SB 520: Nurse-midwifery education program.
- Session Year: 2025-2026
- House: Senate
- Latest Version Date: 2025-10-11
Current Status:
Passed
(2025-10-11: Chaptered by Secretary of State. Chapter 601, Statutes of 2025.)
Introduced
In Committee
Awaiting First Chamber Vote
Passed First Chamber
In Committee
Awaiting Second Chamber Vote
Passed Second Chamber
Enacted
Existing law creates the Vocational Nurse Education Program within the Department of Health Care Access and Information for persons agreeing to serve in an eligible county health facility, state-operated health facility, or a health workforce shortage area, before completing vocational nursing school. Existing law authorizes a person who qualifies for admission to a vocational nursing program to apply for funding under the program, as specified. Existing law establishes the Vocational Nurse Education Fund for the purpose of promoting the education of vocational nurses and related administrative costs.
This bill would create the California Nurse-Midwifery Education Fund within the department for the purpose of establishing California-based, masters level, nurse-midwifery education programs within the California State University, the University of California, or both. The bill would require the department to administer the fund, and receive moneys from the General Fund for these purposes upon appropriation by the Legislature. The bill would require the department to establish a competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, would require the department to ensure that a masters degree is an option for students as the culminating degree of the education programs receiving funds, and would require the education programs to meet specified requirements. The bill would also require the fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or 5 years, whichever is shorter.
Existing law creates the Vocational Nurse Education Program within the Department of Health Care Access and Information for persons agreeing to serve in an eligible county health facility, state-operated health facility, or a health workforce shortage area, before completing vocational nursing school. Existing law authorizes a person who qualifies for admission to a vocational nursing program to apply for funding under the program, as specified. Existing law establishes the Vocational Nurse Education Fund for the purpose of promoting the education of vocational nurses and related administrative costs.
This bill would create the California Nurse-Midwifery Education Fund within the department for the purpose of establishing California-based, masters level, nurse-midwifery education programs within the California State University, the University of California, or both. The bill would require the department to administer the fund, and receive moneys from the General Fund for these purposes upon appropriation by the Legislature. The bill would require the department to establish a competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, would require the department to ensure that a masters degree is an option for students as the culminating degree of the education programs receiving funds, and would require the education programs to meet specified requirements. The bill would also require the fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or 5 years, whichever is shorter.
Existing law creates the Vocational Nurse Education Program within the Department of Health Care Access and Information for persons agreeing to serve in an eligible county health facility, state-operated health facility, or a health workforce shortage area, before completing vocational nursing school. Existing law authorizes a person who qualifies for admission to a vocational nursing program to apply for funding under the program, as specified. Existing law establishes the Vocational Nurse Education Fund for the purpose of promoting the education of vocational nurses and related administrative costs.
This bill would create the California Nurse-Midwifery Education Fund within the department for the purpose of establishing California-based, masters level, nurse-midwifery education programs within the California State University, the University of California, or both. The bill would require the department to administer the fund, and receive moneys from the General Fund for these purposes upon appropriation by the Legislature. The bill would require the department to establish a competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, would require the department to ensure that a masters degree is an option for students as the culminating degree of the education programs receiving funds, and would require the education programs to meet specified requirements. The bill would also require the fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or 5 years, whichever is shorter.
Existing law establishes the California Community Colleges, under the administration of the Board of Governors of the California Community Colleges, the California State University, under the administration of the Trustees of the California State University, the University of California, under the administration of the Regents of the University of California, independent institutions of higher education, as defined, and private postsecondary educational institutions, as defined, as the segments of postsecondary education in the state.This bill would state the intent of the Legislature to enact subsequent legislation that would establish a new high-quality Masters in Science Degree program for midwifery that will address the growing need for skilled maternity health care professionals in California, as provided.Existing law establishes the California Community Colleges, under the administration of the Board of Governors of the California Community Colleges, the California State University, under the administration of the Trustees of the California State University, the University of California, under the administration of the Regents of the University of California, independent institutions of higher education, as defined, and private postsecondary educational institutions, as defined, as the segments of postsecondary education in the state.
This bill would state the intent of the Legislature to enact subsequent legislation that would establish a new high-quality Masters in Science Degree program for midwifery that will address the growing need for skilled maternity health care professionals in California, as provided.
The Legislature finds and declares all of the following:
(a)California is experiencing a maternity care access crisis. Over 50 maternity wards in California have closed since 2013, and 20 freestanding birth centers have closed in just over three years. These closures create significant barriers to reproductive health care, and potential risk to birthing people. The closures compound an already significant problem, the obstetrical and reproductive health care workforce shortage in California.
(b)Midwifery care has demonstrated excellent outcomes to improve maternal health.
(c)When midwives are integrated into health systems, we find more spontaneous vaginal birth, labor after cesarean, vaginal birth after cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower cost, and we also see fewer undesirable outcomes, including cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit admissions, preterm birth and low birth weight infants, infant emergency department visits, and hospitalizations and neonatal deaths.
(d)Midwives are also recognized as a component of the solution to address race-based disparities, especially when provided by culturally, linguistically, and racially competent providers.
(e)The supply of California midwives falls short of other high-income countries where birth outcomes are better. Countries with better birth outcomes rely on midwives to provide the safest, highest quality care to healthy people, freeing up physicians to give the highest quality specialty care to high-risk patients. For example, the California maternal mortality rate is 10.5 per 100,000 births and the ratio of midwives to obstetrics physicians is 1 to 3.3. In the Netherlands, the maternal mortality rate is 2.8 per 100,000 births and the ratio of midwife to physician is 2.5 to 1. In Australia, the maternal mortality rate is 3.5 per 100,000 births and the ratio of midwife to physician is 8.8 to 1.
(f)The Legislature understands and declares that with a robust education pipeline, midwives can provide high-quality outcomes to Californians and fill an urgent need. California currently has only one nurse-midwifery program accepting new students at California State University, Fullerton.
SEC. 2.Article 7 (commencing with Section 128570) is added to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, to read:7.Nurse-Midwifery Education Program128570.(a)The California Nurse-Midwifery Education Fund is hereby created within the Department of Health Care Access and Information for the purpose of establishing California-based, masters level, nurse-midwifery education programs within the California State University, the University of California, or both.
(b)The department shall administer the fund. The fund shall receive moneys from the General Fund for the purposes of this article upon appropriation by the Legislature.
(c)It is the intent of the Legislature for the 202526 state fiscal year, for two million dollars ($2,000,000) to be appropriated from the General Fund to the department for use in the California Nurse-Midwifery Education Fund.
(d)The fund may receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the General Fund.
128571.(a)The department shall establish competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
(b)The department shall ensure that a masters degree is an option for students as the culminating degree of the education programs receiving funds.
(c)The education programs shall meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or preaccredited by the Accreditation Commission for Midwifery Education. The programs are not required to be located within a school of nursing.
(d)The fund shall support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
128572.Any funds, public or private, received for the fund shall supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act pursuant to Article 1 (commencing with Section 128200) of Chapter 4. Any funds allocated to the education programs receiving funds shall supplement, not supplant, the universitys budget allocations for any fiscal year.
The Legislature finds and declares all of the following:
(a)California is experiencing a maternity care access crisis. Over 50 maternity wards in California have closed since 2013, and 20 freestanding birth centers have closed in just over three years. These closures create significant barriers to reproductive health care, and potential risk to birthing people. The closures compound an already significant problem, the obstetrical and reproductive health care workforce shortage in California.
(b)Midwifery care has demonstrated excellent outcomes to improve maternal health.
(c)When midwives are integrated into health systems, we find more spontaneous vaginal birth, labor after cesarean, vaginal birth after cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower cost, and we also see fewer undesirable outcomes, including cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit admissions, preterm birth and low birth weight infants, infant emergency department visits, and hospitalizations and neonatal deaths.
(d)Midwives are also recognized as a component of the solution to address race-based disparities, especially when provided by culturally, linguistically, and racially competent providers.
(e)The supply of California midwives falls short of other high-income countries where birth outcomes are better. Countries with better birth outcomes rely on midwives to provide the safest, highest quality care to healthy people, freeing up physicians to give the highest quality specialty care to high-risk patients. For example, the California maternal mortality rate is 10.5 per 100,000 births and the ratio of midwives to obstetrics physicians is 1 to 3.3. In the Netherlands, the maternal mortality rate is 2.8 per 100,000 births and the ratio of midwife to physician is 2.5 to 1. In Australia, the maternal mortality rate is 3.5 per 100,000 births and the ratio of midwife to physician is 8.8 to 1.
(f)The Legislature understands and declares that with a robust education pipeline, midwives can provide high-quality outcomes to Californians and fill an urgent need. California currently has only one nurse-midwifery program accepting new students at California State University, Fullerton.
