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Bills:
ACHD actively positioned on 30 measures during the legislative session. As the session progressed, we were able to remove opposition, or bills were substantively changed requiring us to remove our position making our final bill total 21 support and oppose bills. For a complete list of all actively positioned bills and their final status please visit our Legislative Reports page, here. Below are a few of the high priority bills and final outcomes. Please note, that several high priority bills will be eligible to move next year, under their two-year status.
SB 7 (McNerney) – Employment and Automated Decision Systems (ADS) - VETO
SB 7 sought to extend new rights and notice requirements to employees and independent contractors subject to algorithmic evaluation. This bill was sponsored by the California Labor Federation and received support from additional labor organizations signaling worker protection concerns, while business groups flagged duplicative processes and potential litigation exposure. The measure was vetoed by the Governor. The veto message can be found here. ACHD was instrumental in this veto effort, bringing the specific voice of health care to the table and helping to co-lead on multiple coalition efforts. ACHD OPPOSE
SB 596 (Menjivar) – Health Facilities: Administrative Penalties – SIGNED
SB 596 sought to clarify California’s nurse-to-patient ratio laws by standardizing definitions for hospital on-call lists and clarifying penalty timelines for staffing violations. The measure passed the Legislature after amendments addressed concerns from healthcare districts, including ACHD, which ultimately removed its opposition and recognized improvements which aligned with current law. ACHD engaged throughout the legislative process, advocating for the practical realities of rural and district hospitals and helping to shape amendments that preserved care delivery and operational flexibility for member hospitals. ACHD NEUTRAL
SB 707 (Durazo) – Ralph M. Brown Act Modernization – SIGNED
SB 707 delivers the most extensive modernization of California’s Ralph M. Brown Act in decades by expanding public access and teleconferencing options for local government meetings across the state. As many may remember, the bill was nearly held in the final days of session but was moved again to allow for extensions to remote participation. ACHD engaged throughout the legislative process, advocating for flexibility and practical solutions that protect the ability of healthcare districts to comply with expanded public access while maintaining operational capabilities for member agencies. Ultimately through our partnership with the California Special District Association (CSDA) we were able to go neutral on the measure. ACHD NEUTRAL
SB 669 (McGuire) – Standby Perinatal Medical Services Pilot – SIGNED
At the intersection of rural healthcare and maternal health access, SB 669 creates a ten-year pilot program allowing up to five qualified critical access hospitals to operate standby perinatal medical units in regions at risk of losing maternity services. The measure was signed by the Governor. As mentioned, ACHD participated as a lead stakeholder in consultation to ensure district and rural hospital interests were represented, advocating for flexibility, appropriate standards, and resources for success under the pilot framework. The bill will require legislative clean-up in 2026 to reflect implementation needs of the Department and other stakeholders. Stay tuned as ACHD continues to engage on this bill and the broader labor and delivery policy discussion for both rural and urban Californians. ACHD SUPPORT
California Budget:
As most are aware, California currently faces a significant budget deficit. This deficit is particularly felt due to continued federal cuts and systemic state budgeting issues, with decreasing/stagnant revenue and increasing costs. Many anticipate that California will feel a $30 billion deficit in the health care budget alone in the next fiscal year. While significant uncertainty remains, ACHD will be spending significant time doing budget work in the coming fiscal year. Today, the Legislative Analyst Office (LAO) released the California Spending Plan. Each year, the LAO publishes the California Spending Plan to summarize the annual state budget. In this publication they provide an overview of the 2025-26 budget package, give a brief description of how the budget process unfolded, and then highlight the major features of the budget approved by the Legislature and signed by the Governor. This report is available, here.
Ballot Propositions:
We anticipate an interesting ballot initiative process over the next two years. With significant budget deficits, both real and anticipated, the legislature and Administration’s willingness to advance certain legislation has softened. Further, as many interests and groups feel tightening financial pressures, they will look to California voters to help generate revenue, protect priorities, and legislate. Through the direct democracy process, we will see significant leveraging between major power players, including labor unions and the business community.
November 2025 Ballot - Proposition 50
Proposition 50 asks voters whether California lawmakers, not the state’s independent Citizens Redistricting Commission, should temporarily redraw the state’s U.S. House district maps for the next three elections (2026, 2028, 2030). Supporters say this would let California “catch up” to mid-decade changes happening in other states, while opponents call it a power grab that undermines the independent process voters created years ago.
The measure reached the ballot after the Legislature approved a package of bills in August 2025, and Governor Newsom called a special statewide election for November 4, 2025, to decide it.
