repayment for failure To complete service
(1)
In general
In the event that any recipient of a grant under this subpart fails or refuses to comply with the service obligation in the agreement under subsection (b), a specified amount as described in paragraph (3) of the MED Grants received by such recipient shall, upon a determination of such a failure or refusal in such service obligation, be converted to a Federal Direct Unsubsidized Stafford Loan under part D of title IV, and shall be subject to repayment, in accordance with paragraph (2).
(2)
Interest and repayment
Amounts that are converted to a Direct Unsubsidized Stafford Loan under paragraph (1) shall accrue interest at the rate applicable to such Direct Unsubsidized Stafford Loans for borrowers as of the date of conversion, and the recipient shall be eligible for the same repayment plans and borrower protections with respect to such converted loans as that recipient would otherwise be eligible for with respect to a Federal Direct Unsubsidized Stafford Loan under part D of title IV for a borrower that is disbursed on the same date.
(3)
Specified amount to be repaid
(A)
5 years or less
If a MED Grant recipient has completed 5 years or less of required service, the lesser of—
(i)
the total amount of MED grants received by the recipient; or
(ii)
$50,000.
(B)
Greater than 5 years and less than 10 years
If a MED Grant recipient has completed more than 5 years of required service but less than 10 years of required service, the lesser of—
(i)
the total amount of MED grants received by the recipient; or
(ii)
$25,000.
(C)
Cap
The amount of MED Grants that is converted to a loan and required to be repaid under this subsection shall not exceed $50,000.
(4)
Reconsideration of conversion decisions
(A)
Request to reconsider
In any case where the Secretary has determined that a recipient of a grant under this subpart has failed or refused to comply with the service obligation in the agreement under subsection (b) and has converted the grant into a Federal Direct Unsubsidized Stafford Loan under part D in accordance with paragraph (1), (including cases where such loans have been fully or partially paid), the recipient may request that the Secretary reconsider such initial determination and may submit additional information to demonstrate satisfaction of the service obligation. Upon receipt of such a request, the Secretary shall reconsider the determination in accordance with this paragraph not later than 90 days after the date that such request was received.
(B)
Reconsideration
If, in reconsidering an initial determination under subparagraph (A) (including cases where such loans were fully or partially paid), the Secretary determines that the reason for such determination was the recipient's failure to timely submit a certification required under subsection (b)(1)(B), an error or processing delay by the Secretary, a change to the fields considered eligible for fulfillment of the service obligation (as described in subsection (b)(1)(A)), a recipient having previously requested to have the MED Grant converted to a loan, or another valid reason determined by the Secretary, and that the recipient has, as of the date of the reconsideration, demonstrated that the recipient did meet, or is meeting the service obligation in the agreement under subsection (b), the Secretary shall—
(i)
discharge the Federal Direct Unsubsidized Stafford Loan under part D, and reinstate the recipient's grant under this subpart;
(ii)
discharge any interest or fees that may have accumulated during the period that the grant was converted to a Federal Direct Unsubsidized Stafford Loan under part D;
(iii)
if the recipient has other loans under part D, apply any payments made for the Federal Direct Unsubsidized Stafford Loan under part D during such period to those other loans under part D;
(iv)
if the recipient does not have other loans under part D, reimburse the recipient for any amounts paid on the Federal Direct Unsubsidized Stafford Loan under part D during such period;
(v)
request that consumer reporting agencies remove any negative credit reporting due to the conversion of the MED Grant to a loan; and
(vi)
use the additional information provided under subparagraph (A) to determine the progress the recipient has made in meeting the service obligation.
(C)
Extension of time to complete service obligation
In the case of a recipient whose MED Grant was reinstated in accordance with subparagraph (B), the Secretary shall, upon such reinstatement—
(i)
extend the time remaining for the recipient to fulfill the service obligation described in subsection (b)(1) to a period of time equal to—
(I)
10 years; minus
(II)
the number of years that the recipient completed service as a physician in primary care prior to the reconversion of the loan to a MED Grant under subparagraph (B), including any years of qualifying service completed during the period when the MED Grant was in loan status; and
(ii)
treat any years of service described in subclause (II) of clause (i) as years that count toward the individual’s service obligation (regardless of whether the MED Grant funds were in grant or loan status) if that time otherwise meets the requirements of this section.
