Top Health Workforce Themes in the 2025 Legislative Session

by Guest Author | Jan 28, 2025 | Data, Policy

The 2025 legislative session is in full swing, and the landscape just got easier to navigate. Almost 300 bills related to health, the health workforce, or the workforce generally were introduced this session. The Bowen Center will be tracking these bills as the session continues. While you’ll still find our comprehensive bill tracking table with all the details on each bill being considered, we’re excited to introduce a new dynamic dashboard that puts the session’s pulse at your fingertips. Our interactive infographic gives you real-time insights into the status of health care workforce legislation, from start to finish, across both chambers. Whether you’re tracking workforce initiatives, regulatory changes, or public health measures, you can now visualize the flow of bills through the legislative process and quickly identify trends in health care policy priorities. We have summarized a few pieces of legislation below that intersect with work previously done by the Bowen Center. Check out the dedicated Bowen Bill Brief page for full details on all the bills we’re tracking.

Nursing Workforce

There are several bills this session focused on the advanced practice registered nurse (APRN) workforce. SB 447 aims to establish a license specifically for APRNs in Indiana. APRNs are licensed registered nurses (RN) with additional training that provides the clinical knowledge and experience to deliver advanced nursing care. Currently, all Indiana APRNs are required to hold an Indiana RN license, and many, but not all, also hold an APRN prescriptive authority license. In 2023, the Bowen Center completed a national review of state approaches to APRN licensing to see how Indiana’s approach compared to other states. Only one other state (Wisconsin) has an approach similar to Indiana’s, and this is still the case in 2025. Check out the full report here.)

Physician Workforce

Indiana is facing a physician workforce shortage due to multiple factors, including burnout, an aging population, and competition from other states. Both HB1068 and HB1400 focus on workforce incentives targeted toward retaining physician talent in Indiana. HB1068 seeks to establish a program for medical school loan forgiveness while HB1400 seeks to provide a tax credit for preceptors in medical education. Many states have used tax credits to retain and recruit the clinical preceptors required for health professions’ education. In 2024, the Bowen Center reviewed tax credits as an incentive strategy for clinical preceptors using data from other state program evaluations. More information can be found here, including considerations for Indiana.

Recruitment of physicians plays a role in alleviating physician workforce shortages. HB 1555 focuses on the recruitment of foreign trained physicians to Indiana. HB1555 seeks to establish a limited medical license for those who have graduated from international medical programs, obtained a sponsor, and agreed to work in a medically underserved area. In 2021, 22% of actively practicing physicians licensed in Indiana reported completing their education in another country. This suggests that HB1555 may have significant impacts on workforce supply. Check out the education tab on the Bowen Center’s Indiana Physician Workforce Dashboard to get information on Indiana Physicians who completed medical school in another country.

Behavioral Health

All of Indiana’s 92 counties contain a federally designated mental health workforce shortage. As a part of the Playbook Project, the Bowen Center convened stakeholders to discuss challenges and opportunities for strengthening the pathway to practice for the mental and behavioral health professionals in Indiana. Opportunities to streamlining licensing while maintaining safety and quality were identified as a top priority by many stakeholders. HB1520 and SB216 include proposed changes to licensing policies for selected professions.

Workforce incentives were another priority identified by stakeholders during the Playbook Project. Incentives are needed to recruit and retain qualified behavioral health and human services professionals into the workforce. HB1154 aims to establish a behavioral health preceptor tax credit. This bill, in hopes of aiding retention, would provide a $1,000 state tax credit for a behavioral health professional who precepts a qualified student. HB 1261HB 1261 seeks to establish a behavior analyst license, which would add a profession to the licensed behavioral health and human services workforce in Indiana.

Direct Care Workforce

Indiana’s population is steadily getting older, with an estimated 1 in 5 Hoosiers over the age of 65. An aging population typically indicates a greater demand for health care professionals, specifically direct care workers, such as home health aides (HHAs) and certified nursing aides (CNAs). HB1161 would establish a license, training, and competency requirements for home health aides. SB 449 would require home health agencies to run a criminal background check on employees on an annual basis.

