In November 2004, 53.4 percent of voters approved Prop. 63, the Mental Health Services Act (MHSA). The measure imposed a 1 percent tax on personal income over $1 million to fund expansion of county-operated mental health services. Revenues from this tax are deposited into the Mental Health Services Fund and administered by the California Department of Mental Health (DMH).

The MHSA mandates funding for six different purposes:

1. Community program planning: Aims to bring stakeholders into the process of planning MHSA-funded mental health services. Stakeholders include clients, families, caregivers, criminal justice, housing, social services, and partner agencies.
2. Community services and support: Includes the programs, services, and strategies for people with mental illness. These programs, services, and strategies vary by county and are identified in the community planning process.
3. Education and training: Seeks to increase the number of qualified individuals providing services to address severe mental illnesses.
4. Capital facilities and technology: Addresses housing and information technology needs to support implementation of MHSA-funded community services and support programs.
5. Prevention and early intervention: Supports the design of programs to prevent mental illnesses from becoming severe or disabling, with emphasis on underserved populations.
6. Innovation: Aims to develop and implement promising and proven practices, as well as increase access to and quality of care.

Agencies charged with implementing these components include the California DMH, local county mental health departments, the MHSA Oversight and Accountability Commission, the Mental Health Planning Council, and stakeholders in the California mental health community. These public agencies enjoy a high level of flexibility in fulfilling their MHSA mandates.

In November 2004, 59.1 percent of voters approved Prop. 71, the California Stem Cell Research and Cures Act. The measure created the California Institute for Regenerative Medicine (CIRM) to regulate stem cell research and provide grants and loans for research and research facilities.

Prop. 71 also:

• Established a constitutional right to conduct stem cell research in California;
• Prohibited the Institute from funding human reproductive cloning research;
• Created an oversight committee to govern the Institute;
• Provided a General Fund loan of up to $3 million for the Institute’s initial administration and implementation costs;
• Authorized the issuance of general obligation bonds to finance Institute activities up to $3 billion subject to an annual limit of $350 million; and
• Appropriated monies from the General Fund to pay for bonds.

In November 2004, 58.1 percent of voters authorized the state to issue $750 million in new general obligation (GO) bonds, a type of long-term loan that the state repays with money from California’s General Fund. These bonds were used to create the Children’s Hospital Fund.

From this fund, the state can award a total of $742 million in grants to build, expand, renovate, remodel, furnish, and equip children’s hospitals. The remaining $8 million in authorized bonds are reserved to cover the expected administrative costs of the program.

Thirteen California children’s hospitals are eligible for Prop. 61 funds. The five eligible University of California children’s hospitals can request up to $30 million each, and the eight eligible private nonprofit hospitals can request up to $74 million each. Bonds are issued as the funds are disbursed.

The MHSA “millionaire tax” took effect after the November 2004 election and affected about 30,000 taxpayers in its first year. The initial funds from the new tax were deposited into the Mental Health Services Fund in the spring of 2005.

As of May 3, 2007, 56 counties have applied for MHSA funding, and 52 of them have been approved to receive a combined total of $575.3 million. See the MHSA Expenditure Report Addendum, FY 2006-07 (p.16) for a list of counties that have applied for and been approved for funding.

In February 2007, DMH released a Summary Workplan outlining its proposed timelines for implementing all MHSA components through FY 2008-09. Because the components of the MHSA are complex, implementation is being staggered over the first several years as follows:

* Local Planning is a maximum of 5 percent of the total amount distributed during a fiscal year
** 5% of Prevention funding will be available for Innovative Programs
*** 5% of CSS funding will be available for Innovative Programs

Source: MHSA Expenditure Report Addendum, FY 2006-2007, California DMH, May 2007, p.8.

Read a post-election timeline of events.

A rough start: Prop. 71 implementation has lagged because of legal challenges against it that started five months before voters approved the measure. Until these lawsuits were resolved on May 16, 2007, over two and a half years after the initiative passed, the Prop. 71 bonds could not be disbursed.

