California Proposition 29, Dialysis Clinic Requirements Initiative (2022)

California Proposition 29
Election date November 8, 2022
Topic Healthcare
Status d Defeated
Type State statute	Origin Citizens

California Proposition 29, the Dialysis Clinic Requirements Initiative, was on the ballot in California as an initiated state statute on November 8, 2022. The ballot measure was defeated.

A "yes" vote supported this ballot initiative to require dialysis clinics to have at least one physician, nurse practitioner, or physician assistant while patients are being treated; report data on dialysis-related infections; and not discriminate against patients based on the source of payment for care.

A "no" vote opposed this ballot initiative to require dialysis clinics to have at least one physician, nurse practitioner, or physician assistant while patients are being treated; report data on dialysis-related infections; and not discriminate against patients based on the source of payment for care.

Election results

California Proposition 29
Result		Votes	Percentage
Yes		3,364,404	31.60%
No		7,281,196	68.40%

Results are officially certified.

Source

Overview

What would this ballot initiative have required of dialysis clinics?

See also: Text of measure

Proposition 29 would have enacted staffing requirements, reporting requirements, ownership disclosure, and closing requirements for chronic dialysis clinics, including:

• requiring clinics to have at least one physician, nurse practitioner, or physician assistant - with at least six months of experience with end-stage renal disease care - onsite during patient treatments;

• requiring clinics to report dialysis-related infections to the California Department of Public Health (CDPH);

• requiring clinics to provide patients with a list of physicians with an ownership interest of 5% or more in the clinic;

• requiring clinics to provide the CDPH with a list of persons with ownership interest of 5% or more in the clinic; and

• requiring clinics to obtain the CDPH's written consent before closing or substantially reducing services to patients.

The ballot initiative would have also prohibited clinics from refusing to care for a patient based on the patient's form of payment, whether the patient was an individual payer, the patient's health insurer, Medi-Cal, Medicaid, or Medicare.

How did Proposition 29 relate to Proposition 23 (2020) and Proposition 8 (2018)?

See also: Proposition 23 (2020) and Proposition 8 (2018)

In 2020, 63.4% of voters rejected Proposition 23, which was also sponsored by SEIU-UHW. Proposition 23 would have required chronic dialysis clinics to: have an on-site physician while patients are being treated; report data on dialysis-related infections; obtain consent from the state health department before closing a clinic; and not discriminate against patients based on the source of payment for care.

In 2018, SEIU-UHW also sponsored Proposition 8, which was defeated with 59.9% of voters rejecting it. Proposition 8 would have required dialysis clinics to issue refunds to patients or patients' payers for revenue above 115% of the costs of direct patient care and healthcare improvements.

Who supported and opposed Proposition 29?

See also: Support and Opposition

Californians for Kidney Dialysis Patient Protection led the Kidney Patients Deserve Better campaign in support of Proposition 29. SEIU-UHW West was the primary sponsor and contributed over $7.97 million to the support committee. David Miller, research director of SEIU-UHW, said, "There’s just so much improvement that can be made, and there’s plenty of resources in the industry to make those improvements. That’s the tension: there’s enormous profitability, then you meet folks of enormous need, and you realize that some of that money should be diverted to patient care."

Stop Yet Another Dangerous Dialysis Proposition led the campaign in opposition to Proposition 29. The committee reported nearly $74.6 million in contributions from DaVita Inc. and Fresenius Medical Care. The initiative was also opposed by the Republican Party of California, California Chamber of Commerce, and California Medical Association. The campaign said, "Since 2012, UHW has wasted $77.7 million of its members’ dues money funding 48 failed ballot initiatives across the country – many of which put patients and their members at risk. That amounts to more than $700 per UHW member that they’ve wasted on these failed and reckless efforts. This is the third ballot measure since 2018 sponsored by UHW targeting dialysis providers. Voters rejected Prop 8 in 2018 by 60% and Prop 23 in 2020 by 63%. It’s shameful that this union would continue to use vulnerable patients as pawns to advance their political agenda."