(d)
Additional administrative provisions
(1)
Extenuating circumstances
The Secretary shall establish, by regulation, categories of extenuating circumstances under which a recipient of a grant under this subpart who is unable to fulfill all or part of the recipient's service obligation may be excused from fulfilling that portion of the service obligation.
(2)
Communication with recipients
The Secretary shall notify MED grant recipients not less than twice per calendar year regarding how to submit the employment certification under subsection (b)(1)(B) and the recommendations and requirements for submitting that certification under paragraph (3).
(3)
Submission of employment certification
(A)
Recommended submissions
(i)
In General
The Secretary shall notify MED Grant recipients that the Department recommends that MED Grant recipients submit the employment certification described in subsection (b)(1)(B) as soon as practicable after the completion of each year of service.
(ii)
Form
The Secretary shall provide a standardized annual certification form for use under this section and allow electronic submission by the recipient or employer.
(B)
Required submission
A MED Grant recipient shall be required to submit to the Department employment certification within the timeframe that would allow that individual to complete their service obligation before the end of the service obligation window.
(C)
Notification
The Secretary shall notify MED Grant recipients of the required submission deadlines described in this paragraph.
(D)
Adjustment of deadline
The Secretary shall adjust the submission deadline described in subparagraph (B) to account for a service obligation window extension.
(E)
Alternative to certification
The Secretary shall provide an alternative to the certification of employment described in subsection (b)(1)(B) for recipients who cannot obtain such required certification of employment because the recipient can demonstrate the employer is no longer in existence or the employer refuses to cooperate.
420V.
Program period and funding
Beginning on July 1, 2026, there shall be available to the Secretary to carry out this subpart, from funds not otherwise appropriated, such sums as may be necessary to provide MED Grants in accordance with this subpart to each eligible applicant.
12
DENTAL Grants
420W.
Definitions
For the purposes of this subpart:
(1)
Eligible institution
The term  eligible institution  means an institution of higher education, as defined in section 101, that is a school of dentistry as defined in section 799B of the Public Health Service Act ( 42 U.S.C. 295p ).
(2)
Dental school candidate
The term  dental school candidate  means a student in attendance at an eligible institution pursuing a professional dental degree.
(3)
Rural area
The term rural area has the meaning given that term in section 861(b)(2).
420X.
Program established
(a)
Program authority
(1)
Payments required
The Secretary shall pay to each eligible institution such sums as may be necessary to pay to each dental school candidate who files an application and agreement in accordance with section 420Y, and who qualifies under such section, a DENTAL Grant in the amount of tuition and required fees for each year during which that dental school candidate is in attendance at the institution.
(2)
References
Grants made under paragraph (1) shall be known as  DENTAL Grants .
(b)
Payment methodology
(1)
Prepayment
Not less than 85 percent of any funds provided to an eligible institution under subsection (a) shall be advanced to the eligible institution prior to the start of each payment period and shall be based upon an amount requested by the institution as needed to pay dental school candidates until such time as the Secretary determines and publishes in the Federal Register with an opportunity for comment, an alternative payment system that provides payments to institutions in an accurate and timely manner, except that this sentence shall not be construed to limit the authority of the Secretary to place an institution on a reimbursement system of payment.
(2)
Direct payment
Nothing in this section shall be interpreted to prohibit the Secretary from paying directly to dental school candidates, in advance of the beginning of the academic term, an amount for which dental school candidates are eligible, in cases where the eligible institution elects not to participate in the disbursement system required by paragraph (1).
(c)
No exceeding cost
The amount of a grant awarded under this subpart, in combination with Federal assistance, shall not exceed the cost of attendance (as defined in section 472) at the eligible institution at which that dental school candidate is in attendance.
(d)
Period of eligibility for grants
The period during which a dental school candidate may receive a DENTAL grant under this subpart shall be the period required for the completion of the professional dental degree being pursued by the dental school candidate at the eligible institution at which the dental school candidate is in attendance, except that the period during which a dental school candidate may receive a DENTAL Grant under this subpart shall not exceed 8 years.
420Y.
Application; award
(a)
Application; award
(1)
Application
The Secretary shall periodically set dates by which dental school candidates shall file applications for grants under this subpart. Each dental school candidate desiring a grant under this subpart for any year shall file an application containing such information as is necessary to demonstrate that the dental school candidate—
(A)
is an eligible student for purposes of section 484;
(B)
has completed a FAFSA;
(C)
would like to receive a DENTAL grant; and
(D)
understands and agrees to the terms and conditions of the agreement to serve described in subparagraph (b).
