Inside the Beltway is a member-only benefit developed by NAPNAP’s Health Policy Team to keep members up to date on key policy issues at the federal level.
Nursing is a Professional Degree: Implications Regarding Proposed Changes to Federal Loans
Contributed by Health Policy Committee Member Jessica Francois, DNP, CPNP-PC
Capping federal loans for nurses to pursue advanced practice degrees will be detrimental to the nursing profession and the patients and communities they serve.
Title VIII of the One Big Beautiful Bill Act  (OBBBA), passed by Congress in July, included provisions to amend the federal student loan program for graduate and professional students. The term “professional degree” was adopted from the existing Higher Education Act (HEA) of 1965. HEA examples of professional degrees include but are not limited to medicine, dentistry, veterinary medicine, pharmacy, law, optometry, osteopathic medicine, podiatry and theology. Historically advanced practice nursing has been treated as a professional level degree for student loan eligibility.
On Nov. 6, the U.S. Department of Education (DOE) rulemaking committee provided recommendations regarding implementation of the OBBBA loan provisions. In the current provisions, advanced practice registered nurse student borrowers are included under graduate student but not professional student, limiting access to federal loans. Recommendations that will go into effect July 2026 include:
- Setting limits for annual and lifetime loans at $20,500 for graduate students ($100,000 aggregate limit), and $50,000 for professional students ($200,000 aggregate limit).
- Eliminating Grad PLUS loans
- Capping Parent PLUS Loans
As the nation’s largest and most trusted health care profession, nurses are critical to health care access and delivery and have an influential voice. APRNs are essential expert clinicians, especially in rural areas, providing access to high quality, evidence-based care for millions of Americans. DOE’s recommendations will significantly impact graduate and doctoral students’ access to higher education programs, disrupt ongoing efforts to develop a diverse workforce, and further exacerbate the health care provider shortage.
Read “Nursing Rallies to Object to Caps on Student Loans” (below) for more information about NAPNAP and other nursing organizations’ responses.
This issue impacts the future of our profession and I urge everyone to join me to take a stand.
- What you can do now: contact your Senators and Representative. Tell them your story, and urge them to recognize nursing as a “professional degree” under federal student loan regulations. Additional information can be found in Dr. Felesia Bowen’s email to NAPNAP members on Nov. 24.
- What you can do in the coming weeks: Watch for NAPNAP’s announcement when the DOE releases the official Notice of Proposed Rule Making and then submit your personal comment because every story matters in this fight.
Key NAPNAP Advocacy Activities
- NAPNAP joined other national nursing organizations in responding to the Department of Education Reimagining and Improving Student Education (RISE) Committee negotiated rulemaking consensus agreement that excluded nursing from the “professional degree” designation eligible for higher annual and lifetime levels of federal student financial aid, including cosponsoring an online petition with the American Nurses Association that collected more than 250,000 signatures by mid-December.
- NAPNAP met and communicated with the staff for the Senate and House Appropriations Committees and the staff supporting the leaders of the House and Senate Nursing Caucuses during and following the government shutdown, urging them to ensure the retention of Division of Nursing staff at the Health Resources and Service Administration and to support the highest possible funding levels for pediatric nursing workforce and research in a final fiscal 2026 Labor-HHS-Education appropriations agreement
- NAPNAP continued to work with national nursing organizations and the staff for the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions Committee on passage of the “Title VIII Nursing Workforce Reauthorization Act of 2025” (H.R. 3593/S. 1874), renewing the funding authorization for those programs through fiscal 2030.
- NAPNAP endorsed the “Mental Health Emergency” package of legislation sponsored by Reps. Bonnie Watson Coleman (D-NJ) and Yassamin Ansari (D-AZ), including resolutions recognizing May 31 as Youth Mental Health Day and Sept. 9 as Youth Suicide Prevention Day, the “Mental Health Crisis Response Act,” authorizing the Department of Justice to grant funds to help communities implement health-centered crisis response strategies, and the “Mental Health Emergency Responder Act,” creating a competitive grant program to expand behavioral health crisis response programs that do not rely primarily on law enforcement.