SEC. 2.Article 7 (commencing with Section 128570) is added to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, to read:7.Nurse-Midwifery Education Program128570.(a)The California Nurse-Midwifery Education Fund is hereby created within the Department of Health Care Access and Information for the purpose of establishing California-based, masters level, nurse-midwifery education programs within the California State University, the University of California, or both.
(b)The department shall administer the fund. The fund shall receive moneys from the General Fund for the purposes of this article upon appropriation by the Legislature.
(c)It is the intent of the Legislature for the 202526 state fiscal year, for two million dollars ($2,000,000) to be appropriated from the General Fund to the department for use in the California Nurse-Midwifery Education Fund.
(d)The fund may receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the General Fund.
128571.(a)The department shall establish competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
(b)The department shall ensure that a masters degree is an option for students as the culminating degree of the education programs receiving funds.
(c)The education programs shall meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or preaccredited by the Accreditation Commission for Midwifery Education. The programs are not required to be located within a school of nursing.
(d)The fund shall support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
128572.Any funds, public or private, received for the fund shall supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act pursuant to Article 1 (commencing with Section 128200) of Chapter 4. Any funds allocated to the education programs receiving funds shall supplement, not supplant, the universitys budget allocations for any fiscal year.
The Legislature finds and declares all of the following:
(a)California is experiencing a maternity care access crisis. Over 50 maternity wards in California have closed since 2013, and 20 freestanding birth centers have closed in just over three years. These closures create significant barriers to reproductive health care, and potential risk to birthing people. The closures compound an already significant problem, the obstetrical and reproductive health care workforce shortage in California.
(b)Midwifery care has demonstrated excellent outcomes to improve maternal health.
(c)When midwives are integrated into health systems, we find more spontaneous vaginal birth, labor after cesarean, vaginal birth after cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower cost, and we also see fewer undesirable outcomes, including cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit admissions, preterm birth and low birth weight infants, infant emergency department visits, and hospitalizations and neonatal deaths.
(d)Midwives are also recognized as a component of the solution to address race-based disparities, especially when provided by culturally, linguistically, and racially competent providers.
(e)The supply of California midwives falls short of other high-income countries where birth outcomes are better. Countries with better birth outcomes rely on midwives to provide the safest, highest quality care to healthy people, freeing up physicians to give the highest quality specialty care to high-risk patients. For example, the California maternal mortality rate is 10.5 per 100,000 births and the ratio of midwives to obstetrics physicians is 1 to 3.3. In the Netherlands, the maternal mortality rate is 2.8 per 100,000 births and the ratio of midwife to physician is 2.5 to 1. In Australia, the maternal mortality rate is 3.5 per 100,000 births and the ratio of midwife to physician is 8.8 to 1.
(f)The Legislature understands and declares that with a robust education pipeline, midwives can provide high-quality outcomes to Californians and fill an urgent need. California currently has only one nurse-midwifery program accepting new students at California State University, Fullerton.
SEC. 2.Article 7 (commencing with Section 128570) is added to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, to read:7.Nurse-Midwifery Education Program128570.(a)The California Nurse-Midwifery Education Fund is hereby created within the Department of Health Care Access and Information for the purpose of establishing California-based, masters level, nurse-midwifery education programs within the California State University, the University of California, or both.
(b)The department shall administer the fund. The fund shall receive moneys from the General Fund for the purposes of this article upon appropriation by the Legislature.
(c)It is the intent of the Legislature for the 202526 state fiscal year, for two million dollars ($2,000,000) to be appropriated from the General Fund to the department for use in the California Nurse-Midwifery Education Fund.
(d)The fund may receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the General Fund.
128571.(a)The department shall establish competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
(b)The department shall ensure that a masters degree is an option for students as the culminating degree of the education programs receiving funds.
(c)The education programs shall meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or preaccredited by the Accreditation Commission for Midwifery Education. The programs are not required to be located within a school of nursing.
(d)The fund shall support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
128572.Any funds, public or private, received for the fund shall supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act pursuant to Article 1 (commencing with Section 128200) of Chapter 4. Any funds allocated to the education programs receiving funds shall supplement, not supplant, the universitys budget allocations for any fiscal year.
SECTION 1.It is the intent of the Legislature to enact subsequent legislation that would establish a new high-quality Masters in Science Degree program for midwifery that will address the growing demand for skilled maternity health care professionals in California, particularly in rural and underserved communities. It is the further intent of the Legislature that the program would do all of the following:(a)Enhance the maternity and reproductive health care workforce.(b)Improve health outcomes.(c)Support the states ongoing efforts to expand access to quality health care for all Californians.It is the intent of the Legislature to enact subsequent legislation that would establish a new high-quality Masters in Science Degree program for midwifery that will address the growing demand for skilled maternity health care professionals in California, particularly in rural and underserved communities. It is the further intent of the Legislature that the program would do all of the following:
(a)Enhance the maternity and reproductive health care workforce.
(b)Improve health outcomes.
(c)Support the states ongoing efforts to expand access to quality health care for all Californians.
|
Date
|
Status
|
|---|---|
| Oct 11, 2025 | Chaptered by Secretary of State. Chapter 601, Statutes of 2025. |
| Oct 11, 2025 | Approved by the Governor. |
| Sep 16, 2025 | Enrolled and presented to the Governor at 3 p.m. |
| Sep 8, 2025 | In Senate. Ordered to engrossing and enrolling. |
| Sep 8, 2025 | Read third time. Passed. (Ayes 79. Noes 0. Page 2994.) Ordered to the Senate. |
| Sep 2, 2025 | Read second time. Ordered to third reading. |
| Aug 29, 2025 | From committee: Do pass. (Ayes 15. Noes 0.) (August 29). |
| Aug 20, 2025 | August 20 set for first hearing. Placed on APPR. suspense file. |
| Jul 9, 2025 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (July 8). Re-referred to Com. on APPR. |
| Jun 25, 2025 | From committee: Do pass and re-refer to Com. on HIGHER ED. with recommendation: To consent calendar. (Ayes 15. Noes 0.) (June 24). Re-referred to Com. on HIGHER ED. |
| Jun 5, 2025 | Referred to Coms. on HEALTH and HIGHER ED. |
| May 29, 2025 | In Assembly. Read first time. Held at Desk. |
| May 29, 2025 | Read third time. Passed. (Ayes 38. Noes 0. Page 1327.) Ordered to the Assembly. |
| May 27, 2025 | Ordered to special consent calendar. |
| May 23, 2025 | Read second time. Ordered to third reading. |
| May 23, 2025 | From committee: Do pass. (Ayes 6. Noes 0. Page 1203.) (May 23). |
| May 16, 2025 | Set for hearing May 23. |
| May 12, 2025 | May 12 hearing: Placed on APPR. suspense file. |
| May 2, 2025 | Set for hearing May 12. |
| May 1, 2025 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 11. Noes 0. Page 965.) (April 30). Re-referred to Com. on APPR. |
| Apr 8, 2025 | Set for hearing April 30. |
| Apr 2, 2025 | Re-referred to Com. on HEALTH. |
| Mar 24, 2025 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Feb 26, 2025 | Referred to Com. on RLS. |
| Feb 20, 2025 | From printer. May be acted upon on or after March 22. |
| Feb 19, 2025 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 8, 2025 | SB 520 Caballero Senate Third Reading By Bonta | Assembly Floor |
Passed |
|
| Aug 29, 2025 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jul 8, 2025 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Higher Education |
Passed |
|
| Jun 24, 2025 | Do pass and be re-referred to the Committee on [Higher Education] with recommendation: To Consent Calendar | Assembly Standing Committee on Health |
Passed |
|
| May 29, 2025 | Special Consent SB520 Caballero et al. | Senate Floor |
Passed |
|
| May 23, 2025 | Do pass | Senate Standing Committee on Appropriations |
Passed |
|
| May 12, 2025 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 30, 2025 | Do pass, but first be re-referred to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Association Of University Women - California | ** Support | |
| American Nurses Association/California | ** Support | |
| Black Women For Wellness Action Project | ** Support | |
| California Association Of Christian Colleges And Universities | ** Support | |
| California Catholic Conference | ** Support | |
| California Latinas for Reproductive Justice | ** Support | |
| CALIFORNIA NURSE MIDWIVES ASSOCIATION (CNMA) | ** Support | |
| Citizens for Choice | ** Support | |
| County of Fresno | ** Support | |
| National Health Law Program | ** Support | |
| The BIPOC Student Midwives Fund | ** Support | |
| Western Center on Law & Poverty, INC. | ** Support |
SENATE THIRD READING
STR Bill Id:SB 520
Author:(Caballero)
As Amended Ver:March 24, 2025
Majority vote
SUMMARY
Creates the California Nurse-Midwifery Education (CNME) Fund in the Department of Health Care Access and Information (HCAI) for the purpose of establishing California-based, master's level nurse-midwifery education programs. Requires HCAI to administer the fund, which will receive money from the General Fund (GF) upon appropriation.
