Medical Board staff warn licensed midwife fund will be insolvent without fee increases

The Medical Board of California’s Midwifery Advisory Council heard on the fund condition for the licensed midwife program and was told the program’s current fees are insufficient to cover operations. Marina Okconor, a board staff member, presented two fund scenarios and said the status-quo path would leave the fund insolvent by fiscal year 2029–2030.

Okconor summarized historical revenue and expenditures and said the fund’s revenue has lagged program costs for years. “Effective January 1, 2022, the license application fee increased from $300 to $450 and the renewal fee increased from $200 to $300,” she said, but “this fee increase was not enough to fully fund the program’s operations and the structural imbalance continued.” Under the board’s baseline projection, the fund would go negative near FY 2029–2030.

To prevent insolvency, staff presented a tiered fee plan that would require legislative change. Okconor described a proposal that phases in higher biennial fees (examples discussed during the presentation: an initial combined application/renewal level that yields roughly $1,260 and a later tier around $1,570) and builds in additional expenditure authority so the program can pay its true operating costs, which staff estimated nearer to $370,000 annually once shared services and enforcement costs are fully accounted for.

Council members pressed staff for more detail on how the board calculates expenditures, particularly enforcement costs. Members noted that even a single fully litigated enforcement case can drive expenses well beyond the program’s current statutory expenditure cap. "Just one enforcement case going all the way through the process can be very costly," a member said during the discussion; staff acknowledged that individual cases can be expensive and described ongoing efforts to make enforcement triage more efficient.

Staff also said the timing of fee changes would likely align with the board’s upcoming sunset review process: any fee statute change would require legislation and could take multiple years. Okconor cautioned that the specific fee numbers would be revisited when a legislative proposal is prepared: “these numbers are based on today’s costs,” she said, and could change before a bill is introduced.

The council requested more transparent, regular reporting on how midwifery fund dollars are allocated — for example, a breakdown of salaries, benefits, licensing processing and investigative costs — and encouraged staff to return with clearer line-item explanations at future meetings. The advisory council did not take any formal action on the proposed fees during the meeting; staff said recommendations would proceed through the board’s legislative and sunset-review processes.

Next steps: staff will refine expenditure breakdowns and continue working with the Department of Consumer Affairs and the Department of Finance; the earliest possible implementation date discussed for the first fee tier was January 1, 2028, but any change requires statutory approval and additional vetting.