Currently, statute does not allow an individual with a felony offense related to substances to work as a CNA within five years of the offense. HB1385 alters this requirement to allow an exception if the CNA becomes certified as a peer recovery coach. The Bowen Center is excited to launch workforce dashboards for CNAs, HHAs, and qualified medication aides later in 2025! In the meantime, you can review a summary of research we completed in 2024 on direct care workforce data here.

Bowen Director Dr. Hannah Maxey featured in article on tax credits for preceptors

by Guest Author | Jan 15, 2025 | News, Policy

Indiana’s Health Workforce Council is exploring an approach to strengthen rural health care training: a tax credit for health care providers who mentor students through clinical preceptorships. Bowen Center Director Dr. Hannah Maxey was recently quoted in IPB News discussing the possible tax credit program for health care mentors.

“It is critically important for states that are developing tax credit programs to clearly define the program, goals and metrics before and prior to developing it,” Maxey notes. Her research indicates these programs typically serve better as retention tools for existing clinical preceptors rather than recruiting new ones.

Want to learn more about Maxey’s insights on program design, retention impacts, and fiscal considerations? Read the full story at IPB News.

The Bowen Center recently published a policy brief on exactly this subject, read more here or in the brief below:

Tax Credits: A Solution for Indiana’s Health Care Workforce Shortage?

by Guest Author | Jan 9, 2025 | Policy

As Indiana continues to lose health care talent to burnout and out-of-state competition, policymakers are searching for innovative solutions. A new policy brief from the Bowen policy team examines how state tax credits could help address our growing health care workforce shortage.

Clinical preceptors are critical for ensuring students are equipped with clinical skills prior to entering the workforce. Several states have already implemented tax credit programs to recruit and retain health care professionals into clinical preceptor roles, and in this brief we take an in-depth look at two of them: Colorado and Hawai’i. These programs offer substantial incentives — up to $10,000 annually in some cases — for medical professionals serving in high-need roles or locations. In 2023, the Indiana General Assembly considered establishing a similar program through HB 1598, which would have provided tax credits for nursing preceptors, but it didn’t make it past its first reading.

The brief outlines key considerations for policymakers, including program administration costs and the importance of strategic targeting. While tax credits aren’t a silver bullet, they represent one evidence-based approach to strengthening Indiana’s health care workforce.

Read the full brief here to learn more about how tax credit strategies could help secure Indiana’s health care future.

What’s Happening in the 2024 Legislative Session?

by Guest Author | Feb 1, 2024 | Policy, Topics of Interest

A

739

Total Bills introduced in Indiana’s 2024 Legislative Session

A

132

Total Bills identified with direct impact on health, health workforce or workforce included in the 2024 B4

A

32

Total bills identified with direct implications for health workforce & distinguished separately.

Full 2024 B4

Top Health Workforce Themes in the 2024 Legislative Session

Let’s cut to the chase. What health workforce legislation has been introduced in the 2024 session? There were a few major themes that arose. We have conceptualized these themes and summarized the outcomes below.

Nursing Workforce

This session has seen many legislative initiatives related to the nursing workforce. One such bill (SB 45) would establish additional training requirements in trauma-informed care for all licensed Registered Nurses (RN). One bill would modify certain licensure requirements for health facility administrators, allow NCLEX passage to satisfy English proficiency requirements for internationally-educated nurse applicants, and eliminate telehealth certification requirement for telehealth nurses and other telehealth providers (HB 132). The final nursing-focused bill making progress this session makes various changes to nurse licensing, education, and training regulations regarding requirements for clinical preceptors, and requirements for certain foreign nursing applicants (HB 1259).
Bills under this theme that were introduced but did not progress include: a bill removing the collaborative practice agreement with physicians and APRNS, and allows a APRN with prescriptive authority to prescribe a schedule II substance (HB 1059); a requirement for nurses to complete implicit bias training as part of their continuing education requirements (HB 1167); establishment of nurse staffing councils within hospitals in order to develop nurse staffing plans (HB 1015); allowing Certified Registered Nurse Anesthetists to administer anesthesia under the immediate presence of a podiatrist or dentist, which is currently only allowed under the presence of a physician (HB 1371).