Major Provisions
COMMENTS
Background. Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that from 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of several drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030. Nurse-midwives have documented excellent care outcomes. California nurse-midwives attend approximately 13% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.
Maternal Health in California. Like the rest of the nation, California is facing a maternal health crisis. Every five days, a Californian loses their life to pregnancy-related complications. According to the California Department of Public Health (DPH) pregnancy-related mortality dashboard, although the state's pregnancy-related mortality ratio is lower than the national ratio, it has been rising in recent years and the majority of these deaths are preventable. The severe maternal morbidity rate in California has also been rising and is higher than the national rate. Severe maternal morbidity (SMM) includes unexpected outcomes of labor and delivery that can result in significant short- or long-term health consequences. SMM has been steadily increasing in recent years. This crisis is disproportionately impacting Black, American Indian/Alaska Native, and Pacific Islander individuals.
California Department of Health Care Services' (DHCS) Birthing Care Pathway Report. With 40% of births statewide covered by Medi-Cal, DHCS is positioned to drive significant improvements in maternal health and birth equity. DHCS began developing the Birthing Care Pathway in 2023 to cover the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum. The Birthing Care Pathway is designed to be a roadmap for state entities, managed care plans (MCP), counties, providers, social service entities, philanthropy, and other key partners serving pregnant and postpartum Medi-Cal members. In February 2025, DHCS released the Birthing Care Pathway Report, which includes a series of policy solutions that address the physical, behavioral, and health-related social needs of pregnant and postpartum members by improving access to providers (including midwives); strengthening clinical care and care coordination across the care continuum; providing whole-person care; and modernizing how Medi-Cal pays for maternity care.
Recent Nurse Midwife program closure. The University of California San Francisco (UCSF) recently closed its nurse-midwifery master's degree program in favor of opening a doctoral degree program. A 2024 California Health Care Foundation report on the closure notes that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year Master of Science in Nursing. Studies show that 71% of nursing master's students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master's degrees. Currently the state only has one other program: the California State University, Fullerton master's degree in nurse-midwifery.
According to the Author
California continues to face significant challenges related to maternal health. Despite efforts, maternal mortality rates remain deeply concerning, particularly among Black, Indigenous, and people of color communities. Many rural and low-income areas of the state suffer from a shortage of healthcare providers capable of delivering essential maternal care. The author notes that nurse-midwives play a critical role in improving maternal physical and mental health outcomes, providing compassionate, culturally competent, and evidence-based care during pregnancy, labor, and postpartum. The author contends that a new Nurse-Midwifery Master's Degree Program will cultivate the next generation of highly trained nurse-midwives who can provide comprehensive maternal care in communities that need it the most, ensuring that more families have access to safe, respectful, and personalized care during their pregnancy journey. The author concludes that the bill represents a significant step to help California achieve its maternal health goals, promote positive health outcomes, and address the healthcare workforce shortage.
Arguments in Support
The California Nurse Midwives Association (CNMA) is the sponsor of this bill and states that there is currently only one nurse-midwifery master's degree program in California, at CSU Fullerton. CNMA points to the fact that that this lack of educational opportunity places limitations on the workforce potential and ultimately on access to high quality reproductive health care in California. To meet current demand, California needs as many clinically prepared midwives as quickly and cost-effectively as possible. With an effective pipeline, midwives can be rapidly and professionally prepared to provide high quality health care to both parent and child. CNMA concludes that this bill would establish a Nurse-Midwifery Fund within HCAI, and that by combining both state and private funds, this fund will support new nurse-midwifery master's degree programs to help the state meet its goals of reducing maternal and infant mortality and improving maternal physical and mental health outcomes, while simultaneously addressing the healthcare workforce needs, particularly in communities with higher rates of adverse pregnancy outcomes and provider shortages.
Arguments in Opposition
None.
FISCAL COMMENTS
According to the Assembly Appropriations Committee, one-time General Fund cost pressures of $2 million to fund the CNME Fund. The author, along with three other legislators, submitted a request for $2 million in the 2025-26 state budget to fund this bill. The request was not granted.
VOTES
SENATE FLOOR: 38-0-2
YES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener
ABS, ABST OR NV: Limón, Reyes
ASM HEALTH: 15-0-1
YES: Bonta, Chen, Aguiar-Curry, Caloza, Carrillo, Flora, Mark González, Krell, Patel, Patterson, Celeste Rodriguez, Sanchez, Schiavo, Sharp-Collins, Elhawary
ABS, ABST OR NV: Addis
ASM HIGHER EDUCATION: 9-0-1
YES: Fong, Boerner, Jeff Gonzalez, Jackson, Muratsuchi, Patel, Celeste Rodriguez, Sharp-Collins, Tangipa
ABS, ABST OR NV: DeMaio
ASM APPROPRIATIONS: 15-0-0
YES: Wicks, Sanchez, Arambula, Calderon, Caloza, Dixon, Elhawary, Fong, Mark González, Ahrens, Pacheco, Pellerin, Solache, Ta, Tangipa
UPDATED
VERSION: March 24, 2025
CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001377
Date of Hearing: August 20, 2025
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Buffy Wicks, Chair
SBPCA Bill Id:SB 520
Author:(Caballero) – As Amended Ver:March 24, 2025
Policy Committee: | Health | Vote: | 15 - 0 |
Higher Education | 9 - 0 | ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill establishes the California Nurse-Midwifery Education (CNME) Fund in the Department of Health Care Access and Information (HCAI) for the purpose of establishing master’s level nurse-midwifery education programs.
Specifically, this bill:
- Establishes the CNME Fund within HCAI for the purpose of establishing California-based, master’s level nurse-midwifery education programs within the California State University (CSU), the University of California (UC), or both.
- Requires HCAI to administer the CNME Fund and requires the CNME Fund receive General Fund (GF) moneys upon appropriation by the Legislature.
- States the intent of the Legislature to appropriate $2 million from the GF to HCAI for the 2025-26 state fiscal year, for use in the Fund.
- Authorizes the CNME Fund to receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the GF.
- Requires HCAI to establish competitive application criteria to ensure optimal site selection for the education programs within the CSU system or UC, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
- Requires HCAI to ensure a master’s degree is an option for students as the culminating degree of the education programs receiving funds. Requires the education programs meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or pre-accredited by the Accreditation Commission for Midwifery Education. Specifies that the programs are not required to be located within a school of nursing.
- Requires the CNME Fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
- Requires any public or private funds received for the CNME Fund supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act. Requires any funds allocated to the education programs receiving funds supplement, not supplant, the university’s budget allocations for any fiscal year.
FISCAL EFFECT:
One-time General Fund cost pressures of $2 million to fund the CNME Fund. The author, along with three other legislators, submitted a request for $2 million in the 2025-26 state budget to fund this bill. The request was not granted.
COMMENTS:
- Purpose. This bill is sponsored by the California Nurse Midwives Association (CNMA). According to the author:
California continues to face significant challenges related to maternal health. Despite our efforts, maternal mortality rates remain deeply concerning, particularly among Black, Indigenous, and people of color (BIPOC) communities. Many rural and low-income areas of the state suffer from a shortage of healthcare providers capable of delivering essential maternal care. Nurse-midwives play a critical role in improving maternal physical and mental health outcomes, providing compassionate, culturally competent, and evidence-based care during pregnancy, labor, and postpartum.
- Background. Maternal Health Crisis. California is facing a maternal health crisis. According to data from the California Department of Public Health, the state's pregnancy-related mortality ratio has been rising in recent years, and the majority of these deaths are preventable. The severe maternal morbidity (SMM) rate in California has also been rising, and disproportionately affects Black, American Indian/Alaska Native, and Pacific Islander individuals. From 2014 to 2024, more than 50 maternity units closed throughout the state. These closures are driven, in part, by the maternity care workforce shortage.
Nurse-Midwives. California nurse-midwives attend approximately 13% of births in California, but could provide greater health care access with workforce expansion. According to a 2023 issue brief from the Commonwealth Fund, incorporating midwives fully into the health care system could reduce perinatal health disparities and help address provider workforce shortages.
Recent Nurse Midwife Training Program Closure. UC San Francisco (UCSF) recently closed its nurse-midwifery master’s degree program in favor of opening a doctoral degree program. The state now has only one other nurse-midwifery training program, at CSU Fullerton. A 2024 California Health Care Foundation report on the closure notes that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year Master of Science in Nursing. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: July 8, 2025
ASSEMBLY COMMITTEE ON HIGHER EDUCATION
Mike Fong, Chair
SBPCA Bill Id:SB 520
Author:(Caballero) – As Amended Ver:March 24, 2025
SENATE VOTE: 38-0
SUBJECT: Nurse-midwifery education program
SUMMARY: Creates the California Nurse-Midwifery Education (CNME) Fund in the
Department of Health Care Access and Information (HCAI) for the purpose of establishing California-based, master’s level nurse-midwifery education programs. Requires HCAI to administer the fund, which will receive money from the General Fund (GF) upon appropriation. Specifically, this bill:
- Establishes the CNME Fund for the purpose of establishing California-based, master’s level nurse-midwifery education programs with the California State University (CSU), the University of California (UC), or both.
