Proposition 44: Requires Community Health Clinics Spend 90% of Revenue on Program Services. Initiative Statute.
Statewide — all of California
General election · Tuesday, November 3, 2026
- Placed on the ballot by petition signatures (citizen initiative), per the Official Voter Information Guide. The Voter Guide lists SEIU-United Healthcare Workers West as the contact for the Yes campaign.[1][4]
The question on the ballot
REQUIRES COMMUNITY HEALTH CLINICS SPEND 90% OF REVENUE ON PROGRAM SERVICES. INITIATIVE STATUTE. Imposes penalties on nonprofit Federally Qualified Health Centers (community clinics providing primary care to medically underserved areas and populations) that spend less than 90% of revenue on "program services" advancing their charitable purpose, including but not limited to patient services. Department of Public Health may waive spending requirements in exceptional circumstances. Authorizes Attorney General to publish guidance defining qualifying expenditures. Monetary penalties may be refunded if centers become compliant within five years. Authorizes criminal charges for false reports or artificially increasing spending ratio.[1]
Requires private nonprofit safety net clinics (Federally Qualified Health Centers) to spend at least 90 percent of total revenue each year on health care services, with the Attorney General defining qualifying expenses starting from existing federal reports. Clinics falling short pay a penalty equal to the spending shortfall; they can recover it by complying within five years, after which the state keeps it for clinic workforce programs. Temporary waivers are possible and false reporting can be criminally charged. Fiscal impact per the Legislative Analyst: state enforcement costs in the low tens of millions of dollars per year, covered by fees on affected clinics; other costs are uncertain and depend on the Attorney General's definitions and whether clinics comply or close.[1][2]
A YES vote means
Certain private nonprofit health care clinics would have to spend at least 90 percent of their revenue each year on providing health care services.
A NO vote means
The new requirement on health care clinic spending would not go into effect.
The law today
There are about 2,000 safety net clinics in California, mostly private nonprofits, serving mainly low-income and uninsured people. Private nonprofit safety net clinics report spending an average of about 80 percent of revenue on health care services, varying by clinic.[2]
Official fiscal estimate
Per the Legislative Analyst: state enforcement costs "in the low tens of millions of dollars per year," which the measure directs the state to cover by charging fees on affected clinics; other state and local costs are uncertain and depend on how the Attorney General defines health care expenses and whether clinics meet the minimum (including possible clinic closures or increased Medi-Cal-funded services).[2]
Arguments made for
- Official argument in favor, signed by initiative proponent Shawna Brown and community clinic worker Brisa J. Barrera: "Proposition 44 is simple. It requires community health clinics to spend at least 90% of their revenue on their non-profit mission—patient care and the services that make care possible."[3]
- Same argument: "Clinics that meet the standard keep every dollar, and even clinics that fall short can recover any penalties by coming into compliance."[3]
Arguments made against
- Official argument against, signed by Eric Ball, MD (American Academy of Pediatrics, California), Katie Nilsson, RN (California School Nurses Organization) and René Bravo, M.D. (California Medical Association): Prop. 44 "restricts clinics from spending resources on essential staff and services, including nurse managers, physician leaders, translation services, insurance assistance and community education."[3]
- Same argument: "Community clinics are already heavily regulated by the federal and state governments, with strict funding rules on patient care and essential services, and regular mandatory public audits." It also says Prop. 44 would "cut $1.7 billion from health clinics in the first year alone."[3]
On record in support
On record in opposition
- California Primary Care Association (named in the official argument against); the No on Prop 44 committee is sponsored by California Primary Care Association Advocates[3][5]
- California Medical Association (signer of the official argument against)[3]
- American Academy of Pediatrics, California (signer of the official argument against)[3]
- California School Nurses Organization (signer of the official argument against)[3]
- Planned Parenthood Affiliates of California (named in the official argument against)[3]
- California Academy of Family Physicians (signer of the official rebuttal; named in the argument against)[3]
Campaign money
Per the Secretary of State's ballot-measure contribution totals, through October 6, 2026: $10,781,565 reported in support (Yes on Prop 44, sponsored by SEIU-United Healthcare Workers West) and $21,609,280 in opposition (No on Prop 44 - Stop the Attack on Patients and Community Health Clinics, sponsored by California Primary Care Association Advocates).[5]
Research notes & limits
All text from the Official Voter Information Guide. Arguments and rebuttals are the authors' opinions and not checked by any agency; each side's claims about the other's motives and funding are not reproduced. Signature counts not stated in pages reviewed.
Sources · 5
Researched 2026-10-19. Green citations are official government records.
- 1.Proposition 44: Official Title and Summary · California Secretary of State, Official Voter Information Guide (Nov. 3, 2026) · 2026-10-05 Official record
- 2.Proposition 44: Analysis by the Legislative Analyst · California Legislative Analyst's Office, via Official Voter Information Guide · 2026-10-05 Official record
- 3.Proposition 44: Arguments and Rebuttals · California Secretary of State, Official Voter Information Guide · 2026-10-05 Official record
- 4.Proposition 44: Summary and What Your Vote Means · California Secretary of State, Official Voter Information Guide · 2026-10-05 Official record
- 5.Proposition 44: Ballot Measure Total Contributions (through 10/06/2026) · California Secretary of State · 2026-10-19 Official record