EMS

There have been several bills introduced regarding Hoosier emergency medical services professionals (EMS) this session. HB 1142 would establish a program of recognition for first responders killed or injured in the line of duty. A new grant pilot program was introduced in SB 10 for the purpose of assisting in the costs of mobile integrated health care programs and mobile crisis teams across Indiana. Finally, SB 142 would require healthcare coverage for mobile integrated healthcare and emergency medical services for all state employees on the state employee health plan (and other insurers).
Bills under this theme that were introduced but did not progress include: HB 1118 would establish a program to support the mental health of first responders through the Indiana first responders mental health wellness fund and program.

Regulatory Changes

House Bill 1214 would add Indiana to the Dental and Dental Hygienist Licensure Compact.
Bills under this theme that were introduced but did not progress include: A bill proposing the expansion of eligible clinical experience supervision to include physicians, and psychologists for the Clinical Social Work Licensure and expansion of supervision through telehealth (SB 261); bills that would establish new licenses – Professional Music Therapists (HB 1103) and Naturopathic Physicians (SB 262); and a bill (SB 110) that would add Indiana as a member of the Social Work Compact.

Behavioral Health Workforce

A bill proposed in the House would allow a Social Worker licensee applicant to take the social worker examination during their last term of a program that meets educational requirements, and provides a letter of good standing from the director of the academic department (HB 1138). This bill would allow a student to sit for their professional exam early if all requirements in the bill are met. House Bill 1238 would add certain physician assistants and advanced practice nurses as potentially qualifying professionals to serve as competency evaluators in criminal proceedings (previously only psychiatrists and psychologists).
Bills under this theme that were introduced but did not progress include: SB 166 which would have allowed community mental health center staff to provide social work services without a license and remove examination requirement for BHHS temporary permits; SB 261 which would have expanded the qualifications for clinical experience supervisors for clinical social workers and expanded tele-supervision.

Other health workforce themes from legislators that didn’t make it to the second chamber:

Health Workforce Incentives

There were a few bills related to health workforce specific incentives, including a bill that would establish a medical school loan forgiveness pilot program (HB 1175). Another bill would establish an Indiana rural hospital and critical health care services fund, new health workforce student loan repayment program, and associated health workforce advisory board (advisory board (HB 1196).

There’s More on the B4!

One way we monitor health workforce trends is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” There are many other health and workforce/education-related bills that have been introduced this session. Check out the full B4 to learn more about those bills and keep track of the active bills as they progress through the second half of session!

Full 2024 B4

Policymakers Tapping into the Power of Indiana’s Health Workforce Data

by Becky Boustani | Jun 7, 2023 | Data, Policy, Topics of Interest

The Bowen Center believes in the power of data to support informed policy.

Workforce data provides valuable insights regarding trends in and dynamics of supply, pinpoints where shortages exist and informs emerging workforce models which aim to fill gaps. The Bowen Center supports Indiana’s efforts to collect data on licensed healthcare occupations. When health professionals renew their Indiana license, they provide supplemental information through a series of questions structured to capture data needed to inform state policy, such as: where they practice, how many hours they work, demographics, and their plans for the future. Our team partners with the state to transform these data into reports and briefs that (we hope) promote a better understanding of Indiana’s health workforce, the strengths, challenges, and where opportunities exist to fill gaps.

Recently, we were approached to provide data insights on the contraceptive care workforce – where Indiana had potential contraceptive care providers, and where there were gaps. These data were used to inform 2023 House Enrolled Act 1568. This bill expanded the role of trained pharmacists by allowing them to prescribe hormonal contraceptives to adult women, a service that was previously held by traditional prescribers – generally physicians, advanced practice registered nurses, and physician assistants. Lawmakers wanted to understand the potential impact on access to contraceptive care if pharmacists were granted the ability to contribute as prescribers.

Read the Brief Here

Leveraging workforce data, the Bowen Center generated a policy brief and map that examined the distribution of primary care and maternity care practitioners and pharmacists across Indiana. The map revealed that pharmacists were spread out more widely across the state than primary care and maternity care practitioners, with at least one pharmacist practicing in every one of Indiana’s 92 counties, including within counties that are underserved by traditional contraceptive prescribers. Supporters of the legislation used this map during debate in the statehouse, and backed by evidence, HB 1568 successfully passed through the legislature and was signed into law by the governor. More information about the methodology and findings from this research request can be found in our accompanying brief.

What makes Effective Data?