If voters say “Yes”, the new legislative-drawn map would take effect immediately for 2026. Counties would update voting materials, and candidates could not list themselves as “incumbent” in those races. The independent commission would return to its normal duties after the 2030 Census to draw maps for 2032 and beyond. If voters say “No”, nothing changes, and California keeps using the existing independent commission maps through the decade. The official voter guide and overview can be found below, as well as the LAO analysis, Secretary of State deadlines and logistics, and the CalMatters primers on the measure.
November 2026 Ballot
As stated, we anticipate many other initiatives at least begin to circulate over the next several months. Notably, for both political and policy reasons, the below initiatives currently circulating are drawing significant attention. ACHD will be taking the measures up for consideration of position through our Advocacy Committee and Board of Directors.
SEIU-UHW has filed two ballot initiatives for the November 2026 election that target healthcare executive compensation and community clinic spending requirements, while the California Hospital Association (CHA) has filed a counter-initiative that imposes restrictions on union political spending. Below is a summary of each measure:
SEIU-UHW Ballot Initiatives
Executive Compensation: This initiative would place a hard cap of $450,000 per year on the compensation packages of non-profit and investor-owned hospital and medical group executives who perform managerial, administrative, or executive roles. The cap applies to all forms of compensation except health benefits and would be enforced by the Attorney General, with a possible private right of action for violations. SEIU-UHW argues this measure is necessary to curb excessive executive pay in the healthcare sector and redirect resources toward patient care.
Community Clinic Spending Accountability: This measure would require Federally Qualified Health Centers (FQHCs) and community clinics to devote at least 90% of their annual revenue to direct patient care and mission-related services. Clinics would be required to publicly report detailed financials and spending priorities, aiming to improve transparency and ensure funds are spent on core services rather than administrative overhead.Supporters believe it will bolster the quality of care, while critics argue it could harm clinics' ability to offer broader services or maintain viability in underserved areas.
California Hospital Association Countermeasure
Health Care Union Transparency, Accountability & Member Right to Vote Act: CHA’s proposed initiative requires that large healthcare unions (>50,000 members, majority in healthcare) obtain a majority vote from members before spending over $1 million on a state ballot measure or $100,000 on a local measure in a single year. Further, the initiative mandates annual disclosure—by mail and email—showing members how union dues are spent on campaigns and political activities. The measure aims to increase transparency and member control over union spending at a time when SEIU-UHW is pursuing major healthcare-related ballot initiatives.
Rural Transformation Program:
The Department of Health Care Access and Information (HCAI) has entered into the drafting phase of its Rural Transformation Program state application. This process follows several listening sessions related to the program and its potential use cases. California has decided not to share its application or proposals with the public prior to submission. The date for the application to be submitted to CMS is November 5, 2025, with final decisions by the close of December 2025. As a reminder, this fund cannot be used to provide funding for direct patient care and does include specified criteria for allowable uses.
ACHD participated in the listening sessions and provided comment to HCAI, however, we anticipate that much of the funds received, if any, will be limited and made available through competitive grants by the state in 2026. While this sentiment has been shared by high-ranking officials, we do know through CMS that many other states and perhaps in California, private industry or public-private partnerships may receive direct allocations through the fund. With that said, major pushes have been made to include workforce investments, telehealth, technological uses, and backfill rural hospital relief efforts. Folks may be seeing a breadth of information and publications geared toward thinking about uses of the funds, for example: The Missing Foundation of Rural Healthcare Transformation. Articles such as this attempt to draw both state and federal attention to potential opportunities to fund important and critical issues, such as workforce. While we are not optimistic that healthcare districts will gain significant access to the fund, new voices entering the conversation to elevate prevailing issues, helps keep rural California at the top of mind for law makers and officials. ACHD will continue to monitor and engage with the Department, Administration and other stakeholders and will keep members apprised as developments unfold.
Office of Health Care Affordability:
Many will have already seen or heard that the California Hospital Association has filed a lawsuit in San Francisco County Superior Court to push back on the Office of Health Care Affordability (OHCA). The lawsuit alleges that OHCA’s board, has violated both the spirit and letter of the law that created the organization. The intent behind the law was to establish a concrete framework and guidance for a thoughtful, data-driven approach to making health care more affordable, however as stated in the suit, has failed to achieve this goal.
If the lawsuit is successful, OHCA would be prevented from implementing five actions, effectively requiring the board to revisit key decisions around statewide health care spending targets, the adoption of hospital sectors, and the setting of even lower spending targets for a select group of hospitals.
Housing Grant Opportunity:
The Governor’s office through a press release on Tuesday, announced new funding opportunities for housing projects. The projects contemplate a number of ways to increase housing in specified areas, including around transit hubs. We flag this for ACHD members that may be engaging in housing projects. Local government entities are encouraged to apply to the fund. More information about these grant opportunities can be found, here.
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