Senate Budget and Fiscal Review Subcommittee No. 5 on Corrections, Public Safety, Judiciary, Labor and Transportation
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Speaker 3
A complaint can include one or more claims, which are independent issues that a person may include in their, complaint that they've sent to us. A staff member of the OIG reviews every single claim, every single complaint, identifies and researches each of the issues brought forth and drafts a response to the complainant. In many circumstances, we will elevate sensitive information to appropriate prison staff, such as an incarcerated person suffering from a mental health crisis or threats of violence against staff or other incarcerated people in any type of PREA allegations. The OIG receives allegations of staff misconduct, which also may be elevated to CDCR at my discretion, within the or the consent of the complainant. So every single complaint that we get is treated confidentially, and information is only shared with the department if the complainant agrees or, if I authorize that, information to be provided for safety or security reasons.
The intake unit currently consists of only 12 full time positions. Between 2022 and 2024, the number of individual complaints that we received increased from 3,200 to 6,591. That was a 105% increase. In 2025, we received 7,860 complaints, a 19% increase over 2,024. And from January to March this year, we've already received over 2,000 over 2,100 basically complaints, which represents an 8% increase already over last year.
To address our increasing volume of complaints, and the additional workload to assess and respond to these complaints, we are requesting two additional analyst positions to ensure we are able to process complaints timely and to minimize the negative effects associated with a backlog of complaints. As of right now, we have a very minimal backlog, and that's because I've borrowed staff from other teams to help staff my intake processing unit. And hopefully, these two additional positions, we can let those staff members go back to their original positions. Thank you very much. That was very brief, but I'm happy to answer any questions.
And miss Poole will be covering the medical inspection unit.
Speaker 4
Good morning, madam chair and committee members. My name is Heather Poole. I'm the Chief Assistant Inspector General for the OIG's Medical Inspection Unit. As you know, our medical inspection process was established in 2008 by request of the Federal Receiver for the purpose of providing permanent independent oversight of California's prison system with the idea of sustaining progress both during and after the delegation, and our authorities now codified in the penal code. And we carry out this mission by evaluating the quality of the medical care each of California's 31 prisons provides, and we do it in a manner that is both objective through random sampling and also metric oriented, meaning that our findings are guided by quantitative data and 15 measurable key performance indicators, so measures of good health, that we use to evaluate it.
And we listed those measures of good health care on the handout that we provided for you. And our approach to these inspections is actually quite unique in two significant key ways. The first is that our policy compliance testing measures each prison's adherence to CDCR and CCHCS's own unique healthcare policies, and we actually adapt our testing to each change in those policies. Second, our doctors and our nurse consultants provide prospective case reviews of individual patient records, where they're evaluating the quality of the clinical judgment and the care for higher risk patients over a six month period or during significant events. And we've, for the first time in cycle seven, actually separated the ratings for those two components so that we could more clearly indicate to the prisons where they're excelling and where they may be still struggling.
We just published our final institution report for cycle seven, and our full cycle new institution tracker reveals some interesting trends. First, we saw generally adequate performance across the prisons in
Speaker 1
cycle seven in the case review component, indicating good quality of decision making with 74.2% or 23 of the 31 institutions passing that component.
Speaker 4
But we also saw generally inadequate performance across the prisons in our policy compliance testing with only 25.8% or eight of those 31 institutions passing that component. We will be in the next few weeks publishing our cycle seven summary report, which will for the first time contain analysis of both those cross institution trends in cycle seven that we have some of those on your sheet, and then also some cross cycle trends that we identified over the past three cycles. And we placed some of our significant findings on the handout for you, but we are happy to provide any further details that you'd like today. And most recently, we've begun our inspections for cycle eight. And prior to beginning cycle eight, we met with our stakeholders, and we actually implemented many of their requests, as well as some of our own ideas for how to further enhance the quality of our inspections.
We also significantly revised multiple components of our medical inspection process to allow us to not only complete the inspection for each prison, but also publish that final report within six months of the last day of our review period. And finally, our current projections indicate that the length of time between when a prison can expect to receive their inspection in cycle eight and then again in cycle nine will be less than three years. Thank you for your time this morning, and I'm available to answer any questions you may
Speaker 1
have. Thank you very much, both of you. Do we have any comments from the LAO office regarding the presentation?