(2)
Award
The Secretary shall award a DENTAL grant to each eligible dental school candidate who meets the requirements described in paragraph (1) for each year that the application under such paragraph is submitted and such requirements are met.
(b)
Agreements To serve
Each application under subsection (a) shall contain or be accompanied by an agreement by the applicant that—
(1)
the applicant will—
(A)
practice general dental care in a rural area, with the option for service to be completed cumulatively across eligible sites and locations, for at least 10 years after their related training is completed (including a residency or fellowship program) within 15 years after completing the degree and such related training for which the applicant received a DENTAL Grant under this subpart (referred to in this section as the  service obligation window ); and
(B)
annually submit an employment certification, for each year of service, showing that the requirement under subparagraph (A) is being met;
(2)
in the event that the applicant is determined to have failed or refused to carry out such service obligation, the specified amount of any DENTAL Grants received by such applicant will be treated as a loan and collected from the applicant in accordance with subsection (c) and the regulations thereunder; and
(3)
contains, or is accompanied by, a plain-language disclosure form developed by the Secretary that clearly describes the nature of the DENTAL Grant award, the service obligation, and the loan repayment requirements that are the consequence of the failure to complete the service obligation.
(c)
Repayment for failure To complete service
(1)
In general
In the event that any recipient of a grant under this subpart fails or refuses to comply with the service obligation in the agreement under subsection (b), a specified amount as described in paragraph (3) of the DENTAL Grants received by such recipient shall, upon a determination of such a failure or refusal in such service obligation, be converted to a Federal Direct Unsubsidized Stafford Loan under part D of title IV, and shall be subject to repayment, in accordance with paragraph (2).
(2)
Interest and repayment
Amounts that are converted to a Direct Unsubsidized Stafford Loan under paragraph (1) shall accrue interest at the rate applicable to such Direct Unsubsidized Stafford Loans for borrowers as of the date of conversion, and the recipient shall be eligible for the same repayment plans and borrower protections with respect to such converted loans as that recipient would otherwise be eligible for with respect to a Federal Direct Unsubsidized Stafford Loan under part D of title IV for a borrower that is disbursed on the same date.
(3)
Specified amount to be repaid
(A)
5 years or less
If a DENTAL Grant recipient has completed 5 years or less of required service, the specified amount to be repaid is the lesser of—
(i)
the total amount of DENTAL Grants received by the recipient; or
(ii)
$50,000.
(B)
Greater than 5 years and less than 10 years
If a DENTAL Grant recipient has completed more than 5 years of required service but less than 10 years of required service, the specified amount to be repaid is the lesser of—
(i)
the total amount of DENTAL Grants received by the recipient; or
(ii)
$25,000.
(C)
Cap
The amount of DENTAL Grants that is converted to a loan and required to be repaid under this subsection shall not exceed $50,000.
(4)
Reconsideration of conversion decisions
(A)
Request to reconsider
In any case where the Secretary has determined that a recipient of a grant under this subpart has failed or refused to comply with the service obligation in the agreement under subsection (b) and has converted the grant into a Federal Direct Unsubsidized Stafford Loan under part D in accordance with paragraph (1), (including cases where such loans have been fully or partially paid), the recipient may request that the Secretary reconsider such initial determination and may submit additional information to demonstrate satisfaction of the service obligation. Upon receipt of such a request, the Secretary shall reconsider the determination in accordance with this paragraph not later than 90 days after the date that such request was received.