Text of measure

The ballot title was as follows:

“

Requires on-site Licensed Medical Professional at Kidney Dialysis Clinics and Establishes Other State Requirements. Initiative Statute.

”

Petition summary

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

“

Requires physician, nurse practitioner, or physician assistant, with six months’ relevant experience, on site during treatment at outpatient kidney dialysis clinics; authorizes exemption for staffing shortage if qualified medical professional is available through telehealth. Requires clinics to disclose to patients all physicians with clinic ownership interests of five percent or more. Requires clinics to report dialysis-related infection data to state. Prohibits clinics from closing or substantially reducing services without state approval. Prohibits clinics from refusing to treat patients based on source of payment.

”

Fiscal impact

The fiscal impact statement was as follows:

“

Increased state and local government costs likely in the low tens of millions of dollars annually.

”

Full text

The full text of the ballot initiative is below:

Readability score

See also: Ballot measure readability scores, 2022

Using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The attorney general wrote the ballot language for this measure.

The FKGL for the ballot title is grade level 16, and the FRE is -1. The word count for the ballot title is 17.

The FKGL for the ballot summary is grade level 14, and the FRE is 20. The word count for the ballot summary is 84.

Support

Californians for Kidney Dialysis Patient Protection led the Kidney Patients Deserve Better campaign in support of Proposition 29.

Supporters

Political Parties

• Democratic Party of California
• Peace and Freedom Party of California

Unions

• SEIU-UHW West

Arguments

• Californians for Kidney Dialysis Patient Protection: "Big dialysis corporations make billions of dollars annually. The average profit margin for DaVita and Fresenius clinics in the United States is 16% and 15.8% respectively — nearly six times as high as the average profit margin for US hospitals."
• David Miller, research director of SEIU-UHW: "There’s just so much improvement that can be made, and there’s plenty of resources in the industry to make those improvements. That’s the tension: there’s enormous profitability, then you meet folks of enormous need, and you realize that some of that money should be diverted to patient care."

Official arguments

The following is the argument in support of Proposition 29 found in the Official Voter Information Guide:

Official Voter Information Guide: Life-Saving Changes for Dialysis Patients Three times every week, 80,000 Californians with End Stage Renal Disease go to one of more than 600 commercial dialysis centers in the state where they spend several hours connected to a machine that removes their blood, cleans it, and returns it to their bodies. Dialysis literally is what keeps them alive, and they must continue the treatment for the rest of their lives or until they receive a kidney transplant. Because the lives of these fellow Californians are so dependent on dialysis done both safely and effectively, we must give our absolute support to the Protect the Lives of Dialysis Patients Act on the Nov. 8 ballot. This initiative makes common-sense improvements to dialysis treatment to protect some of the most medically vulnerable Californians. The initiative does five major things: First, it requires a physician, nurse practitioner, or physician assistant to be in the clinic whenever patients are being treated, which is not currently required. Dialysis is a dangerous procedure, and if something goes wrong, a doctor or highly trained clinician should be nearby. Second, as dialysis patients are prone to infections that can lead to more serious illnesses or even death, it requires clinics to report data on infections to the state so problems can be identified and solved to better protect patients. Third, as life-saving health care facilities, it requires dialysis corporations to get approval from the state before closing clinics or reducing services. This will protect access to dialysis treatment, particularly for patients in rural communities. Fourth, it prohibits clinics from discriminating against patients because of their type of insurance and protects patients in every clinic. Whether in a wealthy neighborhood or a poor, rural, Black or Brown community, all clinics will be required to have a doctor or other highly trained clinician on-site and to report their infection rates, and all dialysis corporations will be prohibited from discriminating against patients based on insurance type. Fifth, it increases transparency and helps patients make informed decisions for their care by requiring clinics and dialysis corporations to disclose information on ownership. As joint ventures between dialysis clinics and doctors become more common, improved transparency is needed to allow stakeholders and policy makers to study the effects of physician ownership. Don’t fall for big dialysis corporations’ claims that this initiative will create huge new costs, harm patients, or create a shortage of doctors—those fake arguments are just designed as scare tactics in their dishonest public relations campaign. The fact is these corporations can easily make these changes and still profit hundreds of millions of dollars a year without disrupting our healthcare system. Proposition 29 will make the changes we need to truly protect dialysis patients. We urge you to vote YES! --- Emanuel Gonzales, Dialysis Patient Care Technician; Reverend Kisheen W. Tulloss, President, The Baptist Ministers Conference of Los Angeles; and Cecilia Gomez-Gonzalez, Dialysis Patient Advocate

Opposition

Stop Yet Another Dangerous Dialysis Proposition led the campaign in opposition to Proposition 29.

