California Changes to the State Children's Services Program Initiative (2024)

California Changes to the State Children's Services Program Initiative
Election date November 5, 2024
Topic Healthcare
Status Not on the ballot
Type State statute	Origin Citizens

The California Changes to the State Children's Services Program Initiative (#23-0029) was not on the ballot in California as an initiated state statute on November 5, 2024.

A "yes" vote would have supported changing the California Children's Services (CCS) Program eligibility requirements and authorizing the program to cover the costs of life-saving specialty drugs.

A "no" vote would have opposed changing the California Children's Services (CCS) Program eligibility requirements and authorizing the program to cover the costs of life-saving specialty drugs.

Measure design

See also: Text of measure

Click on the arrows (▼) below for summaries of the different provisions of the initiative.

Children's Services Program: Qualifying diseases

The California Children's Services Program was created in 1927 and provides health care coverage for individuals under the age of 21 who are diagnosed with qualifying serious or chronic diseases and meet certain financial criteria. As of 2024, state law lists the following diseases as qualifying for coverage:

• Noninfectious diseases of the central and peripheral nervous system that produce a neurologic impairment that is life-threatening or physically disabling;
• Cerebral palsy manifested by the presence of either rigidity, spasticity, hypotonia, involuntary movements, or ataxia;
• Seizure disorder as a component of or secondary to the CCS-eligible condition or has unknown origin; and
• Congenital anomalies of the nervous system.

Other qualifying diseases are specified by state regulation issued by the state Department of Health Care Services (DHCS).

In addition to a qualifying disease, an individual must meet one of the following conditions as of 2024:

• family income of $40,000 or less,
• out-of-pocket medical expenses are likely to be more than 20% of the family income,
• was adopted with a known health problem covered by CCS,
• a need for the Medical Therapy Progam, which is available to any child regardless of family income, or
• enrolled in Medi-Cal with full benefits.

The initiative would have formally specified all qualifying diseases in state law by adopting DHCS's regulations and guidance as of January 1, 2022. The initiative would have also required DHCS to collaborate with stakeholders every five years to determine whether additional diseases should be added to CCS's qualifying list. If additional diseases are added, the initiative would have required the state to pay counties for the associated additional costs of covering such diseases.

New financial assistance program: Covers medically necessary items and services

The initiative would have also created a new financial assistance program through DHCS that covers a portion of medically necessary items and services to treat a qualifying disease regardless of family income level. The family would have been responsible for a minimum amount of the items and services equal to the out-of-pocket expenses of certain health insurance plans offered in the Covered California marketplace. In 2024, this amount equated to $9,100 for most families.

Payments for CCS providers: Increased payments for hospitals, physicians, and specialty drugs

The initiative would have increased payments to hospitals by establishing a new grant program administered by DHCS that provides a grant to each hospital. The grant would have totaled $200 times a hospital's total number of days of inpatient services and the total number of outpatient visits provided to CCS children.

The initiative would have also required DHCS to review all payments made to physicians treating CCS children and make them commensurate with what the federal Medicare program pays for similar services.

The initiative would have required DHCS to pay hospitals for specific high-cost drugs approved by the government and would add to this list any drug designated by the Food and Drug Administration (FDA) as a breakthrough therapy approved on or after July 1, 2021.

Funding the initiative's provisions: Prohibitions and authorizations

The initiative would have prohibited the state from using county funds to support the new financial assistance program or increased payments to providers. The initiative would have also prohibited the state from enacting a tax on health insurance plans to support the provisions and from considering the new hospital grant program as Medi-Cal payments, thereby excluding the state from seeking federal funds to help cover the cost of the program. The state would have been allowed to seek federal funds to help cover the cost of the increased physician fees and specialty drug payments.

Text of measure

Ballot title

The ballot title would have been as follows:

“

Expands state health care program for children with certain medical conditions. Initiative statute.

”

Petition summary

The summary provided for inclusion on signature petition sheets was as follows:

“

Expands California Children’s Services Program, which provides health care to low-middle income children under 21 with specified medical conditions, by requiring state to provide: financial assistance to families not eligible for Program services for certain out-of-pocket treatment costs for covered conditions; new annual grants to hospitals that provide Program services; increased payment rates for physicians that are at least the federal Medicare rate; and coverage for additional medical conditions including cancer, heart disease, certain infectious diseases, and cerebral palsy that are currently covered only by regulation, not by statute.

”

Fiscal impact

The fiscal impact statement was as follows:

“

State General Fund cost potentially ranging in the hundreds of millions of dollars to around a billion dollars each year to assist families with the cost of health care for children with qualifying serious and chronic diseases, as well as to increase payments to providers in the California Children’s Services program.

”

Full text

The full text of the ballot measure is below:

Sponsor

Because We Need Affordable Life-Saving Healthcare for our Critically Ill Children, which is sponsored by the California Children's Hospital Association, led the campaign in support of the initiative.

