A large percentage of dialysis technicians in California have been unable to pass the state’s certification exam after testing was revamped as part of a new federal mandate, according to a story by California Watch.

Within the state, the new rules have cut down the number of technicians working in an industry that is already stretched in terms of staffing. Here’s our former colleague, Christina Jewett:

The California Dialysis Council, which has administered its test to about 1,200 people so far, is seeing a pass rate of about 56 percent, according to the group’s executive director.

Statewide, the workforce of dialysis technicians has fallen from a steady 5,200 to about 3,800, according to a Department of Public Health spokesman. That’s a 27 percent drop in the number of certified technicians.

As we’ve reported, dialysis clinics rely heavily on unlicensed technicians, who can start work with a high-school diploma and in-house training. In 2008, Medicare rules changed to require technicians then at work in clinics to pass national or state certification tests within 18 months. Last April, the deadline passed to comply with those requirements.

California was one of the few states that had a state certification test before Medicare began requiring it—that’s why the state actually has statistics on the drop in certified technicians.

Workers who fail the test can retake it as many times as they want, according to California Watch, but in the meantime they cannot work with patients directly unless supervised. Read their full story.

As we’ve reported, Medicare does not set staffing ratios for dialysis centers, and neither do most states.

To check the quality of the dialysis clinics in your state, check our Dialysis Facility Tracker.