Under California's SB 525, the health care worker minimum wage is set by your facility's type and size, not by your workers' job titles. As of July 1, 2026 the operative rates are $25.00 an hour for facilities with 10,000 or more full-time equivalent employees, for dialysis clinics, and for covered facilities run by a county of more than five million people; $23.00 for all other covered facilities and for those run by counties of 250,000 to five million; $22.00 for community, rural health and intermittent clinics and for urgent care clinics associated with community or rural health clinics; and $19.28 for safety net hospitals, rural independent covered facilities, and covered facilities run by counties under 250,000[1]. Every one of those four rates rose on July 1, 2026. Skilled nursing turns on ownership: a facility a hospital or health system owns, operates or controls is covered, while an independent one is not entitled to the health care minimum wage at this time, because the section written for it takes effect only once a patient care minimum spending requirement exists, and none does[2][3]. Place your facility on the DIR schedule, build your covered-role list deliberately, and re-check your exempt salary floor, which is whichever is greater of 1.5 times your tier rate or twice the state minimum wage.
This article is for general information and is not legal advice. Confirm obligations with qualified counsel.
Somewhere in your payroll or scheduling system, one field holds an hourly floor, and someone has to be able to defend the number in it. Under California's SB 525, that number is not a single statewide figure. It depends on which tier your facility falls into, and the statute never labels your facility with its tier in plain language.
On July 1, 2026, every tier stepped up. If the field still holds last year's number, every covered shift since then is sitting in your records at the wrong rate.
Here is the part the law makes genuinely hard: your tier is set by the kind of facility you are, not by the jobs your people do. Two facilities on the same street can owe different floors, and one of them may owe nothing under this law at all. So the question is not "what is the California health care minimum wage" but "which tier am I, and what do I owe as of 2026."
In this post:
- What you owe as of July 1, 2026
- Why your tier is your facility, not your job titles
- The skilled nursing question, which turns on ownership
- Who the wage covers, and the exempt-salary knock-on
- What a covered employer has to operationalize
What is the California healthcare minimum wage as of July 1, 2026?
As of July 1, 2026, California's SB 525 health care worker minimum wage runs on four rate levels: $25.00 per hour at the top, $23.00 for the catch-all category, $22.00 for a defined set of clinics, and $19.28 for safety net hospitals. Your rate depends entirely on which facility category applies to you.
The California Department of Industrial Relations (DIR) publishes the operative schedule as a supplement to the minimum wage order, and the statute behind it is Labor Code section 1182.14[1][4]. The current supplement covers July 1, 2026 through June 30, 2027. Here are its categories in one place.
| Your facility type | Minimum wage as of July 1, 2026 |
|---|---|
| Facilities with 10,000 or more full-time equivalent employees, or part of an integrated delivery system or health care system of that size[1][4] | $25.00 |
| Dialysis clinics[1] | $25.00 |
| Covered facilities run by a county of more than five million people as of January 1, 2023[1] | $25.00 |
| Community, rural health and intermittent clinics, and urgent care clinics associated with community or rural health clinics, unless the clinic holds a DIR waiver[1][4] | $22.00 |
| Safety net hospitals, rural independent covered facilities, and covered facilities run by a county of fewer than 250,000 people[1][2] | $19.28 |
| All other covered facilities, and those run by a county of 250,000 to five million people[1] | $23.00 |
One caution on the $22.00 row, because the wage order contradicts itself here and a dollar an hour turns on it. Its summary table describes the category as covering "urgent care clinics associated with community or rural health clinics." Its own body text, at section 2(C)(1)(d), instead reaches an urgent care clinic affiliated with the standalone licence-exempt clinic limb, and drops rural health clinics out. The statute is the tiebreaker: section 1182.14(c)(3)(A)(iv) covers "an urgent care clinic that is owned by or affiliated with a facility defined in clause (ii) or (iii)", and those two clauses are the community clinic and the rural health clinic[4]. DIR's clinic waiver guidance tracks the statute as well[5]. So we have followed the narrower reading, which the statute, the waiver guidance and the wage order's own summary table all share. An urgent care clinic affiliated only with a standalone licence-exempt clinic sits at $23.00 on that reading, and paying it $22.00 would leave you a dollar short rather than a dollar over.
