Best Psychiatric-Mental Health Nurse Practitioner Programs in Missouri
- 2026 Best Psychiatric-Mental Health Nurse Practitioner Programs in Missouri
- Why Pursue PMHNP Training in Missouri?
- Understanding Your Degree Options
- Campus, Hybrid & Online: Choosing Your Format
- Accreditation and Licensure in Missouri
- Missouri’s PMHNP Job Market
- Frequently Asked Questions
- Latest Articles & Guides

Missouri is in the middle of a mental health crisis that its workforce is not yet equipped to handle. The state ranks among the worst in the nation for mental health outcomes relative to available care, and nearly half of Missouri’s 114 counties qualify as Mental Health Professional Shortage Areas (MHPSAs). Psychiatric-mental health nurse practitioners (PMHNPs) are one of the most direct solutions to that gap.
For registered nurses and advanced practice clinicians considering this path, the program you choose determines your scope of practice, your licensure timeline, and your readiness for Missouri’s complex behavioral health landscape. This guide breaks it all down.
In this article, you’ll learn:
- How MSN, DNP, and post-master’s PMHNP programs differ in Missouri
- What accreditation and licensure requirements Missouri students need to meet
- How campus, hybrid, and online formats compare for working nurses
- Where PMHNP job demand is strongest across the state
- Key questions to ask before choosing a program
2026 Best Psychiatric-Mental Health Nurse Practitioner Programs in Missouri
Maryville University
Saint Louis, MO - Private 4-year - maryville.edu
BSN to MSN - Master of Science in Nursing (Psychiatric Mental Health Nurse Practitioner)
Online Learning - Visit Website
Maryville University offers an online Master of Science in Nursing with a Psychiatric Mental Health Nurse Practitioner concentration. This program prepares nurses to assess, diagnose, and treat mental health conditions across all ages. It features 100% online coursework with no campus visits required, allowing flexibility for working professionals. Students can complete the MSN in as few as 32 months, with three entry points per year. The curriculum covers advanced health assessment, psychopharmacology, and mental health diagnosis. Total tuition ranges from $18,123 to $69,223. Admission does not require GMAT, GRE, or statistics. The program is accredited by the Commission on Collegiate Nursing Education, ensuring high-quality education for aspiring PMHNPs.
- 100% online format.
- No campus visits required.
- No GMAT or GRE needed.
- Complete clinicals locally.
- No waiting list after acceptance.
- Program length 32 months.
- Three entry points yearly.
- Total tuition $18,123-$69,223.
- CCNE accredited program.
- Flexible 24/7 learning model.
Graduate Certificate - Post-Master’s NP Certificate (Psychiatric Mental Health Nurse Practitioner)
Online Learning - Visit Website
Maryville University offers an online Post-Master's NP Certificate with a Psychiatric Mental Health Nurse Practitioner concentration for MSN-prepared nurses seeking specialization. This 100% online program requires no campus visits, allowing you to complete clinicals locally. It features flexible scheduling with multiple start dates per year. Total tuition ranges from $18,123 to $69,223. Admission does not require GMAT, GRE, or statistics. The program is accredited by the Commission on Collegiate Nursing Education. It prepares you to assess, diagnose, and treat mental health disorders across the lifespan. You'll gain skills in psychopharmacology and psychotherapy. The curriculum focuses on adult, older adult, and lifespan psychiatric care. Graduates can pursue roles in hospitals, clinics, private practices, and other settings. The program emphasizes evidence-based practice and professional autonomy. It supports career advancement in a high-demand field with strong earning potential.
- Online Post-Master's NP Certificate.
- Psychiatric Mental Health Nurse Practitioner concentration.
- 100% online, no campus visits.
- Total tuition $18,123-$69,223.
- Duration 12-40 months.
- No GMAT/GRE required.
- Complete clinicals locally.
- CCNE accredited.
- Multiple start dates yearly.
- Flexible scheduling.
University of Missouri-Kansas City
Kansas City, MO - Public 4-Year - umkc.edu
Graduate Certificate - Graduate Certificate: Psychiatric Mental Health
Online & Campus Based - Visit Website
The University of Missouri-Kansas City offers a Graduate Certificate in Psychiatric Mental Health Nurse Practitioner for nurses with an MSN or DNP. This post-master's certificate prepares you to provide comprehensive psychiatric services. The hybrid program combines online coursework with required on-campus visits. It typically takes 2-3 years to complete 18 credit hours. Estimated cost is $16,609.50. Admission requires a 3.2 GPA, current RN licensure, and specific prerequisite coursework. Graduates can sit for national certification. The program is accredited by the Commission on Collegiate Nursing Education.
