Election 2026: health center results and deadlines in every state

On November 3, 2026, Democrats won the House and the Senate, flipped five governorships and twelve legislative chambers, and California voters rejected Proposition 44, the SEIU-UHW measure that would have set a 90% spending rule for community clinics, by 82% to 18%. None of that changes the law before January. The Community Health Center Fund still ends December 31 and Medicaid work requirements still start January 1. Pick your state below, then read what the next 90 days hold.

Find your state

Each card gives the governor result, any chamber that changed hands, the health measures, local health taxes, Medicaid status, and what it means for health centers and for anyone starting a job there. Counts are unofficial until each state certifies.

Full records: all states · legislation tracker · advocacy watch

The dates that decide the next 90 days

What changed nationally, and what did not

CBS News projects Democrats will hold at least 54 Senate seats, with Alaska and Mississippi still counting as of November 7. Networks called the House for Democrats on election night, and Hakeem Jeffries is in line to become Speaker. NCSL counts five governorships that moved to Democrats (Georgia, Iowa, Nevada, Ohio and Texas), twelve chambers that changed hands, six new Democratic trifectas and five broken Republican ones. Kansas and Alaska were still counting their governor races on November 8.

The new Congress is sworn in on January 3, 2027. Until then the current Congress holds two deadlines that matter more to health centers than any race. The stopgap that funds HHS, P.L. 119-103, expires December 11. The Community Health Center Fund and the National Health Service Corps run out under 42 U.S.C. 254b-2 on December 31, with $1.16 billion for health centers and $88 million for the Corps in the last quarter and nothing after. As of November 8, no bill filed since September 1 extends either program.

• Medicaid. Jeffries told reporters Democrats will fight to reverse the H.R. 1 Medicaid cuts. KFF's Larry Levitt says a rollback is impossible with the president in the White House, and Holland and Knight expects the fight to center on implementation rather than repeal.
• ACA premium tax credits. The enhanced credits ended after 2025, and KFF puts the 2027 benchmark premium increase at 13%. Restoring them is a stated Democratic priority, and Georgetown's Sabrina Corlette expects the question to land inside a broader budget package.
• Work requirements. The CMS rule took effect July 31, 2026, and states must apply it by January 1, 2027. On October 29 a federal judge in Massachusetts ruled CMS went too far on the medically frail exemption, so a condition in one of the five listed groups is enough. The requirement itself stands.
• 340B. HRSA's rebate pilot still starts January 1, 2027, and the American Hospital Association and the Maine Hospital Association have sued to block it. H.R. 10770, introduced October 9, would pause it through 2028. Faegre Drinker expects no 340B bill to move in the lame duck.

California: Prop 44 is gone, the funding question is not

The Secretary of State's semi-official count on November 7 at 5:48 p.m., with all 23,860 precincts reporting, shows Proposition 44 losing 8,171,275 to 1,788,111. No 90% spending rule, no state fines, no new reporting. CPCA president Francisco Silva told LAist that health centers will not be bullied. SEIU-UHW's Dave Regan told CalMatters the union may return in 2028 with a health funding measure if the Legislature does not act, and CPCA's racketeering suit against the union, filed in September, is still pending.

The money picture is tighter than the Prop 44 result suggests. Proposition 40, the one-time billionaire tax whose revenue the voter guide directs primarily to health care, trails 46.6% to 53.4%. Proposition 42, which would cancel it, leads 52.2% to 47.8% and already has more yes votes. Proposition 3 passed with 60.3%, keeping the high-income tax whose revenue funds schools and, supporters say, Medi-Cal. California's current MCO tax runs through December 31, and the California Medical Association and health plans have asked the state Supreme Court to strike SB 125, the law that would charge plans $8.85 per enrollee a month from 2027.

