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Health Care Workforce Training Commission

FY 2027 Budget Hearing Presentation

Submitted by: Kami Fullingim, Executive Director

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The Health Care Workforce Training Commission serves to establish and administer programs and services to support and increase health care availability across the state of Oklahoma in rural locations.

Founded in 1975, as Physician Manpower Training Commission and renamed in 2022, Health Care Workforce Training Commission, this agency now encompasses the following divisions:

Nursing Student Assistance Program

Oklahoma Family Medicine Resident Cost Sharing Program Oklahoma Rural Medical Education Scholarship Loan Program Physician Community Match Scholarship Program

Family Practice Resident Rural Scholarship Program Oklahoma Physician Loan Repayment Program Physician Assistant Scholarship Program

Physician Assistant Loan Repayment Program

ARPA Nurse Training Expansion ARPA Optometry School Expansion

Kami Fullingim

Executive Director

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Agency Vision, Mission and Core Values

Vision: To achieve the healthiest Oklahomans.

Mission: To increase access to health care workers in the rural and underserved areas of Oklahoma.

Core Values:

Access: All citizens of Oklahoma should have access to quality health care.

Accountability: Commitment to be good stewards of its resources and faithful to its mission

Collaboration: Collective efforts with the Oklahoma Legislature and community partners, HWTC maximizes each organization’s knowledge and skills to achieve excellence.

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Accomplishments

Top accomplishments for FY 2025 – FY 2026

HWTC has continued to be able to support salary increases to the Family Medicine Residency programs eligible for agency support for FY25 and FY26. HWTC recognizes competitive salaries for resident positions are vital to recruitment efforts.

The Physician Loan Repayment Program had 69 physicians in obligated rural practice in FY25-FY26 with an additional 6 approved to begin practice FY26 or after. Each of these physicians generates $1.9M in their community which generates over $100M in economic impact statewide. Local physicians provide timely and preventive care, reducing ER visits and travel to urban areas keeping healthcare dollars in the community. This allows more local jobs in office staff in that community which amplifies the economic impact. These physicians also serve over 12,000 tobacco using patients, made 2,353 referrals to the Helpline and conducted 5,951 counseling sessions to support those patients in quitting tobacco use.

General Surgery and APRN were added to the Loan Repayment Program effective November 1, 2024 and we have had 2 General Surgery applicants approved and 4 APRN applicants approved.

HWTC continues to successfully monitor and move funds for ARPA Health Care Education. HWTC has disbursed $77.4M of

$98.62M

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Analysis of Agency Challenges
	Challenge Description	Current Actions (Briefly describe how the agency is currently addressing the challenge.)	Planned Actions (Briefly describe how the agency plans to address the challenge going forward.)
1	Not enough CMS funding for Residents	Agency provides funding to residency programs to fill the gap	Increase funding to residency programs
2	Mandates from Legislature without corresponding funding (HB3351	Restructuring staff and staff responsibilities	Request additional funding to add 1 FTE
3	Behavioral health providers in rural Oklahoma	We cannot at this time without Legislative action	Request that Behavioral Health Care Providers be added to the statute of allowed providers for loan repayment and increase funding
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Savings & Efficiencies (Current or Planned)

Savings or Efficiency Name	Brief description of how savings were achieved	Savings in Unit of Measurement*	FY 2025 (Actual $ Savings)	FY 2026 (Projected $ Savings)	FY 2027 (Projected $ Savings)
Prolonged vacant position	Tried to spread work among current staff	18 months salary	$33,500	$16,750	$0

* Hours, FTE, square feet, etc.

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Agency Goals and Key Performance Metrics

Goal		Metric	FY 25 Target	FY 25 Actuals	FY 26 Target
1	Maintain Family Medicine Residency salary gap funding for 6 FM Residency programs	The gap amount between GME funding and actual resident salaries	100%	100%	100%
2	Increase participants in scholarship and loan repayment programs	Number of participants completing obligated year of service annually	55	54	60
3	Maintain OU Nurse Anesthetist funding	Legislative appropriated funds provided	100%	100%	100%
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Projects for FY 2026

Ongoing collaboration with Oklahoma Office of Rural Health to collect and analyze data on how to incentivize health care

providers to rural Oklahoma.

Continued monitoring and administering ARPA funds to stay in compliance.
Moving from paper to digital documents. Moving digital documents from a shared drive to SharePoint.
Wrap up monitoring of ARPA fund projects.

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Projects for FY 2027

Continued participation on health workforce policy forums, boards, and advisory groups with the goal of continuing efforts to increase education and training opportunities and identify barriers to health care in rural and underserved areas.
Acquire database for program participant information and data collection.
Seek additional sponsorship commitments for Loan Repayment Programs to meet the needs and demands of the health care workforce in rural Oklahoma communities.

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Total Historic Actual

Expenditures

(FY 2021-25) and Current Year Budget (FY 2026)

Explanation of Changes and Trends

FY23 and FY24 had significant increases in Physician Loan Repayment due to public and private partnership fund contributions.
FY23 and FY24 marks the first movement of ARPA funds to subrecipients as well as increase to FTE.
FY25 added appropriations for the OU Nurse Anesthetist Program support.