- Graduate Certificate program.
- Post-Master's Certificate option.
- Psychiatric Mental Health Nurse Practitioner focus.
- Hybrid delivery mode.
- Most coursework online.
- On-campus visits required.
- 18 standard credit hours.
- 2-3 year typical length.
- $16,609.50 estimated cost.
- MSN or DNP required for admission.
BSN to DNP - BSN-DNP (Psychiatric Mental Health Nurse Practitioner)
Online & Campus Based - Visit Website
The Psychiatric Mental Health Nurse Practitioner (PMHNP) program at UMKC offers comprehensive advanced nursing education designed for healthcare professionals seeking specialized mental health expertise. Students can choose from flexible BSN-DNP and MSN-DNP tracks, completing the program in 4-5 years part-time. Graduates are prepared to diagnose, conduct therapy, and prescribe medications across patient lifespans, with clinical training in diverse mental health settings. National certification eligibility through ANCC provides graduates robust professional opportunities in outpatient clinics, hospitals, and private practices.
- Hybrid/Online Flexible Learning
- 74 Credit Hour BSN-DNP Track
- 660+ Clinical Training Hours
- Synchronous/Asynchronous Courses
- ANCC Certification Preparation
- Full and Part-Time Options
- Two Clinical Track Options
- Advanced Pharmacology Focus
- National Certification Eligible
University of Missouri-St Louis
Saint Louis, MO - Public 4-Year - umsl.edu
Graduate Certificate - Psychiatric Mental Health Nurse Practitioner Post-Graduate Certificate
Online Learning - Visit Website
The University of Missouri-St. Louis offers a Psychiatric Mental Health Nurse Practitioner Post-Graduate Certificate for nurses with an MSN or DNP. This program prepares graduates for board certification exams in psychiatric mental health nursing. It requires at least one year of inpatient or outpatient psychiatric or emergency room nursing experience. Students complete a minimum of 12 credit hours, including 8 credit hours of practicum with clinical hours. The curriculum covers advanced pathophysiology, pharmacology, health assessment, diagnostic reasoning, and specialized psychiatric courses. Admission requires a 3.0 GPA, current professional licensure, and a completed Nursing CAS application. The program is tailored to individual student backgrounds and goals.
- Post-graduate certificate program.
- Tailored to individual students.
- Eligible for board certification.
- Minimum 12 credit hours.
- 8 credit hours practicum.
- Clinical practice hours required.
- MSN or DNP required.
- 3.0 minimum GPA.
- Current licensure needed.
- One year psychiatric experience.
BSN to DNP - Nursing DNP, Psychiatric Mental Health Nurse Practitioner Emphasis
Online & Campus Based - Visit Website
The University of Missouri-St. Louis offers a comprehensive Doctor of Nursing Practice (DNP) with a Psychiatric Mental Health Nurse Practitioner emphasis, designed to develop advanced clinical experts in mental health care. This rigorous program prepares nurses to provide holistic, patient-centered care across diverse populations, integrating evidence-based practices and innovative healthcare strategies. Candidates must hold a BSN from an accredited program, maintain a 3.0 GPA, and possess at least one year of psychiatric nursing experience. The curriculum combines foundational healthcare concepts, clinical expertise, and specialized psychiatric mental health training, equipping graduates to become transformative healthcare leaders addressing complex mental health challenges.
- Hybrid program format
- BSN to DNP pathway
- Minimum 3.0 GPA required
- One year psychiatric nursing experience
- 70 total program hours
- Advanced clinical practice focus
- Comprehensive healthcare policy training
- Evidence-based practice emphasis
- Clinical scholarship project required
University of Missouri
Columbia, MO - Public 4-Year - missouri.edu
BSN to MSN - MS in Nursing with Emphasis in Psychiatric Mental Health Nurse Practitioner
Online & Campus Based - Visit Website
The University of Missouri's Master of Science in Nursing with an emphasis in Psychiatric Mental Health Nurse Practitioner prepares nurses for advanced mental health care across all ages. This hybrid program combines online coursework with clinical experiences, focusing on evidence-based practice, psychopharmacology, and psychotherapy. Graduates are eligible for ANCC certification and learn to serve diverse populations, including rural communities. The curriculum covers core nursing sciences and specialized mental health topics, requiring a 3.0 GPA for graduation. Admissions follow Graduate School and program-specific requirements, with application deadlines varying by emphasis area.
