CA Voters To Decide Whether Nonprofit Health Clinics Must Spend 90% Of Their Revenue On Patient Care

Southern California voters and residents across the state will decide in November whether nonprofit community health clinics should be required to spend at least 90% of their revenue on patient care and other program services under a ballot initiative that became eligible Monday for the 2026 general election.

California Secretary of State Shirley N. Weber announced Monday that supporters of the initiative submitted enough valid petition signatures to qualify the measure for the Nov. 3 statewide ballot.

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The initiative would require "nonprofit Federally Qualified Health Centers" — community clinics serving medically underserved populations — to devote at least 90% of their revenue toward services advancing their charitable mission rather than administrative or overhead costs.

Under the proposal, the California Department of Public Health could waive the spending requirement in exceptional circumstances. The measure also would authorize the state attorney general to issue guidance defining qualifying expenditures and impose financial penalties for clinics that fail to comply.

The measure would allow refunds if the clinics come into compliance within five years.

The proposal additionally would authorize criminal charges for false reporting or schemes intended to artificially inflate spending ratios.

State officials estimated enforcement of the measure could cost up to the low tens of millions of dollars annually, with much of the expense offset by fees and penalties imposed on affected clinics.

The measure qualified for the ballot through a random sampling process after election officials determined the projected number of valid signatures exceeded the threshold required under state law.

Secretary of State officials said the initiative will be formally certified for the ballot June 25 unless supporters withdraw it before that date.

The measure was proposed by Shawna Brown and Sean Fleming.

More information can be found at sos.ca.gov/elections/ballot-measures/how-qualify-initiative/.