BY RUSSELL UNDERWOOD, HCC MANAGING EDITOR

On May 1, the U.S. Department of Education published a final rule that would have changed the definition of “professional” degree programs, excluding a number of degrees related to healthcare. The result of the redefinition would have been a significant reduction in the amount of federal student loan funds available to students pursuing degrees in the excluded categories. While a federal judge had since granted a preliminary injunction blocking implementation of the rule, which would have taken effect on July 1, many healthcare experts remain concerned about the potential repercussions of the rule.

Carrie Cochran-McClain, DrPH, Chief Policy Officer at the National Rural Health Association, a nonprofit organization dedicated to improving the health and well-being of rural Americans, spoke with HCC about what the Department of Education final rule could mean for rural healthcare.

Q. What potential impacts do you foresee this rule having on students from rural backgrounds?

The new lifetime borrowing caps established under HR-1 will not cover the average cost of attendance for many students studying health professions nationally, with the average cost to attend 4-year private medical school being $268,476- $363,836. The Department of Education (ED) Reimaging and Improving Student Education (RISE) final rule goes beyond congressional intent by further limiting amounts for certain categories of health professions program based on the definition of professional vs. graduate degrees. Limiting access to federal loans will push rural and low-income students toward private loans with higher interest rates and fewer protections—or deter them from pursuing graduate health professions altogether. Because rural students are disproportionately lower-income, these caps would create a significant new barrier to entering medical, nursing, and other advanced health training programs.

Q. How might these changes influence the pipeline of healthcare professionals serving rural areas?

Rural communities already face persistent challenges recruiting and retaining clinicians. Many of the degrees excluded from the rule’s “professional” definition—such as nurse practitioners and physician assistants—form the backbone of rural primary care. In 2024, 66% of rural Medicare beneficiaries received primary care from an NP or PA, and their rural workforce supply has tripled or quadrupled respectively over the past two decades. Restricting federal loan access for these programs will shrink the pipeline by making training less affordable, increasing reliance on high-cost private loans, and discouraging graduates from practicing in rural areas.

Q. What are the likely consequences of this rule for rural healthcare?

Over 60% of all primary care, mental health, and dental HPSAs are in rural counties, and less than 10% of U.S. physicians practice in rural areas. Any new barrier to entering these fields will exacerbate existing shortages, reduce the availability of essential services, and further limit access to care. Ultimately, this rule will worsen rural health disparities and undermine efforts to stabilize rural health systems.

Q. What was NRHA’s reaction to the preliminary injunction that halted implementation of the rule?

NRHA applauds the court’s nationwide preliminary injunction preventing the Department of Education from enforcing its revised definition of “professional degree” while litigation proceeds. The association agrees with the court’s finding that the definition conflicted with Congressional intent and exceeded ED’s authority under the Administrative Procedure Act. We look forward to final resolution of this issue as it has major implications for graduate health professions programs—including those critical to rural workforce pipelines.