Despite legal setbacks, CIRM and the ICOC sought temporary funding sources and were able to get some work done. CIRM and its 29-member governing board, the Independent Citizens’ Oversight Committee (ICOC), were established when Prop. 71 passed in November 2004. The 27 appointed members of the ICOC elected Robert Klein to chair the committee. Appointed members were chosen based on their experience in academics, research, patient advocacy, and biotechnology.

In addition, the agency began drafting a funding strategy in May and June 2006, and the ICOC met to consider CIRM’s grant policies, governance, legislative outreach, and ways to address the challenges to developing stem cell-related therapies and diagnostics. CIRM also drafted its Scientific Strategic Plan, outlining the agency’s objectives and funding initiatives for the next ten years. The ICOC approved the plan in December 2006.

Any California for-profit or non-profit research institution may apply for Prop. 71 funding, which is allocated based on guidelines developed by the ICOC. CIRM does not disclose the list of organizations that have sought funding but whose applications have not been approved.

In September 2005, the ICOC approved several multi-year training grants to increase the number of researchers with the skills necessary to conduct stem cell research. CIRM awarded the first of these grants in April 2006, totaling $12.1 million, to 16 California nonprofits.

Financial challenges: Now that the constitutional challenges against Prop. 71 have been resolved, funding may come from the $3 billion in bonds authorized by California voters to be sold over a ten-year period. The sale of these bonds and the full funding of CIRM were delayed because of lawsuits challenging the measure’s constitutionality.

Until February 2007, the institute’s operating costs were covered by a $3 million loan from the state General Fund, which was authorized under Prop. 71, and a $5 million donation from the Dolby Family Foundation.

To fund research before the lawsuits ended, CIRM, the Office of the State Treasurer, the state Department of Finance, and the state controller sold $45 million in bond anticipation notes (BANs), which will now be repaid with bond proceeds. In July 2006, Governor Schwarzenegger authorized an additional $150 million loan to CIRM from the state General Fund after President Bush vetoed a federal stem cell research bill. Between the BANs and the governor’s loan, CIRM reported a total of $181 million available at the end of 2006 to fund research, training, and facilities development grants.

The ICOC has granted a total of $208.5 million to 23 California research institutions as of June 5, 2007. (See a complete list of Prop. 71 grant awards.) In addition to these funds, the state treasurer’s office has been authorized to issue up to $250 million in bonds immediately after the constitutional challenges were resolved, and the ICOC expects to issue these bonds in July or August 2007.

Read CIRM’s 2006 annual report for further details on everything from who sits on the ICOC to how Prop. 71 has been implemented in light of the legal challenges against it.

Legal challenges: Two constitutional challenges were brought against Prop. 71. Both plaintiffs in the first case, the People’s Advocate and National Tax Limitation Foundation v. Independent Citizens’ Oversight Committee (case #HG05206766), received funding from the Life Legal Defense Foundation. The California Family Bioethics Council (CFBC), an affiliate of the evangelical organization Focus on the Family, brought the second case against the measure.

Plaintiffs challenged Prop. 71 on constitutional, statutory, and common law grounds. The first plaintiffs asserted that the measure violates Article XVI, §3 of the state constitution because it mandates appropriations from the state General Fund to fund an institution not under the exclusive management and control of the state.

The second plaintiff, CFBC, challenged the measure on the same grounds as People’s Advocate and the NTLF. In addition, CFBC argued that Prop. 71:

• Violates various provisions of conflict of interest law;
• Violates the single subject rule (by law, propositions in California must be limited to one subject);
• Unlawfully revises the state Constitution;
• Revised statutes without providing proper notice to voters by including the full text of the revised statutes;
• Violates the equal protection clauses in the state Constitution;
• Violates Article II, section 12 of the state Constitution by requiring a private entity to perform a public function;
• Violates Article IX, section 9 of the state Constitution by limiting the University of California Regents’ powers to organize and govern the University; and
• Violates state securities laws.

These two cases were consolidated and first heard in the Alameda County Superior Court, which upheld the constitutionality of the measure in April 2006. Read the 2006 court decision. People’s Advocate, the NTLF and the CFBC then appealed the decision to the state Court of Appeals, which upheld the lower court’s decision in February 2007. Read the 2007 court decision.