(B)
Reconsideration
If, in reconsidering an initial determination under subparagraph (A) (including cases where such loans were fully or partially paid), the Secretary determines that the reason for such determination was the recipient's failure to timely submit a certification required under subsection (b)(1)(B), an error or processing delay by the Secretary, a change to the fields considered eligible for fulfillment of the service obligation (as described in subsection (b)(1)(A)), a recipient having previously requested to have the DENTAL Grant converted to a loan, or another valid reason determined by the Secretary, and that the recipient has, as of the date of the reconsideration, demonstrated that the recipient did meet, or is meeting the service obligation in the agreement under subsection (b), the Secretary shall—
(i)
discharge the Federal Direct Unsubsidized Stafford Loan under part D, and reinstate the recipient's grant under this subpart;
(ii)
discharge any interest or fees that may have accumulated during the period that the grant was converted to a Federal Direct Unsubsidized Stafford Loan under part D;
(iii)
if the recipient has other loans under part D, apply any payments made for the Federal Direct Unsubsidized Stafford Loan under part D during such period to those other loans under part D;
(iv)
if the recipient does not have other loans under part D, reimburse the recipient for any amounts paid on the Federal Direct Unsubsidized Stafford Loan under part D during such period;
(v)
request that consumer reporting agencies remove any negative credit reporting due to the conversion of the DENTAL Grant to a loan; and
(vi)
use the additional information provided under subparagraph (A) to determine the progress the recipient has made in meeting the service obligation.
(C)
Extension of time to complete service obligation
In the case of a recipient whose DENTAL Grant was reinstated in accordance with subparagraph (B), the Secretary shall, upon such reinstatement—
(i)
extend the time remaining for the recipient to fulfill the service obligation described in subsection (b)(1) to a period of time equal to—
(I)
10 years; minus
(II)
the number of years that the recipient completed required service in general dentistry in a rural area prior to the reconversion of the loan to a DENTAL Grant under subparagraph (B), including any years of qualifying service completed during the period when the DENTAL Grant was in loan status; and
(ii)
treat any years of service described in subclause (II) of clause (i) as years that count toward the individual’s service obligation (regardless of whether the DENTAL Grant funds were in grant or loan status) if that time otherwise meets the requirements of this section.
(d)
Additional administrative provisions
(1)
Extenuating circumstances
The Secretary shall establish, by regulation, categories of extenuating circumstances under which a recipient of a grant under this subpart who is unable to fulfill all or part of the recipient's service obligation may be excused from fulfilling that portion of the service obligation.
(2)
Communication with recipients
The Secretary shall notify DENTAL grant recipients not less than twice per calendar year regarding how to submit the employment certification under subsection (b)(1)(B) and the recommendations and requirements for submitting that certification under paragraph (3).
(3)
Submission of employment certification
(A)
Recommended submissions
(i)
In General
The Secretary shall notify DENTAL Grant recipients that the Department recommends that DENTAL Grant recipients submit the employment certification described in subsection (b)(1)(B) as soon as practicable after the completion of each year of service.
(ii)
Form
The Secretary shall provide a standardized annual certification form for use under this section and allow electronic submission by the recipient or employer.
(B)
Required submission
A DENTAL Grant recipient shall be required to submit to the Department employment certification within the timeframe that would allow that individual to complete their service obligation before the end of the service obligation window.
(C)
Notification
The Secretary shall notify DENTAL Grant recipients of the required submission deadlines described in this paragraph.
(D)
Adjustment of deadline
The Secretary shall adjust the submission deadline described in subparagraph (B) to account for a service obligation window extension.
(E)
Alternative to certification
The Secretary shall provide an alternative to the certification of employment described in subsection (b)(1)(B) for recipients who cannot obtain such required certification of employment because the recipient can demonstrate the employer is no longer in existence or the employer refuses to cooperate.
420Z.
Program period and funding
Beginning on July 1, 2026, there shall be available to the Secretary to carry out this subpart, from funds not otherwise appropriated, such sums as may be necessary to provide DENTAL Grants in accordance with this subpart to each eligible applicant.
13
NURSE Grants
420AA.
Definitions
For the purposes of this subpart:
(1)
Eligible institution
The term  eligible institution  means an accredited school of nursing, as defined in section 801 of the of the Public Health Service Act ( 42 U.S.C. 296 ), at an institution of higher education, as defined in section 101.
(2)
Nursing student
The term  nursing student  means a student in attendance at an eligible institution.
420BB.
Program established
(a)
Program authority
(1)
Payments required
The Secretary shall pay to each eligible institution such sums as may be necessary to pay to each nursing student who files an application and agreement in accordance with section 420CC, and who qualifies under such section, a NURSE Grant in the amount of tuition and required fees for each year during which that nursing student is in attendance at the institution.
(2)
References
Grants made under paragraph (1) shall be known as  NURSE Grants .
