SB 520 creates the California Nurse‑Midwifery Education Fund, administered by the Department of Health Care Access and Information, to finance the development of California‑based, master’s‑level nurse‑midwifery programs housed at the California State University system, the University of California, or both. The department must run a competitive application process, ensure programs can culminate in a master’s degree if chosen, and limit state support to the development and first‑cohort operating costs for up to five years.
This bill is aimed at expanding the state’s midwifery workforce as a policy response to maternity‑care access gaps and documented facility closures. For professionals who manage clinical education, workforce planning, or university budgets, the law creates a targeted funding stream and operational deadlines that will shape program design, accreditation planning, clinical placement arrangements, and campus resource commitments.
At a Glance
What It Does
Creates the California Nurse‑Midwifery Education Fund within the Department of Health Care Access and Information and authorizes the department to accept General Fund appropriations, donations, and transfers. The department must run a competitive selection for CSU/UC sites, require programs to offer a master’s degree option, and ensure programs meet California regulatory requirements and Accreditation Commission for Midwifery Education (ACME) standards. State support covers operating costs through the graduation of the first cohort or five years, whichever is shorter.
Who It Affects
California State University and University of California campuses that design or host graduate midwifery programs, prospective nurse‑midwifery students, hospitals and clinics that provide clinical training placements, and the Department of Health Care Access and Information (which will administer the fund and selection process).
Why It Matters
It seeds graduate‑level midwifery education capacity where California currently has very limited in‑state training, creating a government tool to increase the midwife supply. The structure — competitive grants plus a short initial funding window — will shape how quickly programs launch, how they stand up accreditation, and whether new graduates ultimately practice in underserved areas.
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What This Bill Actually Does
SB 520 responds to a documented shortage of maternity care capacity by creating a dedicated fund to start master's‑level nurse‑midwifery programs in California’s public university systems. The statute gives the Department of Health Care Access and Information authority to run a competitive process to pick campus sites and directs that chosen programs be capable of conferring a master’s degree as the terminal credential if the program elects to offer it.
The bill builds several operational constraints into the funding. The fund can receive General Fund appropriations (the Legislature signaled an intent to provide $2 million for 2025–26), private donations, and other transfers.
Grants from the fund are explicitly time‑limited: the department must support development and annual operating expenses only through the first cohort’s graduation or for five years, whichever comes first. Programs must comply with California’s nurse‑midwifery education regulations and satisfy ACME accreditation or preaccreditation requirements; the statute also allows programs to be located outside a school of nursing, giving campuses flexibility in academic placement.The law includes a clear anti‑supplanting rule: any funds deposited into the new fund must supplement, not replace, existing midwifery education funding—this includes Song‑Brown allocations and university budget lines.
Practically, that means campuses and the department will need to track baseline funding and document how new grant dollars add capacity rather than substitute for ongoing institutional support. The statute leaves several implementation details to the department, including the competitive criteria, how to demonstrate “areas of demonstrated maternity or midwifery workforce need,” and the specific accountability metrics tied to grant awards.Operationally, launching master’s‑level clinical programs within a short funding horizon creates predictable logistical demands: recruiting faculty with midwifery credentials, securing sufficient clinical preceptor placements, and meeting ACME’s timeline for preaccreditation and candidacy can all take multiple years.
Because the statute only seeds the initial development and early operation, campuses must plan for sustainability beyond the five‑year window if they want to continue enrolling and graduating cohorts on a lasting basis.
The Five Things You Need to Know
Section 128570 establishes the California Nurse‑Midwifery Education Fund and assigns administration to the Department of Health Care Access and Information.
The Legislature signaled an intent to appropriate $2,000,000 to the fund for the 2025–26 fiscal year; the fund may also accept donations, fees, and transfers.
The department must run a competitive application process that prioritizes program sites serving areas of documented maternity or midwifery workforce need.
Programs receiving grants must meet California nurse‑midwifery education regulatory requirements and the Accreditation Commission for Midwifery Education (ACME) accreditation or preaccreditation standards; programs may be outside a school of nursing.
State funding will cover development and annual operating costs only through the graduation of the first cohort or five years, whichever is shorter, and the statute requires those funds to supplement, not supplant, existing midwifery education funding (including Song‑Brown allocations and university budgets).
Section-by-Section Breakdown
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Why the Legislature acted: access, outcomes, and a thin pipeline
The bill opens with findings documenting extensive maternity‑care closures and a shortage of midwives relative to obstetricians, and it cites comparative international midwife‑to‑physician ratios and maternal mortality statistics. Those findings establish the policy justification for using state dollars to expand in‑state training capacity rather than relying solely on out‑of‑state programs or private training pipelines. For implementers, the findings clarify the Legislature’s explicit goal: expand the supply of clinically trained midwives to improve maternal outcomes and reduce geographic disparities.