- NAPNAP supported Rep. Kathy Castor (D-FL) in reintroducing the “Promoting Resources to Expand Vaccination, Education and New Treatments for HPV Cancers Act of 2025,” or the “PREVENT HPV Cancers Act.” The bill creates a national public awareness campaign to promote education and awareness of HPV and HPV-associated cancers and increases funding for the CDC National Breast and Cervical Cancer Early Detection (NBCCED) Program to expand breast and cervical cancer screening.
Join us for CHPLC on Jan. 7
Join special guest speakers to celebrate NAPNAP State Advocacy Efforts and perhaps learn something that will assist with policy in your state. We will hear about Massachusetts: An Act Relative to the Diagnosis and Treatment of Autism Spectrum Disorder (S.754/H.1254) and California: Allergen Disclosure for Dining Experiences (ADDE) Act (SB 68). This is a member-only event. Register here for emailed Zoom instructions.
CDC Advisers’ Recommendation Marks Latest Shift in Vaccine Policies
President Trump issued a presidential memo directing HHS Sec. Kennedy to review the childhood vaccine schedule hours after an advisory panel voted to rescind the recommendation that all newborns receive the hepatitis B vaccine in favor of “individual-based decision-making,” which Trump called “a very good decision.” The CDC Advisory Committee on Immunization Practices (ACIP) also compared the Vaccines For Children (VFC) program with childhood vaccination schedules in other developed countries and debated concerns about aluminum adjuvants. Trump’s memo suggested revising the U.S. vaccine schedule for children to more closely align with those of other nations that recommend fewer vaccinations. As a reminder, NAPNAP’s Executive Board endorsed and recommends the AAP’s Recommended Child and Adolescent Immunization Schedule published on Aug. 19, 2025.
Separately, Sec. Kennedy announced an investigation of the VFC program after allegations that a school vaccinated a child with a federally supplied vaccine despite a religious exemption. The Health Resources and Services Administration (HRSA) was directed to add a condition requiring all federal health center program grantees to comply with federal and state parental-consent laws for all services provided to minors at HRSA-supported health centers. An internal FDA memo leaked earlier in the month indicated that the agency is considering raising the evidentiary standards for all future vaccine approvals and updates, potentially affecting annual updates for flu and other vaccines.
Nursing Rallies to Object to Caps on Student Loans
NAPNAP and other nursing organizations are urging the Department of Education and Congress to fix forthcoming regulations that would impose significantly lower limits on federal financial aid available to nursing students. A negotiated rulemaking committee agreed on policies to implement provisions of the “One Big, Beautiful Bill Act” that cap federal loans for students enrolled in nursing and other “graduate degree” programs to $20,500 annually and $100,000 in total borrowing, compared to $50,000 annually and $200,000 in total for “professional degree” programs. If finalized as proposed, the limits would force many nursing students to either take out high-interest, private loans or abandon advanced practice education altogether.
The Education Department is expected to formally propose regulations by next month, with a period for public comment, allowing nurses and other health care providers to call on the agency to correct the policy in a final rule. NAPNAP will submit comments and will give members an opportunity to provide their individual comments on the rule, as well. NAPNAP joined the American Nurses Association and other national nursing groups in drafting a petition signed by more than 230,000 individuals to date, urging the agency to explicitly recognize nursing as a professional degree in its regulations.
Senate Blocks Extension of Expiring Premium Subsidies
Despite evidence that millions of Americans who purchase health care coverage through Affordable Care Act marketplaces will face massive premium increases, the Senate rejected a Democratic plan to extend the expiring enhanced premium tax credits for three years. A Republican plan to replace the premium subsidies with direct contributions to Health Savings Accounts for enrollees in cheaper marketplace plans also failed. Members of both parties floated alternatives to temporarily extend the enhanced premium tax credits by a year or two, with income caps on eligibility, minimum premiums, and tougher anti-fraud protections. However, none are expected to pass before the year-end holidays.