(b)
Payment methodology
(1)
Prepayment
Not less than 85 percent of any funds provided to an eligible institution under subsection (a) shall be advanced to the eligible institution prior to the start of each payment period and shall be based upon an amount requested by the institution as needed to pay nursing students until such time as the Secretary determines and publishes in the Federal Register with an opportunity for comment, an alternative payment system that provides payments to institutions in an accurate and timely manner, except that this sentence shall not be construed to limit the authority of the Secretary to place an institution on a reimbursement system of payment.
(2)
Direct payment
Nothing in this section shall be interpreted to prohibit the Secretary from paying directly to nursing students, in advance of the beginning of the academic term, an amount for which nursing students are eligible, in cases where the eligible institution elects not to participate in the disbursement system required by paragraph (1).
(c)
No exceeding cost
The amount of a grant awarded under this subpart, in combination with Federal assistance, shall not exceed the cost of attendance (as defined in section 472) at the eligible institution at which that nursing student is in attendance.
(d)
Period of eligibility for grants
The period during which a nursing student may receive a NURSE grant under this subpart shall be the period required for the completion of the professional nursing degree being pursued by the nursing student at the eligible institution at which the nursing student is in attendance, except that the period during which a nursing student may receive a NURSE Grant under this subpart shall not exceed 8 years.
420CC.
Application; award
(a)
Application
The Secretary shall periodically set dates by which nursing students shall file applications for grants under this subpart. Each nursing student desiring a grant under this subpart for any year shall file an application containing such information as is necessary to demonstrate that the nursing student—
(1)
is an eligible student for purposes of section 484;
(2)
has completed a FAFSA; and
(3)
would like to receive a NURSE grant.
(b)
Award
The Secretary shall award a NURSE grant to each nursing student who meets the requirements described in subsection (a) for each year that the application under such subsection is submitted and such requirements are met.
420DD.
Program period and funding
Beginning on July 1, 2026, there shall be available to the Secretary to carry out this subpart, from funds not otherwise appropriated, such sums as may be necessary to provide NURSE Grants in accordance with this subpart to each eligible applicant.
  .
(b)
Increasing enrollment at health professions schools
Part E of title VII of the Public Health Service Act ( 42 U.S.C. 294n et seq. ) is amended by adding at the end the following:
4
Increasing enrollment at health professions schools
779.
Grant program to increase enrollment at health professions schools
(a)
Schools of medicine and schools of osteopathic medicine
(1)
In general
The Secretary shall award grants to eligible schools of medicine and schools of osteopathic medicine to assist such schools in expanding student enrollment.
(2)
Eligibility
To be eligible to receive a grant under this section, a school of medicine or school of osteopathic medicine shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan to increase enrollment in the school by at least—
(A)
50 percent by year 2 of the grant; and
(B)
an additional 50 percent by year 4 of the grant.
(3)
Use of funds
A school of medicine or school of osteopathic medicine that receives a grant under this section shall use the funds awarded through such grant for activities that include—
(A)
enhancing enrollment and retention of students at such school using evidence-based practices, with a priority for students from disadvantaged backgrounds (including racial or ethnic groups underrepresented in the physician workforce), individuals from rural and underserved areas, low-income individuals, individuals with a disability, and first generation college students (as defined in section 402A(h)(3) of the Higher Education Act of 1965), including through mentorship programs, providing tools and programming for underrepresented students, and addressing other student needs;
(B)
retaining current faculty and clinical preceptors, and recruiting and hiring new faculty and clinical preceptors, including by increasing wages and providing loan repayment, with an emphasis on faculty and clinical preceptors from racial or ethnic groups who are underrepresented in the physician workforce;
(C)
partnering with a health care facility, community health center, or other facility that provides health care in order to provide educational opportunities for the purpose of establishing or expanding clinical education, with emphasis on community-based clinical education;
(D)
modernizing infrastructure at such school, including audiovisual or other equipment, simulation and augmented reality resources, telehealth technologies, and virtual and physical laboratories;
(E)
creating, supporting, or modernizing educational programs and curriculum, including rural and community-based clinical education, at such school; or
(F)
other activities that the Secretary determines further the development, improvement, and expansion of schools of medicine and schools of osteopathic medicine.
(b)
Schools of nursing
(1)
In general
The Secretary shall award grants to eligible schools of nursing to assist such schools in expanding student enrollment.