On May 16, the state Supreme Court declined to hear the plaintiffs’ next appeal.

Stem cell research and the federal government: Prop. 71 proponents spearheaded the measure in California largely because they believed that the Bush administration would not authorize additional federal funding for embryonic stem cell research. They have proven correct so far.

Congressional efforts to fund embryonic stem cell research, as well as the Bush administration’s refusal to allow such funding, have attracted a good deal of attention. To ease the restrictions that the Bush administration imposed on stem cell research in 2001, the U.S. Senate passed the federal Stem Cell Research Enhancement Act (HR 810) with a vote of 63-37 in July 2006 (see the Senate roll call on THOMAS). The House of Representatives had already passed the bill in May 2005 with a 238-194 vote (see the House roll call).

President Bush vetoed the bill the day after the Senate passed it, using his veto power for the first time during his tenure in the White House. Congress tried to override the veto but failed to gain the necessary 2/3 vote in the House. The vote was 235-193 (see the House roll call).

In response to Bush’s veto, Governor Schwarzenegger directed a $150 million loan to CIRM in July 2006. The $45 million granted from this loan in February 2007 exceeded the $38 million the National Institutes of Health spent on human embryonic stem cell research nationwide in 2006.

In April 2007, the Senate passed another Stem Cell Research Enhancement Act (S.5), this time with a vote of 63-34 (read the Senate roll call). The House passed the bill on June 7 with a vote of 247-176. President Bush veto the bill on June 20.

According to the Los Angeles Times (5/17/07), the next U.S. president is expected to lift the Bush administration’s stem cell restrictions, but even then, federal spending is not likely to match California’s spending.

The California Health Facilities Financing Authority (CHFFA) is responsible for administering grants from Prop. 61 bond funds. Once Prop. 61 passed, CHFFA had 60 days to create applications and regulations for Prop. 61 funding. To date, seven of the eight eligible private children’s hospitals and two of the five eligible UC children’s hospitals have submitted the extensive applications.

As of May 25, CHFFA has awarded $306 million and disbursed $159 million to eight of those hospitals.

Prop. 61 provides eligible nonprofit children’s hospitals with a significant new source of funds. Unlike University of California and other public hospitals, private children’s hospitals do not receive funding from revenue bonds, which are approved by the state legislature and repaid with revenues produced by the projects they finance. Rather, private children’s hospitals usually borrow money or generate their own funds to finance capital projects.

Each application for Prop. 61 funding has been evaluated against a list of criteria outlined in the CHFFA’s Children’s Hospital Program Overview and Instructions. Grants have then been allocated and implemented according to specific guidelines also provided by CHFFA. CHFFA officials have conducted site visits to ensure each construction or renovation project’s grant eligibility.

There have been no legal challenges or other court cases related to Prop. 61.

Costs: The California DMH reports that MHSA spending was $168 million for FY 2004-05 and $518 million for FY 2005-06. Projected expenditures for FY 2007-08 are $1.5 billion.

These costs are offset by the millionaire tax imposed by Prop. 63, which has raised far more revenue than initially projected. Before the November 2004 election, the Legislative Analyst’s Office (LAO) estimated that the initiative would raise about $800 million in state revenues annually by FY 2006-07. Total tax revenues from Prop. 63 were $253.8 million in FY 2004-05. Then, because many incomes in the upper tax brackets increased significantly in 2005, revenues jumped to $1.3 billion in FY 2005-06 and an estimated $1.5 billion in FY 2006-07. Projected revenues for FY 2007-08 are $1.7 billion.

DMH is maintaining a “prudent reserve” of funds to maintain a consistent level of funding from year to year, as top incomes may decline in the future. For details on state MHSA revenues and spending, see the MHSA Expenditure Report Addendum, FY 2006-07.

The rapid influx of tax revenues has presented DMH with two dilemmas. First, a management infrastructure for spending this huge increase in funds did not exist and had to be built quickly. And second, new Prop. 63 funding must be used to create and expand new programs only, so many existing county mental health programs are still facing budget cuts.

