Michigan’s two main pathways for hiring J-1 physicians in shortage areas are set for another busy season, with the Michigan Conrad-30 Waiver Program opening its 2025–2026 application window on the first business day of September and the federal HHS Clinical-Care Waiver operating on a rolling basis. Both options waive the two-year home residency requirement that normally applies after graduate medical training in the United States 🇺🇸, but they differ in authority, timelines, and specialty focus. State officials and hospital recruiters say early preparation will matter again this fall because the Michigan Conrad-30 Waiver remains capped at 30 slots and demand typically exceeds supply.
Programs, authorities, and the basic commitment
- The Michigan Department of Health and Human Services (MDHHS) administers the Conrad-30 state program as the Interested Governmental Agency.
- The U.S. Department of Health and Human Services (HHS) runs the separate HHS Clinical-Care Waiver (sometimes called the Supplement B Waiver).
- Both waivers require a 3-year, full-time employment commitment in a facility that serves a federally designated Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population (MUP).
- Employers emphasize these commitments as essential to stabilizing care in rural counties and strained urban clinics that struggle to recruit primary care and specialty physicians.
Key 2025 dates and contacts
- Michigan’s application cycle opens on the first business day of September and closes on the first business day of November.
- For planning: expected window is September 2, 2025, to November 1, 2025.
- MDHHS accepts up to 30 recommendations each fiscal year.
Contacts for questions and remaining slots after the deadline:
– Megan Linton — [email protected]
– Kyra Burkeen, Workforce Initiative Manager — [email protected], 517-355-7758
Applicants should be ready to move quickly because processing depends on a dual track: the state review and the federal waiver pipeline.
Federal sequence and required forms
Both pathways follow the same federal sequence:
- The U.S. Department of State Waiver Review Division issues a case file number and recommendation.
- USCIS provides final approval, allowing the physician to change to a work-authorized status (most often H-1B).
Required forms and steps:
– Applicants complete the online Form DS-3035 (J-1 waiver application) available from the Department of State.
– Employers file Form I-129 for H-1B classification with USCIS after the Department of State recommendation.
– Physicians must start the approved job within 90 days of waiver approval.
Department of State’s explanation of the J-1 waiver process is available at: J-1 Visa Waiver.
Differences in scope and speed: Conrad-30 vs. HHS Clinical-Care Waiver
- Michigan Conrad-30 Waiver
- State-sponsored (MDHHS).
- Covers primary care and many specialist roles when there is a documented shortage.
- Capped at 30 recommendations per fiscal year.
- Competitive; timing and paperwork are critical.
- HHS Clinical-Care Waiver (Supplement B)
- Federally sponsored (HHS).
- Generally focuses on primary care specialties: family medicine, general internal medicine, general pediatrics.
- Some critical specialties considered case-by-case.
- Operates year-round on a rolling basis and can be faster for clinics that meet federal criteria because it is not limited by the state’s 30-slot cap.
- HHS has increased scrutiny on documentation of HPSA/MUA/MUP status and population served.
Documentation and preparation — what employers and candidates must do
Employers and attorneys stress that thorough documentation is essential. Typical preparation includes:
- Confirming that the job site carries the required federal designation at both filing and approval.
- Preparing detailed:
- Job descriptions with clear work locations
- Clinic metrics and schedules
- Duty logs and call coverage to demonstrate full-time service
- Community need statements and patient volume data
- Securing a “no objection” statement from the physician’s home government when required by the physician’s contract.
- Not every J-1 physician needs this, but those who do must obtain it before the state or HHS can support the waiver.
- Maintaining consistent documentation across state and federal filings if applying to both pathways.
Attorneys note that the HHS route has stepped up documentation checks, especially around proof of HPSA/MUA/MUP status and the population served.
Application process flow (Michigan Conrad-30 example)
- Candidate and employer submit a complete package to MDHHS for review.
- If MDHHS approves, it issues a recommendation to the Department of State.
- The Department of State issues a case file number and favorable recommendation to USCIS.
- USCIS adjudicates the final change of status (usually H-1B).
