Bills

AB 2132: California Medical School Tuition for Medical Service Pilot Program.

Session Year: 2021-2022
House: Assembly
Latest Version Date: 2022-03-10

Version:

Existing law establishes the Student Aid Commission as the primary state agency for the administration of state-authorized student financial aid programs available to students attending all segments of postsecondary education. Existing law expresses the intent of the Legislature to review, during the annual budget process, the distribution of University of California medical school graduates with regard to placement in areas, and service to populations, underserved by the medical profession, as specified.

This bill would establish the California Medical School Tuition for Medical Service Pilot Program under the administration of the Student Aid Commission. The bill would provide financial aid to certain students to support their undergraduate, medical school, and graduate medical educations. The bill would require these students to commit to practicing for a specified period of time in primary care or a high-needs specialty in California in medically underserved populations and areas. The bill would require the commission to begin implementing the pilot program during the 202324 academic year, including by developing program eligibility, outreach, and monitoring criteria. The bill would, among other things, require the commission to develop eligibility criteria, including by prioritizing students who are underrepresented in medicine based on race, ethnicity, and language.

The bill would establish the Medical School Tuition for Medical Service Pilot Program Scholarship Fund in the State Treasury. The bill would authorize the commission to enter into certain contracts related to the pilot program with nonprofit entities headquartered in California, as specified. The bill would, regarding certain aspects of the pilot program, prohibit an exercise of discretion by the commission and its contractors from being subject to judicial review, except as specified. The bill would make its provisions operative only upon the appropriation of funds for purposes of the pilot program by the Legislature in the annual Budget Act or in another statute.

Existing law, the Song-Brown Health Care Workforce Training Act, establishes a state medical contract program with accredited medical schools, hospitals, and other programs and institutions to increase the number of students and residents receiving quality education and training in specified primary care specialties and maximize the delivery of primary care and family physician services to underserved areas of the state. Existing law requires the Director of the Department of Health Care Access and Information to take specified actions regarding this program, including, among others, developing application and contract criteria based on health care workforce needs and the priorities of the California Health Workforce Education and Training Council.This bill would state the intent of the Legislature to enact legislation to address the physician workforce shortage.

Version:

The people of the State of California do enact as follows:SECTION 1.

(a)The Legislature finds and declares all of the following:

(1)California is facing a growing shortage of primary care physicians and physicians providing specialty care.

(2)Attracting and keeping quality physicians in California is a constant challenge that has reached crisis proportions in some areas, and is a particularly acute challenge in rural areas.

(3)According to a 2017 report from the University of California, San Francisco, Healthforce Center, California is predicted to see a shortage of over 4,000 primary care clinicians by 2030. In regions such as the central valley, Inland Empire, and Imperial Valley, communities are already experiencing the pains of a clinician shortage.

(4)Without making dramatic, paradigm-shifting, and long-term investments in the health care workforce, California will not be able to reduce and eliminate the physician shortage, thereby reducing access to care in medically underserved communities.

(5)In the United States, household income and education levels are tightly linked. Higher household incomes correlate with higher levels of education.

(6)An Association of American Medical Colleges study found that between 1988 and 2017, more than three-quarters of American medical school students came from affluent households.

(7)Those interested in pursuing medicine must complete a minimum of 12 years of higher education, during which they are unlikely to secure even part-time employment to ensure that they are meeting academic requirements.

(8)On average, physicians graduate with educational debt totaling over $280,000. The average physician ultimately pays $365,000 to $440,000 for educational loans, including interest.

(9)Financing a medical education is consistently noted as the biggest barrier to pursuing medical education, particularly for communities underrepresented in medicine.

(10)California has various programs that provide loan forgiveness for medical school graduates who meet certain requirements. Many applicants are socioeconomically and demographically more diverse than the general California physician population. Medical students and residents underrepresented in medicine are more likely to practice with minority, poor, and uninsured patients, often leading to lower salary employment.

(11)Financing medical school is extremely challenging and includes a combination of school-specific scholarships, student loans, personal savings, and assistance from family.

(12)Undocumented students are often ineligible for private, commercial loans due to their legal status.

(13)Many students underrepresented in medicine may not be willing to take on this enormous financial burden at the onset. The average debt of a medical school graduate, $280,000, is a strong disincentive to accept relatively lower paying practice opportunities in medically underserved areas.

(14)California will continue to have a severe shortage in primary care and specialty physicians. An estimated 11,226,111 people in California live in an area with a physician shortage.

(15)There are no statewide public or private programs that provide end-to-end financial support for diverse students from diverse and underrepresented communities during their medical educations.

(b)Therefore, it is the intent of the Legislature to accomplish both of the following:

(1)To create a pilot program to identify and select individuals from diverse, underrepresented communities to fund their educational expenses from community college or undergraduate education through medical school and a postgraduate training program.