Speaker 6
Hi, Ryan Weinberg, department of finance. We have nothing to add, happy to take questions if you have any.
Speaker 1
Thank you. Okay, members, any questions for the panel? Senator D'Aralso, you'll be up first today.
Speaker 7
Thank you, Madam Chair. I have some questions on the intaking intake processing unit. The complaints doubled, in two years. So what types which of the, types of complaints are driving its over 100% increase? And are you identifying systemic issues, not just, you know, individual cases, but what's what could be wrong with the system that's leading to this double doubling of complaints?
Speaker 3
We have looked at thank you for your question. We actually track the types of complaints we receive. So what we've done in our case management system is identify are the complaints coming in falling into a variety of categories such as prison conditions, prison policies, operations, staff misconduct, grievances, PREA, health care, safety concerns. So we we basically categorize every single complaint that comes in. The increase we have determined is is twofold.
One, we've have greater visibility in the institutions. We go out to the prisons more often. My intake unit goes out to each prison, and meets with the incarcerated person advisory councils to identify who we are and what services we can provide to the population. We are accessible through the, incarcerated person's tablets directly, as opposed to them having to go to a telephone, and we make sure that our our poster with our 1800 number is out there for all of the incarcerated population so they can get ahold of us as necessary. And when we do see systemic issues, we do share that information with the Department of Corrections.
Speaker 7
But considering you gather that information, what are the types of complaints that you can see are driving this double this a 100% increase? What types of complaints?
Speaker 3
The two greatest numbers of complaints we get are are issues with conditions, conditions at the prisons, and staff misconduct.
Speaker 7
Okay. And so are you identifying any systemic? Are these systemic? Or how are if you don't classify them as either systemic or just one individual complaint, then how do you move forward with solving the problems?
Speaker 3
What we do is we also identify which prison that the complaint is coming from. So we are able to to look at, like, prison A has received a significant number of, we've received a significant number of complaints in regarding this condition or, like visiting. Like we keep getting prison a is having, we've received multiple complaints about visiting. So we reach out to that individual prison and identify for them, hey, we've, we're getting these types of complaints. We make sure that the the warden, the the chief deputy warden, the public information officer, or whoever is important knows the type of complaint we're getting.
So we are able to do that based on the specific prisons.
Speaker 7
Which I assume then would lead you to how to fix or how to address the problems, the complaints?
Speaker 3
We make recommendations to the prison as to what we see, and we also let the complainant know what we've done and what avenues they can take in order to continue addressing their concerns.
Speaker 7
Okay. Let's see. On the medical inspections, something very similar. You just completed the seventh cycle. What, are the most significant trends on the medical side?
Speaker 4
So some of the most significant trends that we saw were the specific indicators that had the highest and the lowest passing rates. And one of the most significant correlations that we found is then, and this is on the backside of your handout. The case review component indicator with the lowest passing rate was emergency services and we did not previously have a specific indicator for emergency services on the compliance side. However, we did have four individual tests that tracked different types of emergency preparedness such as making sure treatment carts or emergency bags are well stocked. That they're doing their quarterly trainings, they're conducting the reviews after responses.
And those were three of the lowest scoring individual tests among other indicators. So one of the responses that we did to that is we took those tests, we relocated them in a new indicator, indicator three emergency services for our compliance team so that we can highlight that for the institutions. And we also noted that there are several of the indicators where almost
Speaker 4
of the institutions are doing very well. In fact, the access to care, 100% of the institutions passed that on the case review side. And then we also had quite a few institutions passing some of the compliance indicators. But we also saw on the compliance side that there were only one out of 31 institutions passing two of our indicators, medication management and healthcare environment. So those are probably the most significant of the findings, specific to the cycle.
Speaker 4
Correct. Those are our scores. Proficient indicates an extraordinarily high level of service. And then adequate is a passing level, and then inadequate is a non passing level.
Speaker 4
None of the institutions were ultimately rated proficient overall for any of the indicators.
Speaker 4
we provide recommendations that will hopefully increase. And if you look at the cross cycle trends on the backside, we actually have seen a general increase in the number of adequate performances on the case review component. You can see fewer inadequate ratings for individual indicators over the three cycles, indicating that we are seeing improvement in clinical judgment. And then with the compliance side, we do see a little bit more of
Speaker 7
a mixed performance, but we are seeing indicators that are improving over time. And then final, four prisons have not yet had medical care delegated back to the state. What are the barriers that they are facing?