- Requires HCAI to administer the CNME Fund upon appropriation by the Legislature. States the intent of the Legislature to appropriate two million dollars from the GF to HCAI for the 2025-26 fiscal year. Authorizes the funds to receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the GF.
- Requires HCAI to establish competitive application criteria to ensure the optimal sites selection for the education programs within the CSU system or the UC, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
- Requires HCAI to ensure that a master’s degree is an option for students as the culminating degree of the education programs receiving funds. Requires the education programs to meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or pre-accredited by the Accreditation Commission for Midwifery Education. Specifies that the programs are not required to be located within a school of nursing.
- Requires the CNME Fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
- Requires any funds, public or private, received for the CNME Fund to supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song- Brown Health Care Workforce Training Act. Requires any funds allocated to the education programs receiving funds to supplement, not supplant, the university’s budget allocations for any fiscal year.
EXISTING LAW:
- Establishes HCAI, and requires HCAI, among other functions, to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation (HPEF) within HCAI to develop criteria for evaluating applicants for various scholarships and loans. (Health and Safety Code (HSC) Sections 127000, et seq. and § 127750, et seq.)
- Requires HCAI, as part of the Midwifery Workforce Training Act, which became operative January 1, 2022, to establish a program to contract with programs that train certified nurse midwives (CNMs) and licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a licensed midwife. [HSC Section 128298(b)(1))
- Requires HCAI to only contract with programs that train CNMs and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. (HSC Section 128298(b)(2))
FISCAL EFFECT: According to the Senate Committee on Appropriations, HCAI anticipates minor and absorbable costs for state administration. Ongoing General Fund cost pressures of two million dollars to support the California Nurse-Midwifery Education Fund.
COMMENTS: Double-referral. SB 520 (Caballero) was heard in the Assembly Committee on Health on June 24, 2025, where it passed with unanimous support.
Purpose. According to the author, “California continues to face significant challenges related to maternal health. Despite our efforts, maternal mortality rates remain deeply concerning, particularly among Black, Indigenous, and people of color (BIPOC) communities. Many rural and low-income areas of the state suffer from a shortage of healthcare providers capable of delivering essential maternal care. Nurse-midwives play a critical role in improving maternal physical and mental health outcomes, providing compassionate, culturally competent, and evidence-based care during pregnancy, labor, and postpartum.”
“SB 520 will establish a new Nurse-Midwifery Master’s Degree Program in California to help address the critical need for skilled healthcare professionals who can deliver high-quality maternal care, particularly in underserved communities. This bill directly supports California’s efforts to reduce maternal mortality and improve maternal physical and mental health. A new Nurse-Midwifery Master’s Degree Program will cultivate the next generation of highly trained nurse-midwives who can provide comprehensive maternal care in communities that need it the most, ensuring that more families have access to safe, respectful, and personalized care during their pregnancy journey.”
“The bill represents a significant step to help California achieve its maternal health goals, promote positive health outcomes, and address the healthcare workforce shortage. It is a crucial investment in the health and well-being of families and in the future of our healthcare system.”
Background. Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that from 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of several drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030. Nurse-midwives have documented excellent care outcomes. California nurse-midwives attend approximately 13% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.
Committee staff notes a trend over the past fifteen years authorizing the expansion of doctoral programs in medical fields. Notwithstanding the differentiation of the mission envisioned by the Master Plan, and as outlined in statute, the Legislature has authorized the CSU to go beyond its original mission to offer professional doctoral degrees which include the Doctor of Audiology (Au.D), Doctor of Physical Therapy (D.P.T.), Doctor of Nursing Practice (DNP), Doctor of Occupational Therapy (OTD), and Doctor of Public Health (Dr.PH). Each program was individually approved through legislation.
Recent Nurse Midwife program closure. UC San Francisco (UCSF) recently closed its nurse-midwifery master’s degree program in favor of opening a doctoral degree program. A 2024 California Health Care Foundation report on the closure notes that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared to $65,000 for a two-year Master of Science in Nursing. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly, or no more, than those with master’s degrees. Currently the state only has one other program: the California State University, Fullerton master’s degree in nurse-midwifery.
Arguments in support. The County of Fresno wrote in support, arguing that AB 520 (Caballero) “is vital for addressing the significant maternal healthcare workforce shortages and improving health outcomes for families in Fresno County and across the Central Valley. Fresno County, like many regions in California, particularly those with large rural and underserved populations, faces persistent challenges in ensuring adequate access to quality maternal and infant healthcare. The shortage of maternity care providers directly impacts the health and well-being of our mothers and babies.”
“SB 520 offers a direct and impactful solution by establishing the California Nurse-Midwifery Education Fund to support new master's-level nurse-midwifery programs within the CSU and UC systems. If a program were to be established at a campus in or near Fresno County, such as CSU Fresno, it would create a crucial pipeline of highly trained nurse-midwives who are more likely to practice in our region upon graduation. This would significantly increase access to comprehensive and evidence-based maternal care for our diverse communities.”
“The integration of more nurse-midwives into our healthcare system is proven to lead to better birth outcomes, lower maternal and infant mortality rates, and greater patient satisfaction. SB 520 is a strategic investment in our healthcare workforce that will directly contribute to improving these vital health metrics for Fresno County residents. This initiative represents a valuable opportunity for workforce development and job creation within our county, providing well-paying careers in a critical healthcare field.”
Related and prior legislation. AB 836 (Stefani) requires HCAI, upon appropriation from the
Legislature, to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. AB 836 is pending in the Senate Health Committee.
AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.
SB 65 (Skinner), Chapter 449, Statutes of 2021, establishes the California Momnibus Act, which, among other provisions, requires HCAI to work to increase the number of students receiving training as certified nurse-midwives or licensed midwives.
REGISTERED SUPPORT / OPPOSITION:
Support
American Association of University Women - California
American Nurses Association/california
Black Women for Wellness Action Project
California Association of Christian Colleges and Universities
California Catholic Conference
California Latinas for Reproductive Justice
California Nurse Midwives Association (CNMA)
County of Fresno
March of Dimes
National Health Law Program
The Bipoc Student Midwives Fund
Western Center on Law & Poverty, INC.
Opposition
None on file.
Analysis Prepared by: Kevin J. Powers / HIGHER ED. / (916) 319-3960
Date of Hearing: June 24, 2025
ASSEMBLY COMMITTEE ON HEALTH
Mia Bonta, Chair
SBPCA Bill Id:SB 520
Author:(Caballero) – As Amended Ver:March 24, 2025
SENATE VOTE: 38-0
SUBJECT: Nurse-midwifery education program.
SUMMARY: Creates the California Nurse-Midwifery Education (CNME) Fund in the Department of Health Care Access and Information (HCAI) for the purpose of establishing California-based, master’s level nurse-midwifery education programs. Requires HCAI to administer the fund, which will receive money from the General Fund (GF) upon appropriation. Specifically, this bill:
- Establishes the CNME Fund for the purpose of establishing California-based, master’s level nurse-midwifery education programs with the California State University, the University of California, or both.
- Requires HCAI to administer the CNME Fund upon appropriation by the Legislature. States the intent of the Legislature to appropriate two million dollars from the GF to HCAI for the 2025-26 state fiscal year. Authorizes the funds to receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the GF.
- Requires HCAI to establish competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
- Requires HCAI to ensure that a master’s degree is an option for students as the culminating degree of the education programs receiving funds. Requires the education programs to meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or pre-accredited by the Accreditation Commission for Midwifery Education. Specifies that the programs are not required to be located within a school of nursing.
- Requires the CNME Fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
- Requires any funds, public or private, received for the CNME Fund to supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act. Requires any funds allocated to the education programs receiving funds to supplement, not supplant, the university’s budget allocations for any fiscal year.
EXISTING LAW:
- Establishes HCAI, and requires HCAI, among other functions, to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation (HPEF) within HCAI to develop criteria for evaluating applicants for various scholarships and loans. [Health and Safety Code (HSC) § 127000, et seq. and § 127750, et seq.]