Potential savings : Before Prop. 63 passed, the LAO predicted that the initiative could reduce other state and local expenses related to state prison and county jail operations, medical care, homeless shelters and social services programs. Read the 2004 LAO report.

It is still too early to know whether Prop. 63 will result in such savings, since funding has only been distributed for just over two years. Not only must the Prop. 63 programs be fully in place before they can reduce expenditures, but they also must be in place long enough to affect mental health in the state.

Costs: The Legislative Analyst’s Office (LAO) estimated that Prop. 71 would cost the state about $6 billion over 30 years to pay off both the principal ($3 billion) and interest ($3 billion) on the bonds in payments averaging about $200 million per year.

Because Prop. 71 bonds have been tied up in court until May 2007, the measure has not yet begun to meet the LAO’s projection. The interest rate the state will pay for Prop. 71 bonds is market variable and, as a result, depends on current economic conditions when the bonds are sold. Because this has not yet taken place, it is not yet possible to determine whether the LAO’s estimate was correct.

A CIRM press release (5/16/07) announced that the agency intends to use its first bond funding to repay the state and private philanthropists who provided funds while the bonds were being challenged in court. The bond anticipation notes (BANs) sold during the court proceedings have a 5 percent interest rate for a 30-year period, which would amount to $35 million ($14 million plus $21 million in interest) if the debt were paid off over 30 years. Because CIRM will repay these BANs in the short run, however, their cost will be far below $35 million and will be absorbed by the $3 billion 10-year budget approved by voters. Governor Schwarzenegger’s $150 million loan from the state General Fund was also a temporary cost that will be repaid now that the court has upheld the constitutionality of the Prop. 71 bonds.

Potential savings: The LAO forecasted unknown potential state and local revenue gains and cost savings to the extent that the research projects funded by Prop. 71 result in additional economic activity and reduced public health care costs. Because Prop. 71 has been held up in court until recently, however, it is not yet possible to determine to what extent the measure will result in such savings.

Before the 2004 election, the Legislative Analyst’s Office estimated that Prop. 61 would cost the state General Fund about $1.5 billion over 30 years to pay off both the principal ($750 million) and interest ($756 million) costs of the bonds, to be paid in amounts of about $50 million per year.

This cost estimate is likely to be accurate, since Prop. 61 bonds are limited to $750 million. In the two and a half years since Prop. 61 passed, CHFFA has awarded $306 million and disbursed $159 million. The California Children’s Hospital Association expects that approximately 68 percent of all Prop. 61 funds will be awarded by spring of 2008.

CHFFA will continue to accept grant applications from eligible children’s hospitals until Prop. 61 funding is exhausted, or until June 30, 2014, whichever comes first. If all $750 million has not been granted by 2014—an unlikely prospect—then CHFFA will conduct a second round of funding with specifics to be determined.

Proponents said: During the Prop. 63 campaign, proponents argued that the MHSA would support innovative programs that are proven to work. It is too early to know how well MHSA-funded programs work. However, the measure includes several requirements regarding program effectiveness. For example, MHSA-funded prevention and early intervention programs must include “services similar to those provided under other programs effective in preventing mental illnesses from becoming severe, and shall also include components similar to programs that have been successful in reducing the duration of untreated severe mental illnesses and assisting people in quickly regaining productive lives” (MHSA section 4, part 3.6c).

As mentioned above, Prop. 63 proponents also argued that the measure would reduce other state health care, homeless shelter and law enforcement expenses and provide effective treatment for all of those being denied care. It is also too early to know whether these assertions are true. The Petris Center on Health Care Markets and Consumer Welfare, a research center at the University of California, Berkeley, plans to study these issues but will not have an answer for at least three years.

Opponents said:Opponents argued that MHSA funding is “tied to dangerously volatile income sources, which can vanish in a heartbeat.” Taxes on incomes over $1 million are indeed sensitive to economic conditions, but so far this has worked in DMH’s favor, as the “millionaire tax” has brought in far more revenues than originally projected.

