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AlignAlgo Vote · Explainers · Prop 44

California · November 3, 2026 · Initiative Statute

Proposition 44: Requires Community Health Clinics Spend 90% Of Revenue on Program Services.

Requires nonprofit Federally Qualified Health Centers (community clinics serving medically underserved areas) to spend at least 90% of revenue on program services advancing their charitable purpose.

The official ballot language

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.

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. 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. Summary of Legislative Analyst's 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.

Source: California Secretary of State

What your vote does

A YES vote

Supports requiring nonprofit federally qualified health centers (FQHCs) and FQHC Look-Alikes to spend at least 90% of annual total revenue on expenses that advance the health center's mission (the mission spend ratio, calculated annually by the Attorney General), with penalties for noncompliance levied by the Department of Public Health.

A NO vote

Opposes the 90% mission-spend requirement; the new clinic spending requirement would not go into effect.

Source: Ballotpedia

What's actually in it — provision by provision

Propositions bundle things together. Here is every operative provision, separately:

  1. Requires nonprofit community health clinics to spend at least 90% of revenue on program services (including patient services) rather than management and overhead.

    Basis: Ballotpedia: 90% spending requirement on program services rather than management/overhead.

  2. Imposes monetary penalties for noncompliance and authorizes criminal charges for false reports or schemes to artificially inflate the spending ratio.

    Basis: Ballotpedia: monetary penalties for noncompliance; criminal charges authorized for false reports or schemes to inflate the spending ratio.

Arguments, both sides

In favor

“The measure is designed to direct more funding into patient services and programs that are key to (a federally qualified health center's) mission.”

— Renée Saldaña, spokesperson for SEIU-UHW [source]

“Prop. 44 holds community clinics and their executives accountable by requiring that 90% of clinic revenue be spent on clinics' charitable mission.”

— Official voter guide PRO argument [source]
Against

“Instead, this proposal will only make it difficult—if not impossible—to … preserve access to vital health services for patients.”

— Carmela Coyle, president and CEO of the California Hospital Association [source]

“Prop. 44 is a dangerous measure that will shut down hundreds of community health clinics and eliminate vital patient services for millions of Californians.”

— Official voter guide CON argument (No on Prop 44) [source]

Who's funding each side

Support: $16.9M  ·  Oppose: $37.6M

As of Reports processed through September 19, 2026; next report deadline October 22, 2026.

Top supporters: SEIU United Health Care Workers West Political Issues Committee ($16,929,633.88)

Top opponents: AltaMed Health Services Corporation ($5,467,867.69); California Primary Care Association ($3,035,766.00); Family Health Centers of San Diego ($1,500,000.00); North East Medical Services ($1,500,000.00); Wellspace Health ($1,500,000.00)

Source: Ballotpedia campaign finance

Endorsements

Supporting
  • Californians for Responsible Healthcare (sponsored by SEIU-UHW West)
  • SEIU United Healthcare Workers West
Opposing
  • American Academy of Pediatrics CA
  • CA School Nurses Org
  • CA Academy of Family Physicians
  • CA Medical Assoc.
  • Association of California Healthcare Districts
  • California Chamber of Commerce
  • California Hospital Association
  • California Primary Care Association
  • Howard Jarvis Taxpayers Association
  • League of Women Voters of California
  • Planned Parenthood Affiliates of California
  • Reform California
  • Open Door Community Health Centers

Source: Ballotpedia

Polling

Public Policy Institute of California · Sept. 4, 2026 – Sept. 10, 2026

Yes 34% · No 61% · Undecided 6%

1103 likely voters (±3.80%)

Source

Fiscal impact

Increased state costs in the low tens of millions of dollars per year, covered by fees. (Ballotpedia.)

How does Proposition 44 line up with your values?

Take the 13-question AlignAlgo Vote questionnaire and get a scored breakdown of this measure — provision by provision.

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Sources