Each category also moved differently to get here. Through June 30, 2026 the top rate was $24.00, the clinic and catch-all categories both sat at $21.00, and the safety net rate was $18.63[6]. So the top tier climbed a dollar, clinics climbed a dollar, and the catch-all jumped two dollars in a single step. The safety net category moved the least, by 65 cents, and it is on the longest ramp: it rises 3.5 percent each July and does not reach $25.00 until July 1, 2033[1][4]. The clinic category reaches $25.00 on July 1, 2027 and the catch-all on July 1, 2028.
One date worth putting in the calendar now. Once a category reaches $25.00, it stops moving in July and starts moving in January instead, adjusted annually by the lesser of 3.5 percent or the change in the national CPI-W, rounded to the nearest ten cents[4]. For the top tier that means $25.00 holds until January 1, 2028, and every increase after that lands on a January 1[2]. A calendar built around a July step-up will miss it.
If you are working from a reference that shows a June 1 start date, or a June 1 anniversary, that reference predates two amendments. SB 828 and SB 159 reworked the timing, and Labor Code section 1182.16 held the first increase back until a triggering event occurred[7]. The Department of Health Care Services notified the Legislature on October 1, 2024, so the wage took effect 15 days later, on October 16, 2024, and every step since has fallen on July 1[2]. County-run facilities started later still, on January 1, 2025[4][2].
Those are the numbers. The harder work is knowing which row is yours.
Why is your SB 525 tier based on facility type, not job title?
Your SB 525 tier is determined by your facility's type and size, not by the roles your workers hold. A registered nurse, a housekeeper, and a billing clerk at the same covered facility share the same hourly floor, because the wage attaches to the facility category and applies regardless of formal job title[4].
"Covered health care facility" is a defined set of employer types. It includes general acute care, acute psychiatric and special hospitals, dialysis clinics, psychology clinics, ambulatory surgical centers certified for Medicare, home health agencies, physician groups of 25 or more physicians, community and rural health clinics, urgent care, psychiatric health facilities, mental health rehabilitation centers, county mental health facilities, and county correctional facilities that provide health care services[4][2].
Two exclusions sit inside that list and both catch people out. A facility owned, controlled or operated by the State of California or a state agency is not covered, and neither is a tribal clinic or a tribal outpatient setting. But a health care district, a municipality, a county, and the University of California all are covered[4][2]. So "public employer" is not the dividing line. State-run is.
The top tier is the one to check carefully, and it does not work the way a headcount usually works. The threshold is 10,000 or more full-time equivalent employees, and the statute defines that as total paid hours divided by 2,080, measured as of January 1, 2022, taken from a specific data extract: the Department of Health Care Access and Information's 2021 Pivot Table, Hospital Annual Selected File, April 2023 Extract[4]. It is a fixed historical figure, not a live count, so growing past 10,000 employees since 2022 does not move you into this tier, and shrinking below it does not move you out.
HCAI publishes the resulting list, and as of its current fact sheet it names twelve systems: Adventist Health, Cedars-Sinai, Dignity Health, Kaiser Foundation Hospitals, Los Angeles County Health Services, Providence, Scripps Health, Sharp HealthCare, Stanford Health Care, Sutter Health, Tenet Healthcare and University of California Health[8].
Being absent from that list is not the same as being outside the tier, and this is the trap. The statute reaches employers the list cannot: an employer that does not report the data behind the pivot table, but that had 10,000 or more full-time equivalent employees as of January 1, 2022, is in the top tier anyway[4]. For those employers the figure is not published anywhere, and no statutory process exists to have your position on this list reviewed. HCAI states plainly that it does not oversee, enforce or control the phase-in schedule[8]. If your organisation is near the line and not on the list, the number is yours to establish from your own 2022 paid hours, and DIR's Labor Commissioner's Office is the authority to ask.
HCAI publishes a second list, and this is the one a $19.28 facility needs. "Safety net hospital" is DIR's shorthand for three statutory categories: a hospital whose combined Medicare and Medi-Cal payor mix is 90 percent or greater of adjusted patient days, an independent hospital not owned or controlled by a parent with two or more licensed hospitals whose combined mix is 75 percent or greater, and a rural independent covered health care facility[2][4]. Both thresholds are inclusive, so a hospital sitting exactly on 90.0 or 75.0 percent is inside the category, not outside it.
Unlike the top-tier list, this one carried a correction route, and it has closed. A facility that believed it had been wrongly left off could ask HCAI to classify it into one of those three categories, and the statute barred HCAI from accepting any further request after January 31, 2025[4][8]. That window applied only to these payor-mix and rural-independent categories. If you believe your hospital belongs at $19.28 and is not on the list, that is now a question for counsel and for DIR's Labor Commissioner's Office rather than an administrative request you can still file.
