California Require Transparency in Health Clinic Funding and Regulate Use of Profits Initiative (2026)

California Require Transparency in Health Clinic Funding and Regulate Use of Profits Initiative
Election date November 3, 2026
Topic Healthcare facility funding and Healthcare governance
Status Signatures submitted
Type Initiated state statute	Origin Citizens

The California Require Transparency in Health Clinic Funding and Regulate Use of Profits Initiative (#25-0008) may appear on the ballot in California as an initiated state statute on November 3, 2026.

Measure design

See also: Text of measure

Click on the following sections for summaries of the different provisions of the ballot measure.

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Spending requirements

The initiative would require nonprofit federally qualified health centers (FQHCs) and FQHC Look-Alikes to spend at least 90% of their annual total revenue on expenses that advance the FQHC’s mission. The initiative defines this as the mission spend ratio, which would be calculated annually by the California Attorney General. A FQHC is defined in federal law as a community-based healthcare center that provides primary care and other services in underserved areas and qualifies for certain reimbursement systems under Medicaid and Medicare. An FQHC Look-Alike is an organization designated by the federal Health Resources and Services Administration as meeting FQHC program requirements.

Each FQHC or a look-alike would be required to submit to the Registry of Charities and Fundraisers the total expenditures on the clinic's exempt purpose and total revenue for the clinic, to calculate the mission spend ratio. The initiative would authorize the attorney general to issue binding guidance on how to report the figures and additional reporting standards for penalties, reimbursements, and expenditures. The initiative would also require the attorney general to make the data publicly available on its website within 90 days of receipt, along with the calculated mission spend ratio. The initiative would authorize the attorney general to conduct audits to verify the accuracy of submitted information and ensure compliance with reporting requirements.

The initiative would require the health centers to submit an additional registration fee to fund the new law. Failure to meet the reporting requirements would result in a fine of $5,000 for the first violation and $10,000 for each subsequent violation.

The mission spend ratio would apply to each clinic's first full fiscal year beginning at least six months after approval of the initiative.

Penalty for not meeting mission spend ratio

The initiative would authorize the state Department of Public Health to levy penalties for not meeting the 90% mission spend ratio. The penalty would be equal to the difference between the 90% requirement and the amount the clinic spent on mission-related expenses in that year.

The initiative would create the Mission Spend Ratio Penalty Account within the state's Special Deposit Fund, where penalty funds would be deposited. The violating clinic could be reimbursed for part of the penalty if the clinic comes into compliance with the 90% mission spend ratio and submits an approved plan to spend all of the money reimbursed on mission-directed expenses. The Department of Public Health would be authorized to subtract operating and enforcement expenses from the penalty amount for reimbursement.

Money in the fund not reimbursed after five years would be allocated by the legislature to clinical worker training, recruitment, and retention.

Clinics would be authorized to dispute the mission spend ratio calculation within 30 days of receiving a penalty for noncompliance by submitting an appeal to the attorney general and the Department of Public Health. Clinics would also be authorized to file for a temporary waiver of the mission spend ratio for unexpected circumstances or poor economic conditions.

The initiative would also create criminal penalties for any director, officer, or agent of a clinic that falsifies information to increase their mission spend ratio.

Text of measure

Ballot title

The ballot title is as follows:

“

Require community health clinics spend 90% of revenue on program services. Initiative statute.

”

Petition summary

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

“

Requires nonprofit Federally Qualified Health Centers (community clinics that provide primary care to medically underserved areas and populations) to spend at least 90% of their revenue on program services advancing their charitable purpose, including but not limited to patient services, rather than management and overhead. Department of Public Health may waive spending requirement in exceptional circumstances. Authorizes Attorney General to publish guidance defining qualifying expenditures. Imposes monetary penalties for noncompliance, which may be refunded if centers become compliant within five years. Authorizes criminal charges for false reports and schemes to artificially increase spending ratio.

”

Full text

The full text of the initiative can be read here.

Sponsor

SEIU-UHW is sponsoring the initiative.

Arguments

• Brisa Barrera, a healthcare worker at a community clinic in Santa Rosa: "We’re calling for accountability because frontline workers and patients at community clinics deserve better. Clinics receive public dollars to serve vulnerable populations, but when that money is siphoned off for bloated administrative costs, it’s the patients and workers who suffer. This measure ensures that resources go where they’re needed most: into the clinics and toward care."

