BILL ANALYSIS                                                                                                                                                                                                    






                          SENATE COMMITTEE ON EDUCATION
                               Gloria Romero, Chair
                            2009-2010 Regular Session
                                         

          BILL NO:       AB 1703
          AUTHOR:        Knight
          INTRODUCED:    March 18, 2010
          FISCAL COMM:   Yes            HEARING DATE:  June 16, 2010
          URGENCY:       No             CONSULTANT:Daniel Alvarez

           SUBJECT  :   Financial Aid: State Nursing Assumption Program -  
          Veterans' Homes

           KEY POLICY ISSUE  

          Should the maximum loan assumption payment for registered  
          nurses participating in the State Nursing Assumption Program  
          of Loans for Education who work in state operated veterans'  
          homes be increased from $20,000 to $40,000?

           SUMMARY   

          This bill increases the maximum loan assumption payment for  
          registered nurses (RNs) participating in the State Nursing  
          Assumption Program of Loans for Education - Nurses in State  
          Facilities (SNAPLE-NSF) who become employed full-time in a  
          state-operated veterans' home from $20,000 for four-years of  
          service to $40,000.

          The bill also expands the conditions under which a SNAPLE-NSF  
          participant may receive a one-year extension in which to  
          complete their required four years of consecutive service to  
          include deployment for active military duty.

           BACKGROUND  

          Existing law, effective January 1, 2007, established the  
          SNAPLE-NSF program, administered by the California Student  
          Aid Commission (CSAC).  This program is intended to encourage  
          registered nurses and students who will become registered  
          nurses to seek employment in state-operated 24-hour  
          facilities (e.g. prisons, psychiatric hospitals, and  
          veterans' homes) that have a registered nurse vacancy rate of  
          greater than 10 percent. It will pay up to a total of $20,000  
          in outstanding student loans ($5,000 per year for up to four  
          consecutive years) for full-time employment as a registered  



                                                                 AB 1703
                                                                  Page 2



          nurse in an eligible state-operated facility. Applicants may  
          be students in an approved pre-licensure nursing program or  
          may have completed a program within the award year.   
          (Education Code  70120)






           ANALYSIS  

           This bill  :

          1)   Increases from $5,000 per year to $10,000 per year for  
               up to four years the maximum amount of loan payment that  
               may be assumed for clinical registered nurses  
               participating in the SNAPLE-NSF program who are employed  
               full-time in a state operated veterans' home.

          2)   Expands the reasons under which a SNAPLE-NSF participant  
               may be granted a one-year extension in which to complete  
               the required four years of consecutive employment to  
               include active military duty.

           STAFF COMMENTS  

           1)   Need for the bill  :  According to the author's office,  
               veterans' homes have been especially challenged in  
               meeting the needs of their patients.  It is hoped that  
               by increasing the loan assumption limit the program will  
               attract far more participants, meaning more qualified  
               nurses in veterans' homes.

           2)   Current Program Status  .  Information from the California  
               Student Aid Commission (CSAC) indicates that:

                        There are currently 20 state operated  
                    facilities that qualify to participate in  
                    SNAPLE-NSF because they have vacancy rates greater  
                    than 10 percent.  Of these, only one is a veterans'  
                    home (14 are correctional institutions and the rest  
                    are developmental centers, diagnostic centers or  
                    state psychiatric hospitals).  The remaining four  
                    veterans' homes have RN vacancy rates of less than  
                    10 percent and, therefore, are not eligible work  
                    sites for participants.



                                                                 AB 1703
                                                                  Page 3




                        Since January 2007, 240 loan assumption  
                    agreements have been made available.  For these,  
                    there have been a total of 13 applicants and 12  
                    selected participants.  Of the 12, two are  
                    currently employed (neither at a veterans' home).

                        Loan assumption payments may not exceed the  
                    participant's student debt.  It is relatively rare  
                    for a student's debt to reach $40,000 ($44,000 is  
                    the largest debt of current participants).

           1)   Legislative Analyst's (LAO) Report due in less than a  
               year  .  It is not clear why overall participation in this  
               program is relatively low.  Could it be because the  
               program is relatively new, not well known or perhaps  
               because nursing students carry less debt?  Could it be  
               for internal structural reasons?  For example, the  
               Yountville Veterans' Home website indicates than RN  
               applicants must have permanent state service status or  
               be working in a class eligible for a lateral transfer, a  
               potential hurdle for a newly licensed nurse.  Whatever  
               the reason(s), current law (EC  70127) requires the LAO  
               to submit a report to the Legislature on the efficacy of  
               this program by May 1, 2011.  Wouldn't it make more  
               sense to wait for the LAO's report and recommendations  
               before changing the structure of this program to address  
               a potential problem for which we don't know the cause?