Xavier Becerra won the governorship 65.5% to 34.5% and takes office January 4, 2027. He says he will seek to reverse the limits that pushed undocumented adults off Medi-Cal, and KQED reports that state law requires the Department of Finance to present options by March 1 for corporations to pay more of Medi-Cal's cost, an idea he says he is open to. Democrats kept their two-thirds majorities and picked up two Assembly seats. In Los Angeles, Nithya Raman defeated Mayor Karen Bass in a race NBC Los Angeles called November 5, while Measure ER's half-cent tax revenue sits in escrow until a lawsuit over it ends.

Texas: Medicaid expansion gets its first real hearing

Gina Hinojosa beat Greg Abbott 52.8% to 45.7% in the Secretary of State's unofficial count, ending three decades of Republican control of the office. James Talarico won the U.S. Senate seat, Vikki Goodwin is lieutenant governor, and the House flipped to Democrats, projected 83 to 67, for the first time since 2002. Republicans keep the Senate 19 to 12.

In an interview republished by KSAT, Hinojosa said she will push the Legislature to expand Medicaid, and House Democrats name expansion an early priority. Expansion still needs the Republican Senate. Bill filing opens November 9 and the 90th Legislature convenes January 12, 2027. Texas has 71 health center organizations serving about 1.86 million patients, a third of them uninsured, in the state with the nation's highest uninsured rate.

• Local votes were mixed. Bell County rejected a new hospital district 81% to 19%. The Fairfield Hospital District in Freestone County approved a tax increase with 60%. Dallas County voters rejected Proposition A, about $100 million a year for homelessness and mental health, 52% to 48%.
• Austin and Houston said on November 6 they will change police orders on immigration enforcement once Hinojosa takes office. Texas can still enforce SB 4 after a Fifth Circuit order on May 29, 2026.

County by county

Local health taxes decided this month, with the latest count each source printed. Most states had none on the November ballot; this table grows as counties certify.

Los Angeles County's Measure ER, the half-cent sales tax for public health, clinics and emergency rooms, passed in June and took effect October 1, 2026; the county holds its revenue in escrow until an August lawsuit ends.

If you are starting an FQHC job in 2027

• Your paycheck. California's SB 525 moves the health care minimum wage to $25 an hour on July 1, 2027, and that date did not move. Oklahoma voters rejected State Question 832 in June, so the minimum wage stays $7.25 there and in Texas. Vermont and Maryland voters added collective bargaining rights to their constitutions.
• Your loan repayment. National Health Service Corps money ends December 31 with the health center fund unless Congress acts in December. HRSA extended some health center grant periods to June 30, 2027. The U.S. Virgin Islands program pays up to $65,000 over three years.
• Your workload. In every expansion state, work requirements and six-month renewals begin by January 1, 2027. Iowa starts December 1 and Nebraska began May 1. Enrollment, outreach and eligibility staff will be the busiest people in the building, and people who can explain the medically frail exemption will be in demand.
• Your patients' coverage. Georgia, Texas and Wisconsin now have leaders who say they want expansion or a stronger Medicaid budget. Alabama, Florida, Mississippi, South Carolina, Tennessee, Kansas and Wyoming stay outside expansion. Mixed-status families face new eligibility limits in several states starting October 1 and January 1.
• Your scope. Texas nurse practitioner practice bills died in 2025 and return in 2027 under a Democratic House. Colorado's Proposition 135 bars Medicaid payment for gender-affirming surgery for minors.

What health center leaders can do now

• Before December 11, tell your House and Senate offices what the fund pays for at your sites. NACHC's ask is a multi-year fund and a $300 million annual increase.
• Budget fiscal 2027 with the fund ending December 31 and your Notice of Award in hand. Treat any extension as upside.
• Train enrollment staff on the five medically frail groups and the renewal calendar before January 1, and start with patients who renew in January and February.
• Compare your 340B savings against the rebate pilot's 25 drugs before January 1, and ask your pharmacy partners how they will bill.
• If you are in California, model the MCO tax and your county's measure. If you are in Texas, Georgia or Wisconsin, put expansion in the 2027 plan as a scenario rather than a line item.