- Hybrid program format.
- Prepares for ANCC certification.
- Serves all age groups.
- Focus on rural populations.
- Core master's coursework included.
- Specialty clinical courses.
- 3.0 GPA required.
- Graduate School admissions.
- Program-specific application criteria.
- State authorization restrictions apply.
Graduate Certificate - Psychiatric Mental Health Nurse Practitioner, Graduate Certificate
Campus Based - Visit Website
The University of Missouri offers a Graduate Certificate in Psychiatric Mental Health Nurse Practitioner, designed for advanced practice nurses seeking specialized training in mental health care. This campus-based program equips students with skills in psychiatric assessment, diagnosis, and treatment. It prepares graduates for certification and practice in diverse clinical settings. Admissions require a master's degree in nursing and relevant licensure. Costs vary based on residency status, with financial aid options available. The program focuses on evidence-based practices and holistic patient care, supporting career advancement in this high-demand field.
- Graduate Certificate program.
- Campus-based learning.
- Psychiatric Mental Health Nurse Practitioner focus.
- Part of University of Missouri Graduate School.
- Located in Columbia, MO.
- Requires master's degree in nursing.
- Prepares for certification.
- Focuses on mental health care.
- Advanced practice nursing training.
- Evidence-based practices included.
MSN to DNP - DNP Psychiatric & Mental Health Nurse Practitioner (Across the Lifespan)
Online & Campus Based - Visit Website
The University of Missouri's Doctor of Nursing Practice in Psychiatric & Mental Health Nurse Practitioner offers advanced training for healthcare professionals seeking to specialize in comprehensive mental health care across the lifespan. This program prepares students to deliver evidence-based mental health interventions, manage psychotropic medications, and provide holistic care to individuals from childhood through advanced age. Graduates gain expertise in independent clinical decision-making, psychotherapeutic techniques, and interdisciplinary healthcare approaches.
- Accredited by Nursing Education Commission
- Hybrid program format
- Care across entire lifespan
- ANCC certification preparation
- Evidence-based mental healthcare
- Multiple career pathways
- Independent clinical practice
Saint Louis University
Saint Louis, MO - Private 4-year - slu.edu
BSN to MSN - Nursing, M.S. (Nurse Practitioner) (Family Psychiatric/Mental Health)
Online Learning - Visit Website
Saint Louis University's online Master of Science in Nursing-Nurse Practitioner (MSN-NP) program offers a specialized Family Psychiatric/Mental Health concentration for registered nurses seeking advanced practice roles. Designed for working professionals, the program provides flexible full- and part-time curriculum options. Students learn to provide evidence-based, culturally sensitive mental health care for children, adolescents, and adults. With a competitive per-credit tuition of $1,370, the program prepares graduates for national certification, offering opportunities to work across diverse mental health settings. Admission requires a 3.0 GPA, unencumbered RN license, and a baccalaureate nursing degree from an accredited program.
- Online flexible learning format
- National certification preparation
- Specialized mental health focus
- $1,370 per credit tuition
- Full and part-time options
- CCNE accredited program
- Individually assigned faculty advisor
- Advanced clinical practicum
- Multiple concentration choices
Graduate Certificate - Family Psychiatric Mental Health Nurse Practitioner, Post-Master's Certificate
Online & Campus Based - Visit Website
Saint Louis University's Trudy Busch Valentine School of Nursing offers a Post-Master's Certificate in Psychiatric Mental Health Nurse Practitioner. This program prepares advanced practice nurses to provide holistic, evidence-based mental health care across the lifespan. The hybrid format combines online coursework with minimal on-campus requirements. Students engage in clinical rotations with faculty support. Admission requires a master's in nursing, a 3.0 GPA, and relevant coursework. Tuition is $1,400 per credit. Graduates qualify for national certification exams, with strong career prospects in a growing field.
- Post-Master's Certificate program.
