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Proposition 44

Requires Community Health Clinics Spend 90% of Revenue on Program Services

On the ballot

California · November 2026 general election · Citizen initiative · Election day November 3, 2026
Topics: Health care

In plain language

Proposition 44 would require nonprofit Federally Qualified Health Centers — community clinics serving medically underserved areas — to spend at least 90 percent of their revenue on "program services" that advance their charitable purpose, including patient services, and would impose monetary penalties on those that spend less. The Department of Public Health could waive the requirement in exceptional circumstances, and penalties could be refunded if a center becomes compliant within five years. The Attorney General could publish guidance defining qualifying expenditures. Filing false reports or artificially inflating the spending ratio could bring criminal charges. Affected clinics currently report spending about 80 percent on average.

Fiscal impact

Legislative Analyst's Office summary of the estimate of net state and local government fiscal impact: "Increased state costs in the low tens of millions of dollars per year to enforce the new requirements on certain private nonprofit health care clinics, covered by fees charged to the affected clinics."

Summarized from the official fiscal analysis listed in the sources below. Figures are the state's, not this site's.

What supporters and opponents say

These are summaries of arguments made by the named organizations, drawn from the sources listed below. They are their claims, not this site's, and this site takes no position on the measure.

What supporters say

  • The ballot argument signed by initiative proponent Shawna Brown and community clinic worker Brisa J. Barrera says some clinic executives divert millions to inflated salaries and other non-essentials, and that the measure would direct at least 90 percent of revenue to patient care.
  • Supporters state in the official argument that expected federal health care cuts make every dollar matter more, and that the requirement would help retain frontline health care workers by keeping money in the health care system.

Attributed to the sources cited below.

What opponents say

  • The ballot argument signed by Eric Ball (American Academy of Pediatrics, California), Katie Nilsson (California School Nurses Organization), and René Bravo (California Medical Association) says community clinics serve one in four Medi-Cal patients and are the only source of care within hundreds of miles in some rural areas, and that the measure would increase wait times and could eliminate care.
  • Opponents state in the official argument that community clinics are already heavily regulated by federal and state governments, with strict funding rules and regular mandatory public audits, making the measure unnecessary.
  • The argument names Planned Parenthood Affiliates of California, the California Academy of Family Physicians, the American College of Emergency Physicians of California, and the National Association of Social Workers California Chapter among opponents.

Attributed to California Medical Association, American Academy of Pediatrics, California, California School Nurses Organization.

Sources

Everything on this page traces to these sources. Follow them to read the original documents.

Last updated . How this page is sourced and corrected is described in the correction policy.