- Requires HCAI, as part of the Midwifery Workforce Training Act, which became operative January 1, 2022, to establish a program to contract with programs that train certified nurse-midwives (CNMs) and licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a licensed midwife. [HSC § 128298(b)(1)]
- Requires HCAI to only contract with programs that train CNMs and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [HSC § 128298(b)(2)]
FISCAL EFFECT: According to the Senate Appropriations Committee, HCAI anticipates minor and absorbable costs to the department for state administration. Ongoing General Fund cost pressures of $2 million to support the California Nurse-Midwifery Education Fund.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, California continues to face significant challenges related to maternal health. Despite efforts, maternal mortality rates remain deeply concerning, particularly among Black, Indigenous, and people of color (BIPOC) communities. Many rural and low-income areas of the state suffer from a shortage of healthcare providers capable of delivering essential maternal care. The author notes that nurse-midwives play a critical role in improving maternal physical and mental health outcomes, providing compassionate, culturally competent, and evidence-based care during pregnancy, labor, and postpartum. The author contends that a new Nurse-Midwifery Master’s Degree Program will cultivate the next generation of highly trained nurse-midwives who can provide comprehensive maternal care in communities that need it the most, ensuring that more families have access to safe, respectful, and personalized care during their pregnancy journey. The author concludes that the bill represents a significant step to help California achieve its maternal health goals, promote positive health outcomes, and address the healthcare workforce shortage.
- BACKGROUND. Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that from 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of several drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030. Nurse-midwives have documented excellent care outcomes. California nurse-midwives attend approximately 13% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.
- Maternal Health in California. Like the rest of the nation, California is facing a maternal health crisis. Every five days, a Californian loses their life to pregnancy-related complications. According to the California Department of Public Health (DPH) pregnancy-related mortality dashboard, although the state's pregnancy-related mortality ratio is lower than the national ratio, it has been rising in recent years and the majority of these deaths are preventable. The severe maternal morbidity rate in California has also been rising and is higher than the national rate. Severe maternal morbidity (SMM) includes unexpected outcomes of labor and delivery that can result in significant short- or long-term health consequences. SMM has been steadily increasing in recent years. This crisis is disproportionately impacting Black, American Indian/Alaska Native, and Pacific Islander individuals.
- California Department of Health Care Services’ (DHCS) Birthing Care Pathway Report. With 40% of births statewide covered by Medi-Cal, DHCS is positioned to drive significant improvements in maternal health and birth equity. DHCS began developing the Birthing Care Pathway in 2023 to cover the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum. The Birthing Care Pathway is designed to be a roadmap for state entities, managed care plans (MCP), counties, providers, social service entities, philanthropy, and other key partners serving pregnant and postpartum Medi-Cal members. In February 2025, DHCS released the Birthing Care Pathway Report, which includes a series of policy solutions that address the physical, behavioral, and health-related social needs of pregnant and postpartum members by improving access to providers (including midwives); strengthening clinical care and care coordination across the care continuum; providing whole-person care; and modernizing how Medi-Cal pays for maternity care.
- Recent Nurse Midwife program closure. The University of California San Francisco (UCSF) recently closed its nurse-midwifery master’s degree program in favor of opening a doctoral degree program. A 2024 California Health Care Foundation report on the closure notes that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year Master of Science in Nursing. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees. Currently the state only has one other program: the California State University, Fullerton master’s degree in nurse-midwifery.
- SUPPORT. The California Nurse Midwives Association (CNMA) is the sponsor of this bill and states that there is currently only one nurse-midwifery master’s degree program in California, at CSU Fullerton. CNMA points to the fact that that this lack of educational opportunity places limitations on the workforce potential and ultimately on access to high quality reproductive health care in California. To meet current demand, California needs as many clinically prepared midwives as quickly and cost-effectively as possible. With an effective pipeline, midwives can be rapidly and professionally prepared to provide high quality health care to both parent and child. CNMA concludes that this bill would establish a Nurse-Midwifery Fund within HCAI, and that by combining both state and private funds, this fund will support new nurse-midwifery master’s degree programs to help the state meet its goals of reducing maternal and infant mortality and improving maternal physical and mental health outcomes, while simultaneously addressing the healthcare workforce needs, particularly in communities with higher rates of adverse pregnancy outcomes and provider shortages.
- RELATED LEGISLATION. AB 836 (Stefani) requires HCAI, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. AB 836 is pending in the Senate Health Committee.
- PREVIOUS LEGISLATION.
- SB 65 (Skinner), Chapter 449, Statutes of 2021, establishes the California Momnibus Act, which, among other provisions, requires HCAI to work to increase the number of students receiving training as certified nurse-midwives or licensed midwives.
- AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.
- DOUBLE REFERRAL. This bill is double referred. Upon passage of this committee, it will be referred to the Assembly Committee on Higher Education.
REGISTERED SUPPORT / OPPOSITION:
Support
California Nurse-Midwives Association (sponsor)
American Association of University Women - California
American Nurses Association/California
Black Women for Wellness Action Project
California Association of Christian Colleges and Universities
California Catholic Conference
California Latinas for Reproductive Justice
Citizens for Choice
County of Fresno
March of Dimes
National Health Law Program
Western Center on Law & Poverty
Opposition
None on file
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 520 |
THIRD READING
Bill No: SB 520
Author: Caballero (D), et al.
Amended: 3/24/25
Vote: 21
SENATE HEALTH COMMITTEE: 11-0, 4/30/25
AYES: Menjivar, Valladares, Durazo, Gonzalez, Grove, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener
SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/23/25
AYES: Caballero, Seyarto, Cabaldon, Grayson, Richardson, Wahab
NO VOTE RECORDED: Dahle
SUBJECT: Nurse-midwifery education program
SOURCE: California Nurse Midwives Association
DIGEST:
This bill creates the California Nurse-Midwifery Education Fund, with $2 million upon appropriation by the Legislature, administered by the Department of Health Care Access and Information to establish master’s level nurse-midwifery education programs within the California State University, the University of California, or both.
ANALYSIS:
Existing law:
- Establishes the Department of Health Care Access and Information (HCAI), and requires HCAI to establish and administer multiple programs and activities. Requires HCAI to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation (HPEF) within HCAI to, among other functions, develop criteria for evaluating applicants for various scholarships and loans. [Health and Safety Code (HSC) § 127000, et seq. and § 127750, et seq.]
- Requires HCAI, as part of the Midwifery Workforce Training Act, which became operative January 1, 2022, to establish a program to contract with programs that train certified nurse-midwives (CNMs) and licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a licensed midwife. [HSC § 128298(b)(1)]
- Requires HCAI to only contract with programs that train CNMs and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [HSC § 128298(b)(2)]
This bill:
- Creates the California Nurse-Midwifery Education Fund (the Fund), with $2 million upon appropriation by the Legislature from the General Fund (GF), within HCAI to establish California-based, master’s level, nurse-midwifery education programs within the California State University (CSU), the University of California (UC), or both.
- Permits the Fund to receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the GF. Requires any funds, public or private, received for the Fund to supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act. Requires any funds allocated to the education programs receiving funds to supplement, not supplant, the university’s budget allocations for any fiscal year.
- Requires HCAI to establish competitive application criteria to ensure optimal site selection for the education programs within the CSU or the UC, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need. Requires HCAI to ensure that a master’s degree is an option for students as the culminating degree of the education programs receiving funds.
- Requires the Fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
- Requires the education programs to meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or preaccredited by the Accreditation Commission for Midwifery Education. Specifies the programs are not required to be located within a school of nursing.
- Makes Legislative findings and declarations about the maternity care access crisis the state is facing, and about the benefits the midwifery workforce brings to various health systems and to positive outcomes for births they attend as well as for the babies and parent.
Comments
According to the author of this bill:
California continues to face significant challenges related to maternal health. Despite our efforts, maternal mortality rates remain deeply concerning, particularly among Black, Indigenous, and people of color (BIPOC) communities. Many rural and low-income areas of the state suffer from a shortage of health care providers capable of delivering essential maternal care. Nurse-midwives play a critical role in improving maternal physical and mental health outcomes, providing compassionate, culturally competent, and evidence-based care during pregnancy, labor, and postpartum. This bill will establish a new Nurse-Midwifery Master’s Degree Program in California to help address the critical need for skilled health care professionals who can deliver high-quality maternal care, particularly in underserved communities. This bill directly supports California’s efforts to reduce maternal mortality and improve maternal physical and mental health. A new Nurse-Midwifery Master’s Degree Program will cultivate the next generation of highly trained nurse-midwives who can provide comprehensive maternal care in communities that need it the most, ensuring that more families have access to safe, respectful, and personalized care during their pregnancy journey. The bill represents a significant step to help California achieve its maternal health goals, promote positive health outcomes, and address the health care workforce shortage. It is a crucial investment in the health and well-being of families and in the future of our health care system.
