California's 2026 Ballot Initiative Would Eliminate Lien-Based Medical Care for Auto Accident Victims

James Wong — Founder & Pharmacist, LienScripts | February 22, 2026 | 9 min read

A ballot initiative backed by Uber and heading toward the November 2026 California ballot would cap medical expense recovery at Medicare and Medi-Cal rates and ban referral arrangements between personal injury attorneys and medical providers. For uninsured accident victims who currently rely on lien-based care, the consequences would be severe.

What Is Initiative #25-0022?

In October 2025, a ballot initiative was filed in California under the title "Protecting Automobile Accident Victims from Attorney Self-Dealing Act." The initiative — funded primarily by Uber Technologies — would amend the California Constitution to impose three significant changes on personal injury automobile accident cases.

As of February 2026, signature collection is underway. The campaign has reached approximately 25% of the roughly 547,000 valid signatures required to qualify for the November 2026 ballot. The Consumer Attorneys of California has organized a major opposition campaign and filed three counter-initiatives in response.

[!KEY] This initiative is specific to automobile accident cases. Its provisions — including the medical expense caps — would not apply to slip-and-fall, workers' compensation, or other personal injury case types. But for auto accident victims in California, it would fundamentally change how medical care is accessed and paid.

What the Initiative Would Actually Do

1. Cap Medical Expense Recovery at Government Reimbursement Rates

The most consequential provision limits what medical providers can collect for treating personal injury auto accident patients to rates established by Medicare, Medi-Cal, and a national health insurance database.

This is not simply a cap on what can be awarded at trial. It would cap what providers — including pharmacies, physicians, surgeons, chiropractors, acupuncturists, and physical therapists — can ultimately collect at settlement or judgment for services rendered to auto accident patients.

Why this matters for lien-based care: Lien-based medical providers accept treatment without upfront payment, deferring all collection to when the case settles. The economic viability of this model depends on collecting market-rate compensation at settlement. If recovery is limited to Medicare or Medi-Cal reimbursement rates, many lien-based providers would be unable to sustain operations serving auto accident patients.

For context: Medicare reimbursement rates are the lowest in the market, typically far below what providers accept from commercial insurers, and well below what is required to cover the operational costs of serving injury patients with complex, ongoing needs.

2. Restrict Contingency Fees so Victims Retain at Least 75%

The initiative would require that auto accident victims receive at least 75% of the total amount of damages recovered. This effectively limits contingency fee arrangements to a maximum of 25%.

California personal injury attorneys currently charge 33% to 40% contingency fees — rates that reflect the risk, complexity, and duration of injury litigation. The initiative frames this as consumer protection, but critics argue it would make complex cases economically unviable for plaintiff firms and deny injured people access to experienced legal representation.

3. Ban Referral Arrangements Between Law Firms and Medical Providers

The initiative would prohibit referral arrangements between personal injury law firms and medical care providers.

The target is financial conflicts of interest — situations where attorneys receive compensation for steering clients to specific providers, or where providers pay for referrals. These arrangements are already prohibited under California Rules of Professional Conduct and existing law. However, the initiative's broad language could sweep in standard lien enrollment processes, where an attorney connects a client with a pharmacy or clinic that offers lien-based care — even without any financial arrangement between the attorney and the provider.

The Patient Population This Would Affect

2 New California accident patients cannot always wait years for a settlement to access medications and treatment. Lien-based care exists to solve a specific access problem: what happens when a person is injured in an auto accident, has no health insurance, has exhausted their PIP coverage, or has had their insurance claims disputed?

The answer — without lien-based providers — is often: they go without care.

Uninsured Californians — California's uninsured rate remains significant, particularly in lower-income communities. An uninsured accident victim who cannot access lien-based care faces a binary choice: pay out of pocket (typically impossible given the injury caused financial disruption) or forgo treatment.

Patients with disputed PIP or health insurance — Insurers frequently dispute accident-related claims. During a dispute, lien-based care is the only mechanism that allows treatment to continue while the dispute is resolved.