- Physician begins H-1B employment and must remain in the job full time for the required 3-year term.
Note: The federal steps are the same for both routes, but the entry to the federal channel differs — the state sponsors Conrad-30, while HHS sponsors the Clinical-Care Waiver.
Timing and coordination tips
- Build a timeline backward from the September–November Michigan window.
- Many teams start preparing in late spring or early summer:
- Confirm site designations
- Finalize employment contracts with precise work locations
- Draft community need statements
- Coordinate with counsel to ensure:
Form DS-3035is ready to initiate the federal case file once the state recommendation is in motionForm I-129is prepared to request H-1B status promptly after Department of State and USCIS decisions
- Align onboarding and credentialing with the waiver calendar because job start dates must fall within 90 days of approval.
Practical considerations when choosing a route
Four core questions help determine the best path:
- Does the job meet the right federal designation (HPSA/MUA/MUP)?
- Is the role primary care or a specialty with documented local demand?
- How quickly does the employer need the physician to start?
- Is a Michigan state slot available during the fall window?
Common strategies:
– Attorneys sometimes advise applying through Michigan while preparing an HHS file if the physician fits both routes, to avoid losing a recruitment cycle.
– This approach requires careful coordination to keep filings accurate and consistent across agencies.
Recruiter checklist and compliance warnings
Recruiters emphasize simple but essential checkpoints:
– Match work locations in the contract to the waiver site.
– Track call coverage and clinic hours to demonstrate full-time service.
– Keep copies of designation screenshots, patient volume data, and community letters.
– If a physician has a return-home obligation, request the “no objection” letter early.
– If a position changes midstream, consult counsel before altering duties or moving sites — material changes can affect waiver compliance.
Warning: Timing missteps or incomplete documentation can derail a plan to retain a resident physician in Michigan after training.
Why this matters — the human impact
The waivers do more than process paperwork. Real-world impacts include:
– A family medicine resident’s waiver approval in northern Michigan can translate to thousands of primary care visits each year that would otherwise go to emergency departments.
– A pediatrician serving an MUP in Detroit can help lower wait times for well-child visits and immunizations.
These outcomes explain the urgency employers feel each fall when the Michigan Conrad-30 window opens and the parallel HHS route remains available.
Current policy status and outlook
- No major legal changes announced for late 2025 or early 2026.
- Michigan’s cap remains at 30.
- HHS continues to prioritize primary care and selected critical specialties, with increased documentation scrutiny.
- Consistency in rules helps planning, but ongoing workforce shortages may prompt stakeholders to ask the Legislature and MDHHS for adjustments within existing authority.
Final guidance and contacts
- Prepare early, document fully, and choose the waiver route that best fits the job and the community.
- For direct program questions in Michigan, contact MDHHS staff: Kyra Burkeen and Megan Linton (contacts listed above).
- For federal steps and timelines, see the Department of State’s J-1 waiver page: J-1 Visa Waiver.
As the 2025–2026 season begins, the state cap of 30 and the HHS Clinical-Care Waiver’s year-round availability will continue to shape physician recruitment strategies for underserved parts of Michigan.
This Article in a Nutshell
For 2025–2026, Michigan’s Conrad-30 and the federal HHS Clinical-Care Waiver remain the primary routes for J-1 physicians to obtain waivers of the two-year home residency requirement. Michigan’s Conrad-30 program opens its application window the first business day of September (expected Sept. 2, 2025) and closes the first business day of November (expected Nov. 1, 2025), with a strict cap of 30 recommendations per fiscal year. Both waivers require a three-year, full-time commitment in a federally designated HPSA, MUA, or MUP. The federal process involves Department of State case-file issuance followed by USCIS adjudication, typically enabling a shift to H-1B status. The HHS route runs year-round, prioritizes primary care, and can be faster because it is not limited by state slots, but HHS has increased documentation scrutiny. Employers and candidates must prepare detailed job descriptions, site designation proof, community-need statements, and consistent filings when applying to both routes. Early planning, accurate documentation, and coordination with immigration counsel are essential to secure slots and avoid delays.