Opponents

Political Parties

• Republican Party of California

Organizations

• American Academy of Nephrology PAs
• California Chamber of Commerce
• California Medical Association
• California Taxpayer Protection Committee
• National Hispanic Medical Association

Arguments

Official arguments

The following is the argument in opposition to Proposition 29 found in the Official Voter Information Guide:

Official Voter Information Guide: DIALYSIS PATIENTS STRONGLY OPPOSE PROP. 29 BECAUSE IT PUTS OUR LIVES AT RISK "This is the third time a special interest has placed a proposition on the ballot putting my life and the lives of 80,000 other dialysis patients at risk. Twice, voters have overwhelmingly rejected these dangerous propositions. Please, reject Prop. 29 to stop yet another dangerous dialysis proposition."—Angel De Los Santos, dialysis patient, Los Angeles "I’ve been on dialysis for two years. Dialysis is literally my life support. I am so angry that one special interest is pushing a third proposition that puts my life at risk. Please, protect patients like me . . . again. Vote NO on 29."—Rachel Sprinkle-Strong, dialysis patient, Sacramento PROP. 29 WOULD FORCE COMMUNITY DIALYSIS CLINICS TO CUT SERVICES OR SHUT DOWN—RISKING PATIENTS’ LIVES Dialysis patients, nurses and doctors strongly oppose Prop. 29. More than 80,000 Californians with failed kidneys need dialysis treatments three days a week to stay alive. Missing even a single dialysis treatment increases patients’ risk of death by 30%. Proposition 29 would force dialysis clinics to have new administrators on-site at all times—even though they would not provide direct patient care. This unnecessary requirement would cost hundreds of millions every year, forcing dialysis clinics throughout the state to cut back services or shut down, making it harder for patients to access their treatments—putting their lives at risk. DIALYSIS CLINICS ARE STRICTLY REGULATED AND PROVIDE HIGH QUALITY CARE California’s dialysis clinics are regulated by federal and state agencies and have high ratings for quality care and patient satisfaction. Each dialysis patient in California is under the care of their own kidney specialist and dialysis treatments are administered by specially trained nurses and licensed technicians. It makes no sense to also require a physician administrator on-site full-time who will not be involved in providing care. PROP. 29 WOULD WORSEN OUR HEALTH CARE WORKER SHORTAGE AND LEAD TO MORE EMERGENCY ROOM OVERCROWDING "Proposition 29 would take thousands of doctors, physician assistants and nurse practitioners away from hospitals and clinics—where they’re needed—and place them into administrative jobs at dialysis clinics where they aren’t."—Marketa Houskova, Doctor of Nursing Practice, RN, Executive Director of American Nurses Association\California. "Prop. 29 would make our growing physician shortage even worse by taking doctors away from hospitals and clinics where they are needed, increasing wait times and reducing capacity to deal with other medical emergencies."—Robert E. Wailes, M.D., President, California Medical Association ANOTHER SPECIAL INTEREST ABUSE This is the third time this special interest has placed similar dialysis measures on the ballot. Twice, California voters have overwhelmingly rejected these measures. Special interests need to respect the will of the voters and stop threatening dialysis patients’ lives. JOIN DIALYSIS PATIENTS, FAMILIES, NURSES AND DOCTORS: NO ON 29 Prop. 29 opposed by: • Tens of thousands of dialysis patients and families • American Nurses Association\California • American Academy of Nephrology Physician Assistants • Dialysis Patient Citizens, representing thousands of patients • California Medical Association, representing 40,000 California physicians • Emergency room doctors www.NoProp29.com ---Anthony Hicks, Kidney Dialysis Patient; Angelic Nicole Gant, Kidney Dialysis Patient; and Gregory Ridgeway, Kidney Dialysis Patient

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 January 31, 2023.