Background
Midwifery in California. According to February 2025 California Health Care Foundation (CHCF) Issue Brief, midwives play a crucial role in the maternity care workforce, providing comprehensive health services during pregnancy, labor, and postpartum, including as the primary birth attendant. In many countries that have better birth outcomes than California and the U.S., midwives provide the majority of care for uncomplicated pregnancies and births. The midwifery model of care emphasizes respectful, relationship-based, and person-centered care, supporting the progress of labor and birth with minimal intervention unless necessary. An element of successful midwifery care is appropriate consultation with obstetrician/gynecologists and transfer to physician care if the need arises (e.g., if a patient develops medical complications outside the scope of midwifery care or requires surgery). California has two types of midwives: licensed midwives (LMs) and CNMs. LMs, regulated by the Medical Board of California, primarily practice in community-based settings, including birth centers and home births. Nationally certified LMs are credentialed as certified professional midwives and are legally recognized in 38 states. CNMs are also registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Nationally, CNMs are legally recognized in all 50 states. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.
An October 22, 2024 CHCF publication on California’s midwife workforce notes:
- Only 12% of LMs and 10% of CNMs were Latina/x, while 45% of the state’s population of women/birthing people age 15 to 44 (considered reproductive age by the U.S. Centers for Disease Control and Prevention) was Latina/x;
- Two percent of LMs and 4% of CNMs were Black, compared to 6% of the Black women/birthing people of reproductive age;
- Many LMs (25%) and CNMs (33%) said they spoke a non-English language fluently; and,
- LMs estimated that 6% of their patients preferred to receive services in a non-English language, and CNMs reported that 33% of their patients preferred to receive services in a non-English language.
Two-fold crises. A September 16, 2024 article in CalMatters stated that since their 2023 story regarding the increasing maternity care desert in the state, Californian continued to lose access to labor and delivery services. In 2024, four hospitals shut down their maternity wards, with another four slated to close that November—nearly on par with the ten maternity ward closures in 2023. According to CalMatters’ analysis of state records, a total of 56 hospitals have stopped delivering babies since 2012—that’s 16% of all general acute care hospitals in the state. In comparison, at least 267 hospitals nationwide, closed labor and delivery between 2011 and 2021, representing about 5% of the country’s hospitals. CalMatters cited that hospital administrators blamed service cuts on high costs, labor shortages, and declining birth rates. But in some instances, CalMatters found highly profitable hospitals closing maternity wards that delivered more than 700 babies annually—a number that research suggests is well above the threshold for safety and financial viability. The crisis of losing this service runs up against the rapidly increasing crisis of California’s worsening birth outcomes. Black women account for only 5% of pregnancies in the state but make up 21% of pregnancy-related deaths, according to CalMatters. Low-income women also have some of the highest rates of complications and death. The mortality rate for Black infants is also three times higher than for White infants, and nearly 1.5 times higher than for Pacific-Islander babies, the second highest mortality rate. Investigations into the cause of all pregnancy-related deaths by the California Department of Public Health determined that more than half are preventable, citing that it is well-documented that racism in health care settings contributes to poor outcomes, particularly Black women who consistently report poor experiences with medical professionals during pregnancy, including mistreatment because of their race, age, socioeconomic class, sexuality, and assumed or actual marital status. Black women also struggle to convince providers they are in pain, and report mistreatment when advocating for their health during pregnancy. A national survey from 2016 revealed half of White medical students and residents believed false and debunked myths about the biological differences between White and Black patients. Those who endorsed the beliefs were more likely to dismiss patients’ pain and make inaccurate treatment decisions. Yet, despite these statistics, CalMatters states that more than two and a half years after a law took effect requiring maternity care staff to complete racism in medical training, only 17% of hospitals were in compliance, according to an investigation published by the California Department of Justice.
Could a continued push for the Doctor of Nursing Practice (DNP) create a third crisis? In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs: clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists) and transition to DNP preparation only by 2015. An April 16, 2020, article in Nursing Outlook notes this move coincided with some Institute of Medicine’s (IOM) reports on medical errors, quality of care and safety, as well as, in 2003, the IOM calling for health system transformation through interprofessional, evidence-based care, including expert clinical leadership by nurses. Given the growing complexity of care, and strong recommendations by the IOM, many believed health care would benefit from doctorate-educated practitioners—this was at a time during which other disciplines, such as pharmacy and physical therapy, also moved their disciplines to a doctoral level. Yet, when it released the Future of Nursing report in 2010, IOM did not explicitly state a need for a practice doctorate as a universal requirement for APRN entry. The article notes this omission was an early indication of the challenges the profession would face surrounding adoption of the DNP. But the number of DNP programs and graduates continued to grow steadily over the next decade: the national DNP program count rose from 92 in 2008 to 354 in 2018. In 2025, Univeristy of California, San Francisco (UCSF), one of only two California master’s level programs for midwifery, stopped admitting master’s students while it revamped its curriculum to offer only doctoral degrees through the Bachelor of Science in Nursing Entry to DNP (BSN-DNP) model. The article states that this resulted in critics—alumni, health policy experts, and faculty—accusing the UC of putting profits above public health needs.
A large number of schools actually retained their Master of Science in Nursing (MSN) option while instituting a nonclinical version of the DNP. Many nursing schools kept up robust MSN enrollment and only added the post-MSN-DNP, which did not require extensive investment in clinical sites and could be delivered to large numbers of students online. This approach neglected the practice component of the DNP, sidestepping one of its central purposes as a practice doctorate, the article stated. Many of the post-master’s DNP programs were designed for working nurse executives and practicing APRNs; these programs often did not include clinical hours at all, but rather allocated hours to the final project. The 500 additional project hours were often used to develop leadership initiatives and were not primarily designed to increase APRN clinical proficiency.
A September 6, 2024 CHCF blog notes that the national transition to DNPs has not caught on the way AACN envisioned, and an acute need for maternal health practitioners has some universities moving in the other direction. CHCF notes that in 2024, Rutgers University reinstated the nurse-midwifery master’s training it had eliminated in 2016. The University of Alabama-Birmingham also restarted its master’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, George Washington University in Washington, DC; Loyola University in New Orleans; and, the University of Nevada-Las Vegas added master’s training in nurse-midwifery. CHCF states that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year MSN. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees. The 2020 article in Nursing Outlook argued that the financial implication of requiring the DNP degree is the largest barrier to adoption, both for students and organizations, as a universal DNP requirement would have financial ramifications on three levels: a) cost to individual students; b) cost to institutions that financially support advanced nursing practice education; and, c) cost to schools. The article cites a 2019 study that revealed the average 2014 salary for DNP-educated CNMs to be $105,968; the average salary for master's-prepared CNMs was $102,576 in 2014. This annual differential of $3,392 in mean salary dollars pales in comparison to the differences in time, effort, and tuition dollars required of DNP students, compared to CNM students.
Does a DNP degree outweigh the costs? According to the 2020 Nursing Outlook article, to date, the data is sparse. Many studies that do exist on the subject are descriptive, based on self-reporting, utilize small convenience samples, and/or do not address patient outcomes. Importantly, many studies do not differentiate outcomes between those who are CNMs and DNPs; they also tend not to distinguish between graduates of BSN-DNP programs and those who have received a post-master’s DNP. Several studies do indicate that DNP graduates are practicing in an array of settings and serving complex patients. Yet, in one 2019 study, 59% of DNP-prepared survey respondents from key professional nursing organizations (e.g., the American Academy of Nurse Practitioners, the American Organization of Nurse Executives, and the American Association of Nurse Anesthetist) reported that a DNP was neither required, nor preferred by their current employers. The article further notes that in a qualitative study of DNP employers, respondents reportedly perceived similar functions between DNPs and CNMs and were unable to differentiate between preparations due to several factors: a lack of DNP-specific positions in their organizations, limited employment of DNP-prepared nurses, and/or the fact that DNPs were too new to organizations to be accurately evaluated. Employers did, however, report that DNPs exhibited a better understanding of evidence-based clinical guidelines, a greater focus on translation of evidence into practice, and stronger knowledge of health policy, compared to master’s-level APRNs. This underscores the need for nursing leaders to gain consensus on what makes the DNP different, to disseminate that information to health system stakeholders, and to adjust their evaluation criteria accordingly, says the article.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee, HCAI anticipates minor and absorbable costs for state administration. Ongoing General Fund cost pressures of $2 million to support the California Nurse-Midwifery Education Fund.
SUPPORT: (Verified 5/8/2025)
California Nurse Midwives Association (source)
American Association of University Women of California
American Nurse Association\California
Black Women for Wellness Project
California Association of Christian Colleges and Universities
California Catholic Conference
California Latinas for Reproductive Justice
Citizens for Choice
National Health Law Program
Western Center on Law & Poverty
OPPOSITION: (Verified 5/8/2025)
None received
ARGUMENTS IN SUPPORT: The California Nurse Midwives Association, as sponsor, and other supporters state that California is experiencing a maternity care and labor and delivery crisis. This is despite the fact that the United States and California have a higher maternity and newborn death rate than other high-income countries. Further, over 50 maternity units in California have closed since 2013 and 20 freestanding birth centers have closed in just over three years. Midwifery care has demonstrated excellent clinical outcomes, but it is underutilized, and midwives can be mobilized to help address provider shortages. When they are integrated into health systems, midwives assist in more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, and vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower costs. There are also fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, Neonatal Intensive Care Unit (NICU) admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. Supporters further argue there is currently only one nurse-midwifery master’s degree program in California: CSU Fullerton. This lack of educational opportunity places limitations on the workforce potential and ultimately on access to high quality reproductive health care in California. To meet current demand, California needs as many clinically prepared midwives as quickly and cost-effectively as possible. With an effective pipeline, midwives can be rapidly and professionally prepared to provide high quality health care to both parent and child.
