California Form 3805P.   There is an additional tax for California.

CA does not conform to the federal law that allows a rollover from an MSA to an Health Savings Account (HSA) to be treated as a tax-free distribution. If a California taxpayer rolls over his MSA into an HSA, this distribution is treated as an MSA distribution not used for qualified medical expenses and is subject to California income tax and the additional 12.5% tax under R&TC Section 17215.