California
Prop 44Requires Community Health Clinics Spend 90% of Revenue on Program Services
What your vote does
A NO vote means
No new spending minimum or penalty. Clinics now report spending an average of about 80% of revenue on health care, though it varies. 3
Both ovals are empty on purpose. The choice is yours.
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. Fiscal Impact: Increased state costs in the low tens of millions of dollars per year, covered by fees. Supporters: None submitted Opponents: American Academy of Pediatrics CA; CA School Nurses Org; CA Academy of Family Physicians; CA Medical Assoc.
This is the exact wording from the official voter guide.
If it fails
Nothing changes if it fails
If Prop 44 fails, current rules stay and the 90 percent minimum is not added. The Legislative Analyst (LAO) says private nonprofit safety net clinics now report spending an average of about 80 percent of revenue on health care services. The share varies. 3
Why it’s on the ballot now
Safety net clinics mainly serve low-income and uninsured people, often at low or no cost. California has about 2,000 of them. Most are private nonprofits. 3
Clinics spend most of their revenue on health care for patients. They also have other costs, such as administrative costs. 3
The measure's "Findings and Declarations," which argue for it, say many clinics pay executives "excessive shares" of revenue, causing "underinvestment" in patient services. They also cite long waits. 5
The money
The Legislative Analyst (LAO) says state enforcement costs would be in the low tens of millions of dollars per year, covered by fees on affected clinics. It says there could be other uncertain state and local costs. See the money chart for the latest filed totals. 3
- Amount
- Low tens of millions of dollars a year in state costs, covered by clinic fees
- How long
- No end date; starts with each clinic's first full fiscal year beginning at least 6 months after passage
- Who pays
- Affected clinics would pay fees to cover state enforcement costs. A clinic that falls short of the 90% minimum would pay a penalty equal to the spending needed to reach it. It could get the money back if it complies within five years. If not, the state would keep the money and spend it on clinic workforce programs. The LAO also says, for example, clinics might spend more on direct health care to comply. This could increase state costs, because some of those patients are in Medi-Cal. Some clinics that could not meet the minimum might close instead. The Attorney General's summary says the measure also allows criminal charges for false reports or for artificially raising a clinic's spending ratio. 32
Who bears the cost
Private nonprofit safety net clinics
What they already pay
- The LAO says private nonprofit safety net clinics now report spending an average of about 80 percent of revenue on health care services. 3
If it passes
- The LAO says a clinic below the 90 percent minimum would pay the state a penalty equal to the spending needed to reach it. It can get the money back by complying within five years; otherwise the state spends it on clinic workforce programs. Temporary waivers possible in some cases. 3
- Opponents say Prop 44 would cut $1.7 billion from health clinics in the first year. Supporters say it does not cut clinic funding or reduce services. 4
State government
If it passes
- The LAO says state enforcement costs would be in the low tens of millions of dollars a year. The measure directs the state to cover them by charging fees on affected clinics. 3
- The LAO says other state and local costs are uncertain. They depend on how the Attorney General defines health care expenses and whether clinics meet the minimum. Clinics might spend more on direct care, which could raise state Medi-Cal costs, or some might close instead. 3
Who’s behind it
How it got on the ballot: Citizen petition
The ballot label calls it an "Initiative Statute." The legal text says this initiative measure "is submitted to the people." It does so under Section 8 of Article II of the California Constitution. 15
Where the support comes from
Placed by who endorsed it and who funded it, not by our opinion. How we place measures
The California Democratic Party, the California Republican Party and the Howard Jarvis Taxpayers Association all recommend No on Prop 44. The California Teachers Association, a labor organization, and the League of Women Voters of California also oppose it, while the San Francisco Green Party and the San Francisco Women's Political Committee support it. The largest donor to the committee supporting Prop 44 is SEIU United Healthcare Workers West. The largest donors to the committee opposing it are Altamed Health Services Corporation and California Primary Care Association Advocates. 89101211761314
Endorsements
| Group | YES | NO | Neutral |
|---|---|---|---|
| Progressive slate | |||
| San Francisco League of Pissed Off Voters | No | ||
| Harvey Milk LGBTQ Democratic Club | No position | ||
| Moderate slate | |||
| GrowSF | No | ||
| Political parties | |||
| San Francisco Democratic Party | No | ||
| San Francisco Green Party | Yes | ||
| California Democratic Party | No | ||
| California Republican Party | No | ||
| Labor | |||
| California Teachers Association | No | ||
| Other groups | |||
| San Francisco Women's Political Committee | Yes | ||
| Alice B. Toklas LGBTQ Democratic Club | No | ||
| Edwin M. Lee Asian Pacific Democratic Club | No | ||
| Howard Jarvis Taxpayers Association | No | ||
| League of Women Voters of California | No | ||
Follow the money
YESTop donors
One donor gave more than half of this side’s money.