(2)
Eligibility
To be eligible to receive a grant under this section, a school of nursing shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan to increase enrollment in the school by at least—
(A)
30 percent by year 2 of the grant; and
(B)
an additional 30 percent by year 4 of the grant.
(3)
Use of funds
A school of nursing that receives a grant under this section shall use the funds awarded through such grant for activities that include—
(A)
enhancing enrollment and retention of students at such school using evidence-based practices, with a priority for students from disadvantaged backgrounds (including racial or ethnic groups underrepresented in the nursing workforce), students who identify as an underrepresented sex in the nursing workforce, individuals from rural and underserved areas, low-income individuals, individuals with a disability, and first generation college students (as defined in section 402A(h)(3) of the Higher Education Act of 1965), including through mentorship programs, providing tools and programming for underrepresented students, and addressing other student needs;
(B)
retaining current faculty and clinical preceptors, and recruiting and hiring new faculty and clinical preceptors, including by increasing wages and providing loan repayment, with an emphasis on faculty and clinical preceptors from racial or ethnic groups who are underrepresented in the nursing workforce;
(C)
partnering with a health care facility, nurse-managed health clinic, community health center, or other facility that provides health care in order to provide educational opportunities for the purpose of establishing or expanding clinical education, with emphasis on community-based clinical education;
(D)
modernizing infrastructure at such school, including audiovisual or other equipment, simulation and augmented reality resources, telehealth technologies, and virtual and physical laboratories;
(E)
creating, supporting, or modernizing educational programs and curriculum, including rural and community-based clinical education, at such school;
(F)
enhancing and expanding nursing programs that prepare nurse researchers and scientists;
(G)
establishing nurse-led intradisciplinary and interprofessional educational partnerships;
(H)
supporting registered nurses in baccalaureate degree programs or advanced degree programs described in section 811(b), with a goal of becoming nurse faculty and clinical preceptors; or
(I)
other activities that the Secretary determines further the development, improvement, and expansion of schools of nursing.
(4)
Definition
In this section, the term  school of nursing  has the meaning given such term in section 801(2).
(c)
Schools of dentistry
(1)
In general
The Secretary shall award grants to eligible schools of dentistry to assist such schools in expanding student enrollment.
(2)
Eligibility
To be eligible to receive a grant under this section, a school of dentistry shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan to increase enrollment in the school by at least—
(A)
20 percent by year 2 of the grant; and
(B)
an additional 20 percent by year 4 of the grant.
(3)
Use of funds
A school of dentistry that receives a grant under this section shall use the funds awarded through such grant for activities that include—
(A)
enhancing enrollment and retention of students at such school using evidence-based practices, with a priority for students from disadvantaged backgrounds (including racial or ethnic groups underrepresented in the dental workforce), individuals from rural and underserved areas, low-income individuals, individuals with a disability, and first generation college students (as defined in section 402A(h)(3) of the Higher Education Act of 1965), including through mentorship programs, providing tools and programming for underrepresented students, and addressing other student needs;
(B)
retaining current faculty and clinical preceptors, and recruiting and hiring new faculty and clinical preceptors, including by increasing wages and providing loan repayment, with an emphasis on faculty and clinical preceptors from racial or ethnic groups who are underrepresented in the dentistry workforce;
(C)
partnering with a dental clinic, community health center, or other facility, including a school-based dental clinic, that provides dental care in order to provide educational opportunities for the purpose of establishing or expanding clinical education, with emphasis on community-based clinical education;
(D)
modernizing infrastructure at such school, including audiovisual or other equipment, simulation and augmented reality resources, telehealth technologies, and virtual and physical laboratories;
(E)
creating, supporting, or modernizing educational programs and curriculum, including rural and community-based clinical education, at such school; or
(F)
other activities that the Secretary determines further the development, improvement, and expansion of schools of dentistry.
(d)
Grant amounts; grant period
Each grant awarded under this section shall be in an amount determined by the Secretary, and for a period of 10 years.
(e)
Reporting
Each recipient of a grant under this section shall submit to the Secretary an annual report that describes—
(1)
the number of students enrolled during the year preceding the date of the report;
(2)
the percentage by which such enrollment for such year has increased or decreased, as compared to enrollment for the year preceding such year;
(3)
the number of new faculty and clinical preceptors that were hired during such year; and
(4)
in the case of a recipient of a grant under subsection (c), with respect to graduates of the applicable school of dentistry—
(A)
the number who are practicing dentistry in a rural community;
(B)
the number who are enrolled as a participating provider under a State plan under title XIX of the Social Security Act or under a waiver of such a plan;
(C)
the rates of passage of the Integrated National Board Dental Examination, and of any exam or process by which a dentist obtains a license to practice dentistry; and
(D)
the rates at which such graduates are practicing dentistry 3 and 5 years after graduation.