Opponents also said, “[proponents] claim that similar programs have ‘demonstrated their effectiveness’ in terms of ‘providing services,’ but that is not the same thing as reducing mental illness or manifestations of it.” While effective provision of mental health care does not equate to effective mental health care, proponents clearly intended to reduce mental illness. As the Petris Center studies the MHSA, the measure’s effectiveness will become clearer.

In addition, opponents argued that no evidence shows that state and local costs have declined as a result of providing mental health care. This is true for California, although lack of evidence could simply mean that data was simply never collected to determine whether mental health care provision has saved money for state and local governments in California. The Petris Center is collecting state and local-level data for health care costs and savings related to the MHSA.

Health policy experts and economists generally agree that providing mental health services can reduce general medical costs (Olfson, Sing, and Schlesinger, “Mental health/medical care cost offsets; opportunities for managed care,” Health Affairs v18, n2: 80). However, Olfson, Sing and Schlesinger point out that cost savings from providing mental health care are only likely with careful implementation of a given mental health care program (p.81).

Finally, opponents argued, “[t]he benefit is much smaller and the price tag much larger than proponents are telling you.” As discussed above, benefits from the MHSA are yet to be determined. Moreover, the price tag depends on those benefits. Prop. 63 may not pay for itself, but if the MHSA creates cost savings for the state, then those savings should be subtracted from any costs incurred by the measure.

Proponents said: Proponents’ primary argument in favor of Prop. 71 was that it would be “an affordable solution that closes the research gap, so new treatments and cures can be found.” It is still too early to assess either of these claims. Treatments and cures that could eventually reduce state health care costs have not yet materialized. CIRM's draft ten-year plan indicates that clinical trials will be just beginning ten years from now. If after that time the measure pays for itself by saving more than it costs, as proponents suggested it could, then its affordability would be difficult to dispute.

Proponents also argued that Prop. 71 does not create or increase any taxes. The measure itself does not create or raise taxes, but as with any increase General Fund expenditures, the money has to come from somewhere: raising taxes, borrowing, or reallocating funds from other services. In some form, taxpayers still pay for Prop. 71.

Opponents said: Opponents argued against launching “a costly new state bureaucracy when vital programs for health, education, and police and fire services are being cut. We cannot afford to pile another $3 billion in bonded debt on top of a state budget teetering on the edge of financial ruin.” This argument’s strength depends partly on how much CIRM costs relative to how much it saves the state General Fund, as well as when any potential savings take place.

In the short run, CIRM will probably cost more than it saves. On the other hand, if Prop. 71 eventually saves more than it costs and therefore does not detract from any other state programs or services, then the expenditure may be financially justifiable in the long run.

The state expects to spend $7 billion more than it will receive in revenues in 2006-07 alone and plans to cover this deficit with funds from the state reserve, which is similar to taking money out of a savings account. With this deficit, new programs like CIRM must be covered by raising taxes, borrowing, or reallocating funds from other programs or services. Whether any of these funding strategies are right or wrong depends on how one prioritizes stem cell research relative to other state fiscal responsibilities.

Opponents also argued that Prop. 71 “prohibits the governor and legislature from exercising oversight and control over how this money is spent—or misspent. Even if the state teeters on the brink of financial ruin, our elected representatives will still have to borrow and spend this money, because the proponents are putting this money grab into our constitution.” It is true that Prop. 71 constitutionally requires the legislature to appropriate funds to CIRM, and that oversight and control by the governor and legislature over CIRM are more limited than is the case for many public agencies.

The governor and legislature do not completely lack authority over CIRM, however. They appoint three-quarters of the ICOC members, who oversee CIRM’s operations and finances. Twenty-two of the 29 ICOC members are appointed by the governor, lieutenant governor, state controller, state treasurer, state Senate pro tempore and speaker of the Assembly. The chair and vice-chair are then nominated by the governor, lieutenant governor, state controller and state treasurer and elected by the 27 appointed members. (The chancellors of the University of California at San Francisco, Davis, Los Angeles, Irvine, and San Diego each appoint an executive officer from his or her campus.) These provisions afford the governor and legislature significant control over who sits on CIRM’s decision-making and oversight body, and this authority is renewed every six years as ICOC members’ terms expire.

