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CEO MESSAGE

This month, ACHD would like to highlight for all healthcare districts an issue that impacts many districts, but which may not be on your radar. Last fall, ACHD was made aware that many Health Professional Shortage Areas (HPSAs) in the state of California are under review by the Department of Health Care Access and Information (HCAI). HPSAs are official federal designations for places or groups of people in the United States that do not have enough primary care, dental, or mental health providers to meet local needs. California’s HPSAs are submitted in line with federal requirements for approval by Health Resources and Services Administration (HRSA). HRSA currently has several areas where HPSAs are proposed for withdrawal. These HPSAs and the proposed action can be found on HRSA’s website, here.

Here is the problem: HCAI does not have discretion over the criteria that determine HPSA scores. HPSAs have been used as a criterion to access several state and federal programs and flexibility. If a HPSA is withdrawn, the providers utilizing these programs would no longer be able to utilize them as of July 1, 2026. In addition, “HPSA” has been used as a definition in several state statutes. This would call these definitions, in many cases defining what is a “rural area”, into question for statutory applicability purposes. Furthermore, many healthcare district boundaries overlap with HPSA designated areas. Healthcare districts of all types fall into HPSAs that are currently being reviewed, many of which are proposed for withdrawal. For districts taking advantage of a state program or relying on any statutory provisions related to HPSA designation, they would no longer be eligible.

To address this important issue, ACHD is Co-Sponsoring AB 1811 (Rogers/Gonzalez) with the Rural County Representatives of California (RCRC). RCRC is co-sponsoring this legislation with ACHD as a trusted partner. ACHD’s Sarah Bridge has been working diligently since last fall on this issue, engaging the appropriate stakeholders and lawmakers to craft a solution, at least in the near term, so that healthcare districts in California, serving the most vulnerable populations with very few providers, do not lose access to state funding tied to this federal designation. Please reach out directly to Sarah if you have questions about this bill.

In addition, HCAI is hosting its upcoming HSPA Designation Workshop March 26-27. While this workshop is being held in San Diego, ACHD encourages members from throughout the state to attend if they are available. This will be an important informational gathering on this process and it is being hosted by HCAI, so you will hear from the source about this process.

In closing, the ACHD Board of Directors met for two days last week to discuss the next two years of our 2025-28 Strategic Plan. I’d like to personally thank the Board for their time commitment, energy and contributions to ensuring ACHD is on a promising path, well into the future.



As always, please feel to contact us directly if we can be helpful or provide assistance on any matter. 

With gratitude,

ACHD Leg Update

With the final day to introduce legislation in the second year of the two-year session, ACHD is in the process of reviewing well over one thousand bills for impacts on healthcare districts. Bills must be in print for 30-days before they can be heard. Additionally, March 2 was the deadline for offices to get substantive language in on bills. That means, many bills that were in spot form (place holder bills) will now have substantive language. Please be vigilant for calls to action on our sponsored legislation. We will be sending out requests for support letters as soon as the bills are set in Committee.

Bills

AB 2311 (Schiavo): Health Care District: employment - ACHD Sponsor

Currently, California allows critical access hospitals, federally qualified health centers (FQHC), designated public hospitals and academic medical centers to directly employ a physician. This leaves (as of 3/5/2026) fifteen district hospitals as the only, independent, public hospitals unable to utilize this critical tool. AB 2311 would allow district hospitals, as specified, to directly employ a physician. The fact sheet can be accessed here.

AB 1811 (Rogers) Health Professional Shortage Areas - ACHD Co-Sponsor

Would preserve health profession shortage areas (HPSAs) for the purposes of state programs and can serve as a vehicle for other necessary changes needed to preserve or support the preservation of these designations. A fact sheet can be accessed here.

AB 1923 (Soria) Distressed hospital loan program - ACHD Support

Sponsored by the California Hospital Association (CHA), AB 1923 would modify the existing distressed hospital loan program (DHLP) to allow for entire loan forgiveness and re-authorize the fund for an additional $300 million.

AB 2096 (Pacheco) Vocational Nursing: respiratory care - ACHD Support

Due to continued regulatory erosion, licensed vocational nurses (LVN) have lost the ability to provide most respiratory care tasks in specified settings. AB 2096 would authorize a licensed vocational nurse to perform respiratory tasks and services consistent with the scope of practice of a licensed vocational nurse, as it existed on December 31, 2022.

SB 947 (McNereny) Employment: automated decision systems (ADS) - ACHD Oppose

For those who recall SB 7, from last year, Senator McNerney and The Labor Federation have re-introduced the bill with some modifications. However, while worse in some places and better in other, the policy would increase disclosure and notice requirements for use of ADS in decisions materially related to an employment action. ACHD is currently among a coalition of local government associations that will adopt an initial oppose position on the matter.

California State Assembly & Senate Informational Hearing

On March 10, 2026, the Assembly and Senate Health Committees will meet for an informational hearing related to H.R. 1 response. The title of the hearing is “The Cost of Uncertainty: Health Coverage Access and Affordability Amid Federal Instability”. ACHD was offered a panelist spot to discuss the impacts of H.R. 1on healthcare districts. Darren Beatty, Chief Operating Officer, will present on behalf of Plumas District Hospital and ACHD to share impacts and solutions as we currently understand them. These comments and materials have been guided by collaboration with the Senate and Assembly Health Committees and ACHD’s H.R. 1 Response Working Group. We thank everyone for their feedback and participation and look forward to Mr. Beatty’s remarks next week. For those interested in the materials or live streaming the hearing, those details can be found here 24-hours before the hearing.