- SEIU United Healthcare Workers West (committees combined)$16.9M
Who is this?
Statewide local union of the Service Employees International Union in California. It had about 97,000 members in 2020. 1
What they’ve said
The union sponsors the Yes on Prop 44 committee; Prop 44 would penalize nonprofit Federally Qualified Health Centers that spend less than 90% of revenue on program services. In a press release, the union said many clinics are “spending excessive amounts on executive compensation and other non-essentials.” 234
- SEIU United Healthcare Workers West - Wikipedia
- Campaign finance filings as of 2026-10-23 (compiled by this guide from CA Secretary of State: Proposition 44 contribution totals)
- Proposition 44: Official Title and Summary (prepared by the Attorney General), CA Official Voter Information Guide, Nov 3, 2026, p. 1
- SEIU-UHW submits signatures for California ballot initiatives capping executive pay and requiring clinics to spend 90% on patient care - Ballotpedia News
- The top 5 donors gave 100% of this side’s money.
- 0% came from outside California.
Committees: Yes on Prop 44, Sponsored by Service Employees International Union - United Healthcare Workers West
NOTop donors
- Altamed Health Services Corporation$6.1M
Who is this?
Health care provider in Los Angeles and Orange counties. Its website says it serves more than 500,000 patients and is an independent federally qualified health center. 1
- California Primary Care Association Advocates$1.7M
Who is this?
CPCA Advocates says it is the advocacy affiliate of the California Primary Care Association. It says it works for community health centers through state and federal advocacy. 1
What they’ve said
- Family Health Centers of San Diego$1.5M
Who is this?
Family Health Centers of San Diego is a federally qualified health center. Its website says it runs more than 90 sites in San Diego County and treats more than 227,000 patients each year. 1
What they’ve said
Clinic and community representatives gathered at FHCSD to urge a no vote on Prop 44. Pauline Lucatero, a vice president of FHCSD, said the measure “will exclude funding for critical patient care and staff services.” 2
- North East Medical Services$1.5M
Who is this?
North East Medical Services is a nonprofit community health center based in San Francisco. Its website says it runs 32 clinics and service sites in the Bay Area and Las Vegas. 1
- WellSpace Health$1.5M
Who is this?
A nonprofit health system in the Sacramento area. Its website says it offers medical, dental and behavioral health care to underserved people. 1
- San Ysidro Health$1M
- Innercare$1M
Who is this?
Innercare's website says it is a private nonprofit. It gives primary care to people in Imperial and Riverside counties. 1
- Neighborhood Healthcare$920.6K
Who is this?
Its website says it is a community health center serving three Southern California counties, with a big presence in Escondido. It is a federally qualified health center. 1
What they’ve said
Its chief executive officer, Rakesh Patel, said Prop 44 has “major flaws” that penalize clinics for spending on staff and patient services. Patel said health centers already must follow strict rules and go through audits. 1
- Community Health Center Network$776.9K
- SAC Health$766.7K
Who is this?
A federally qualified health center. It runs 10 clinics in Barstow, Blythe, Indio, Murrieta and San Bernardino. 1
- The top 5 donors gave 32% of this side’s money.
- 0% came from outside California.
- Independent spending (not controlled by the campaign): $55K
Committees: No on Prop 44 - Stop the Attack on Patients and Community Health Clinics, Sponsored by California Primary Care Association Adovcates
- NO side independent expenditures (Form 496) of $54,956, mostly by: Reform California with Carl DeMaio - Ballot Measure Committee $31,000; California Partnership for Health PAC $10,000; Million Voter Project Action Fund, Sponsored by Social Justice Organizations $5,299. Separate from total_raised.