Patients with exhausted coverage — Serious injury cases generate sustained medication needs that can exhaust policy limits quickly. Lien-based pharmacy bridges the gap between coverage exhaustion and settlement.

[!KEY] The California Chiropractic Association, Consumer Attorneys of California, and multiple patient advocacy organizations have identified the medical expense cap as the provision most likely to eliminate access to care for uninsured and underinsured accident victims. The concern is not about inflated billing — it is about whether providers can economically afford to serve this patient population at all under a Medicare rate cap.

The Counter-Initiatives Filed by CAOC

In response to Initiative #25-0022, the Consumer Attorneys of California filed three counter-ballot measures:

1. People's Right to Contract With Counsel of Choice Act — A constitutional amendment that would protect Californians' right to hire an attorney on any fee arrangement they choose, and prohibit corporate interference in attorney-client relationships.

2. Sexual Assault Against Rideshare Passengers and Drivers Prevention and Accountability Act — Would require rigorous background checks (including fingerprinting) for rideshare drivers and mandate public reporting of sexual misconduct incidents.

3. Rideshare Company Public Accountability Act — Would classify rideshare companies as common carriers, making them legally responsible for harm caused by their drivers — a liability standard rideshare companies have long resisted.

The opposing campaigns have each raised substantial funds: Uber's initiative committee had accumulated approximately $12 million; CAOC-affiliated committees had raised approximately $38 million as of early 2026.

What This Means for Personal Injury Attorneys in California

If you practice auto accident law in California, this initiative warrants close attention regardless of how you feel about its motivations. The medical expense cap would restructure how you document, present, and settle cases. The referral provision could affect how you connect clients with treating providers.

For lien-based care specifically: The question attorneys are asking is whether their clients will continue to have access to lien-based medications, chiropractic care, imaging, and other services if the initiative passes. The answer will depend heavily on how courts interpret the medical expense cap and how providers respond to reduced recovery potential.

Track the signature-gathering process: The initiative needs approximately 547,000 valid signatures to qualify for the November 2026 ballot. As of early February 2026, the campaign was at approximately 25% of that threshold. If signatures are gathered, attorneys will need to advise clients on how the initiative's transition provisions (if any) affect pending cases.

Follow the CAOC opposition: The Consumer Attorneys of California is the leading organized opposition to Initiative #25-0022. Their updates, legal analysis, and advocacy resources are the most comprehensive available for California PI attorneys tracking this issue.

How This Fits the National Tort Reform Pattern

California is not alone. A national wave of legislation is pushing toward "reasonable value" standards for medical expense recovery in personal injury cases:

• Florida HB 837 (2023): Limits medical damages to "amounts actually paid" and requires disclosure of letters of protection at the outset of any lien-based claim.
• Georgia SB 68 (2025): Eliminates "phantom damages" by limiting medical expense claims to the "reasonable value of medically necessary care," with insurer payment rates admissible as evidence of reasonableness.
• California Initiative #25-0022 (2026): Would cap recovery at Medicare and Medi-Cal rates for auto accident cases.

All three share a common structural feature: they make it harder to sustain lien-based care by limiting the maximum that providers can ultimately collect.

Related Resources

• Why New York Personal Injury Pharmacies Keep Getting Sued
• Florida's 2023 Tort Reform and Pharmacy Liens
• Georgia's 2025 Tort Reform and Pharmacy Liens
• The Tort Reform Wave: FL, GA, and CA
• California Pharmacy Lien Laws Explained
• What Is a Pharmacy Lien?

[!SOURCE] Ballotpedia — California Establish Personal Injury Lawyer Regulations Initiative (2026) — Full initiative text, provisions, and campaign finance information for Initiative #25-0022.

[!SOURCE] California Chiropractic Association — How Uber's 2026 Initiative Threatens PI Care — February 2026 analysis from the California Chiropractic Association on the impact of the initiative on lien-based personal injury care providers.