Registered nurse Christie Lindog works at the Cardiovascular Intensive Care Unit at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California on September 2, 2021. (APU GOMES/AFP via Getty Images)

In essence, Proposition 35 promised to secure Medi-Cal funding but left voters to weigh the trade-offs of budget stability and flexibility.

Californians took that deal and passed it, cementing the state's tax on managed-care organizations and directing an estimated $7 to $8 billion each year exclusively to Medi-Cal.

The funds are meant to improve access to primary care, specialty care, mental health services, and prescription drugs, as well as, enhance provider availability and reduce patient wait times.

Lawmakers, however, are limited in reassigning these funds, and the measure remains contingent on federal approval for continued matching funds.

Despite Proposition 35's innocuous and seemingly straightforward title -- "Provides permanent funding for Medi-Cal health care services," -- the measure is one the most complex on California's ballot. At its core is an obscure tax that most voters have never heard of. Basically, California levies a tax on managed-care organizations -- otherwise known as health insurers like Anthem Blue Cross and Kaiser Permanente. The state uses the tax revenue to draw federal matching funds, effectively doubling its impact, and applies it toward Medi-Cal services.

Under the proposition, tax revenue from managed-care organizations would be strictly reserved for Medi-Cal, expanding access to services like mental health, primary care, and prescription drugs. Supporters argue this dedicated funding will improve access for the two in five Californians reliant on Medi-Cal, with funds directed to providers like hospitals and emergency services. With many patients currently facing prolonged wait times and few physicians accepting Medi-Cal's lower reimbursement rates, proponents said it would help alleviate these pressures by increasing provider compensation.