Fund creation, administration, and revenue sources
This section creates the California Nurse‑Midwifery Education Fund inside the Department of Health Care Access and Information and authorizes the department to receive appropriations from the General Fund and other contributions. The statute names the department as the fund administrator, which centralizes selection, contracting, and reporting responsibilities in a single state agency. Practically, that places responsibility for grant design, solicitation, and compliance monitoring with an agency that already manages health workforce investments.
Competitive selection, degree option, and accreditation hurdle
The department must design competitive application criteria that prioritize sites in areas with demonstrated maternity or midwifery workforce need. Awarded programs must offer a master’s degree as an available culminating credential if they choose, meet state nurse‑midwifery program regulations, and satisfy ACME accreditation or preaccreditation requirements. Notably, the statute permits programs to be organized outside conventional schools of nursing, which gives campuses latitude in locating programs within public university structures. The section also caps state support to the development and initial operating costs through first‑cohort graduation or five years, emphasizing short‑term seeding rather than ongoing subsidy.
Supplement‑not‑supplant and budget protections
This clause requires that any funds deposited into the new fund augment existing midwifery education funding streams—explicitly including Song‑Brown program allocations—and not displace them. It also instructs that grant dollars must supplement, not replace, any university budget allocations. For universities and auditors, this creates an accounting requirement: awardees will need to show incremental expenditures and avoid budgetary substitutions that would undermine the Legislature’s intent.
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Who Benefits
- Birthing people in underserved counties and maternity‑care deserts — expanded in‑state training is intended to increase the supply of midwives who can staff clinics and birthing centers in areas currently lacking services.
- Aspiring nurse‑midwives — the fund reduces geographic and capacity constraints by creating additional master’s‑level program slots and a local pathway to clinical training and credentialing.
- Public university campuses that win grants — they receive seed funding to develop new graduate programs, which can bolster campus clinical education profiles and attract allied health faculty.
- Public payers and health systems — increased midwifery capacity can translate into more low‑intervention births and potential cost savings in perinatal care, benefiting Medi‑Cal programs and safety‑net providers.
Who Bears the Cost
- The State General Fund — the department may receive appropriations (the bill signals an initial $2 million), so taxpayers underwrite the startup costs of new programs.
- CSU and UC campuses beyond the grant period — because state support is time‑limited, campuses that want to sustain programs must reallocate institutional funds or secure other revenues to continue operations after the first cohort.
- Clinical training sites and existing maternity providers — hospitals and clinics will need to provide preceptors, supervision, and clinical slots, potentially increasing operational strain without direct offsets in the statute.
- Department of Health Care Access and Information — the department must run the competitive process and oversee compliance, which requires administrative capacity and program monitoring resources.
Key Issues
The Core Tension
The central dilemma is speed versus sustainability: the bill pushes for quick expansion of in‑state midwifery training with short, targeted seed funding, but establishing accredited, clinically robust master’s programs requires multi‑year investment, stable institutional commitments, and sufficient clinical capacity—trade‑offs that could produce graduates sooner but not necessarily sustainably increase access where it’s most needed.
The statute seeds program development but does not specify the scale of investment needed to launch and sustain accredited master’s programs. The Legislature’s $2 million intent for 2025–26 is useful as startup capital but likely insufficient to fully underwrite faculty hires, long clinical placements, and the accreditation timeline required by ACME for multiple campuses.
That funding picture creates a practical tension: programs may launch in name but struggle to meet accreditation and clinical volume requirements without additional resources.Answerability and accountability are thin in the text. The department must create competitive criteria and prioritize areas of “demonstrated need,” but the bill does not define metrics for that determination or require specific retention or placement outcomes for graduates.
This ambiguous targeting raises implementation questions about geographic allocation, how to measure success, and how the department will enforce the supplement‑not‑supplant clause. Tracking incremental versus baseline funding will require clear accounting rules and audit capacity.Finally, the statute expects universities to absorb ongoing program costs if state support ends after the inaugural cohort; it does not provide explicit sustainability grants or loan‑forgiveness tied to practice in shortage areas.
As a result, the state could produce new graduates without sufficient incentives to retain them in underserved settings, limiting the bill’s intended workforce impact. There are also practical barriers—faculty recruitment, preceptor availability, and collective bargaining differences across CSU and UC—that could delay program start dates and increase costs beyond the five‑year support window.
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