- Hybrid online and on-campus format.
- One on-campus visit required.
- Minimum 15 credits for completion.
- Tuition $1,400 per credit.
- Accredited by CCNE.
- Requires master's in nursing.
- 3.0 GPA admission requirement.
- Clinical hours included.
- Prepares for national certification.
MSN to DNP - Nursing Practice, D.N.P. (Family Psychiatric Mental Health Nurse Practitioner)
Online & Campus Based - Visit Website
Saint Louis University's Doctor of Nursing Practice (D.N.P.) in Family Psychiatric Mental Health Nurse Practitioner offers an advanced pathway for nurses seeking specialized mental health expertise. This comprehensive program prepares professionals to provide holistic, evidence-based care for individuals across the lifespan, addressing complex psychiatric needs. Students develop advanced clinical skills in assessment, diagnosis, and treatment, with a focus on culturally sensitive, recovery-oriented approaches. The rigorous curriculum spans 62-67 credits, includes extensive clinical hours, and provides opportunities for national certification. With a competitive per-credit tuition of $1,370 and a projected 38% job growth, graduates are positioned for impactful careers in mental health care settings.
- Hybrid program format
- 62-67 total credit hours
- National certification eligible
- Comprehensive clinical training
- Advanced mental health focus
- 6-year maximum completion time
- 1050-1125 clinical hours
- Multiple specialty concentrations
- Research translation opportunities
- $1,370 per credit tuition
Missouri State University
Springfield, MO - Public 4-Year - missouristate.edu
MSN to DNP - BSN to DNP: Psychiatric-Mental Health Nurse Practitioner Option
Online & Campus Based - Visit Website
Missouri State University's BSN to DNP Psychiatric-Mental Health Nurse Practitioner Option empowers nurses to become advanced mental health leaders. This innovative hybrid program prepares professionals to address critical mental health needs through comprehensive training. Students develop expertise in developing treatment plans, conducting research, and influencing policy. Graduates can pursue diverse roles in clinical, administrative, educational, and research settings, meeting the growing demand for specialized mental health professionals.
- Hybrid learning format
- CCNE Accredited Program
- Leadership development focus
- Mental health career advancement
- Innovative treatment approach training
BSN to DNP - BSN to DNP: Psychiatric-Mental Health Nurse Practitioner
Online & Campus Based - Visit Website
The BSN to DNP: Psychiatric-Mental Health Nurse Practitioner program at Missouri State University prepares students for advanced roles in mental health care. This hybrid program combines online and seated courses, offering flexibility. Students learn to develop treatment plans and advocate for mental health. The program is accredited by the Commission on Collegiate Nursing Education. Graduates can pursue careers in clinical, administrative, or research roles. Admission requires a BSN and meeting specific academic standards. Financial aid and scholarships are available to eligible students.
- Hybrid learning format
- Accredited by CCNE
- Focus on mental health
- Flexible course options
- Career advancement opportunities
- Financial aid available
- BSN required for admission
- Combines online and seated courses
- Prepares for leadership roles
- Advocacy and policy influence
Rockhurst University
Kansas City, MO - Private 4-year - rockhurst.edu
Graduate Certificate - Online Post-Master's PMHNP Certificate
Online Learning - Visit Website
Rockhurst University offers an online Post-Master's PMHNP Certificate for nurses seeking specialization in psychiatric mental health. This CCNE-accredited program requires 22 credit hours minimum and can be completed in four semesters. Students complete 750 clinical hours with free placement services included. The program prepares graduates for ANCC PMHNP-BC certification with a 92% first-time pass rate. Competitive tuition is $780 per credit hour plus $1,750 per practicum course. Admission requires an MSN or higher degree with nurse practitioner focus, active RN license, 3.0 GPA, and residence in approved states including Missouri.
