State Policy · CA
California Ballot Measure Would Require Community Clinics to Spend 90% of Revenue on Patient Care
California voters will decide in November 2026 whether to approve Proposition 44, which would require nonprofit community health clinics to spend 90% of their revenue on patient care and empower the Attorney General to settle disputes. A study commissioned by the California Primary Care Association estimates that 91% of health centers do not currently meet this standard and could face $1.7 billion in penalties in the first year alone. The measure would penalize clinics for capital projects, equipment purchases, technology upgrades, and budget reserves. Community health clinics serve more than 7 million patients annually, including one in three Medi-Cal enrollees.
Why it mattersIf approved, the ballot measure could destabilize the community clinic infrastructure that serves one-third of California's Medi-Cal enrollees, forcing facility closures and service reductions across the state's safety-net delivery system.