(f)
Authorization of appropriations
There are authorized to be appropriated, for the period of fiscal years 2026 through 2035—
(1)
$2,800,000,000 for purposes of carrying out subsection (a);
(2)
$1,980,000,000 for purposes of carrying out subsection (b); and
(3)
$615,000,000 for purposes of carrying out subsection (c).
  .
3.
Program of payments to teaching health centers that operate graduate medical education programs
Section 340H of the Public Health Service Act ( 42 U.S.C. 256h ) is amended—
(1)
in subsection (c)(2)(B), by adding at the end the following:  Notwithstanding any other provision of this section, the Secretary shall update such per resident amount for each such qualified teaching health center such that such amount for fiscal year 2026 is not less than $170,000, and such amount for fiscal year 2027 and each fiscal year thereafter is not less than the sum of the amount determined for the previous fiscal year plus $10,000. ; and
(2)
in subsection (g)(1)—
(A)
in subparagraph (E), by striking  ; and  and inserting a semicolon;
(B)
in subparagraph (F), by striking the period and inserting a semicolon; and
(C)
by adding at the end the following:
(G)
$892,500,000 for fiscal year 2026;
(H)
$1,890,000,000 for fiscal year 2027;
(I)
$2,992,500,000 for fiscal year 2028;
(J)
$3,150,000,000 for fiscal year 2029;
(K)
$3,307,500,000 for fiscal year 2030;
(L)
$3,465,000,000 for fiscal year 2031;
(M)
$3,622,500,000 for fiscal year 2032;
(N)
$3,780,000,000 for fiscal year 2033;
(O)
$3,937,500,000 for fiscal year 2034; and
(P)
$4,095,000,000 for fiscal year 2035.
 .
4.
Distribution of additional Medicare GME residency positions
(a)
Distribution
(1)
In general
Section 1886(h) of the Social Security Act ( 42 U.S.C. 1395ww(h) ) is amended—
(A)
in paragraph (4)(F)(i), by striking  and (10)  and inserting  (10), and (11) ;
(B)
in paragraph (4)(H)(i), by striking  and (10)  and inserting  (10), and (11) ; and
(C)
by adding at the end the following new paragraph:
(11)
Distribution of additional residency positions in psychiatry and psychiatry subspecialties and primary care
(A)
Additional residency positions
(i)
In general
For each of fiscal years 2027 through 2036 and for each succeeding fiscal year until the aggregate number of full-time equivalent residency positions distributed under this paragraph is equal to the aggregate number of such positions made available (as specified in clause (ii)(I)), the Secretary shall, subject to the succeeding provisions of this paragraph, increase the otherwise applicable resident limit for each qualifying hospital that submits a timely application under this subparagraph by such number as the Secretary may approve effective beginning July 1 of the fiscal year of the increase.
(ii)
Number available for distribution
(I)
Total number available
The aggregate number of such positions made available under this paragraph shall be equal to 50,220.
(II)
Annual limit
The aggregate number of such positions so made available shall not exceed 5,022 for a fiscal year.
(iii)
Distribution for psychiatry or psychiatry subspecialty residencies; primary care residencies
For each of fiscal years 2027 through 2036, of the positions made available under this paragraph—
(I)
at least 15 percent shall be distributed for a psychiatry or psychiatry subspecialty residency (as defined in subparagraph (F));
(II)
at least 30 percent shall be distributed for a primary care residency (as defined in such subparagraph); and
(iv)
Timing
The Secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as a result of an increase in the otherwise applicable resident limit by January 31 of the fiscal year of the increase. Such increase shall be effective beginning July 1 of such fiscal year.
(B)
Considerations in distribution
In determining for which qualifying hospitals an increase in the otherwise applicable resident limit is provided under subparagraph (A), the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions made available under this paragraph within the first 5 training years beginning after the date the increase would be effective, as determined by the Secretary.