Prepared by: Reyes Diaz / HEALTH / (916) 651-4111
5/26/25 14:04:35
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anna Caballero, Chair
2025 - 2026 Regular Session
SB 520 (Caballero) - Nurse-midwifery education program
Version: March 24, 2025 | Policy Vote: HEALTH 11 - 0 |
Urgency: No | Mandate: No |
Hearing Date: May 12, 2025 | Consultant: Agnes Lee |
Bill Summary:
SB 520 would create the California Nurse-Midwifery Education Fund within the Department of Health Care Access and Information (HCAI) for the purpose of establishing California-based, master’s level, nurse-midwifery education programs within the California State University, the University of California, or both.
Fiscal Impact:
- HCAI anticipates minor and absorbable costs to the department for state administration.
- Ongoing General Fund cost pressures of $2 million to support the California Nurse-Midwifery Education Fund.
Background:
Current law requires HCAI, as part of the Midwifery Workforce Training Act, to establish a program to contract with programs that train certified nurse-midwives (CNMs) and licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a licensed midwife. Current law requires HCAI to only contract with programs that train CNMs and programs that train licensed midwives that, at a minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities.
In California, licensed midwives (LMs) are regulated by the Medical Board of California, and primarily practice in community-based settings, including birth centers and home births. Certified nurse-midwives (CNMs) are registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.
Proposed Law:
Specific provisions of the bill would:
- Create the California Nurse-Midwifery Education Fund within the HCAI for the purpose of establishing California-based, master’s level, nurse-midwifery education programs within the California State University, the University of California, or both.
- Require the California Nurse-Midwifery Education Fund to receive moneys from the General Fund upon appropriation by the Legislature, and state the intent of the Legislature for the 2025–26 state fiscal year, for $2,000,000 to be appropriated from the General Fund to HCAI for use in the California Nurse-Midwifery Education Fund.
- Permit the California Nurse-Midwifery Education Fund to receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the General Fund.
- Require HCAI to establish competitive application criteria to ensure the optimal sites selection for the education programs within the California State University system or the University of California, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need.
- Require HCAI to ensure that a master’s degree is an option for students as the culminating degree of the education programs receiving funds.
- Require the education programs to meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or preaccredited by the Accreditation Commission for Midwifery Education, as specified.
- Require the California Nurse-Midwifery Education Fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
- Require that any funds, public or private, received for the California Nurse-Midwifery Education Fund must supplement, not supplant, any current or future funding to midwifery workforce education programs, and that any funds allocated to the education programs receiving funds must supplement, not supplant, the university’s budget allocations for any fiscal year.
Related Legislation:
AB 836 (Stefani) requires HCAI, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. AB 836 is currently on the suspense file in the Assembly Appropriations Committee.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Caroline Menjivar, Chair
BILL NO: SB 520
AUTHOR: | Caballero | ||
VERSION: | March 24, 2025 | ||
HEARING DATE: | April 30, 2025 | ||
CONSULTANT: | Reyes Diaz | ||
SUBJECT: Nurse-midwifery education program
SUMMARY:
Creates the California Nurse-Midwifery Education Fund, with $2 million upon appropriation by the Legislature, administered by the Department of Health Care Access and Information to establish master’s level nurse-midwifery education programs within the California State University, the University of California, or both.
Existing law:
- Establishes the Department of Health Care Access and Information (HCAI), and requires HCAI to establish and administer multiple programs and activities. Requires HCAI to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation (HPEF) within HCAI to, among other functions, develop criteria for evaluating applicants for various scholarships and loans. [HSC §127000, et seq. and §127750, et seq.]
- Requires HCAI, as part of the Midwifery Workforce Training Act, which became operative January 1, 2022, to establish a program to contract with programs that train certified nurse-midwives (CNMs) and licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a licensed midwife. [HSC §128298(b)(1)]
- Requires HCAI to only contract with programs that train CNMs and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [HSC §128298(b)(2)]
This bill:
- Creates the California Nurse-Midwifery Education Fund (the Fund), with $2 million upon appropriation by the Legislature from the General Fund (GF), within HCAI to establish California-based, master’s level, nurse-midwifery education programs within the California State University (CSU), the University of California (UC), or both.
- Permits the Fund to receive donations and contributions from public and private entities, partnerships between public and private entities, fees, cash advances, and transfers from the GF. Requires any funds, public or private, received for the Fund to supplement, not supplant, any current or future funding to midwifery workforce education programs, including allocations to midwifery education programs administered through the Song-Brown Health Care Workforce Training Act. Requires any funds allocated to the education programs receiving funds to supplement, not supplant, the university’s budget allocations for any fiscal year.
- Requires HCAI to establish competitive application criteria to ensure optimal site selection for the education programs within the CSU or the UC, including prioritization of programs that serve an area of demonstrated maternity or midwifery workforce need. Requires HCAI to ensure that a master’s degree is an option for students as the culminating degree of the education programs receiving funds.
- Requires the Fund to support the annual operating costs for the development, operation, and maintenance of the education programs through the graduation of the first cohort of matriculated students, or five years, whichever is shorter.
- Requires the education programs to meet the regulatory requirements for nurse-midwifery education in California and the necessary requirements to be accredited or preaccredited by the Accreditation Commission for Midwifery Education. Specifies the programs are not required to be located within a school of nursing.
- Makes Legislative findings and declarations about the maternity care access crisis the state is facing, and about the benefits the midwifery workforce brings to various health systems and to positive outcomes for births they attend as well as for the babies and parent.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, California continues to face significant challenges related to maternal health. Despite our efforts, maternal mortality rates remain deeply concerning, particularly among Black, Indigenous, and people of color (BIPOC) communities. Many rural and low-income areas of the state suffer from a shortage of health care providers capable of delivering essential maternal care. Nurse-midwives play a critical role in improving maternal physical and mental health outcomes, providing compassionate, culturally competent, and evidence-based care during pregnancy, labor, and postpartum. This bill will establish a new Nurse-Midwifery Master’s Degree Program in California to help address the critical need for skilled health care professionals who can deliver high-quality maternal care, particularly in underserved communities. This bill directly supports California’s efforts to reduce maternal mortality and improve maternal physical and mental health. A new Nurse-Midwifery Master’s Degree Program will cultivate the next generation of highly trained nurse-midwives who can provide comprehensive maternal care in communities that need it the most, ensuring that more families have access to safe, respectful, and personalized care during their pregnancy journey. The bill represents a significant step to help California achieve its maternal health goals, promote positive health outcomes, and address the health care workforce shortage. It is a crucial investment in the health and well-being of families and in the future of our health care system.
- Midwifery in California. According to February 2025 California Health Care Foundation (CHCF) Issue Brief, midwives play a crucial role in the maternity care workforce, providing comprehensive health services during pregnancy, labor, and postpartum, including as the primary birth attendant. In many countries that have better birth outcomes than California and the U.S., midwives provide the majority of care for uncomplicated pregnancies and births. The midwifery model of care emphasizes respectful, relationship-based, and person-centered care, supporting the progress of labor and birth with minimal intervention unless necessary. An element of successful midwifery care is appropriate consultation with obstetrician/gynecologists and transfer to physician care if the need arises (e.g., if a patient develops medical complications outside the scope of midwifery care or requires surgery). California has two types of midwives: licensed midwives (LMs) and CNMs. LMs, regulated by the Medical Board of California, primarily practice in community-based settings, including birth centers and home births. Nationally certified LMs are credentialed as certified professional midwives and are legally recognized in 38 states. CNMs are also registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Nationally, CNMs are legally recognized in all 50 states. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.
An October 22, 2024 CHCF publication on California’s midwife workforce notes:
- Only 12% of LMs and 10% of CNMs were Latina/x, while 45% of the state’s population of women/birthing people age 15 to 44 (considered reproductive age by the U.S. Centers for Disease Control and Prevention) was Latina/x;
- Two percent of LMs and 4% of CNMs were Black, compared to 6% of the Black women/birthing people of reproductive age;
- Many LMs (25%) and CNMs (33%) said they spoke a non-English language fluently; and,
- LMs estimated that 6% of their patients preferred to receive services in a non-English language, and CNMs reported that 33% of their patients preferred to receive services in a non-English language.