Campaign finance

See also: Campaign finance requirements for California ballot measures

The campaign finance information on this page reflects the most recent scheduled reports that Ballotpedia has processed, which covered through March 31, 2024.

Ballotpedia identified one committee—Because We Need Affordable Life-Saving Healthcare for our Critically Ill Children—registered in support of the initiative. It reported over $9.9 million in contributions.

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$9,999,500.00	$0.00	$9,999,500.00	$7,914,754.09	$7,914,754.09
Oppose	$0.00	$0.00	$0.00	$0.00	$0.00
Total	$9,999,500.00	$0.00	$9,999,500.00	$7,914,754.09	$7,914,754.09

Support

The following table includes contribution and expenditure totals for the committee in support of the measure.

Committees in support of Changes to the State Children's Services Program Initiative
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Because We Need Affordable Life-Saving Healthcare for our Critically Ill Children	$9,999,500.00	$0.00	$9,999,500.00	$7,914,754.09	$7,914,754.09
Total	$9,999,500.00	$0.00	$9,999,500.00	$7,914,754.09	$7,914,754.09

Donors

The following were the top donors who contributed to the support committee.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Children's Hospital Los Angeles	$1,428,500.00	$0.00	$1,428,500.00
Children's Hospital of Orange County	$1,428,500.00	$0.00	$1,428,500.00
Loma Linda University Children's Hospital	$1,428,500.00	$0.00	$1,428,500.00
Lucile Packard Children's Hospital	$1,428,500.00	$0.00	$1,428,500.00
MemorialCare Health System and Affiliates	$1,428,500.00	$0.00	$1,428,500.00
Rady Children's Hospital - San Diego	$1,428,500.00	$0.00	$1,428,500.00
UCSF Benioff Children's Hospital	$1,428,500.00	$0.00	$1,428,500.00

Background

California Children's Services (CCS) program

California Children's Services (CCS) program was created in 1927 and is a state program administered by the California Department of Health Care Services that provides health care services to individuals under the age of 21 with qualifying diseases and financial circumstances. If a child qualifies the program pays for doctor visits, hospital stays, surgery, physical and occupational therapy, lab tests, X-rays, orthopedic appliances, and medical equipment.

As of 2024, state law lists the following diseases as qualifying for coverage:

• Noninfectious diseases of the central and peripheral nervous system that produce a neurologic impairment that is life-threatening or physically disabling;
• Cerebral palsy manifested by the presence of either rigidity, spasticity, hypotonia, involuntary movements, or ataxia;
• Seizure disorder as a component of or secondary to the CCS-eligible condition or has unknown origin; and
• Congenital anomalies of the nervous system.

Other qualifying diseases are specified by state regulation issued by the state Department of Health Care Services (DHCS).

In addition to a qualifying disease, an individual must meet one of the following conditions as of 2024:

• family income of $40,000 or less,
• out-of-pocket medical expenses are likely to be more than 20% of the family income,
• was adopted with a known health problem covered by CCS,
• a need for the Medical Therapy Progam, which is available to any child regardless of family income, or
• enrolled in Medi-Cal with full benefits.

As of December 2023, 13,409 children were enrolled in CCS, and 161,840 qualified through Medi-Cal enrollment.

Medi-Cal

California's Medicaid program is called Medi-Cal. The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level, which amounted to $​20,121 for individuals and $41,400 for a family of four in 2023 in California. As of November 2023, total enrollment in Medi-Cal is over 14.9 million individuals with about 88% receiving health care through managed care plans and 12% receiving care through a fee-for-service delivery system. Fee-for-service means the state pays providers directly for the Medi-Cal services needed by the beneficiary.

Path to the ballot

See also: Laws governing the initiative process in California

The state process

In California, the number of signatures required for an initiated state statute is equal to 5 percent of the votes cast in the preceding gubernatorial election. Petitions are allowed to circulate for 180 days from the date the attorney general prepares the petition language. Signatures need to be certified at least 131 days before the general election. As the verification process can take multiple months, the secretary of state provides suggested deadlines for ballot initiatives.

The requirements to get initiated state statutes certified for the 2024 ballot:

• Signatures: 546,651 were required.
• Deadline: The deadline for signature verification was 131 days before the general election, which was around June 27, 2024. However, the process of verifying signatures can take multiple months and proponents are recommended to file signatures at least two months before the verification deadline.

Signatures are first filed with local election officials, who determine the total number of signatures submitted. If the total number is equal to at least 100 percent of the required signatures, then local election officials perform a random check of signatures submitted in their counties. If the random sample estimates that more than 110 percent of the required number of signatures are valid, the initiative is eligible for the ballot. If the random sample estimates that between 95 and 110 percent of the required number of signatures are valid, a full check of signatures is done to determine the total number of valid signatures. If less than 95 percent are estimated to be valid, the initiative does not make the ballot.

