NHSC FY2026 Loan Repayment STILL Excludes Optometrists — Single Largest Federal Workforce Headwind for FQHC Vision Care

NHSC FY2026 Loan Repayment Application Guidance confirms optometrists remain ineligible for the program. Eligible disciplines: MD/DO, NP, PA, CNM, dental (DDS/DMD), dental hygienists, CRNAs, behavioral health providers. Optometry was historically eligible but was removed; AOA has been actively lobbying for restoration via NHSC Improvement Act (HR 920 / S. 1445). HHS has interpretive authority to add optometry without new legislation but has so far declined, citing 'primary health services' intent. This is the single biggest recruitment friction point for FQHC optometry — dental and primary care providers can pursue $50,000 in tax-free loan repayment for 2-year service while ODs cannot. Counter-intuitive consequence: 3 of 4 CA FQHCs without vision programs are likely making the decision based on workforce difficulty when vision actually has the strongest PPS economics in the FQHC service mix.