ABN Article 6 vs NHSC Loan Forgiveness

Overview

Article VI of the Alabama Nurse Practice Act, which governs the loan program for advanced practice nurses, does not explicitly limit eligibility or repayment obligations to nurse practitioners working in primary care.

Eligible Degrees: Master's or doctoral degrees preparing applicants for certification as a Certified Registered Nurse Practitioner (CRNP), Certified Nurse Midwife (CNM), or Certified Registered Nurse Anesthetist (CRNA).

Employment Requirement: The recipient must agree to work in Alabama in the advanced practice nursing role after graduation. The law does not specify a required specialty, such as family, adult-gero, or psychiatric primary care. There is no clause restricting practice to primary care settings.

Loan Forgiveness: The loan may be forgiven in exchange for full-time employment in Alabama as an advanced practice nurse. Failure to comply with the service agreement may require repayment.

Advocacy Framing

Unlike the NHSC, which limits eligibility for loan repayment to primary care disciplines, the State of Alabama recognizes that all advanced practice nurses—including those in specialty areas—play a critical role in meeting healthcare workforce needs. Alabama's Article VI explicitly offers loan forgiveness without requiring practice in primary care. This sets a precedent for federal programs to adopt a more inclusive model.

• Workforce Needs Vary Regionally: Alabama includes NPs in any specialty because rural areas often lack both primary and specialty care.
• No Specialty Restriction: Alabama does not distinguish between a family NP and a rheumatology NP—service to the state is what matters.
• State-Federal Discrepancy: NHSC exclusions conflict with inclusive state policies already in place.
• Call to Action: NHSC should:
  • Remove the “primary care only” limitation
  • Allow specialty NPs in underserved areas to qualify
  • Use state models like Alabama’s as examples of feasibility

Side-by-Side Comparison

Feature	NHSC (Federal)	Alabama NPA Article VI (State)
Eligibility for NPs	Only NPs in primary care, mental health, or SUD	All CRNPs, CNMs, and CRNAs eligible
Specialty Inclusion	❌ Excludes specialty care (e.g., Rheumatology)	✅ Includes all NP specialties
Service Area Requirement	Must work in HPSA-designated area	Must work in Alabama in an advanced practice role
Forgiveness Terms	2+ year commitment for partial/full repayment	Forgiveness tied to in-state service after graduation
Administering Agency	HRSA (Federal)	Alabama Board of Nursing (ABN)
Policy Orientation	Restrictive: only certain specialties qualify	Inclusive: recognizes all advanced practice specialties