The debate over premium subsidies also reignited talks about a possible package of health policies that could be attached to a government funding plan in January. At this point, there is no consensus on what should be in such a package, nor are there any significant bipartisan negotiations. House Republicans are discussing legislation focused on market-based reforms, including increased price transparency, pharmacy benefit manager reforms, and site-neutral payment policies, along with consumer-directed options like HSAs and Association Health Plans for small businesses.
In Other News
After Historic Shutdown, Congress Faces Another Post-Holiday Funding Cliff
After 43 days, Congress and the Trump administration ended the longest government shutdown in the nation’s history last month, extending fiscal 2025 funding for nursing workforce and research programs, along with most of the rest of the government, through Jan. 30 of the new year. When lawmakers return from their holiday break, they will have fewer than 20 legislative days to wrap up fiscal 2026 appropriations or pass another stopgap spending bill to avoid closing down the government again.
Supplemental nutrition programs are protected against the threat of another funding cutoff, since the “Continuing Appropriations and Extensions Act, 2026” (H.R. 5371) including full-year funding through Sept. 30 for programs in the Agriculture-FDA, Military Construction-Veterans’ Affairs, and Legislative Branch appropriations bills.
Senate appropriators are trying to clear the way for consideration of a five-bill “minibus” that would include the Labor-HHS-Education bill, along with the Defense, Interior-Environment, Commerce-Justice-Science, and Transportation-Housing measures. That would leave the Energy-Water Development, Financial Services, Homeland Security, and State-Foreign Operations to be resolved by the end of January, potentially by a full-year continuation of current funding policies.
Administration Seeks To Reimpose “Public Charge” Immigration Policy
The Department of Homeland Security proposed regulations last month that would rescind the 2022 “public charge” policy implemented by the Biden administration and restore a broader test directing officers to consider “all factors and information” about whether an immigrant is likely at any time to become a “public charge” to the federal government. The rule proposes to explicitly include past or potential use of any means-tested benefits such as Medicaid, supplemental nutrition, and housing assistance, removing detailed protections and definitions from the 2022 rule, giving adjudicators much broader discretion, and reviving a multi-factor test that emphasizes income, health status, age, English proficiency, education, and credit history. The agency projected billions of dollars in reduced transfer payments as immigrants and mixed-status families disenroll from benefits, not due to lack of eligibility but out of fear of being targeted for deportation.
Immigrant advocacy groups have denounced the proposal as a “wealth test” that punishes low-income families and people with disabilities, and echoes Trump’s 2019 rule. Health advocates warn it will chill enrollment in health, nutrition, and housing programs and disproportionately harm U.S.-citizen children, pregnant people, and mixed-status households. NAPNAP will join other children’s health advocates in submitting comments opposing the proposed rule.
CMS Issues Guidance to States on Medicaid Work Requirements
With state Medicaid programs scrambling to develop policies to implement the “community engagement” requirements adopted by Congress in the “One Big, Beautiful Bill Act,” the Centers for Medicare and Medicaid Services issued guidance this month on “transformative Medicaid reforms,” focusing on the new Medicaid work requirement. The bulletin directs states to condition eligibility for most adults in Medicaid expansion populations between 19 and 64 on completing at least 80 hours a month of work, education, job training, or community service, verified at each redetermination (at least every six months), with disenrollment and loss of Affordable Care Act subsidies for non-compliance. Exemptions are provided for caregivers of children under 14, pregnant people, veterans, people with disabilities and their caregivers, and part-time students, with states having some flexibility to add hardship exemptions.
Children’s advocacy organizations warned that the work and redetermination rules will result in massive coverage losses among parents and caregivers, thereby threatening children’s coverage, access to preventive and specialty care, and family financial security. They characterize the policy as a “paperwork requirement” aimed at generating savings for the federal government by knocking eligible families out of Medicaid coverage, with particular risks for rural pediatric providers. Groups are urging states to use every available flexibility to minimize procedural disenrollment or resist the policy.
