AB 836 directs the Department of Health Care Access and Information (HCAI) to administer, subject to a legislative appropriation, a statewide study of midwifery education carried out by an outside consultant. The bill specifies a broad scope: education trends, financing and student debt, diversification of student pipelines, clinical preceptor shortages, possible consortia and training innovations, and workforce demand and job prospects.
Why it matters: the study is designed to produce an actionable inventory of where midwifery education can expand and how it can be financed and staffed to meet California’s birthing needs, including rural coverage and interprofessional training pathways. Because the work is appropriation-dependent and wide-ranging, the study will shape near-term planning for educators, health systems, and state workforce policy if funded and implemented.
At a Glance
What It Does
The bill requires HCAI, once the Legislature appropriates funds, to hire an outside consultant to conduct a statewide study of midwifery education and training capacity in California. The study must cover financing, student debt, pipeline diversification, clinical preceptor capacity, program locations (including sites outside schools of nursing), interprofessional training sites, and workforce projections.
Who It Affects
Directly affected parties include midwifery education programs (existing and prospective), health systems and hospitals that host clinical preceptorships, community-based birth centers, students and prospective students in midwifery programs, and state workforce and education planners. Rural communities and institutions not affiliated with nursing schools are specifically within the study’s scope.
Why It Matters
The study creates a roadmap for expanding midwifery training capacity and financing options, potentially unlocking new program models (consortia, community-based programs) and identifying clinical-site bottlenecks. For compliance officers and planners, the report will inform program accreditation choices, funding requests, and partnerships between midwifery programs and clinical sites.
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What This Bill Actually Does
AB 836 tasks the Department of Health Care Access and Information with running a statewide study of midwifery education — but only if the Legislature provides funding. HCAI must hire an outside consultant who understands California’s health and midwifery landscape to carry out the work.
That consultant is expected to survey both current programs and potential program hosts, and to analyze national and state trends in midwifery education.
The bill lays out specific subjects the study must address. Those items fall into three practical buckets: finances (cost to educate midwives, student debt, sustainable financing and available federal/state funding), training capacity (locations able to house programs, consortium models, innovations that let different midwifery paths train together, and strategies to diversify the student pipeline), and clinical capacity/workforce (preceptor and site shortages, rural and urban program viability, interprofessional training sites, and projected job openings and workforce needs).Once the consultant completes the study, HCAI must submit a report to the Legislature in the manner required by Government Code section 9795 and post the report to its website.
The bill requires HCAI to notify its reproductive health and maternity care mailing list no later than 36 months after the actual appropriation of funds. The statute closes by defining “reproductive health care professionals” broadly to include clinicians (MDs, CNMs, RNs, PAs, NPs, LVNs), licensed midwives, doulas, and perinatal community health workers, reflecting the cross-disciplinary workforce the study must consider.
The Five Things You Need to Know
The department may only start the study if and when the Legislature appropriates funds; funding is a precondition to contracting an outside consultant.
The consultant’s scope must include a financial sustainability plan that reports the cost to educate midwives in California and proposes long-term financing options, including assessment of state and federal funding sources and average student debt per program.
The study must identify institutions and programs that can host midwifery education — explicitly including organizations outside of traditional schools of nursing — and evaluate program models for both rural and urban areas.
The bill directs the study to propose concrete solutions for the shortage of clinical preceptors and precepting sites, and to map potential sites for interprofessional education between resident obstetricians and midwives.
HCAI must file the consultant’s report with the Legislature per Government Code section 9795 and post it online; the department must notify its reproductive health and maternity care email list no later than 36 months after the actual appropriation of funds.
Section-by-Section Breakdown
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Appropriation-dependent administration and outside consultant requirement
This subsection makes the study conditional on a legislative appropriation and assigns HCAI the administrative role. Practically, HCAI must run the procurement, selection, and contract management for an outside consultant — the bill does not allocate funds itself or specify procurement rules, so standard state contracting and appropriation processes will control timing and vendor selection.
Education trends, financing, and student debt
Paragraphs 1–4 require the consultant to measure current midwifery education models and financial realities: program costs, typical student debt, and where long-term financing might come from. This is the bill’s fiscal core — the deliverable is not just a cost inventory but a financial sustainability plan that evaluates federal and state funding options and recommends pathways to cover tuition and fees.
