HHS Waiver vs Conrad 30: Which J-1 Physician Waiver Fits Your Job?

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

Two waiver paths, one contract: how to tell which one your job needs

You are finishing residency on a J-1 visa. A hospital or clinic wants to hire you, and someone on the recruiting team has asked: "Are we doing this through Conrad 30 or HHS?" If you are not sure what the difference is, you are in good company. The two programs share a goal and a three-year commitment, yet they run on different rules, different gatekeepers, and different calendars.

Both are ways around the two-year home residence requirement in INA 212(e), which applies to anyone who came to the US on a J-1 "to receive graduate medical education or training." Until that requirement is met or waived, you cannot get H-1B status or a green card. This guide puts the two physician waivers side by side so you and your employer can pick the right one before anyone signs anything. For the full menu of waiver routes, see our J-1 waiver practice page.

HHS waiver vs Conrad 30 at a glance

As of November 1, 2026, per the statute, the regulations, and the current HHS and USCIS program pages:

What is the core difference between an HHS waiver and Conrad 30?

The core difference is who asks for the waiver and how much flexibility comes with it. Conrad 30 is a state request, capped at 30 per state, open to specialists, and shaped by each state’s own policies. The HHS clinical waiver is a federal request with no state slot to compete for, but it is limited to primary care and general psychiatry in the neediest shortage areas.

Both paths end in the same place. The State Department’s Waiver Review Division reviews the request and sends a recommendation to US Citizenship and Immigration Services (USCIS), which makes the final decision. The statute that governs both is INA 214(l), 8 USC 1184(l): it sets the three-year commitment, the 30-per-state cap, and the H-1B rules for waivers requested by "an interested State agency, or by an interested Federal agency."

Who sponsors each waiver, and who files?

For the HHS clinical waiver, the employer files. The HHS regulation at 45 CFR 50.6 says the review board "will not accept applications submitted by Exchange Visitors." The physician supplies documents to the employer, and the employer submits the full package to HHS.

The HHS sequence, per its program page, runs like this:

1. The physician files Form DS-3035 with the State Department and receives a case number.
2. The institution submits the waiver package and HHS Form 426, with that case number, to HHS.
3. HHS reviews for completeness and eligibility under 45 CFR Part 50 and, if favorable, recommends the waiver to the State Department.
4. The State Department reviews and forwards its recommendation to the Department of Homeland Security.
5. USCIS makes the final waiver decision.

Clinical care requests also need a state health department acknowledgment or support letter, according to the current HHS application instructions. So the state still plays a role in an HHS case, just not as the requesting agency.

For Conrad 30, the state health department is the requesting agency. Under 22 CFR 41.63(e), the state’s director sends the State Department a letter stating that the waiver is in the public interest, along with the employment contract. Each state decides how to collect and rank applications. Our Conrad 30 waiver guide walks through the state process in detail.

Which specialties qualify for each program?

Conrad 30 can cover specialists. HHS cannot. That single row decides many cases.

The HHS regulation at 45 CFR 50.5(b) limits clinical waivers to "primary care physicians and general psychiatrists." The current HHS instructions list five residencies: family medicine, general internal medicine, general pediatrics, obstetrics and gynecology, and general psychiatry. The physician must also be board certified or board eligible in that discipline and licensed, or applying for a license, in the practice state.

The statute lets a Conrad 30 physician "practice primary care or specialty medicine." For a specialist, INA 214(l)(1)(D)(iii) requires the request to show a shortage of professionals in that specialty for the patients the doctor will serve. Each state decides how many of its slots go to specialists, so a cardiologist may find room in one state and none in another.

The 12-month rule that catches HHS applicants

HHS requires that you begin work under the waiver contract no more than 12 months after finishing your primary care or psychiatry residency. The regulation explains the purpose: to make sure your primary care training "is current" and that you "are not engaged in subspecialty training."

There is one carve-out in current HHS guidance. If you go straight from residency into a fellowship in geriatrics, addiction medicine, or child and adolescent psychiatry, the 12-month window starts when that fellowship ends. Any other fellowship, such as cardiology or gastroenterology, generally takes you outside HHS eligibility. Conrad 30 has no comparable federal rule, which is why fellowship-trained doctors usually look to the state program or another agency.

What kind of practice site does each waiver require?

The HHS waiver has the stricter site rule. As of November 1, 2026, HHS will only consider a facility in or with a primary care or mental health Health Professional Shortage Area (HPSA) score of 7 or higher. Conrad 30 sites can be in any HHS-designated shortage area, including Medically Underserved Areas and Populations (MUA/P).

Here is a trap several ranking pages miss. The HHS regulation at 45 CFR 50.5 still mentions sites in a "primary care HPSA or MUA/P." But the current HHS instructions say: "Withdrawn HPSAs and Medically Underserved Area or Population (MUA/P) designations are not accepted." A clinic that qualifies only through an MUA designation, or whose HPSA score is 6, is not a fit for HHS today. Check the HPSA score for every practice location before you choose a path, because scores change when HRSA updates designations.

HHS also sets facility rules in 45 CFR 50.5(e), including serving patients regardless of ability to pay and offering a sliding fee scale for people at or below 200 percent of the poverty level.