- Committee totals are the Secretary of State's per-measure 'Total Reported Contributions' through 2026-10-22 (secretary of state page), plus later 24-hour reports from the Cal-Access bulk export built 2026-10-28. Donors, geography and independent expenditures come from the itemized Cal-Access filings. Contributions to committees that back several measures are credited pro rata to the share the Secretary of State assigns to this measure.
- Source cutoff: the Cal-Access export used was built 2026-10-27 (UTC) and the Secretary of State's per-measure totals run through 2026-10-22. as_of is the latest filing from this measure's own committees, which can be earlier.
- Money given to a committee by another committee is shown as that committee, not the money's original source (e.g. a union's issues PAC, not its members). Donor type is inferred from the name; check the filing for sponsors.
Sources: CA Secretary of State: Proposition 44 contribution totals · Cal-Access raw campaign finance data export · FPPC Top 10 Contributors, November 2026 General Election
The strongest case for and against
Each side’s best argument, written as its supporters would make it. Neither is our view.
Strongest case for
Prop 44's official argument is signed by "Shawna Brown, Initiative Proponent" and "Brisa J. Barrera, Community Clinic Worker." They say clinics get billions of taxpayer dollars, yet some spend under half their funding on patient care and services. Supporters argue large shares go to CEO salaries and spending they call wasteful. They say patients wait months for appointments. They say the 90% must go to patient care and services that make care possible. These "can include" nurse managers, medical equipment and information technology. Supporters say the measure "does not cut clinic funding or reduce services patients rely on." They say clinics that fall short can recover penalties by complying. They say the campaign against it is "funded by the same highly paid clinic executives who benefit from the current system." 4
Strongest case against
Opponents include the American Academy of Pediatrics, California, the California School Nurses Organization, the California Medical Association and the California Academy of Family Physicians. They say Prop 44 sets unworkable limits. These keep clinics from giving patients needed care. They say economic and health experts warn it would cut $1.7 billion from clinics in the first year and cause 88% of clinics to operate at a loss. They argue it limits spending on nurse managers, physician leaders, translation, insurance help, community education, mammogram, X-ray and CT machines, information technology and clinic upgrades. Opponents say clinics are strictly regulated, with laws requiring "regular audits and public reporting of clinic spending." They say clinics serve 1 in 4 Medi-Cal patients. They argue one special interest wrote and funded Prop 44. 14
Sources
Every fact on this page links to one of these sources.
- Ballot label: title (table of contents) and summary (Quick Reference Guide), Proposition 44 (en edition), CA Official Voter Information Guide, Nov 3, 2026, p. 3, 11
- Proposition 44: Official Title and Summary (prepared by the Attorney General), CA Official Voter Information Guide, Nov 3, 2026, p. 1
- Proposition 44: Analysis by the Legislative Analyst, CA Official Voter Information Guide, Nov 3, 2026, p. 1-2
- Proposition 44: Arguments and rebuttals, CA Official Voter Information Guide, Nov 3, 2026, p. 3-4
- Proposition 44: Text of Proposed Law, CA Official Voter Information Guide, Nov 3, 2026, p. 1-5
- San Francisco Women's Political Committee: recommendations for the November 3, 2026 election
- San Francisco Green Party: recommendations for the November 3, 2026 election
- California Democratic Party: recommendations for the November 3, 2026 election
- California Republican Party: recommendations for the November 3, 2026 election
- Howard Jarvis Taxpayers Association: recommendations for the November 3, 2026 election
- League of Women Voters of California: recommendations for the November 3, 2026 election
- California Teachers Association: recommendations for the November 3, 2026 election
- How endorsers line up on Prop 44: this guide's coalition groupings (endorsement method 1.0, data as of 2026-10-27)
- Campaign finance filings as of 2026-10-23 (compiled by this guide from CA Secretary of State: Proposition 44 contribution totals; data/money/ca-2026-11-p44.json, main@0dcbec8)