This explainer was originally published by our news partners CalMatters. Be prepared for California’s primary: Sign up for CalMatters' free election newsletter and be the first to know when they update the CalMatters 2026 Voter Guide with information on key races.
What does California Proposition 44 do?
Proposition 44 would require community clinics that serve low-income patients to spend 90% of their annual revenue on patient care. The measure directs the attorney general to publish guidance on what spending qualifies and allows the state to fine clinics that don’t spend the full 90%. The labor union SEIU-UHW pushed a similar bill last year, but it failed. Clinics failed to keep the measure off the ballot with a lawsuit earlier this year.
What do supporters and opponents say?
- SEIU-UHW
- California Primary Care Association
- California Medical Association
- Planned Parenthood Affiliates of California
- California Hospital Association
- California Democratic Party
Ballot text
This is how the proposition will appear 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. Fiscal Impact: Increased state costs in the low tens of millions of dollars per year, covered by fees.
Source: California Secretary of State
