Mid-Session Update – Highlights:
- State budget includes major new funding for health workforce: Fueled by a multi-billion surplus and federal COVID-19 recovery funds, the Governor and Legislature approved a 2021-22 state budget that provides unprecedented support for expanding the health workforce—putting essential health care workers at the center of the state’s efforts to reduce health disparities exposed by the pandemic. All told, the budget includes more than $1.3 billion for expanding behavioral health and public health programs, providing new state support for community health workers, and expanding a range of new and existing programs aimed at growing and diversifying the health workforce.
- Legislature continues to expand health workforce in underserved communities: Health workforce will also remain a priority for the remainder of the legislative session, as more than a dozen bills continue to advance seeking to close shortages of health professionals, increase diversity among health workers, and expand successful state programs like the Health Professions Career Opportunity Grant Program (HCOP) and Song-Brown Health Care Workforce Training Program.
State budget includes major new funding for health workforce
After more than a year of fighting the pandemic, Governor Newsom and the Legislature finalized a budget in July that makes unprecedented investments in expanding and strengthening the state’s health workforce—and adopts many of the strategies championed in 2019 by the Future Health Workforce Commission.
The budget includes an $834 million expansion of behavioral health programs with funding for workforce training, $300 million to reduce health disparities and support a public health workforce, and $16 million to include community health workers (CHWs) as Medi-Cal providers, along with $150 million for a range of new and existing programs aimed at growing the health workforce providing care for underserved populations. The state will also reorganize one of its main departments to have a greater focus on health workforce—renaming and refocusing the Office of Statewide Health Planning and Development (OSHPD) into the Department of Health Care Access and Information.
Additional details below on key workforce investments in this year’s budget.
The budget includes $834 million for what the Governor has called “a comprehensive transformation of the behavioral health system for all Californians age 25 and younger”—providing health agencies with substantial new resources to close glaring gaps in access to care revealed by the pandemic among communities of color, lower-income groups, LGBTQ+ communities, and Californians living in rural areas. The funds will be used to train new behavioral health workers, create a statewide portal that can connect young people with telehealth visits, and expand prevention programs and acute care services.
After decades of underinvestment in the state’s public health system, the budget also includes $300 million each year, beginning in 2022-23, to rebuild public health infrastructure and advance health equity in every community.
Community health workers
California has also joined a growing number of states to recognize contributions being made by community health workers to improve health outcomes in the state’s most vulnerable communities. For the first time, this year’s budget adds CHWs to the list of health workers who are able to provide benefits and services to Medi-Cal beneficiaries.
The budget adopts a proposal by the Governor to reorganize the Office of Statewide Health Planning and Development—one of the Future Health Workforce Commission’s top recommendations in 2019. The final budget will rename the agency the “Department of Health Care Access and Information” (HCAI) as part of an effort to improve coordination and data collection around health workforce programs as well as with new programs like the Health Care Payments Data Program and the proposed Office of Health Care Affordability. The HCAI’s focus, according to the Governor’s Office, will be “centered on safe health care facilities, increasing the health workforce, improving the affordability and quality of health care, and financing health facilities.” As part of this reorganization, OSPHD’s Healthcare Workforce Clearinghouse will be eliminated and replaced with a new California Health Workforce Research and Data Center, charged with establishing uniform requirements for the reporting and collection of workforce data.
Ongoing investments – Successful health workforce programs
In addition to new investments outlined above, this year’s budget also continues to support a range of successful health workforce programs identified in the Commission’s 2019 final report, including:
- Graduate Medical Education: The budget will maintain $40 million in ongoing funding for GME program expansion, supporting residencies and fellowships for physicians working in shortage specialties and regions. The Charles Drew University of Medicine and Science will also receive $50 million for capital costs for facilities supporting its graduate medical education program.
- Physician/Dentist Loan Repayment: While the state has long relied on Prop 56 funds to support its successful $340 million physician and dentist loan repayment program, this year a portion of the state General Fund was used for the first time to bolster the program. With tobacco tax revenues declining, the investment is a positive sign that the state remains committed to a program that has provided debt relief to physicians providing care to underserved patients in 38 counties.
- Medical Residency Programs: The final budget also includes $50 million over six years for additional awards to support and sustain new primary care residency programs through the Song-Brown Health Care Workforce Training Program. An additional $10 million is specifically to support Board of Registered Nursing-approved pre-licensure programs, with a priority for public programs.
- Workforce Pipeline: The budget makes a number of targeted investments in successful workforce pipeline initiatives: It includes $12.9 million in new funding for the UC PRIME program—one of the state’s most successful programs for increasing diversity among physicians; $10.5 million to pilot a new California Medicine Scholars Program aimed at preparing students for careers as primary care physicians in underserved communities; $16 million for HCOP; and $8 million over six years to expand the geriatric workforce.
- Community Paramedicine: The budget also includes $2.3 million to implement last year’s AB 1544 (Gipson), which allowed California’s successful community paramedicine pilot programs to be expanded into communities statewide.
Legislature continues to expand health workforce in underserved communities
In addition to this year’s budget investments in the health workforce, the Legislature also continues to advance bills that aim to close provider gaps. Several notable health workforce bills include:
- AB 240 (Rodriguez): Would require the State Department of Public Health to conduct an evaluation of the adequacy of local health department infrastructure and make recommendations for future staffing and workforce needs.
- AB 1015 (Rubio): Would require the Board of Registered Nursing to incorporate regional forecasts in its biennial analyses of the nursing workforce and to develop a plan for addressing regional shortages.
- AB 1130 (Wood): Would establish a new Office of Health Care Affordability within OSHPD (HCAI) and authorize the office to set priority standards for various health care metrics, including health care quality, costs, and equity, and health care workforce stability.
- AB 1204 (Wicks): Would require hospitals to submit an annual equity report to OSHPD (HCAI) that includes an analysis of access to care and employment disparities based on race, ethnicity, and gender and plans for addressing those them.
- AB 1306 (Arambula): Would allow OSHPD (HCAI) to fund 20 pilot programs on UC, CSU, and community college campuses to fund internships and fellowships to enable more underrepresented people of color and students with low incomes to compete for admission to graduate health professions schools or employment in health workforce fields.
- SB 40 (Hurtado): Would create the California Medicine Scholars Program, a 5-year pilot program that would establish a regional pipeline for community college students to pursue premedical training and enter medical school.
- SB 395 (Caballero): Would extend Proposition 56 tobacco taxes to e-cigarettes and direct a percentage of revenues to the Health Careers Opportunity Grant Program Fund for the purpose of improving access to the state’s health profession programs by underrepresented students from disadvantaged backgrounds.
- SB 441 (Hurtado): Would require OSHPD (HCAI) to include students and professionals with training in geriatrics when administering health workforce professions programs, such as the Health Professions Career Opportunity Program and the Steven M. Thompson Physician Corps Loan Repayment Program.