The legislature also has some authority over how CIRM conducts its competitive bidding process. All CIRM contracts, excluding loans and grants, that the ICOC approves, are subject to the same competitive bidding requirements followed by the University of California, which the state legislature determines.

The public can also act as a watchdog over CIRM. Prop. 71 requires the agency to issue an annual report and to commission an independent audit of its financial activities, both of which must be publicly available. Moreover, the state controller must report publicly on the audit. Prop. 71 also requires a Citizens’ Financial Accountability Oversight Committee, including the controller as chair, four members appointed by elected officials and one member appointed by the ICOC. Finally, with some exceptions, the ICOC must conduct public meetings consistent with the Bagley-Keene Open Meeting Act.

Another argument set forth against Prop. 71 was that the measure “specifically supports ‘embryo cloning’ research—also called ‘somatic cell nuclear transfer’….” This is not true. The measure allows “somatic cell nuclear transfer,” but this process involves unfertilized eggs in the early stages of development—not embryos. Moreover, Prop. 71 prohibits the use of bond proceeds from the measure for funding human reproductive cloning.

According to the Association of American Medical Colleges (AAMC), “Somatic Cell Nuclear Transfer (SCNT) or therapeutic cloning involves removing the nucleus of an unfertilized egg cell, replacing it with the material from the nucleus of a ‘somatic cell’ (a skin, heart, or nerve cell, for example) and stimulating this cell to begin dividing. Once the cell begins dividing, stem cells can be extracted 5-6 days later and used for research. … Reproductive cloning, on the other hand, is intended to create human beings by cloning human embryos. The AAMC and the National Academy of Sciences recommend a ban on all forms of this type of cloning.”

Proponents said: Proponents’ principal argument for Prop. 61 was that it would help increase capacity in children’s hospitals, as well as to purchase medical technology and equipment. These benefits have materialized for the children’s hospitals that have received Prop. 61 grants. Grants have been used for expansion of existing children’s hospital facilities, construction of new facilities, and the purchase of medical equipment.

However, Prop. 61’s impact is limited to the 13 hospitals that meet certain requirements outlined in the initiative, as hospitals were required to have already met certain requirements between the years 2001 and 2003 to be eligible for grants. (See below for a list of hospitals that have received or are eligible to receive grants.)

Proponents also said that Prop. 61 would not raise taxes. It is true that the language of Prop. 61 did not authorize any taxes. Yet the $750 million in bonds, in addition to the $756 million in interest, has and will continue to be repaid from the state General Fund, which is made up of taxpayer dollars.

Opponents said: Opponents held that Prop. 61 does not expand or improve health coverage. It is true that Prop. 61 contains no health coverage provisions, although expanded capacity in existing children’s hospitals allows hospitals to provide care for more children.

Prop. 61 opponents also argued California voters have already “mortgaged the future” by approving billions of dollars in bond sales, and that Prop. 61 will only add to this problem. Since 1972, California voters have approved $129.1 billion in GO (general obligation) bonds like those authorized by Prop. 61—$42.7 billion of which resulted from the November 2006 election, when voters passed a four infrastructure ballot measures (Propositions 1B through 1E). The LAO reports that the state had about $45 billion in outstanding infrastructure-related GO bond debt as of November 2006. This number will increase in the next few years as the bonds from Prop. 61 and other recently-approved bond measures are sold. In FY 2005-2006, this debt cost the General Fund $3.2 million in debt service, which made up 3.5% of total General Fund spending. Learn more about bonds and the state budget from the California Budget Project.

The Petris Center on Health Care Markets and Consumer Welfare has received a grant from the California HealthCare Foundation to study the implementation and effects of the MHSA. The Center says it will take several years to understand the Act’s impact fully.

The Center plans to study several aspects of the MHSA. Data collection began in 2006 to determine whether Prop. 63 has reduced state health care spending overall, as well as how many Californians MHSA-funded programs serve.

The Center is also studying MHSA implementation, particularly county-level processes and management of system change stimulated by the MHSA. It is conducting annual site visits and interviews with county mental health staff and stakeholders to evaluate implementation in 12 counties.