Pipeline, clinical training capacity, and innovation in program models
Paragraphs 5–12 direct the study to examine barriers to entry and retention (prospective and current students, preceptors), identify institutions that can host programs (including non-nursing entities), assess rural versus urban program viability, explore consortium models to keep students in their communities, and evaluate co-training innovations allowing nurse-midwives and licensed midwives to train together with distinct exit requirements. These requirements push the consultant to produce programmatic models, not just descriptive analysis.
Workforce needs and job-market assessment
Paragraphs 13 and 14 require current and projected demand estimates for midwifery and related reproductive health professionals, and an assessment of jobs available for new graduates with projected growth. These workforce projections are meant to connect education-capacity recommendations to real labor-market demand so policymakers can weigh expansion against employability and regional needs.
Reporting, publication, timelines, and definitions
Subsection (c) requires HCAI to submit the study’s report to the Legislature in compliance with Government Code section 9795; subsection (d) requires posting the report to HCAI’s website and notifying the department’s reproductive health and maternity care mailing list no later than 36 months after actual appropriation. Subsection (e) provides a broad statutory definition of “reproductive health care professionals,” explicitly including doulas and perinatal community health workers — signaling that the study must consider roles beyond licensed clinicians.
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Who Benefits
- Midwifery students and prospective students — the study’s financing analysis and tuition/funding mapping could identify scholarships, loan supports, or program models that reduce student debt and barriers to entry.
- Community birthing programs and rural communities — the study’s focus on rural program viability and consortium models aims to generate training pathways that keep students and services in underserved areas.
- Midwifery education programs and nontraditional academic hosts — institutions outside schools of nursing that could host programs will get an assessment of capacity and potential funding routes to stand up curricula.
- State workforce planners and policymakers — the report’s workforce projections and financing plan provide evidence to justify budget requests and program approvals.
- Hospitals and residency programs — mapping interprofessional education sites creates opportunities to formalize partnerships with obstetrics residencies and integrate midwives into clinical training pipelines.
Who Bears the Cost
- Department of Health Care Access and Information — HCAI must manage contracting, oversight, and the reporting process; if appropriation is limited, those administrative costs and staff time will compete with other priorities.
- The Legislature or state budget — because the study is appropriation-dependent, funding the study and any ensuing program expansions will require state dollars or reallocated budget authority.
- Educational institutions that implement recommendations — programs that adopt new curricula, consortium arrangements, or expanded clinical placements will incur start-up and ongoing costs not covered by the study itself.
- Hospitals and clinical sites — expanding preceptorships and interprofessional training will require investment in supervision time, scheduling adjustments, and possibly compensation for preceptors.
- Potential federal/state program administrators — if the study recommends new funding mechanisms, agencies may face administrative costs to design and distribute grants or tuition supports.
Key Issues
The Core Tension
The core tension in AB 836 is between urgency to expand and diversify midwifery training to meet access and equity goals, and the practical limits of financing, clinical precepting capacity, accreditation, and quality assurance; solutions that broaden the pipeline and geographic reach may require new funding and supervisory resources the system currently lacks.
The bill is intentionally broad; that breadth is both a strength and an implementation risk. By asking for finance, program design, workforce projections, and clinical-site solutions in one study, AB 836 creates a deliverable that could become a high-level catalog rather than a set of actionable, prioritized recommendations — unless the consultant’s scope and HCAI’s contract explicitly require implementation-ready options and cost estimates.
The statute leaves procurement, vendor selection criteria, timeline specifics, and deliverable format to HCAI and Government Code section 9795, which could produce variability in quality and stakeholder trust.
Another practical tension is timing and conditionality. Making the study contingent on appropriation avoids automatic spending but introduces uncertainty: stakeholders cannot plan around the study’s findings until funds are released, and the bill’s 36-month deadline for posting and notification is measured from the actual appropriation, not from contract execution.
That creates a potentially long lag between authorization and usable results. Finally, the bill directs the study to consider non-nursing hosts and co-training models, but it does not engage accreditation, licensure, or scope-of-practice issues that will determine whether proposed program models are viable in practice — leaving a follow-on policy gap between study recommendations and regulatory or accreditation steps required to implement them.
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