Conrad 30 has one feature HHS lacks: non-designated or "flex" slots. Under INA 214(l)(1)(D)(ii), a state may use up to 10 of its 30 waivers for physicians at facilities outside a designated area that serve patients who live in one. Iowa’s health department, for example, describes its program as having 30 spots each year, "10 of which may be considered as ‘non-designated requests’."

How many waivers are available under each program?

Conrad 30 is capped by statute at 30 waivers per state per fiscal year. The HHS regulation sets no fixed annual number. Instead, 45 CFR 50.3 lets the HHS review board "determine the appropriate numbers and geographic areas for waivers for the delivery of health care service."

In practice, that difference shapes timing. Each state runs its own application cycle, and once its 30 waivers for the fiscal year are used, it cannot request more. Iowa’s 2026 to 2027 cycle, for example, opened September 1, 2026. HHS accepts clinical applications on a rolling basis and, according to its FAQ, processes them "on a first-come, first-served basis," without expedites for expiring J-1 status. HHS also says it "does not charge a fee to process a waiver request," though other agencies in the chain may.

HHS does not publish a processing time. For the State Department and USCIS stages, see our guide to J-1 waiver processing time.

Can you apply for HHS and Conrad 30 at the same time?

No. You must pick one. An HHS clinical request requires your signed statement, under penalty of 18 U.S.C. 1001, that you have no other waiver request pending with "any United States Government department or agency or any State Department of Public Health, or equivalent." The same certification appears in State Department regulation 22 CFR 41.63(c)(4)(iii).

So the choice has to be made early. Agree on the path with your employer and its counsel before either application goes out.

Does the Conrad 30 expiration affect HHS waivers?

Conrad 30 depends on Congress, and HHS does not in the same way. The state program’s authority is tied to a date in section 220(c) of the Immigration and Nationality Technical Corrections Act of 1994, which Congress extends periodically. That date applies to physicians admitted in, or who acquired, J-1 status before it.

According to the statutory notes under 8 USC 1182, Public Law 119-75, signed February 3, 2026, set that date at September 30, 2026. The Congressional Research Service reports that the stopgap funding law signed September 2, 2026 (Public Law 119-103) carries the extension through December 11, 2026. USCIS’s Conrad 30 program page still showed an October 1, 2025 alert about the earlier lapse when we checked on November 1, 2026, so confirm the current status before you rely on either date.

HHS’s role rests on INA 212(e) itself, which lets "an interested United States Government agency" request a waiver, and on HHS’s own regulation at 45 CFR 50.1. That is why the HHS waiver can matter more when the Conrad deadline is uncertain. How a lapse would affect any particular case is a question for an attorney.

What stays the same either way?

Whichever path you take, several core rules from INA 214(l) apply to waivers requested by a federal or state agency:

• A bona fide offer of full-time employment at a health facility, determined to be in the public interest.
• At least three years of service, with a narrow exception for extenuating circumstances such as facility closure, in which case you need another qualifying job for the rest of the term.
• A change to H-1B status that is exempt from the annual H-1B cap.
• A penalty for walking away: if you fail to fulfill the contract, you must spend two years in your home country before you can get a green card or another status change.

For the H-1B side of the job, see our guide to H-1B for physicians, and for the longer road to permanent residence, green cards for doctors.

When does each waiver fit best?

The HHS waiver tends to fit when:

• You trained in family medicine, general internal medicine, general pediatrics, OB/GYN, or general psychiatry.
• You will start within 12 months of finishing residency, or within 12 months of one of the three qualifying fellowships.
• Every practice site is in a primary care or mental health HPSA scored 7 or higher.
• Your state’s Conrad slots are full, its cycle has closed, or the Conrad extension is in doubt.
• The employer can take on the full federal package and its recruitment documentation.

Conrad 30 tends to fit when:

• You are a specialist or subspecialist, including most fellowship-trained physicians.
• Your residency ended more than 12 months before your start date.
• The site qualifies only through an MUA/P, has a HPSA score below 7, or sits outside a designated area but serves patients from one.
• Your target state has open slots and its timeline fits your J-1 end date.

Some doctors fit neither cleanly. Federal regional commissions, such as the Appalachian Regional Commission and the Delta Regional Authority, run their own programs with their own rules, and the VA can request waivers too. Our guide to the interested government agency J-1 waiver covers those options.

One more point for doctors who came for graduate medical training: you cannot rely on a "no objection" statement from your home government alone. Under 22 CFR 41.63(d)(3), a foreign medical graduate in graduate medical training is barred from a waiver based solely on no objection, so these physician programs, or hardship or persecution grounds, are the realistic routes.

Before you sign: get your path confirmed

Choosing between HHS and Conrad 30 is not a formality. The wrong pick can cost you months, a state slot, or eligibility you cannot get back, and the details turn on your specialty, your training dates, each site’s designation, and your state’s calendar. A licensed Ellis Porter attorney can review your offer, check the site designations, and tell you which path fits your situation before an application is filed.

This article is general information, not legal advice, and does not create an attorney-client relationship. Program rules, HPSA scores, state cycles, and the Conrad 30 expiration date change; confirm current details with the official sources linked above and a licensed immigration attorney.

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