Proposition 44: Clinic spending ruleNonprofit community clinics must spend 90% of revenue on patient services
Read the full text of the measure: Official Voter Information Guide (PDF)
In plain words
California has about 2,000 "safety net" clinics that mainly serve low-income and uninsured people. Affected clinics now report spending about 80% of their money on health care services on average. This requires at least 90%, which caps other costs like administration at 10%. The Attorney General decides what counts. A clinic that falls short pays the state the difference; it gets the money back if it complies within five years, or the state spends it on clinic workforce programs. Clinics can ask for a temporary waiver. (lao.ca.gov (Legislative Analyst's Office) )
Before and after
| Question | Today | If it passes |
|---|---|---|
| Share of revenue clinics must spend on health care services | No minimum (average about 80%) | At least 90% |
| If a clinic falls short | Nothing | Pays the shortfall to the state; refunded if it complies within 5 years |
| Who decides what counts | Not applicable | The Attorney General |
Numbers from the official ballot title (ballot title ); also see (lao.ca.gov (Legislative Analyst's Office) )
Example
Illustration only: a clinic with $10 million in revenue must spend $9 million on health care services. If it spends $8 million, it pays $1 million to the state. (lao.ca.gov (Legislative Analyst's Office) )
Biggest change
- Private nonprofit safety-net clinics must spend at least 90% of annual revenue on health care services. source: lao.ca.gov (Legislative Analyst's Office)
- The Department of Public Health may waive the rule in exceptional cases; the Attorney General publishes guidance on what spending counts; false reports or artificially raising the spending ratio can bring criminal charges. source: sos.ca.gov (Official Voter Information Guide)
Who it affects most: Private nonprofit community clinics, their staff and their patients, many of them on Medi-Cal.
Cost to the state: Increased state enforcement costs in the low tens of millions of dollars per year, covered by fees on clinics; other effects uncertain (Legislative Analyst).
Our plain-words summary. Every line points to its source.
What your vote means
Nonprofit community clinics must spend at least 90% of their revenue on health care services or pay the shortfall to the state.
No minimum spending rule for nonprofit community clinics.
Our one-line summary. The official "What your vote means" statements are in the Secretary of State's Official Voter Information Guide, linked below.
Why people want it, and why others object
Why this is on the ballot
Voters put this on the ballot by signing a petition. It changes a state law, which lawmakers can later change. It passes with a simple majority.
- The union SEIU-UHW put it on the ballot after a similar bill it backed failed. Clinics sued to keep it off the ballot; it was not removed. source: CalMatters
Why supporters want it
- Official argument in favor: some clinics "spend less than half of their funding on patient care and services"; supporters target executive pay and overhead. Signed by Shawna Brown (initiative proponent) and Brisa J. Barrera (community clinic worker). source: voterguide.sos.ca.gov (Secretary of State)
Why opponents object
- Official argument against: "Prop. 44 is a dangerous, poorly drafted measure that would threaten care for millions of California patients." 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). source: voterguide.sos.ca.gov (Secretary of State)
- Opponents estimate clinics would owe more than $1.7 billion in noncompliance fees in the first year. source: CalMatters
Who backs each side
- For: SEIU-UHW (the guide lists no supporters). Against: American Academy of Pediatrics CA, CA School Nurses Org, CA Academy of Family Physicians, California Medical Association, California Primary Care Association, Planned Parenthood Affiliates of California, California Hospital Association, California Democratic Party. source: CalMatters
- Money (Secretary of State, through Oct. 6, 2026): "Yes on Prop 44," sponsored by SEIU-UHW, reported $10,781,565. "No on Prop 44," sponsored by California Primary Care Association Advocates, reported $21,609,280. source: sos.ca.gov (Secretary of State)
In each side's own words where we could find them, quoted or summarized with a link to the source. We don't endorse either side.
What you will see on your ballot
Official ballot wording, word for word (tap to open)
The official ballot title, word for word from the Secretary of State's Official Voter Information Guide .
REQUIRES COMMUNITY HEALTH CLINICS SPEND 90% OF REVENUE ON PROGRAM SERVICES. INITIATIVE STATUTE.
YES
NO
Official title copied word for word from the Official Voter Information Guide (page 70). The title and summary are prepared by the Attorney General.
Official summary by the Attorney General (tap to open)
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.(sos.ca.gov (Official Voter Information Guide) )
Latest news
Recent reporting from a range of outlets, newest first. We link to it; we don't endorse it.
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Full text of the measure
The full text of the proposed law is printed in the Official Voter Information Guide. Read it in the Official Voter Information Guide (PDF) .
Read more
- Secretary of State: Official Voter Information Guide, Nov. 3, 2026 (PDF)
- Official Voter Information Guide: Proposition 44
- Official arguments and rebuttals
- Legislative Analyst's analysis
We link to analysis from several sources; we don't endorse it.