The PAC Californians for Kidney Dialysis Patient Protection was registered to support the ballot initiative. The PAC raised over $7.9 million from the SEIU-UHW West.

The PAC No on 29: Stop Yet Another Dangerous Dialysis Proposition was registered to oppose the ballot initiative. The PAC raised over $74.6 million in contributions.

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$7,960,667.45	$17,899.06	$7,978,566.51	$7,928,804.85	$7,946,703.91
Oppose	$74,557,628.58	$0.00	$74,557,628.58	$83,254,732.52	$83,254,732.52
Total	$82,518,296.03	$17,899.06	$82,536,195.09	$91,183,537.37	$91,201,436.43

Support

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

Committees in support of Proposition 29
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Californians for Kidney Dialysis Patient Protection - Yes on 29	$7,960,667.45	$17,899.06	$7,978,566.51	$7,928,804.85	$7,946,703.91
Total	$7,960,667.45	$17,899.06	$7,978,566.51	$7,928,804.85	$7,946,703.91

Donors

The following were the top donors to the committee.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
SEIU-UHW West	$7,960,167.45	$16,843.97	$7,977,011.42

Oppose

The following table includes contribution and expenditure totals for the committee in opposition to the initiative.

Committees in opposition to Proposition 29
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
No on 29: Stop Yet Another Dangerous Dialysis Proposition	$74,557,628.58	$0.00	$74,557,628.58	$83,254,732.52	$83,254,732.52
Total	$74,557,628.58	$0.00	$74,557,628.58	$83,254,732.52	$83,254,732.52

Donors

The following were the top donors to the committee.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
DaVita, Inc.	$52,730,766.00	$0.00	$52,730,766.00
Fresenius Medical Care	$27,346,017.58	$0.00	$27,346,017.58
U.S. Renal Care Inc.	$5,930,845.00	$0.00	$5,930,845.00
Satellite Healthcare, Inc.	$250,000.00	$0.00	$250,000.00
Dialysis Clinic Inc.	$100,000.00	$0.00	$100,000.00

Media editorials

See also: 2022 ballot measure media endorsements

Ballotpedia identified the following media editorial boards as taking positions on Proposition 29.

Ballotpedia lists the positions of media editorial boards that support or oppose ballot measures. This does not include opinion pieces from individuals or groups that do not represent the official position of a newspaper or media outlet. Ballotpedia includes editorials from newspapers and outlets based on circulation and readership, political coverage within a state, and length of publication. You can share media editorial board endorsements with us at editor@ballotpedia.org.

Support

Ballotpedia did not identify media editorial boards in support of the ballot measure.