- Online coursework delivery
- Four semester completion time
- 22 credit hours minimum
- 750 clinical hours required
- Free clinical placement services
- ANCC PMHNP-BC exam preparation
- CCNE-accredited program
- $780 per credit hour tuition
- $1,750 per practicum course
- MSN or higher degree required
Missouri Baptist University
Saint Louis, MO - Private 4-year - mobap.edu
Graduate Certificate - Post-MSN Certificate in Psychiatric Mental Health Nurse Practitioner
Online Learning - Visit Website
Missouri Baptist University offers a Post-MSN Certificate in Psychiatric Mental Health Nurse Practitioner. This program prepares nurses for advanced practice in mental health care. It is delivered online, providing flexibility for working professionals. The curriculum includes courses like psychopathology, psychopharmacology, and psychotherapy. Students complete clinical practicums to gain hands-on experience. The program focuses on diagnosing and treating mental health disorders across the lifespan. It requires 24 to 34 credit hours, depending on prior coursework. Admissions typically need a master's degree in nursing and a valid RN license. Costs vary, and financial aid options are available. This certificate helps nurses advance their careers in psychiatric care.
- Post-MSN Certificate program.
- Online delivery format.
- 24 to 34 credit hours.
- Includes clinical practicums.
- Courses in psychopathology and psychopharmacology.
- Focus on lifespan mental health care.
- Requires master's degree in nursing.
- Valid RN license needed.
- Flexible for working professionals.
- Part of School of Nursing.
Why Pursue PMHNP Training in Missouri?
The numbers tell a stark story. Missouri has fewer than 400 practicing psychiatrists statewide, and rural regions, such as the Ozarks, the Bootheel, and northwest Missouri, often go months between psychiatric appointments. PMHNPs fill that gap directly, functioning as independent prescribers and diagnosticians under Missouri’s full practice authority law, which took effect in 2023 and allows APRNs to practice without a physician collaborative agreement after an initial transition period.
That legislative shift changed the calculus for PMHNP graduates in Missouri significantly. You can now open an independent practice, take on rural telehealth panels, or step into leadership roles at federally qualified health centers without the administrative friction that collaboration agreements once required.
Why It Matters: The U.S. Bureau of Labor Statistics projects 40% job growth for nurse practitioners through 2033, and psychiatric specialties are among the highest-demand NP concentrations in the country.
Check out nurse practitioner schools in Missouri.
Understanding Your Degree Options
MSN-PMHNP
The Master of Science in Nursing (MSN) with a PMHNP concentration is the traditional entry point to advanced psychiatric nursing practice. Programs typically run 3–4 semesters of full-time study (or longer part-time) and include both didactic coursework and supervised clinical hours across the lifespan — child/adolescent, adult, and geriatric populations.
MSN programs are best for:
- BSN-prepared RNs entering advanced practice for the first time
- Students who want the fastest path to licensure and clinical practice
- Nurses who plan to work in direct care rather than academic or leadership roles
DNP-PMHNP
The Doctor of Nursing Practice (DNP) is the terminal clinical degree in nursing and is increasingly positioned as the future standard for entry-level NP practice. Some programs offer BSN to DNP tracks; others are designed for MSN holders seeking doctoral preparation.
DNP programs are best for:
- Nurses pursuing leadership, health system administration, or faculty roles
- Clinicians who want the competitive edge a doctoral credential provides
- MSN-prepared PMHNPs seeking degree completion without a second full master’s
Post-Master’s PMHNP Certificate
For APRNs who already hold a master’s or doctoral degree in another nursing specialty (family NP, adult-gerontology, psychiatric, or other concentrations), a PHMNP post-master’s certificate offers the most efficient route to certification without repeating graduate-level coursework already completed.
TIP: Missouri’s Board of Nursing requires PMHNP candidates to pass the ANCC Psychiatric-Mental Health Nurse Practitioner board certification exam. Confirm that any program you consider, including post-master’s certificates, fully prepares you for and makes you eligible to sit for this exam.
PMHNP Degree Comparison At a Glance
| Degree | Typical Length | Best Starting Point | Clinical Hours Required |
| MSN-PMHNP | 2–3 years | BSN-prepared RN | 500+ supervised hours |
| BSN to DNP | 3–4 years | BSN-prepared RN | 1,000+ supervised hours |
| MSN to DNP | 2–3 years | MSN-prepared APRN | Varies by program |
| Post-Master’s Certificate | 1–2 years | MSN or DNP holder | 500+ supervised hours |
Campus, Hybrid & Online: Choosing Your Format
Campus Programs
On-campus PMHNP programs are concentrated in Missouri’s urban centers. University of Missouri–Columbia (Mizzou) and Saint Louis University anchor the state’s campus-based nursing graduate offerings, with access to major health systems like MU Health Care, SSM Health, and BJC HealthCare for clinical rotations. Campus formats offer structured simulation labs, in-person faculty mentorship, and cohort-based peer learning, which are particularly valuable for nurses new to psychiatric assessment and psychopharmacology.