The study will also measure the costs and benefits of new services made available through new funding, such as changes in rates of homelessness, incarceration, and access to mental health care. The Center plans to use this information to estimate which services and service strategies, under which circumstances, produce the most successful recovery-oriented outcomes.

“Once data is collected,” say MHSA staff, “it could take a minimum of three years to see changes. New programs are currently being implemented as part of the counties’ three-year community services and support plans. Changes in the number of Californians receiving mental health care and increases in services provided to racial or ethnic minorities will probably be seen first. It may take longer to see differences in homeless or incarcerated populations and in suicide rates.”

Total authorized: $750,000,000
Total awarded: $306,109,274
Total disbursed: $159,256,600

1. Children’s Hospital Central California (nonprofit)
   Authorized: $74,000,000
   Awarded: $9,079,215
   Disbursed: $8,821,232*
   Project status: Projects are complete (grant award reimbursed expenditures for medical equipment and to expand the neonatal intensive care unit by 12 beds).


2. Children’s Hospital Los Angeles (nonprofit)
   Authorized: $74,000,000
   Awarded: $74,000,000
   Disbursed: $53,000,000
   Project status: In progress. Grant award was for partial funding of a new $280 million, 280 bed seismically compliant hospital.


3. Children’s Hospital & Research Center Oakland (nonprofit)
   Authorized: $74,000,000
   Awarded: $1,696,546
   Disbursed: $1,695,274*
   Project status: Project is complete (grant award reimbursed medical equipment expenditures).


4. Children’s Hospital of Orange County (nonprofit)
   Authorized: $74,000,000
   Awarded: $22,909,844
   Disbursed: $12,700,516
   Project status: Project is complete (award was granted to help the hospital expand and remodel its Ambulatory Care Center and reimbursement for medical equipment).  


5. Long Beach Memorial Medical Center (Miller Children’s Hospital; nonprofit)
   Authorized: $74,000,000
   Awarded: $74,000,000
   Disbursed: $21,495,693
   Project status: In progress. Grant was awarded to help the hospital build, equip, and furnish a new four-story inpatient pediatric tower adjacent to its existing 281-bed facility.  


6. Rady Children’s Hospital (formerly Children’s Hospital and Health Center, San Diego; nonprofit)
   Authorized: $74,000,000
   Awarded: $11,266,631
   Disbursed: $11,258,181*
   Project status: Grants were awarded to expand and remodel the Hematology/Oncology clinic, Emergency Department, and Ortho Clinic, upgrade helipad and reimbursement for medical equipment. The first project is complete, and the other two are still in progress. 


7. Lucile Salter Packard Children’s Hospital at Stanford (nonprofit)
   Authorized: $74,000,000
   Awarded: $74,000,000
   Disbursed: $20,458,204
   Project status: In May 2006, CHFFA approved a grant to partially fund an expanded and consolidated Oncology Unit, construct a new 6-room surgical suite, and expand NICU by 20 beds and reimbursement for medical equipment.  


8. University of California, Davis Children's Hospital
   Authorized: $30,000,000
   Awarded: $9,157,038
   Disbursed: $0
   Project status: In May 2006, CHFFA approved a grant to partially fund an expanded NICU by 13 beds in its new patient tower and reimbursement for medical equipment.  


9. Mattel Children’s Hospital at University of California, Los Angeles
   Authorized: $30,000,000
   Awarded: $30,000,000
   Disbursed: $29,827,500*
   Project status: In progress. Grant was awarded for partial funding of a new $600 million, 520-bed seismically compliant hospital.

* Bond issuance costs, which vary based on the market rate when the bond was issued, are subtracted from the total amount awarded. Thus, disbursed amounts will always be slightly lower than the amount awarded.

1. Loma Linda Children’s Hospital (nonprofit; authorized to receive $74 million)
2. University Children’s Hospital at University of California, Irvine (authorized to receive $30 million)
3. University of California, San Francisco Children’s Hospital (authorized to receive $30 million)
4. University of California, San Diego Children’s Hospital (authorized to receive $30 million)