Local ballot measures: County of Fresno.

New Section 1 requires any Fresno County initiative petition certified as sufficient by the Registrar of Voters on or before July 8, 2026 to be submitted without alteration to voters at the November 3, 2026 statewide general election. This is tied to a local transportation funding measure facing an expiring tax.

The bill's description now includes 'An act relating to elections' in addition to the hospital-related language, formally expanding the bill's subject matter beyond health and safety.

The extensive legislative findings about hospital financial distress (subdivisions a through j) were replaced with a brief finding that a special statute is necessary for Fresno County due to the unique fiscal circumstances arising from the expiration of its local transportation tax.

Removed the provision that would have made any hospital regardless of ownership type or system affiliation eligible for program loans after an appropriation is made. The prior restriction limiting eligibility to not-for-profit and public hospitals (with the two-facility system cap) remains in place for pre-existing awards.

Removed the new definition of 'associated entities' (affiliates, subsidiaries, or other controlling/controlled entities) that would have been used to evaluate hospital eligibility and limit loans based on parent company capacity.

Removed expanded financial distress methodology factors including credit rating, debt capacity, capital investment, reserves, investments, commercial prices, and the requirement that projections account for federal and state policy changes such as the One Big Beautiful Bill Act.

Removed loan conditions that would have required hospitals to maintain labor and delivery services, emergency services, Medi-Cal participation, and community benefit/charity care as conditions of receiving loans.

Removed the requirement that payouts to investors, shareholders, and management companies in the last three years be deducted from any loan amount issued to a hospital with associated entities.

Senator Caballero was added as a principal coauthor, reflecting the Senate's involvement in reshaping the bill.

Chapter number 108 was removed and replaced with a blank 'CHAPTER' line, as the chapter number is assigned only after gubernatorial approval.

The approval date (August 6, 2026) was removed and replaced with a blank signature line for the Governor to fill in upon signing.

Lines indicating 'Passed the Assembly August 6, 2026' and 'Passed the Senate August 6, 2026' were added, along with a 'Private Secretary of the Governor' receipt line, consistent with the enrolled bill format sent to the Governor.

The $300 million General Fund appropriation to the Distressed Hospital Loan Program Fund was deleted. The bill title no longer references making an appropriation, and the fiscal note changes from 'Appropriation: yes' to 'Appropriation: no.'

Section 129385 (fund establishment, transfer authorizations, and fund abolition provisions) and Section 129387 were removed from the bill entirely.

A two-tier activation structure was created: current simplified provisions become inoperative on July 1 of the year an appropriation is made, and new expanded sections become operative on that same date. This means the full program does not activate until funding is separately appropriated.

The immediately-operative version of Section 129383 simplifies the financial distress methodology to consider only cash on hand and negative operating margins, removing credit rating, debt capacity, capital investment, reserves, investments, and commercial prices. It also removes the requirement that projections account for federal and state policy changes (including the One Big Beautiful Bill Act).

The immediately-operative version adds a requirement that the department make its methodology publicly accessible on its website, and grants the department authority to determine service provision requirements for the duration of loans.

The immediately-operative version removes the detailed associated-entity financial statement requirements and the specific loan conditions (maintaining labor and delivery, emergency services, Medi-Cal participation, community benefit care). Eligibility is simplified to a flat rule: not-for-profit and public hospitals in integrated systems with more than two separately licensed facilities are ineligible.

All Health and Safety Code amendments related to the Distressed Hospital Loan Program were removed. The bill no longer amends or adds sections 129384 or 129387 of the Health and Safety Code.

The provision extending the Distressed Hospital Loan Program from January 1, 2032 to January 1, 2035 was removed and did not become law.

The loan forgiveness criteria requiring good faith compliance through January 1, 2026 and financial projections showing distress from loan repayments or the federal One Big Beautiful Bill Act (Public Law No. 119-21) were removed.

The requirement that loan forgiveness evaluations incorporate projections of future financial performance in addition to point-in-time financial condition was removed.

Fund availability period extended from December 31, 2031 to December 31, 2034 (Section 129385(d)).

Fund abolition date changed from December 31, 2031 to December 31, 2034 (Section 129385(j)).

Chapter sunset extended from January 1, 2032 to January 1, 2035 (Section 129387).

Added a deadline requiring the department to provide loan forgiveness to pre-existing participants meeting criteria no later than two months after the effective date of the act adding those criteria (Section 129384(c)(2)).

Removed the requirement that the Department of Finance approve any loan forgiveness or modification extending the payback period by more than one year (Section 129384(c)(2)).

Removed the requirement that the department establish terms and conditions for accepting loan forgiveness or modification, subject to Department of Finance approval (former Section 129384(c)(3)).

Added Assembly Members Carrillo, Harabedian, and Michelle Rodriguez as coauthors.

The legislative summary now conditions the expanded eligibility for all hospitals regardless of ownership type, the new financial distress methodology, and the loan forgiveness provisions on 'if an appropriation is made for this purpose,' making these provisions explicitly dependent on actual funding being provided.

The appropriation line in the bill summary changed from 'Appropriation: yes' to 'Appropriation: yes no,' which may reflect uncertainty about whether a specific appropriation is included in this version of the bill.

Grammatical corrections throughout operative sections: removed redundant phrasing such as 'that meets if the hospital' (now simply 'if the hospital') in Section 129380(c) and 'if it meets the hospital meets the' (now 'if the hospital meets the') in Section 129383(f)(2).

Removed duplicate section numbering artifacts (a stray 'SEC. 3.' before 'SEC. 4.') and cleaned up duplicate letter designations in the definitions section (Section 129381) where letters like (a), (b), (c) appeared twice.

New Section 129381 adds a definition of 'associated entities' as affiliates, subsidiaries, or other entities that control, govern, or are financially responsible for the hospital, foreign or domestic. Other existing definitions (Authority, Closed hospital, Department, Not-for-profit hospital, Program, Public hospital) are consolidated into this new section.

A hospital with associated entities is now only eligible for state assistance if those associated entities are determined not to have capacity to provide sufficient financial resources to resolve the hospital's financial distress. This creates a new 'deep pocket' test that could disqualify hospitals whose parent companies or affiliates are financially healthy.

The financial distress methodology now includes additional metrics beyond cash on hand and negative operating margins: credit rating, debt capacity, capital investment, reserves, investments, and commercial prices. The applicable criteria must include the fiscal condition of both the hospital and its associated entities.

Hospitals with associated entities must submit consolidated financial statements covering all associated entities. If any entity is for-profit (even privately held), they must disclose payouts to investors, shareholders, and management companies.

The department may now impose conditions on loans to maintain timely access to services, including maintaining labor and delivery services, emergency services, continued participation in Medi-Cal and county contracts, and community benefit or charity care.

Amounts paid out to investors, shareholders, and management companies in the last three years shall be deducted from any loan amount issued under the program. This effectively reduces the net loan available to for-profit affiliated hospitals that have been distributing profits.

Section renumbering throughout the bill due to insertion of new Section 129381. The urgency statute provision moves from Section 7 to Section 8. All cross-references are updated accordingly.