In fulfilling this data request, we realized this exercise might provide us an opportunity to share our thoughts on the “values” that a dataset might hold in order to be used most effectively to support informed policy.

1. Timeliness and Accuracy.

It is crucial to use the most up-to-date information to have a current understanding of labor market conditions. Outdated or inaccurate data can lead to decisions based on flawed information.

The supplemental data used for the Bowen Center’s primary care, maternity care, and pharmacist map were collected within the last two to three years, ensuring its relevancy. Physician and APRN data came from the 2021 license renewal cycle, while pharmacist data was sourced from the 2020 report. To identify primary care shortage areas and maternity care capacity, a trusted federal source, the Health Resources & Services Administration, was utilized.

2. Relevance.

Workforce data analysis should align with the strategic goals and priorities of the inquiry and should provide actionable insights that can help improve stakeholder understanding without the addition of extraneous data points. This means that the data should be sufficient to provide an understanding of the workforce’s capacity and capabilities with the minimum amount of information needed to answer the research question.

In the case of the policy relevant inquiry related to contraception prescribing, the quick turnaround map was created to gain a better understanding of the issue. The map included only relevant data, designed to be easily comprehensible “at a glance.” Each data element in the map contributed to answering the central question: Might access to contraceptives be impacted if pharmacists were permitted contraceptive prescribing privileges?

3. Comprehensiveness.

To maximize the utilization of data, it is ideal to have a complete picture of the workforce that addresses the initial query. It’s important to consider all the necessary information that contributes to an accurate understanding of workforce distribution.

Indiana’s practice of collecting supplemental data during the licensure renewal process provides essential workforce information that would not be gleaned from the license renewal data alone. Without this additional data, Indiana would be unable to identify such elements as practice location, FTE and practitioner specialty, severely hampering a comprehensive understanding of the workforce in Indiana. From this valuable supplemental data, we were able to incorporate both primary care and maternity care capacity as separate mapped elements since both groups can prescribe hormonal contraceptives. By including all significant workforces, we assure that the take-away is a comprehensive depiction of the current state of relevant healthcare in Indiana.

4. Balance of Granularity and Aggregation

Data should strike a balance between being detailed enough to capture the nuances of the workforce landscape and providing an overview of the bigger picture.

The policy map achieved this balance by using both granular and aggregate data in a user-friendly format. Indiana Primary Care Health Professional Shortage Areas and Maternity Care Practitioner capacity were aggregated across counties using two different visual tools, while pharmacist data was presented more granularly with individual pinpoints for each practice location. This allowed for a quick understanding of workforce capacity in specific areas without losing sight of the broader workforce gaps.

Research and data analysis are vital components of the policy and legislative process. Data analysis that is carefully considered and displayed in a user-friendly way can play an important supporting role in policymaking by providing actionable, evidence-based insights. The successful passage of House Enrolled Act 1568-2023 in Indiana demonstrates that data-driven approaches can help policymakers make informed decisions that can positively impact the health and well-being of people in the state. Ultimately, it contributes to the delivery of comprehensive, high-quality healthcare. At the Bowen Center, we are honored to be able to provide data that empowers Indiana policymakers.

Through My Eyes: Work Experience in Diversity

by Chelsea Sparks | May 24, 2023 | Data, Policy, Topics of Interest

Often, I have heard that you learn more by way of experience than from school. I found this to be true as during the past year and a half that I have worked with the Bowen Center. I have learned valuable information that has made me a well-rounded public health professional and have gained an abundance of skills. The Bowen Center has taught me about the importance of access to care, diversity in our health workforce, and expanding care through policy implications such as health workforce training programs, loan repayment programs, and other means to retaining our health workforce.

Diversity in the health workforce is important for creating a thriving and successful work environment and work culture for all health professions. Moreover, diversity in the health workforce is crucial for both better access to care and higher quality of care for underserved communities (Walker, et al, 2012).[1] Recruitment of a diverse staff can lead to the removal of barriers to health-care access in these underserved communities. A workforce that is diverse in race, ethnicity, sex, and age can lead to delivering the best possible care to diverse patient populations (Stanford, 2020).[2] Higher quality of care in these areas then leads to increased patient satisfaction, which can also improve the overall health outcomes of Indiana (Gomez, 2019) (Harker, 2020)[3], [4]. Considering this impact, it is no wonder that recruiting and retaining a diverse health workforce has become a top priority at the state and federal levels.