Background

Nonprofit federally qualified health centers

The initiative would apply to nonprofit federally qualified health centers (FQHC). A FQHC is an organization that receives federal funds to provide prevention and primary services in an outpatient clinic setting in underserved areas. The criteria to be a FQHC includes:

• being located in or serving a high-need community;
• being governed by a community board that is made up of at least 51% of health center patients;
• providing comprehensive healthcare services on a sliding fee scale based on ability to pay; and
• becoming a Health Center Program aware recipient or a Health Center Program look-alike.

A medically underserved population is defined in federal law as "the population of an urban or rural area designated by the Secretary [of the Department of Health & Human Services (HHS)] as an area with a shortage of personal health services or a population group designated by the Secretary as having a shortage of such services."

Nonprofit FQHCs are required to file revenue and expense reports with the IRS and the state attorney general. The reports include detailed revenue sources, such as Medi-Cal, private insurance, out-of-pocket payments from patients, federal grants, and charitable donations. FQHCs are also required to report the portion of total expenses that advance the clinic’s mission to provide primary care services to medically underserved groups, excluding the clinic’s management and fundraising expenses.

SEIU-UHW ballot measures

State

The following table details SEIU-UHW West's stances on statewide ballot measures that were on the ballot:

Statewide ballot measure support and opposition for SEIU-UHW West
Ballot measure	Year	Position	Status
California Proposition 36, Drug and Theft Crime Penalties and Treatment-Mandated Felonies Initiative	2024	Opposed	a Approved
Arizona Proposition 209, Healthcare Debt Interest Rate Limit and Debt Collection Exemptions Initiative	2022	Supported	a Approved
California Proposition 29, Dialysis Clinic Requirements Initiative	2022	Supported	d Defeated
California Proposition 23: Dialysis Clinic Requirements Initiative	2020	Supported	d Defeated
California Proposition 8: Limits on Dialysis Clinics' Revenue and Required Refunds	2018	Supported	d Defeated
Michigan Proposal 2: Independent Redistricting Commission	2018	Supported	a Approved

Local

The following table details SEIU-UHW West's stances on local ballot measures:

Local ballot measure support and opposition for SEIU-UHW West
Ballot measure	Year	Position	Status
Livermore, California, Measure U: Healthcare Cost Regulations	2018	Supported	d Defeated
Palo Alto, California, Measure F: Healthcare Cost Regulations	2018	Supported	d Defeated
San Francisco, California, Proposition D: Vacancy Appointments	2016	Opposed	d Defeated
San Francisco, California, Proposition J: Minimum Wage Increase	2014	Supported	a Approved

Path to the ballot

See also: Laws governing the initiative process in California

An initiated state statute is a citizen-initiated ballot measure that amends state statute. There are 21 states that allow citizens to initiate state statutes, including 14 that provide for direct initiatives and nine (9) that provide for indirect initiatives (two provide for both). An indirect initiated state statute goes to the legislature after a successful signature drive. The legislatures in these states have the option of approving the initiative itself, rather than the initiative appearing on the ballot.

In California, the number of signatures required for an initiated state statute is equal to 5% of the votes cast in the last gubernatorial election. A simple majority vote is required for voter approval. The requirements to get initiated state statutes certified for the 2026 ballot:

• Signatures: 546,651 valid signatures are required.
• Deadline: The deadline for signature verification is June 25, 2026. However, the secretary of state suggested deadlines for turning in signatures of January 12, 2026, for initiatives needing a full check of signatures and April 17, 2026, for initiatives needing a random sample of signatures verified.

Initiative #25-0008

• July 15, 2025: Shawna Brown and Sean Fleming filed the initiative with the California Attorney General's Office.
• August 1, 2025: The Attorney General's Office published the initiative, issued it a serial number, and placed it under official review.
• October 8, 2025: The initiative was cleared for signature gathering.
• November 12, 2025: The secretary of state reported the campaign had collected at least 25% of signatures required.
• April 1, 2026: The campaign reported submitting over 1 million signatures.

See also

2026 measures

• 2026 ballot measures
• Healthcare governance on the ballot
• Healthcare facility funding on the ballot

California

• California ballot measures
• California ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• #25-0008 Full Text

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