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Estimated Impact of Federal Funding Changes

Program Name	Federal Agency	Description of expected change (s) (i.e. change in state match, admin costs, program requirements or client eligibility, etc.)	Actual FY 25 Total Federal Funding Received ($)	Projected FY 26 Total Federal Funding To Be Received ($)	Estimated FY 27 Total Federal Funding To Be Received ($)
No Changes			$	$	$
			$	$	$
			$	$	$
			$	$	$
			$	$	$
			$	$	$
			$	$	$
			$	$	$
			$	$	$

* Only list programs with federal funding that are expected to change. Refer to the agency’s Federal Funds Schedule in the Budget Request document.

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FY 2026

Budgeted Full Time Equivalents (FTE)

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	FY 2026 Budgeted FTE
Total FTE	8 appropriated, 2 ARPA funded
Supervisor FTE	3 appropriated, 1 ARPA funded
Supervisors to Total FTE Ratio (%)	37.5% appropriated, 50% ARPA funded
Current Budgeted but Unfilled FTE	1

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Appropriation History

	Five-Year Appropriation History
$90.0M
	$79.5M
$80.0M

$70.0M

$60.0M

$50.0M

$40.0M

$30.0M
			$19.1M
$20.0M
	$6.9M	$7.2M	$7.7M		$10.4M		$10.5M
$10.0M

$0.0K
		FY 2023 Appropriation		FY 2024 Supplemental
	FY 2022				SRF	FY 2025	FY 2026

Fiscal Year	Legislated Appropriation ($) (Includes supplementals and SRF/ARPA.)
FY 2022	$6,946,877
FY 2023	$86,771,411
FY 2024	$26,754,419
FY 2025	$10,411,715
FY 2026	$10,476,713

*Includes Supplemental and Statewide Recovery Fund (ARPA) appropriations.

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Financial Resource Analysis

Carryover	FY 2022	FY 2023	FY 2024	FY 2025
Total appropriated carryover amount expended ($)	$894,643	$807,638	$975,019	$1,168,068

Revolving Class Fund # (Unrestricted only)	Revolving Class Fund Name (Unrestricted only)	Current cash balance ($)	Projected FY 2026 year-end cash balance ($)
#21000	HWTC Revolving	$1,120,276	$
#		$	$
#		$	$
#		$	$
#		$	$
#		$	$
	Total Unrestricted Revolving Fund Cash balance:	$	$

Historical Cash Balances	FY 2022	FY 2023	FY 2024	FY 2025
Year End Revolving Fund Cash Balances (All Revolving Funds)	$2,552,651	$2,602,189	$2,859,392	$2,806,095

Unrestricted funds are those that are not limited by state or federal law, rule, regulation, other legally binding method, or donor restriction.

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FY 2024 – 2025 Appropriation Change Review

Purpose of appropriation increase or decrease	Amount FY 2024	Amount FY 2025	Total amount received FY 2024 - 25	Total amount expended by 11/1/2025	Included in FY 2026 approp? (Yes/No)	If not expended fully, please explain.
Better alignment of salaries to work and title	$139,000	$	$139,000	$139,000	yes
Increase to dedicated residency program salary funds	$181,300	$425,085	$606,385	$606,385	yes
Additional match funds for loan repayment program	$112,000	$	$112,000	$112,000	yes
	$	$	$	$
	$	$	$	$
	$	$	$	$
	$	$	$	$
	$	$	$	$
Totals	$432,300	$425,085	$857,385	$857,385

*Do not include SRF / ARPA appropriation increases.

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FY 2026 Appropriation Change Review

Purpose of appropriation increase or decrease	Amount of increase or decrease ($)	Does this need to be included in your FY 2027 appropriation? (Yes/No)	If yes, included in appropriation for same purpose? (Yes/No)	If not included for same purpose, please explain.
No adjustments	$
	$
	$
	$
	$
	$
	$
	$
Total adjustment	$

*Do not include SRF / ARPA appropriation increases.

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Incremental & Supplemental Request Summary

Request Name		FY 2027 Incremental Appropriation Request Amount ($) {or FY 2026 for Supplementals}	Type of Request: Recurring, One-time, or Supplemental
1	Salary for Grant Director after ARPA ends December 2026	$50,000	One-time
2	Physician Loan Repayment Program	$102,916	Recurring
3		$
4		$
5		$

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(1) Incremental Budget Request

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Salary for Grant Director after ARPA ends December 2026
Type: One-Time	$ 50,000
Once the ARPA funds are disbursed, closeout processes will extend a few months as well as reports and audits. This will be better managed by the current Grant Manager that knows the ARPA budget, expenses, and reports best since she has worked with them the full 3 years HWTC has had the project. The funds requested cover salary and benefits needed for 6 months.

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(2) Incremental Budget Request

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Physician Loan Repayment Program
Type: Recurring	$ 102,916
The increase of funding for financial assistance has resulted in an expanded presence of healthcare providers across rural Oklahoma. Now that we offer General Surgery and APRN loan repayment, we have had an increase of applications from providers to participate in our programs.