The Conrad 30 Waiver: How the State Program Works for J-1 Doctors

Written by the Ellis Porter content team. This article has not been reviewed by an attorney. It is general information, not legal advice.

You are finishing training, and the J-1 rule is in your way

You matched, you trained, and now you have a job offer you want to take. Then the two-year home residency requirement shows up on the calendar. For many J-1 doctors, the Conrad 30 waiver is the path that keeps them in the US and in practice, in exchange for three years caring for patients who need more doctors.

This guide walks through how the program actually works: the law behind it, who qualifies, what the state does, how the 30 slots and the 10 flex slots work, what you commit to, and what happens if things fall apart. It also explains the program’s 2026 status, which is less settled than most pages admit. If you are weighing all your J-1 options first, our J-1 waiver practice page lays out the five waiver bases side by side.

What is a Conrad 30 waiver?

A Conrad 30 waiver is a waiver of the J-1 two-year home residency requirement for a foreign medical graduate, requested by a state health department. In return, the doctor agrees to start work within 90 days and practice full-time for at least three years, generally in an area the Department of Health and Human Services (HHS) designates as short of health professionals.

The rules come from INA 214(l), codified at 8 USC 1184(l). The statute says the government "shall not grant such waiver" on a state’s request unless the conditions in that subsection are met. The regulation that carries the program out is 8 CFR 212.7(c)(9).

The name comes from the per-state limit. Each state can request up to 30 waivers a year. You will also see it called the Conrad State 30 program or simply a Conrad waiver.

Who qualifies for a Conrad 30 waiver?

You qualify if you came to the US in J-1 status to receive graduate medical education or training, have a bona fide offer of full-time employment at a health facility, and a state health department agrees to request the waiver for you. If your home government is owed a return, you also need its written no objection statement.

The USCIS Conrad 30 page lists the core requirements that apply in every state. The J-1 foreign medical graduate must:

• Have been admitted under INA 101(a)(15)(J) to receive graduate medical training;
• Enter into a bona fide, full-time contract to practice medicine in H-1B status for at least 3 years at a facility in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population (MUP), or one serving patients who live in those areas;
• Obtain a written no objection statement from the home country, if contractually obligated to return; and
• Agree to begin employment at the facility named in the application within 90 days of receiving the waiver.

USCIS adds that the Department of State (DOS) considers "full-time" employment to be 40 hours per week.

Who does not fit: J-1 researchers and scholars who did not come for clinical training. Conrad 30 covers only doctors described in INA 212(e)(iii), meaning those who came "to receive graduate medical education or training." Others usually look at other bases, such as an interested government agency waiver or a no objection statement. The reverse is also true: under INA 212(e), the no objection statement waiver is not available to a doctor who came for graduate medical training.

What does the state health department do?

The state health department, or its equivalent, is the sponsor. It decides which doctors and facilities it will put forward, then asks DOS to recommend a waiver to USCIS. Without a state’s request, there is no Conrad 30 waiver, no matter how strong your job offer is.

That role gives each state wide control. The USCIS page says it plainly: "each state has developed its own application rules and guidelines." States decide things like:

• How many slots go to primary care versus specialists;
• If they use their flex slots at all;
• Application windows, fees, and required documents;
• Extra contract terms, reporting, and site rules.

For specialists, the statute adds a hurdle. Under INA 214(l)(1)(D)(iii), a request for a doctor practicing specialty medicine must show, "based on criteria established by such agency," a shortage of professionals in that specialty for the patients the doctor will serve. In practice, each state sets that standard.

How many slots does each state get, and what are flex slots?

Each state may request up to 30 Conrad waivers per federal fiscal year, which starts October 1. Up to 10 of those 30 may go to doctors at facilities outside a designated shortage area, if the state finds the facility serves patients from designated areas. States call these flex or non-designated slots.

Both numbers come straight from the statute. INA 214(l)(1)(B) bars a waiver that would push a state’s count for the fiscal year above 30. INA 214(l)(1)(D)(ii) caps the out-of-area waivers at 10 within that 30.

To check if a site is in a shortage area, HHS’s Health Resources and Services Administration runs a public HPSA Find tool on data.hrsa.gov. Your state and employer will usually confirm the designation for you.

One quirk worth knowing if you read the regulation yourself: 8 CFR 212.7(c)(9) still says a state’s waivers cannot "exceed 20" in a fiscal year, and it still refers to the U.S. Information Agency. Those are older numbers and names. The statute was amended to 30, and the statute controls.

Do not confuse these slots with federal programs. HHS, the Appalachian Regional Commission, and other regional agencies run separate physician waiver programs that do not count against your state’s 30. Our comparison of the HHS waiver vs. Conrad 30 explains when each one fits.

What is the 3-year service commitment?

You must practice medicine full-time for at least three years, in H-1B status, at the facility named in the waiver application, and begin within 90 days of receiving the waiver. Until those three years are done, you cannot apply for a green card or change to another nonimmigrant status.

The 90-day clock runs from receipt of the waiver. USCIS stresses it is "not the date their J-1 visa expires." Build that into your start date and your licensing timeline.

The H-1B piece has two features that matter to employers. First, the statute lets USCIS change your status from J-1 to H-1B even though J-1 doctors with the two-year rule normally cannot change status inside the US. Second, under INA 214(l)(2)(A), the H-1B annual cap "shall not apply" to a doctor whose status is changed this way. No lottery is involved. (The regulation still says Conrad doctors are subject to the cap, another outdated line the statute overrides.)