           2)   Do loan assumption programs change behavior  ?   There is  
               very little literature to indicate that loan assumption  
               programs actually change a participant's behavior.  In  
               fact, there is substantial concern that such programs  
               may only be providing financial incentives to  
               individuals who would have undertaken the same action  
               even without the incentive.  Does it make sense to  
               increase the financial incentive for this program  
               without knowing if, in fact, it will change a person's  
               behavior?

           3)   Should there be differential loan assumption amounts  ?   
               SNAPLE-NSF was established to try and attract RNs to any  
               of the state's 24-hour facilities with substantial  
               vacancy rates (defined as exceeding 10% for purposes of  
               this program).  This bill will have the effect of making  
               employment under this program at a veterans' home  
               potentially twice as lucrative as employment at any  



                                                                 AB 1703
                                                                  Page 4



               other participating state facility, even ones with  
               greater RN vacancy rates.  Does it make sense to provide  
               double the incentive ($40,000) to an RN who works at the  
               Yountville veterans' home which has a 20% vacancy rate,  
               than to an RN who would work at the Salinas Valley  
               psychiatric program which has a 21% RN vacancy rate or  
               the Ventura Youth Correctional Facility which has a 26%  
               vacancy rate?  

           4)   2007 Budget included Funding for Pay Increases in  
               Veterans' Homes  .  The 2007 Budget included $1.5 million  
               for pay increases for various health care positions  
               within Veteran Affairs Homes, including registered  
               nurses.  The pay increases were to provide greater  
               parity between positions in Veterans Affairs and their  
               counterparts within the Department of Corrections and  
               Rehabilitation and the private sector, and better enable  
               Veterans Affairs to recruit and retain medical and  
               health care personnel.

           5)   Why $40,000  ?  This bill increases the maximum loan  
               assumption under the SNAPLE-NSF program from $20,000 to  
               $40,000 for selected participants.  Why $40,000?  
           

          6)   Amend bill to allow CSAC to offer extensions of greater  
               than one-year  .  The bill proposes to add  "active  
               military duty" as a circumstance under which  
               participants who are unable to complete one of their  
               four consecutive years of nursing employment are  
               required to be granted a one-year extension.  This would  
               be consistent with several other CSAC-administered loan  
               assumption programs (e.g.: SNAPLE - nursing faculty EC  
               70104 (b); California Physician Assistant Loan  
               Assumption Program EC  69667 (b)(2); and APLE -  
               Assumption Program of Loans for Education (APLE)          
                      EC  69613.6).  Under current law [EC  70124  
               (b)], participants in SNAPLE-NSF may be granted an  
               extension only for one of the following three reasons:  
               (a) serious illness, (b) pregnancy or (c) other natural  
               causes.  

          In addition, in other loan assumption programs current law  
               also allows CSAC, at its discretion, to extend a  
               deferral for longer than the one-year period.   
               Accordingly, staff recommends amending the bill to make  
               it consistent with the other loan assumption programs to  



                                                                 AB 1703
                                                                  Page 5



               also allow CSAC to extend a deferral for longer than the  
               one-year period.

           7)   Nursing shortage  .  This program was established as part  
               of comprehensive legislation (SB 1309, Scott; Ch 837,  
               Statutes of 2006) which addressed many aspects of the  
               overall nursing shortage.  At the time, it was not  
               uncommon for hospitals to offer "signing bonuses" of  
               $20,000 - $25,000 and the SNAPLE-NSF program was  
               established, in part, to compete with such signing  
               bonuses.  However, currently, the demand for nurses has  
               declined (primarily due to the poor economy: nurses are  
               delaying retirement and/or working more shifts) and it  
               is rare that a recruitment bonus is offered.  A recent  
               RN opening in Sacramento, for example, had over 600  
               applicants for a single position. 

           8)   General Fund Pressure Increases in Future Years  .  The  
               fiscal implications of increasing the funding level of  
               loan assumption warrants is not immediate, but rather in  
               future years because actual costs are delayed while the  
               participant begins to complete their employment  
               requirements.  

               The Assembly Appropriations Committee indicated that  
               "assuming the availability of higher loan assumption  
               payments results in two additional SNAPLE-NSF  
               participants each year, additional general fund costs  
               would be $20,000 in 2011-12, increasing to $80,000 in  
               2014-15 and thereafter.  The California Student Aid  
               Commission (CSAC) also indicates a need for additional  
               administrative resources for the SNAPLE-NSF."

           SUPPORT
           
          None received.

           OPPOSITION
           
          None received.