Michigan Conrad-30 and HHS Waivers for J-1 Physicians (2025-2026)

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:

1. The U.S. Department of State Waiver Review Division issues a case file number and recommendation.
2. 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)

1. Candidate and employer submit a complete package to MDHHS for review.
2. If MDHHS approves, it issues a recommendation to the Department of State.
3. The Department of State issues a case file number and favorable recommendation to USCIS.
4. USCIS adjudicates the final change of status (usually H-1B).
5. 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-3035 is ready to initiate the federal case file once the state recommendation is in motion
  • Form I-129 is 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:

1. Does the job meet the right federal designation (HPSA/MUA/MUP)?
2. Is the role primary care or a specialty with documented local demand?
3. How quickly does the employer need the physician to start?
4. 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.