Your family moves with you. Under 8 CFR 212.7(c)(9), J-2 dependents may change to H-4 once the waiver is approved. USCIS says spouses and children file Form I-539 for that change. For the H-1B side of the picture, see our guide to H-1B for physicians.

What happens if you do not finish the 3 years?

If you stop complying with the waiver terms, the two-year home residency requirement comes back. Under INA 214(l)(2)(B), you cannot get an immigrant visa, permanent residence, or any other change of nonimmigrant status until you have lived in your home country for two years. USCIS can excuse early departure only for extenuating circumstances.

The statute names two examples of extenuating circumstances: "closure of the facility or hardship to the alien." Even then, the regulation at 8 CFR 212.7(c)(9)(v) says that "in all cases" you must submit a contract with another health care facility in an HHS-designated shortage area for the rest of the three years. A hardship claim must also show the hardship came from unforeseen circumstances beyond your control.

INA 214(l)(3) adds a broader trigger. The two-year requirement reattaches if you stop complying with your agreement, or if your employment "ceases to benefit the public interest" at any time during the three years.

So here is what that means for you. If your employer is in financial trouble, your contract is changing, or you are thinking about leaving, talk to an attorney before anything happens. The order of steps matters, and an H-1B amendment or new petition may be required for material changes.

What is the Conrad 30 process, step by step?

The process runs in a fixed order: job offer and contract, a DOS case number, the state application, the state’s request to DOS, the DOS recommendation, the USCIS waiver decision, and then the H-1B. You cannot start work under the waiver until both the waiver and the H-1B are approved.

1. Secure a bona fide, full-time job offer and sign a 3-year contract with an eligible facility.
2. Complete DOS Form DS-3035, J-1 Visa Waiver Review Application, through the DOS J-1 waiver online system, which issues your case number.
3. File the state application with your state health department during its cycle, following its checklist.
4. The state, if it agrees to sponsor you, sends its request and your file to the DOS Waiver Review Division.
5. DOS makes a recommendation and notifies USCIS electronically, and notifies you, your attorney, and the state by mail.
6. USCIS decides. Its page says that after a favorable DOS recommendation, USCIS "will generally grant the waiver as long as there are no underlying concerns." You do not file Form I-612 for a Conrad waiver.
7. Your employer files Form I-129 for the H-1B change of status, with the favorable DOS recommendation letter. Family members file Form I-539 for H-4.
8. Start work within 90 days of receiving the waiver.

To follow your file once it reaches DOS, see our guide to checking your J-1 waiver status.

Why Conrad 30 rules and deadlines differ by state

Because each state runs its own program inside the federal limits, application windows, fees, and priorities vary widely. You need to read your target state’s health department page directly, and early, since some states fill their slots fast.

Two examples from official state pages, both checked on November 1, 2026:

• The Iowa HHS J-1 waiver page says Iowa began accepting 2026-2027 applications on September 1, 2026, and describes 30 spots a year, 10 of which may be non-designated requests.
• The Pennsylvania physician visa waiver page says its Conrad 30 application period runs October 1, 2026 through December 18, 2026.

Same program, different calendars. We do not list other states here because their windows change every year. Search for your state’s department of health and "J-1 visa waiver," and use only the official .gov page.

Is the Conrad 30 program still active in 2026?

As of November 1, 2026, yes, but on short-term extensions. Congress has never made the state authority permanent. It extended the program to September 30, 2026 in February 2026, and the stopgap funding law signed September 2, 2026 carried that extension forward through December 11, 2026.

Here is how the sunset works, because it is widely misunderstood. The state authority is tied to a date in section 220(c) of the Immigration and Nationality Technical Corrections Act of 1994. That date controls which doctors are covered: it applies to those admitted in or acquiring J-1 status before it. Pub. L. 119-75, signed February 3, 2026, substituted September 30, 2026 as that date, according to the statutory notes under 8 USC 1182.

Then the FY2027 continuing resolution, Pub. L. 119-103, continued authority under the Homeland Security appropriations baseline "including sections 5013 through 5016 of division I of Public Law 119-75." Section 5013 is the Conrad extension. That law’s authority ends December 11, 2026, unless Congress acts sooner.

What does a lapse mean in practice? When the program lapsed during the October 2025 shutdown, USCIS posted that doctors who acquired J-1 status on or after October 1 would not be eligible, but that the program "will remain available" to those who acquired J-1 status on or before September 30. That alert was still on the USCIS page when we checked on November 1, 2026, so read it as history, not current status.

Most doctors finishing residency now took J-1 status years ago, so a short lapse may affect them less than the headlines suggest. But states, DOS, and employers can pause or slow work during uncertainty.

Planning beyond the waiver

The Conrad years can also count toward a green card. Many Conrad doctors pursue a physician national interest waiver, which has its own service requirement and its own rules about what time counts. Plan the two together, not one after the other.

Get your situation looked at before you sign

Every Conrad 30 case turns on details: your training history, any home-government funding, your state’s rules this cycle, the contract language, and the facility’s designation. If you have an offer in hand, or you are an employer recruiting a J-1 physician, have an immigration attorney review the plan before the state window opens. A short review now can keep a three-year commitment on track.

Frequently asked questions