(2)To require these individuals to commit to practicing in medically underserved areas in California for a certain number of years after completion of their postgraduate training programs.

SEC. 2.Article 23.5 (commencing with Section 70040) is added to Chapter 2 of Part 42 of Division 5 of Title 3 of the Education Code, to read:23.5.California Medical School Tuition for Medical Service Pilot Program70040.

This article shall be known, and may be cited, as the California Medical School Tuition for Medical Service Pilot Program.

70041.

(a)The California Medical School Tuition for Medical Service Pilot Program, which may be also referred to as the MST for MSP Program, is hereby established under the administration of the Student Aid Commission.

(b)Notwithstanding any other law, the commission shall develop and administer the MST for MSP Program to provide financial aid to qualifying California undergraduate students committed to practicing in primary care or a high-needs specialty, or both, in medically underserved populations and areas. Financial aid shall be provided to qualifying students to support their undergraduate, medical school, and graduate medical educations. To be eligible for financial aid under the pilot program, a student shall commit to practicing in primary care or a high-needs specialty, or both, in California in medically underserved populations and areas for a specified period of time.

(c)In implementing the pilot program, the commission shall consult with other state entities and affected stakeholders, including by establishing an advisory council to develop recommendations regarding, among other recommendations, eligibility and program criteria, service obligation criteria, and monitoring awardees for compliance.

(d)The commission shall begin implementing the pilot program during the 202324 academic year. Implementation shall include developing pilot program eligibility, outreach, and monitoring criteria.

(e)Moneys appropriated to the commission to implement the pilot program shall be available to fund the administrative costs incurred by the commission and any contracted entity pursuant to subdivision (i). No more than 10 percent of the total funds appropriated for purposes of the pilot program shall be used to support program operations.

(f)The commission shall develop the eligibility criteria to be used to evaluate participation in the pilot program. In developing the eligibility criteria, the commission shall prioritize all of the following:

(1)Students who are underrepresented in medicine based on, and including, but not limited to, race, ethnicity, and language.

(2)Students who demonstrate financial need.

(3)Reducing health access disparities in medically underserved populations and areas.

(g)The commission shall develop criteria for the pilot program that does all of the following:

(1)Ensures that awardees receive financial aid during their undergraduate, medical school, and graduate medical education training.

(2)Requires awardees to commit to practicing medicine in California with medically underserved populations and areas for a specified period of time.

(3)Distributes financial aid payments to awardees.

(4)Establishes the service obligation for working in California in a medically underserved population or area, or both, to qualify for financial aid payments pursuant to the pilot program.

(5)Monitors the compliance of awardees with the requirements of the pilot program, including instances where awardees may not be in compliance with the pilot programs requirements.

(h)The selection of students to participate in the pilot program and the amount of financial aid assistance awarded to a participating student shall be at the discretion of the commission and any contracted entity pursuant to subdivision (i), and shall be based on criteria developed pursuant to this section. An exercise of discretion by the commission and a contracted entity pursuant to this subdivision shall not be subject to judicial review, except that an applicant who is not selected for participation in the program may file for a writ of mandate pursuant to Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the commission and a contracted entity.

(i)For purposes of the pilot program, the commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, with nonprofit entities headquartered in California that have previous experience contracting with state agencies to administer statewide workforce programs aimed at building a diverse health care provider workforce. Contracts entered into or amended pursuant to this subdivision shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the review or approval of a division of the Department of General Services.

(j)The commission shall publish an annual report that includes, but is not limited to, pilot program eligibility and awarding criteria, the student selection process, the monitoring process, the number of applicants and awardees, and the amount of funds requested and awarded.

(k)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the commission may implement, interpret, or make specific this section, in whole or in part, by means of policy letters, provider bulletins, or other similar instructions, without taking regulatory action. The commission shall consult with affected stakeholders before taking action pursuant to this subdivision.

70042.

The Medical School Tuition for Medical Service Pilot Program Scholarship Fund is hereby established in the State Treasury. Moneys in the fund, upon appropriation by the Legislature, shall be allocated by the commission in accordance with this article to make higher education and medical school more affordable and attainable for individuals who are underrepresented in medicine.

70043.

This article shall become operative only upon an appropriation of funds for purposes of the article by the Legislature in the annual Budget Act or in another statute.

SECTION 1.It is the intent of the Legislature to enact legislation to address the physician workforce shortage.

Date	Status
Mar 14, 2022	Re-referred to Com. on HIGHER ED.
Mar 10, 2022	Referred to Coms. on HIGHER ED. and HEALTH.
Feb 16, 2022	From printer. May be heard in committee March 18.
Feb 15, 2022	Introduced. To print.

Authors shown for version:
Amended Assembly (3/10/2022)