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Proposition 44, also known as the Clinic Funding Accountability and Transparency Act, would require federally qualified healthcare clinics to spend no less than 90% of their funding on patient services.
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California currently has about 2,000 federally qualified health centers, also called community clinics. Most report spending an average of 80% of their revenue on healthcare services — although that percentage can vary significantly.
THE BEE’S VOTER GUIDE: Your guide to Proposition 44
If Prop. 44 is passed, community clinics that spend less than 90% on patient services would need to petition the state attorney general to determine what counts as healthcare-related spending, and could seek temporary waivers in certain circumstances.
Opponents say Prop. 44 would impose severe financial penalties that could force hundreds of community health clinics to reduce vital patient services or close, harming millions of patients. The proposition specifically targets community clinics that provide low-income communities with access to quality healthcare. It also would affect some school clinics that serve as community clinics. If clinics fail to comply, they could face severe financial penalties and ultimately be forced to close.
“We see this as an existential threat to the safety net, to community health centers and to our patients,” said Francisco Silva, CEO of the California Primary Care Association, a group in formal opposition to the proposition.
Other groups in opposition include the California Democratic Party, the California Teachers Association, California Chamber of Commerce, California Hospital Association, California Medical Association and Planned Parenthood Affiliates of California.
Silva bluntly called Prop. 44 “a shakedown” by SEIU–United Healthcare Workers West, a labor union that sponsored the three statewide dialysis propositions that California voters rejected in 2018, 2020 and 2022.
McClatchy’s California editorial board, representing The Sacramento Bee, Modesto Bee, Merced Sun-Star, Fresno Bee and San Luis Obispo Tribune, recommends a “No” vote on Prop. 44.
Now is not the time to impose strict spending requirements on hundreds of clinics, forcing them to eliminate vital patient services or shut down entirely.
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Community clinics keep large reserves in their accounts for rainy days, said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California. “Reserves, quite frankly … saved us when we were quickly defunded this year,” she said. “Had we not had reserves, those health centers would have all had to close.”
“It’s just so dangerous to sort of be pulling these numbers out the way that this initiative does, without any reflection to what we’re facing in this next year,” Hicks said.
Prop. 44 is a threat to nearly 7 million patients who rely on community health clinics. Vote “No” on Prop. 44
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This story was originally published October 2, 2026 at 2:00 PM.