Do skilled nursing facilities have to pay $23 an hour in 2026?
It depends on who owns the facility, and the two answers are far apart. A licensed skilled nursing facility is a covered facility under Labor Code section 1182.14 only if a hospital, an integrated health care delivery system or a health care system owns, operates or controls it[4][2]. A facility that meets that test is covered and generally pays $23.00 as of July 1, 2026, or $25.00 if it belongs to a system with 10,000 or more full-time equivalent employees.
A skilled nursing facility that is independent of any hospital or system is a different case entirely. It is not covered by section 1182.14. It is addressed by a separate section, 1182.15, written specifically for skilled nursing facilities "not covered by Section 1182.14", and that section carries its own schedule: $21.00 from July 1, 2024 through June 30, 2026, $23.00 from July 1, 2026 through June 30, 2028, then $25.00[3].
That schedule is not in force, and it never has been. The final line of the section conditions the whole thing: "This section shall only take effect when a patient care minimum spending requirement applicable to skilled nursing facilities, as covered in this section, is in effect"[3]. No such requirement exists. DIR puts it in the plainest terms available, answering whether workers at skilled nursing facilities not owned, operated or controlled by hospitals are entitled to the health care minimum wage: "Not at this time." Creating a spending requirement takes separate legislative action[2].
So an independent skilled nursing facility does not owe $23.00, and it does not fall into the "all other covered facilities" category as a substitute. It owes the ordinary California minimum wage, $16.90 as of January 1, 2026, or a higher local general minimum wage where the city or county has one that applies to all employers[9][2]. If a spending requirement is ever enacted, the $23.00 figure switches on for these facilities, which is why the number circulates as though it already applies. Ownership structure is what settles it, so confirm yours with counsel before you set a rate either way.
Managing scheduling and pay across several jurisdictions at once? See Predictive Scheduling Laws in 2026: Full U.S. Map for the advance-notice rules that may apply alongside the wage floor.
Does SB 525 apply to all employees or only clinical staff?
SB 525 applies to covered health care employees, meaning people who work for a covered facility and provide health care services or services that support the provision of care. It is broader than clinical staff, but it does not automatically cover every person on the payroll.
The definition expressly reaches support roles: janitorial and housekeeping work, groundskeeping, guard duties, business office clerical and nonmanagerial administrative work, food service, laundry, medical coding and billing, call center and warehouse work, scheduling, and gift shop work[4][2]. It also names four exclusions that are easy to miss, and they do not all work the same way. Outside salespeople are excluded outright, with no qualifier attached. Delivery and waste collection work on the premises, and medical transportation in and out of the facility, are excluded only where the worker is not employed by anyone who owns, controls or operates a covered facility, so a hospital's own drivers stay covered. The fourth turns on something else entirely: a public employee is excluded where they are not primarily engaged in covered services, meaning more than half their work time in a workweek[4].
A contractor's employee can be covered as well, and the test has a precise threshold. The contract has to run to a covered facility, directly or through another contractor, and then either the facility acts as a joint employer, or the worker performs more than one-half of their work time in a workweek on the facility's premises[4]. Exactly half does not clear it. DIR works the example through: a janitor above that line is owed the health care minimum wage for all hours worked at the facility, while a janitor at or below it is owed it only if the facility is their employer or joint employer[2]. So the covered-role list at a single site is wide, and it extends past your own payroll.
The step-up also moves a line most employers forget: the exempt salary threshold. To keep a health care employee exempt, their salary has to be at least 1.5 times the health care minimum wage, or twice the state minimum wage, whichever is greater[4]. DIR's published example uses the $23.00 rate: 1.5 times $23.00 across a full-time year is $71,760, and that is the threshold for a worker entitled to $23.00[2].
Which half of that test governs depends on your tier, and it is not the same answer for everyone. At $23.00 and $25.00 the health care multiplier is the higher figure, so the exempt floor does rise with your tier. At $22.00 and $19.28 it does not: twice the state minimum wage is the greater number, so the state rate is what sets the floor, and it moves on January 1 rather than July 1. One note on checking this against DIR: the health care wage FAQ is dated June 2025 and its worked example still uses the 2025 state minimum wage of $16.50. DIR's own minimum wage page publishes $16.90 effective January 1, 2026, and that is the figure we have used here[9][2]. Either way, a salaried employee who was clearly exempt last year can quietly slip under the new line.