(C)
Requirements
(i)
Prohibition on distribution to hospitals without an increase agreement
No increase in the otherwise applicable resident limit of a hospital may be made under this paragraph unless such hospital agrees to increase the total number of full-time equivalent residency positions under the approved medical residency training program of such hospital by the number of such positions made available by such increase under this paragraph.
(ii)
Requirement for hospitals to expand programs
If a hospital that receives an increase in the otherwise applicable resident limit under this paragraph would be eligible for an adjustment to the otherwise applicable resident limit for participation in a new medical residency training program under section 413.79(e)(3) of title 42, Code of Federal Regulations (or any successor regulation), the hospital shall ensure that any positions made available under this paragraph are used to expand an existing program of the hospital and not for participation in a new medical residency training program.
(D)
Application of per resident amounts for nonprimary care
With respect to additional residency positions in a hospital attributable to the increase provided under this paragraph, the approved FTE per resident amounts are deemed to be equal to the hospital per resident amounts for nonprimary care computed under paragraph (2)(D) for that hospital.
(E)
Permitting facilities to apply aggregation rules
The Secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to, beginning in the fifth year after the effective date of such increase, apply such positions to the limitation amount under paragraph (4)(F) that may be aggregated pursuant to paragraph (4)(H) among members of the same affiliated group.
(F)
Definitions
In this paragraph:
(i)
Otherwise applicable resident limit
The term  otherwise applicable resident limit  means, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and (H) of paragraph (4) on the resident level for the hospital determined without regard to this paragraph, but taking into account paragraphs (7)(A), (7)(B), (8)(A), (8)(B), (9)(A), and (10)(A).
(ii)
Primary care residency
The term  primary care residency  means a residency in a program described in paragraph (5)(H).
(iii)
Psychiatry or psychiatry subspecialty residency
The term  psychiatry or psychiatry subspecialty residency  has the meaning given that term in paragraph (10)(F).
(iv)
Reference resident level
The term  reference resident level  means, with respect to a hospital, the resident level for the most recent cost reporting period of the hospital ending on or before the date of enactment of this paragraph, for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary.
(v)
Resident level
The term  resident level  has the meaning given such term in paragraph (7)(C)(i).
 .
(2)
IME
Section 1886(d)(5)(B) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(B) ) is amended—
(A)
in clause (v), in the third sentence, by striking  and (h)(10)  and inserting  (h)(10), and (h)(11) ; and
(B)
by adding at the end the following new clause:
(xiii)
For discharges occurring on or after July 1, 2027, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(11), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause (ii) with respect to such resident positions.
 .
(3)
Prohibition on judicial review
Section 1886(h)(7)(E) of the Social Security Act ( 42 U.S.C. 1395ww(h)(7)(E) ) is amended by inserting  paragraph (11),  after  paragraph (10), .
5.
Rural relocation grant program
Subpart 2 of part E of title VII of the Public Health Service Act ( 42 U.S.C. 295 et seq. ) is amended by adding at the end the following:
778A.
Rural relocation grant program
(a)
In general
The Secretary shall award grants to eligible physicians, nurses, and dentists for purposes of assisting such individuals in relocating to a rural area in which the individual intends to practice medicine, nursing, or dentistry, as applicable.
(b)
Eligibility
To be eligible to receive a grant under this section, a physician, nurse, or dentist shall—
(1)
be licensed to practice medicine, nursing, or dentistry, as applicable, in the State in which the rural area to which the individual is relocating is located;
(2)
prior to such relocation, be practicing in an area that is not a rural area;
(3)
upon such relocation, have a permanent position in the area to which the individual is relocating and intend to practice in such area for not fewer than 3 years; and
(4)
submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(c)
Grant amounts; use of funds; repayment
(1)
In general
A grant awarded under this section shall be in an amount determined by the Secretary, not to exceed $20,000.
(2)
Use of funds
An individual receiving a grant under this section may use such grant for eligible life and relocation expenses, as determined by the Secretary.
(3)
Repayment
If an individual receiving a grant under this section leaves the area described in subsection (b)(3) before the expiration of the 3-year period described in such subsection, such individual shall repay to the Secretary an amount equal to 50 percent of the amount of the grant.
(d)
Authorization of appropriations
To carry out this section, there is authorized to be appropriated $1,800,000,000 for the period of fiscal years 2026 through 2035.
 .