- Two-fold crises. A September 16, 2024 article in CalMatters stated that since their 2023 story regarding the increasing maternity care desert in the state, Californian continued to lose access to labor and delivery services. In 2024, four hospitals shut down their maternity wards, with another four slated to close that November—nearly on par with the ten maternity ward closures in 2023. According to CalMatters’ analysis of state records, a total of 56 hospitals have stopped delivering babies since 2012—that’s 16% of all general acute care hospitals in the state. In comparison, at least 267 hospitals nationwide, closed labor and delivery between 2011 and 2021, representing about 5% of the country’s hospitals. CalMatters cited that hospital administrators blamed service cuts on high costs, labor shortages, and declining birth rates. But in some instances, CalMatters found highly profitable hospitals closing maternity wards that delivered more than 700 babies annually—a number that research suggests is well above the threshold for safety and financial viability. The crisis of losing this service runs up against the rapidly increasing crisis of California’s worsening birth outcomes. Black women account for only 5% of pregnancies in the state but make up 21% of pregnancy-related deaths, according to CalMatters. Low-income women also have some of the highest rates of complications and death. The mortality rate for Black infants is also three times higher than for White infants, and nearly 1.5 times higher than for Pacific-Islander babies, the second highest mortality rate. Investigations into the cause of all pregnancy-related deaths by the California Department of Public Health determined that more than half are preventable, citing that it is well-documented that racism in health care settings contributes to poor outcomes, particularly Black women who consistently report poor experiences with medical professionals during pregnancy, including mistreatment because of their race, age, socioeconomic class, sexuality, and assumed or actual marital status. Black women also struggle to convince providers they are in pain, and report mistreatment when advocating for their health during pregnancy. A national survey from 2016 revealed half of White medical students and residents believed false and debunked myths about the biological differences between White and Black patients. Those who endorsed the beliefs were more likely to dismiss patients’ pain and make inaccurate treatment decisions. Yet, despite these statistics, CalMatters states that more than two and a half years after a law took effect requiring maternity care staff to complete racism in medical training, only 17% of hospitals were in compliance, according to an investigation published by the California Department of Justice.
- Could a continued push for the Doctor of Nursing Practice (DNP) create a third crisis?
In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs: clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists) and transition to DNP preparation only by 2015. An April 16, 2020, article in Nursing Outlook notes this move coincided with some Institute of Medicine’s (IOM) reports on medical errors, quality of care and safety, as well as, in 2003, the IOM calling for health system transformation through interprofessional, evidence-based care, including expert clinical leadership by nurses. Given the growing complexity of care, and strong recommendations by the IOM, many believed health care would benefit from doctorate-educated practitioners—this was at a time during which other disciplines, such as pharmacy and physical therapy, also moved their disciplines to a doctoral level. Yet, when it released the Future of Nursing report in 2010, IOM did not explicitly state a need for a practice doctorate as a universal requirement for APRN entry. The article notes this omission was an early indication of the challenges the profession would face surrounding adoption of the DNP. But the number of DNP programs and graduates continued to grow steadily over the next decade: the national DNP program count rose from 92 in 2008 to 354 in 2018. In 2025, UCSF, one of only two California master’s level programs for midwifery, stopped admitting master’s students while it revamped its curriculum to offer only doctoral degrees through the Bachelor of Science in Nursing Entry to DNP (BSN-DNP) model. The article states that this resulted in critics—alumni, health policy experts, and faculty—accusing the UC of putting profits above public health needs.
A large number of schools actually retained their Master of Science in Nursing (MSN) option while instituting a nonclinical version of the DNP. Many nursing schools kept up robust MSN enrollment and only added the post-MSN-DNP, which did not require extensive investment in clinical sites and could be delivered to large numbers of students online. This approach neglected the practice component of the DNP, sidestepping one of its central purposes as a practice doctorate, the article stated. Many of the post-master’s DNP programs were designed for working nurse executives and practicing APRNs; these programs often did not include clinical hours at all, but rather allocated hours to the final project. The 500 additional project hours were often used to develop leadership initiatives and were not primarily designed to increase APRN clinical proficiency.
A September 6, 2024 CHCF blog notes that the national transition to DNPs has not caught on the way AACN envisioned, and an acute need for maternal health practitioners has some universities moving in the other direction. CHCF notes that in 2024, Rutgers University reinstated the nurse-midwifery master’s training it had eliminated in 2016. The University of Alabama-Birmingham also restarted its master’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, George Washington University in Washington, DC; Loyola University in New Orleans; and, the University of Nevada-Las Vegas added master’s training in nurse-midwifery. CHCF states that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year MSN. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees. The 2020 article in Nursing Outlook argued that the financial implication of requiring the DNP degree is the largest barrier to adoption, both for students and organizations, as a universal DNP requirement would have financial ramifications on three levels: a) cost to individual students; b) cost to institutions that financially support advanced nursing practice education; and, c) cost to schools. The article cites a 2019 study that revealed the average 2014 salary for DNP-educated CNMs to be $105,968; the average salary for master's-prepared CNMs was $102,576 in 2014. This annual differential of $3,392 in mean salary dollars pales in comparison to the differences in time, effort, and tuition dollars required of DNP students, compared to CNM students.
- Does a DNP degree outweigh the costs? According to the 2020 Nursing Outlook article, to date, the data is sparse. Many studies that do exist on the subject are descriptive, based on self-reporting, utilize small convenience samples, and/or do not address patient outcomes. Importantly, many studies do not differentiate outcomes between those who are CNMs and DNPs; they also tend not to distinguish between graduates of BSN-DNP programs and those who have received a post-master’s DNP. Several studies do indicate that DNP graduates are practicing in an array of settings and serving complex patients. Yet, in one 2019 study, 59% of DNP-prepared survey respondents from key professional nursing organizations (e.g., the American Academy of Nurse Practitioners, the American Organization of Nurse Executives, and the American Association of Nurse Anesthetist) reported that a DNP was neither required, nor preferred by their current employers. The article further notes that in a qualitative study of DNP employers, respondents reportedly perceived similar functions between DNPs and CNMs and were unable to differentiate between preparations due to several factors: a lack of DNP-specific positions in their organizations, limited employment of DNP-prepared nurses, and/or the fact that DNPs were too new to organizations to be accurately evaluated. Employers did, however, report that DNPs exhibited a better understanding of evidence-based clinical guidelines, a greater focus on translation of evidence into practice, and stronger knowledge of health policy, compared to master’s-level APRNs. This underscores the need for nursing leaders to gain consensus on what makes the DNP different, to disseminate that information to health system stakeholders, and to adjust their evaluation criteria accordingly, says the article.
- Related legislation. AB 836 (Stefani) requires HCAI, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. AB 836 is pending on the Assembly Appropriations Committee suspense file.
- Prior legislation. AB 1918 (Petrie-Norris, Chapter 561, Statutes of 2022) establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.
SB 65 (Skinner, Chapter 449, Statutes of 2021) establishes a comprehensive program to improve maternal and infant outcomes, including: a) requiring state and local investigating, tracking reviewing and reporting of maternal and infant deaths throughout the state; b) enacting the Midwifery Workforce Training Act to increase the number of students educated and trained as CNMs and midwives prepared for service in specified neighborhoods and communities; c) creating a workgroup related to Medi-Cal coverage for doulas; and, d) enhancing Cal WORKS benefits.
SB 1237 (Dodd, Chapter 88, Statutes of 2020) authorizes a CNM to attend to low-risk pregnancies and perform related incidental functions without physician supervision; replaces the supervision requirement for higher-risk pregnancies with mutually agreed-upon policies and protocols; requires the Board of Registered Nursing to establish a Nurse-Midwifery Advisory Committee; establishes a disclosure and informed consent requirement; and, establishes new reporting and data collection requirements.
- Support. The California Nurse Midwives Association, as sponsor, and other supporters state that California is experiencing a maternity care and labor and delivery crisis. This is despite the fact that the United States and California have a higher maternity and newborn death rate than other high-income countries. Further, over 50 maternity units in California have closed since 2013 and 20 freestanding birth centers have closed in just over three years. Midwifery care has demonstrated excellent clinical outcomes, but it is underutilized, and midwives can be mobilized to help address provider shortages. When they are integrated into health systems, midwives assist in more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, and vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower costs. There are also fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, NICU admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. Supporters further argue there is currently only one nurse-midwifery master’s degree program in California: CSU Fullerton. This lack of educational opportunity places limitations on the workforce potential and ultimately on access to high quality reproductive health care in California. To meet current demand, California needs as many clinically prepared midwives as quickly and cost-effectively as possible. With an effective pipeline, midwives can be rapidly and professionally prepared to provide high quality health care to both parent and child.
SUPPORT AND OPPOSITION:
Support: California Nurse Midwives Association (sponsor)
American Association of University Women of California
American Nurse Association\California
California Association of Christian Colleges and Universities
California Catholic Conference
California Latinas for Reproductive Justice
Citizens for Choice
National Health Law Program
Oppose: None received
-- END --
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