November 8, 2022 Ballot Prop. 29

Proposition N: Dialysis Clinic Requirements Initiative

Official Results

Available once the California Secretary of State has certified the election. This can take up to 3 weeks or more.

Yes votes: 3,368,257 (31.6%)

No votes: 7,277,255 (68.4%)

Proposition 29 enacts staffing requirements, reporting requirements, ownership disclosure, and closure requirements for chronic dialysis clinics. Specifically, this ballot measure requires clinics to:

  • have a  physician, nurse practitioner, or physician assistant on-site during all treatment hours. 
  • report all dialysis-related infection information to the California Department of Public Health (CDPH) every three months.
  • disclose clinic ownership disclosed to patients.
  • notify and obtain permission from CDPH before closing or reducing services.
  • pay penalties if clinics do not report required information.
  • treat patients regardless of how they are paying for their treatment, be it through Medicare, Medi-Cal, patient’s health insurance, or out of pocket.

This measure was put on the ballot by petition signatures.

Fiscal Impacts 

According to the California Legislative Analyst's Office:

Proposition 29 would increase costs for clinics. In particular, the proposition’s requirement that each clinic have a physician, nurse practitioner, or physician assistant on-site during all treatment hours would increase each clinic’s costs by several hundred thousand dollars annually on average. Other requirements of the proposition would not significantly increase clinic costs. How each clinic chooses to manage these costs will vary. Three possible options could be an increase in costs to patients, clinic closure, or continued operation with lower profit.

Additionally, estimated costs to state and local governments could increase likely in the tens of millions of dollars annually. This would be due to higher patient treatment costs, either from the clinic itself or due patients requiring treatment in costlier settings like hospitals, if a  clinic closes in response to the proposition.

Increased administrative costs for CDPH due to new regulatory responsibilities likely would not exceed the low millions of dollars annually and could be covered by the annual licensing fee paid by clinics.

What your vote means

YES vote on this measure means: Chronic dialysis clinics would be required to have a physician, nurse practitioner, or physician assistant on-site during all patient treatment hours.

NO vote on this measure means: Chronic dialysis clinics would not be required to have a physician, nurse practitioner, or physician assistant on-site during all patient treatment hours.

Official Voter Information 

Non-Partisan Resources

 Public Opinion

No polls available for this proposition at this time.

Pro/Con Statements

The proponents claim that Proposition 29 requirements or the Protect the Lives of Dialysis Patients Act makes common-sense and needed improvements to dialysis treatment to protect the health and safety of some of the most medically vulnerable Californians. Specifically they claim that dialysis is a dangerous procedure, and if something goes wrong, a doctor or highly trained clinician should be nearby. Clinics must be required to report data on infections to the state so problems can be identified and solved to better protect patients. Being required to report intended clinic closure to the state protects access to dialysis treatment, particularly for patients in rural communities. Proposition 29 also prohibits clinics from discriminating against patients because of their type of insurance and protects patients in every clinic. And lastly, Prop. 29 increases transparency and helps patients make informed decisions for their care by requiring clinics and dialysis corporations to disclose information on ownership. Supporters push back against arguments that Proposition will create huge new costs, harm patients, or create a shortage of doctors stating that the dialysis corporations can easily make these changes and still profit hundreds of millions of dollars a year without disrupting our healthcare system.
Opponents claim that Proposition 29 would increase costs for kidney dialysis treatment and result in cutting of services and even the closure of clinics. They state that dialysis clinics are already strictly regulated and provide high quality care. Opponents note that this is the third attempt by SEIU United Healthcare Workers West California to pass a dialysis clinic proposition and that voters have overwhelmingly rejected similar dialysis propositions twice in the past (Proposition 8 in 2018 and Proposition 23 in 2020).
Californians for Kidney Dialysis Patient Protection Yes on 29 No on Prop. 29