Twelve governors flagged health care workforce needs as a key priority in their 2018 State of the State Addresses, an increase from only eight in 2017. States across the country are experiencing shortages of health care professionals, with the gap projected to increase in the coming years as America’s population continues to age. These workforce shortages can be more acute in rural areas and in specific fields (behavioral health, oral health, and primary care), and can affect access to care, cost of care, and state delivery system reform efforts. To address critical health care workforce shortages, policymakers are working across state agencies, aligning resources, data, and expertise to better address the problem.
States have a number of resources, typically dispersed across multiple agencies, which can be used to address healthcare workforce, including:

• Every four years the governor’s office in each state submits their Work Force Innovation and Opportunity Act (WIOA) state plan, which sets the state’s workforce priorities; some states (for instance, Montana) have opted to include healthcare as a focus area. To support these priority areas, governors can allocate up to 15 percent of state WIOA formula funds to statewide workforce development initiatives.
• State departments of labor often administer programs, such as employment services and training and skill building programs for adults, dislocated workers, and youth.
• State departments of education often administer vocational rehabilitation services programs, which provide employment, training, and support services to individuals with disabilities, as well as adult education programs. State universities, community colleges, and/or departments of education can develop and administer career pipeline or pathway programs, which introduce students to health professions or provide adults with career training opportunities. Medical and nursing schools across the country serve as Area Health Education Centers (AHECs) to provide resources and training for health careers to their communities.
• State departments of health in most states manage their state loan repayment programs, including any federal matching funds, and the Primary Care Offices are responsible for submitting applications for Health Professional Shortage Area (HSPAs) designations and resources.
• Medicaid often contributes to state graduate medical education (GME) funding. Medicaid can also incorporate workforce initiatives into 1115 Demonstration waivers.

A Closer Look at Indiana
To avoid silos, states, often through governors’ initiatives, are bringing together agencies such as health and human services, labor, and education (including state universities) to maximize available resources and ensure a coordinated approach. In one leading state, Indiana’s then-Governor Mike Pence established the Indiana Governor’s Health Workforce Council. The Council brings together a diverse group of stakeholders, including state agencies, legislators, state universities, professional associations, and employers, to identify and coordinate on the state’s healthcare workforce needs and solutions. The workgroup has prioritized several areas, including:

• Pre-nursing certificate pathway. In response to recommendations and findings from the Council’s Education, Pipeline, and Training Taskforce, Ivy Tech Community College established a pre-nursing certificate pathway for certified nursing aides (CNAs) to make it easier for them to become licensed practical nurses (LPNs) or registered nurses (RNs).
• Community health worker (CHW) certification and reimbursement. The Council has convened a Community Health Worker Workgroup, which is working to develop a statewide definition and certification requirements. The Council has also been collaborating with Medicaid to develop a reimbursement methodology for CHWs.
• Telehealth. The Council’s Mental and Behavioral Health Workforce Taskforce also put forward recommendations that led to the adoption of House Enrolled Act 1337, which allows for the delivery of some mental health and addiction treatment services through telehealth.

Cross-agency partnerships provide a foundation for states to implement workforce development programs and reforms, such as those in Indiana. As part of a cooperative agreement with the HRSA, NASHP is researching state partnerships across the country, learning how they have used diverse governance models and policy levers to address state healthcare work force needs. Look for a series of state case studies and other NASHP resources that explore these issues. NASHP’s 31st Annual State Health Policy Conference, taking place on Aug. 15-17, 2018, will also feature sessions on state strategies to address health care workforce challenges. Register here.

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