Opposition

• Bay Area Reporter Editorial Board: "Mandating a doctor to be at a dialysis clinic is not an effective use of their time — the same would be true of other eligible staff under the proposition — because they need to be at hospitals and other clinics attending to other sick kidney patients. If a dialysis center has issues with a patient, staff can contact physicians immediately and they can send a patient to a hospital if needed. Vote NO on Prop 29."
• Mercury News & East Bay Times Editorial Boards: "Regulation of the industry is complex and best suited for the Legislature rather than the ballot box. If changes are needed, lawmakers should hear from experts in the field, thoroughly vet any new laws and be open to alterations dictated by sound medical advice. The California Medical Association understands that, which is why it steadfastly opposes Prop. 29. ... Voters have rejected the two previous kidney dialysis ballot measures with good reason. They should do so again by voting no on Prop. 29."
• Santa Cruz Sentinel Editorial Board: "Proposition 29 on the November ballot is an abuse of California’s election system – again. For the third time in five years, leaders of a large labor union are asking voters to approve unnecessary regulations for the kidney dialysis industry that would make it harder for patients to receive critical care. ... Voters have rejected the two previous kidney dialysis ballot measures for good reason. They should do so again and vote no on Prop. 29."
• Marin Independent Journal Editorial Board: "Voters have rejected the two previous kidney dialysis ballot measures with good reason. They should do so again by voting no on Prop. 29."
• Los Angeles Times Editorial Board: "The proponents says the proposition is intended to improve patient care. It’s an assertion they can’t back up with evidence. No other state requires a doctor on-site, nor do the Centers for Medicare & Medicaid Services or the California State Department of Public Health, which regulates dialysis centers. Nor is there evidence that the current arrangement has harmed patients. ... Voters should reject Proposition 29."
• San Francisco Chronicle Editorial Board: "Nearly 75% of licensed dialysis clinics in California are owned or operated by two for-profit companies: DaVita Inc. and Fresenius Medical Care. Proponents of Prop. 29 don’t hide the fact that they see this measure as part of a strategy to unionize the facilities owned by these companies. ... Voters should reject Prop. 29’s cynical tactics in November — and as many times as they need to in the future."
• The Orange County Register Editorial Board: "The union thinks that the admittedly small number of firms that run most of the dialysis clinics in this state and throughout the country are too profitable, and this irks them. Again, not a good reason to legally demand artificially high staffing levels just to spite them. That’s why the state’s physicians and other healthcare providers, including the California Medical Association, American Nurses AssociationCalifornia and the American Academy of Nephrology PAs all oppose Prop. 29. ... Vote no on Prop. 29 this November."
• The San Diego Union-Tribune Editorial Board: "The union thinks if it forces the companies to spend around $100 million every two years to defend the status quo, they will stop opposing unionization. That this tactic could kill people is apparently of no concern. The San Diego Union-Tribune Editorial Board recommends a 'no' vote on Proposition 29."
• The Sacramento Bee Editorial Board: "Voters resoundingly rejected nearly identical propositions in 2018 and 2020, and they should do the same this year. Proposition 29, the Dialysis Clinic Requirements Initiative, is not a significant improvement on the earlier attempts. Just like the previous measures, it’s a proposed solution in search of a problem."

Background

California Proposition 8 (2018)

See also: California Proposition 8, Limits on Dialysis Clinics' Revenue and Required Refunds Initiative (2018)

In 2018, the campaign Californians for Kidney Dialysis Patient Protection supported a ballot initiative to require dialysis clinics to issue refunds to patients or patients' payers for revenue above 115% of the costs of direct patient care and healthcare improvements. On the ballot as Proposition 8, 59.9% of voters rejected the proposal. On November 7, 2018, Californians for Kidney Dialysis Patient Protection announced that a similar ballot initiative would be filed for 2020.

The committees in support or opposition of Proposition 8 had raised a combined $130.43 million, making the ballot measure the most expensive of 2018. The SEIU-UHW West sponsored Californians for Kidney Dialysis Patient Protection, which raised $18.94 million. The California Democratic Party and California Labor Federation supported the campaign. Opponents, organized as Patients and Caregivers to Protect Dialysis Patients, raised $111.48 million, with DaVita and Fresenius Medical Care North America providing 90% of the campaign's funds.

California Proposition 23 (2020)

See also: California Proposition 23, Dialysis Clinic Requirements Initiative (2020)

In 2020, the SEIU-UHW West launched a new campaign for a ballot initiative to have a minimum of one licensed physician present at the clinic while patients are being treated; report data on dialysis-related infections to the state health department and National Healthcare Safety Network (NHSN); and provide a written notice to the state health department and obtain consent from the state health department before closing a chronic dialysis clinic. At the election on November 3, 2020, 63.4% of voters rejected the ballot initiative.

Proposition 23 saw $114.23 million raised between supporters and opponents. The Californians for Kidney Dialysis Patient Protection PAC raised $8.99 million from the SEIU-UHW West. The Stop the Dangerous & Costly Dialysis Proposition PAC was registered to oppose the ballot initiative. The committee had raised $105.24 million, with $66.8 million from DaVita, Inc. and $29.8 million from Fresenius Medical Care.