I participated in an examination of diversity in Indiana’s health workforce, and the first examination used historical data specific to Indiana physicians gathered during license renewal. This data shows much growth in diversity among physicians over the last 25 years. In 1997, less than 20% of physicians identified as non-white. In 2021, nearly one-third of fell into this group. Likewise, gender diversity has also increased, with women making up 18% in Indiana physicians 1997 and 32% in 2021.

More than looking at the numbers, I also examined the multitude of programs and initiatives which address workforce diversity and aim to support early recruitment of health professionals from underrepresented communities. Elements of these programs and initiatives may include incentive programs, such as scholarships and loan repayment options. It is essential to understand how important programs like these are and their roles in increasing the amount of diversity in the health workforce in Indiana.

Chelsea Sparks

Graduate Research Assistant

I utilized this experience in my graduate work by creating a pilot program for one of my master’s degree courses with guidance from the Bowen Center. This program was named “Better Together in the Physician Workforce” and aimed to promote culturally inclusive, and diversity driven workplace environments, starting with 3 program implementation locations. This program promotes change in diversity at these three locations through increased educational opportunities on the importance of workplace diversity, increased culturally sensitive materials, and opportunities for scholarship. The intended outcome of this program is that physicians working in these implementation locations will feel a better sense of belonging in their work environment, workplace culture will harbor diversity and inclusion overall, and physicians could further their education from funding opportunities such as scholarships or grants. It is important to me that I have contributed in some way to achieving health equity and the better representation of underrepresented minority group members and I feel as though I have done just that by building this program. This program has not been implemented; however, it is important to me that the entire program structure be built in hopes of one day launching a similar program and increasing diversity rates among the health workforce.

From this position, I now have several useful skills and even publications that I possess and can take with me to my future career. I currently have been working on a diversity report series that encompasses 11 different health professions for about a year now. This report series provides longitudinal trends in health workforce diversity in hopes of informing existing programs which aim to diversify the health workforce. I understand that I have contributed not only to public health, but also population health. Throughout this working experience I have been able to learn about higher level concepts regarding healthcare and how these concepts are tied to specific policies and impact public health overall. Not only did this graduate employment opportunity allow me to build public health skills, but it also gave me a deeper understanding of how the health workforce and other issues impact health equity. I now understand what racial concordance means and how healthcare workers reflect the populations that they serve

My colleagues at the Bowen Center have not only been the best mentors but have also given some of the best guidance and life advice to help me on my way. The Bowen Center also provides a space where I have maintained close relationships with my mentors and other coworkers. I understand that the next individual welcomed to the team as a graduate research assistant will gain a large amount of knowledge and plentiful experiences. I am thankful for this opportunity and am excited for the future.

If you would have asked me if I would have thought that at the start of my college career I would be in school for 7 years, I would have laughed. So, as for me, I am not sure what my future holds, but I am sure that I am prepared for my next adventure as this team has helped me prepare a foundation for the career that I will pursue.

References

[1] Walker, K. O., Moreno, G., & Grumbach, K. (2012). The Association Among Specialty, Race, Ethnicity, and Practice Location Among California Physicians in Diverse Specialties. Journal of the National Medical Association, 104(1-2), 46–52. https://doi.org/10.1016/s0027-9684(15)30126-7

[2] Stanford FC. The Importance of Diversity and Inclusion in the Healthcare Workforce. J Natl Med Assoc. 2020 Jun;112(3):247-249. doi: 10.1016/j.jnma.2020.03.014. Epub 2020 Apr 23. PMID: 32336480; PMCID: PMC7387183.

[3] Harker, L. (2020, January 15). Unlocking the Benefits of an Inclusive Health Workforce. Georgia Budget and Policy Institute. Retrieved November 14, 2022, from https://gbpi.org/unlocking-benefits-diverse-health-workforce/

[4] Gomez LE, Bernet P. Diversity Improves Performance and Outcomes. J Natl Med Assoc. 2019 Aug;111(4):383-392. doi: 10.1016/j.jnma.2019.01.006. Epub 2019 Feb 11. PMID: 30765101.