Details about this initiative

• The initiative was filed on October 23, 2023, by Ann-Louise Kuhns.
• The initiative was cleared for circulation on November 27, 2023.
• The secretary of state reported that the initiative had collected at least 25% of the required number of signatures on January 26, 2024.
• The secretary of state reported that the campaign submitted signatures on May 9, 2024.
• On June 21, the secretary of state reported that the campaign had qualified for the ballot. The verification process determined that at least 604,112 signatures were valid.
• On June 27, 2024, the secretary of state reported that sponsors had withdrawn the initiative. Gov. Gavin Newsom (D) announced a legislative compromise with the sponsors to dedicate additional funding for the DHCS to support California children’s hospitals.

How to cast a vote

See also: Voting in California

See below to learn more about current voter registration rules, identification requirements, and poll times in California.

How to vote in California

Poll times

All polls in California are open from 7:00 a.m. to 8:00 p.m. Pacific Time. An individual who is in line at the time polls close must be allowed to vote.

Registration

Check your voter registration status here.

To vote in California, an individual must be a U.S. citizen and California resident. A voter must be at least 18 years of age on Election Day. Pre-registration is available at 16 years of age. Pre-registered voters are automatically registered to vote when they turn 18.

Automatic registration

California automatically registers eligible individuals to vote when they complete a driver's license, identification (ID) card, or change of address transaction through the Department of Motor Vehicles. Learn more by visiting this website.

Online registration

See also: Online voter registration

California has implemented an online voter registration system. Residents can register to vote by visiting this website.

Same-day registration

California allows same-day voter registration.

Californians must be registered to vote at least 15 days before Election Day. If the registration deadline has passed for an upcoming election, voters may visit a location designated by their county elections official during the 14 days prior to, and including Election Day to conditionally register to vote and vote a provisional ballot, which are counted once county election officials have completed the voter registration verification process. The state refers to this process as Same Day Voter Registration.

Residency requirements

To register to vote in California, you must be a resident of the state. State law does not specify a length of time for which you must have been a resident to be eligible.

Verification of citizenship

See also: Laws permitting noncitizens to vote in the United States

California's constitution requires that voters be U.S. citizens. When registering to vote, proof of citizenship is not required. Individuals who become U.S. citizens less than 15 days before an election must bring proof of citizenship to their county elections office to register to vote in that election. An individual applying to register to vote must attest that they are a U.S. citizen under penalty of perjury.

As of November 2024, two jurisdictions in California had authorized noncitizen residents to vote for local board of education positions through local ballot measures. Only one of those jurisdictions, San Francisco, had implemented that law. Noncitizens voting for board of education positions must register to vote using a separate application from the state voter registration application.

All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment. Seven states — Alabama, Arizona, Georgia, Kansas, Louisiana, New Hampshire, and Wyoming — have laws requiring verification of citizenship at the time of voter registration, whether in effect or not. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.

Verifying your registration

The secretary of state's My Voter Status website allows residents to check their voter registration status online.

Voter ID requirements

California does not require voters to present identification before casting a ballot in most cases. However, some voters may be asked to show a form of identification when voting if they are voting for the first time after registering to vote by mail and did not provide a driver license number, California identification number, or the last four digits of their social security number. On September 29, 2024, Gov. Gavin Newsom (D) signed SB 1174 into law prohibiting any jurisdiction in the state from adopting a local law that requires voters to present ID before voting.

The following list of accepted ID was current as of October 2024. Click here for the California Secretary of State page to ensure you have the most current information.

“

Current and valid photo identification provided by a third party in the ordinary course of business that includes the name and photograph of the individual presenting it. Examples of photo identification include, but are not limited to, the following documents: driver's license or identification card of any state; passport; employee identification card; identification card provided by a commercial establishment; credit or debit card; military identification card; student identification card; health club identification card; insurance plan identification card; or public housing identification card. Any of the following documents, provided that the document includes the name and address of the individual presenting it, and is dated since the date of the last general election…: utility bill; bank statement; government check; government paycheck; document issued by a governmental agency; sample ballot or other official elections document issued by a governmental, agency dated for the election in which the individual is providing it as proof, of residency or identity; voter notification card issued by a governmental agency; public housing identification card issued by a governmental agency; lease or rental statement or agreement issued by a governmental agency; student identification card issued by a governmental agency; tuition statement or bill issued by a governmental agency; insurance plan card or drug discount card issued by a governmental agency; discharge certificates, pardons, or other official documents issued to the individual by a governmental agency in connection with the resolution of a criminal case, indictment, sentence, or other matter; public transportation authority senior citizen and disabled discount cards issued by a governmental agency; identification documents issued by governmental disability agencies; identification documents issued by government homeless shelters and other government temporary or transitional facilities; drug prescription issued by a government doctor or other governmental health care provider; (R) property tax statement issued by a governmental agency; vehicle registration issued by a governmental agency; or vehicle certificate of ownership issued by a governmental agency.

”

See also

2024 measures

• 2024 ballot measures
• Healthcare on the ballot
• 2024 petition deadlines

California

• California ballot measures
• California initiative laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls
• Ballot measure signature costs

External links

• Initiative and referendum status
• Full text