Conflict between labor and dialysis businesses

Propositions 8 and 23 established a new front in the conflict between the SEIU-UHW West, a labor organization, and the state's two largest dialysis businesses DaVita and Fresenius Medical Care.

The SEIU-UHW West said workers at dialysis clinics had been attempting to unionize since 2016, but that their employers were retaliating against pro-union employees. Kent Thiry, CEO of DaVita, argued that "Proposition 8 puts California patients at risk in an effort to force unionization of employees." Kathy Fairbanks, an opposition spokesperson, similarly stated, "[Sponsors] want to bring the dialysis community to the table and unionize it. This is just leverage." Wherley, a spokesperson for the SEIU-UHW West, contended that dialysis workers "want these [initiative] reforms regardless of what happens with their union efforts." Dave Regan stated, "The reason Prop. 8 is on the ballot is because they have a terrible business model and they’re gouging patients and insurers."

Jim Miller, a columnist for The Sacramento Bee, and Melanie Mason, a state politics journalist for the Los Angeles Times, both stated that the ballot initiative would also provide the SEIU-UHW West with leverage over legislation to enact new regulations on dialysis clinics in the California State Legislature. Wherley said the union was taking a two-pronged approach, wanting to make "sure we have as many options available as possible." In 2017, legislation was introduced, but not passed, to require staff-patient ratios in dialysis clinics and, like the ballot initiative, limit the revenue of businesses.

What is dialysis treatment?

Dialysis is a medical treatment that removes waste products and excess fluids and chemicals from a person's bloodstream. Dialysis is recommended when a person's kidneys lose most of their function. Kidneys filter a person's blood, removing wastes, excess water, and surplus chemicals and nutrients. The substances removed from the bloodstream are deposited in the bladder and discharged as urine.

There are two main types of dialysis treatment—hemodialysis and peritoneal dialysis.

• Hemodialysis: Before hemodialysis treatments can begin, surgeons create an access point, typically in an arm, to allow technicians to remove blood for treatments. Tubing is attached to allow blood to be pumped between the access point and a hemodialyzer machine, also known as an artificial kidney machine. The machine filters the blood and adds a solution to help remove waste. How often a person needs hemodialysis treatment can vary. According to the National Kidney Foundation, hemodialysis treatments usually occur three times per week and take around four hours each time.

• Peritoneal dialysis: Surgeons insert a catheter into the lining of a person's abdomen. The treatment involves pumping a solution into the abdomen. The solution absorbs wastes and uses the lining of the abdomen as a filter. A few hours after the solution has been pumped into the abdomen, the catheter is reopened to allow the solution to drain. Peritoneal dialysis typically occurs three to five times every day, with each treatment taking about 30 to 40 minutes, according to the National Kidney Foundation.

Path to the ballot

See also: Laws governing the initiative process in California

Process in California

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 2022 ballot:

• Signatures: 623,212 valid signatures were required.
• Deadline: The deadline for signature verification was 131 days before the general election, which was around June 30, 2022. 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.

Initiative #20-0013

Sean Fleming and Jonathan Everhart filed the ballot initiative on August 24, 2021. The attorney general of California issued ballot language for the initiative on October 29, 2021, allowing a signature drive to begin. Signatures were due on April 27, 2022. Proponents reported collecting 25% of the required signatures (155,803) on January 24, 2022.

The initiative campaign submitted 1,018,730 raw signatures.

On June 20, 2022, the secretary of state reported that the random sample concluded that 725,890 signatures were valid.

Sponsors of the measure hired Kimball Petition Management to collect signatures for the petition to qualify this measure for the ballot. A total of $13,374,336.75 was spent to collect the 623,212 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $21.46.

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. As of January 2025, six states — Alabama, Arizona, Georgia, Kansas, Louisiana, and New Hampshire — had passed laws requiring verification of citizenship at the time of voter registration. However, only two of those states' laws were in effect, in Arizona and New Hampshire. In three states — California, Maryland, and Vermont — at least one local jurisdiction allowed noncitizens to vote in some local elections as of November 2024. 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

2022 measures

• 2022 ballot measures
• Healthcare 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

• Petition #21-0013