Hybrid Programs
Hybrid formats blend online didactics with periodic on-campus intensives (typically one to two weekends per semester) for skills assessment and simulation. This structure suits Missouri nurses who live within driving distance of a program hub but can’t commit to a traditional class schedule. Programs based in Kansas City or Springfield often build hybrid cohorts specifically to serve working nurses in the I-44 and I-70 corridors.
Online Programs
Fully online PMHNP programs have become the dominant format nationally, and Missouri students have strong options, both from in-state institutions and regionally accredited out-of-state programs that allow Missouri clinical placements. Online programs are especially critical for nurses in rural Missouri, where driving to Columbia or St. Louis for class is not realistic.
TIP: Missouri does not restrict where you complete your clinical hours. Online students are typically responsible for identifying their own preceptors, though many programs offer placement assistance. Reach out early to community mental health centers (CMHCs), VA facilities, and federally qualified health centers in your region; all are common PMHNP preceptor sites in Missouri.
Strong clinical placement regions for Missouri online students:
- St. Louis metro — BJC Behavioral Health, Compass Health Network, SSM Health
- Kansas City metro — Truman Medical Centers, ReDiscover, Burrell Behavioral Health
- Springfield/Branson area — Burrell Behavioral Health’s largest regional hub
- Columbia/mid-Missouri — MU Health Care, Welcome Home
- Rural/telehealth — Missouri Telehealth Network connects students to remote preceptors
Accreditation and Licensure in Missouri
All PMHNP programs in Missouri (and out-of-state online programs that Missouri students attend) should carry accreditation from either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). These credentials are required for Missouri Board of Nursing approval and for ANCC certification eligibility.
Missouri PMHNP licensure checklist:
- Graduate from a CCNE- or ACEN-accredited PMHNP program
- Complete required supervised clinical hours across the lifespan
- Pass the ANCC PMHNP-BC certification exam
- Apply for APRN licensure through the Missouri State Board of Nursing
- Complete the transition to practice period before exercising full independent practice authority
Missouri’s PMHNP Job Market
Missouri’s behavioral health workforce shortage is most acute outside St. Louis and Kansas City, creating concentrated opportunity in underserved regions.
| Region | Demand Level | Notable Employers |
| St. Louis metro | High | BJC HealthCare, Mercy, SSM Health |
| Kansas City metro | High | Truman Medical, AdventHealth, ReDiscover |
| Springfield | Very high | Burrell Behavioral Health, Cox Health |
| Columbia/mid-MO | High | MU Health Care, Boone Hospital |
| Rural/Ozarks | Critical | Community mental health, telehealth panels |
| Bootheel | Critical | FQHCs, state-operated programs |
Graduates willing to commit to underserved areas may qualify for the National Health Service Corps (NHSC) loan repayment program, which can cover substantial student debt for full-time PMHNP service in a designated shortage area; a significant financial consideration when comparing MSN and DNP program costs.
Frequently Asked Questions
Q: Does Missouri require a specific number of clinical hours for PMHNP programs?
A: The ANCC certification exam requires completion of a graduate-level PMHNP program with supervised clinical hours across the lifespan. CCNE and ACEN accreditation standards set minimum hour thresholds, and programs typically exceed 500 hours. DNP programs often require 1,000 or more. Missouri’s Board of Nursing defers to accreditation standards rather than setting its own hour minimum.
Q: Can I complete my PMHNP clinical hours via telehealth in Missouri?
A: Yes, in part. Missouri allows telehealth-based psychiatric care, and some programs permit a portion of supervised hours to be completed via telehealth preceptorship. However, most accrediting bodies and programs require at least some in-person patient contact, particularly for physical and psychiatric assessment competencies. Confirm your program’s specific policy before enrolling.
Q: What’s the salary range for PMHNPs in Missouri?
A: Missouri PMHNP salaries vary by setting and region. Positions in hospital systems and private practice in St. Louis or Kansas City typically fall toward the upper end of the state range, while rural and nonprofit roles may offer lower base salaries but often offset this with loan repayment benefits, sign-on bonuses, or reduced caseloads.
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