What does a covered employer have to operationalize in 2026?
A covered employer has to encode the correct tier rate against the right roles and sites, date it to the day it takes effect, and catch any schedule or pay configuration that does not match the tier. Knowing the number is step one; paying it correctly on every run is the operational problem.
Two administrative duties sit alongside the rate itself, and both are in the statute. You must post DIR's health care supplement to the minimum wage order in a conspicuous place your employees frequent, and you must give each employee written notice identifying which paragraph of the schedule applies to your facility and what their wage schedule is, in the language you normally use for employment matters[4][2]. The notice obligation attached to the date the wage first took effect, so an employer who never issued it has an open gap rather than a passed deadline.
Clinics have one more lever. A community, rural health, intermittent or associated urgent care clinic can apply for a waiver that postpones its increase by 12 months, and can do so in consecutive years. HCAI evaluates whether the financial criteria are met, DIR issues the waiver, and the criteria are demanding: audited financials, an accountant's attestation on cash flow, fewer than 45 days cash on hand and a current ratio of one or less. No waiver is available after July 1, 2032, and every clinic pays the adjusted wage from July 1, 2033 regardless of any waivers it received. A clinic granted one has 10 days to post it and notify its workers[4][2]. The window for the July 1, 2026 increase has already closed: DIR accepted applications from April 20, 2026 until June 1, 2026[5], so a clinic that did not apply owes $22.00 now and should watch for the next window rather than assume relief is available retroactively.
There is also a preemption clause worth knowing before you reconcile this against a city ordinance. A city or county cannot enact or enforce a rule setting wages or compensation specifically for covered health care facility employees, and any such measure taken after September 6, 2023 is void. A general local minimum wage that applies to all employers still binds you, and you pay whichever is higher[4][2]. The bar is also dated rather than permanent: the statute lets a city or county enact a rule relating to compensation for covered health care facility employees after January 1, 2030, and a minimum wage aimed at them after January 1, 2034, each to be judged on ordinary preemption principles[4].
Whether the clause reaches a local premium-pay or predictability-pay rule aimed at health care employees today is a further step. The words it turns on are "establishes, requires, imposes, limits, or otherwise relates to wages or compensation"[4]. Reading a scheduling premium into "compensation" there is ours, not a position DIR has published, since its guidance addresses local minimum wage ordinances only. Treat it as a question for counsel rather than a settled answer.
The reason this is hard is structural, not clerical. You have covered roles and uncovered roles in the same building. You may run several facilities that do not all sit in the same tier, and one of them may not be covered at all. You have a floor that changed on a specific date, and an exempt threshold that may move on a different date than the floor does. Track that by spreadsheet and hand-checking, and the July 1 step-up becomes a fire drill you rerun every year.
That is the layer a configurable rule engine is built to hold. You encode the tier rate against the roles and sites it applies to, and you date it to the day it takes effect, so the step-up is already live on the effective date without a manual sweep across every location. When a schedule or a pay configuration does not match the tier, the engine surfaces the mismatch as the schedule is built and flags it for the person building it, with the cost of the mismatch visible before anyone commits to it. The point is not to take the decision away from your team. It is to make sure the decision is made against the current tier, not last year's.
The tier decision is hard precisely once. After that, the system should be the thing that remembers it.
WorkAxle is a compliance-first workforce management platform built for regulated, multi-site operations, and this is the kind of problem it is built around. Premiums and rates get codified once per agreement and applied upstream through time and attendance that classifies hours before they reach payroll, so hours arrive already carrying the right floor for each role and site, rather than getting reconciled by hand after the fact. Because rules are effective-dated and jurisdiction-aware, a facility selects the correct tier automatically, and the next step-up is a dated change you make once.
What this means for you
Start by placing each facility on the DIR schedule, one facility at a time, and settle two questions before the rate: whether the facility is covered at all, and whether it sits in the top tier on the January 1, 2022 full-time equivalent basis rather than on today's headcount. If you run skilled nursing, the ownership test decides which of two very different answers applies. Build your covered-role list deliberately, since it reaches well past clinical staff and past your own payroll, and re-check your exempt salary threshold against whichever prong governs your tier. Then make sure the system that pays people is applying that rate, per role and per site, as of the effective date, not the number that was correct twelve months ago.
The rate itself is public and knowable. Getting it paid right, everywhere, on the day it changes, is the part worth engineering once so you never have to chase it again.