Speaker 4
So it's actually currently three institutions that have not been delegated. CHCF was the most recent delegation. The three remaining are California State Prison Sacramento, Salinas Valley State Prison, and the California Substance Abuse Treatment Facility. And I think the barriers in the past have mostly just been related to what the receiver is looking for. So what I can tell you is that from our perspective, we are treating the delegated and undelegated the same way, and we are providing the same level of inspection and service.
Speaker 7
But there must be something yet, or you think it's just a matter of time, or are we really facing more serious, issues, in those three three prisons?
Speaker 3
The delegation issue is something that the receiver handles. It's not the inspector general's office. It's whether it's up to the receiver as to whether or not he elects to delegate a prison back to the department of corrections. They use our reports- as information but they have a whole host of other information they use and we have no- control over that.
Speaker 10
Thank you. I want to go back to a little bit of our complaint. Load because it is exploding as a senator said Do you you keep track of. What percentage of those complaints actually have validity to him because I I know when we have an end an anonymous complaint or or You know when when people don't find out who's doing it who's complaining. Sometimes people file complaints just to get others in trouble.
So do you have any indication of of how much of that is part of that complaint load.
Speaker 3
We don't. We don't assess the complaint and decide whether or not it's valid or not we take every complaint as a valid complaint we do our research we get information that's relevant to the allegation that presented to us, and we either respond to the complainant with, you know, here are some avenues that you need to address in order to have your complaint addressed, through Department of Corrections, or we will guide them to another State entity that may be able that might be able to help them or we provide the information to the department of corrections and we let the complainant know that we've forwarded your issues to the department of corrections for further handling. We don't we treat every single complaint the same we don't- discredit any of them.
Speaker 10
Right. But I would imagine once you've investigated it, you have some idea whether it has validity or not. Are we even keeping track of that?
Speaker 3
I hesitate to say yes, but no. I I don't believe that 90% are trivial. Just Okay.
Speaker 10
Let's not use 90%. Let's use 50%. Because I I you know, we have some dealings in in complaints, receiving complaints, and and especially in the anonymous complaint world. A lot of codes complaints are meant to get people in trouble. And it and after they've been investigated investigated and they figured out all the facts there are categories where while this is very valid we need to take some legal action and remove people.
And then there's the, oh, you know what? This is kind of BS. That's what we need to kind of figure out. Because we're spending a lot of money on this stuff, a lot of money. And and that's you know something we need to be more efficient at so that the valid complaints are actually.
Followed up on like you said and we have the manpower to do it. But we are not opening the door to this abuse of the system where people are using it to retaliate on. Each other or on guards or on you know whoever.
Speaker 3
Absolutely, I agree. We do review each complaint and the our our staff member looks at what the allegation is. If, hypothetically speaking, if if we get an anonymous complaint saying officer x is doing x, y, and z, We look into how much information can we find, dates, details. We pull records from department of corrections. Was the officer even working that day?
So we we gather all of that and we respond accordingly. If we find it to to not pan out, we will address the complainant and say you either need to provide us more information, or you know, you need to pursue some other avenues in regards to this complaint. If we're even able to do that, If it's an anonymous person there's really nothing more we can do with that other than doing our due diligence to make sure- that the issue is addressed.
Speaker 10
And but at at the end of the day we don't have. Statistics that show that we have a lot of these versus a lot of these.
Speaker 3
That's not really our role is to determine whether or not people's complaints are valid what we do is we get the complaints and we make sure that the complainants whoever it may be whether it's an incarcerated person or a member of the public- has somewhere that they can report alleged misconduct.
Speaker 26
Because I would think if we knew kind of- what. What was going on that we could put additional measures in place that would help the valid ones get. Get addressed With more In a more robust process and the invalid are the ones that are that we're seeing a problem with wind up not even getting in to the system because they've been identified early on That there's there's some Problems with it with how they're act what they're doing with the system In other words we need to identify this we need to know how much of this is real and how much of the distant. If we're going to come up with a program to re define how CDC our employees. Are are monitored and and disciplined and all that we kind of need to know what.
Speaker 10
You know. It how much of this is valid versus you know if we have a but a process where 90% of the complaints have extreme validity to them. And we can prove them. And we need to take action that's a real that's identifying a real problem with our personnel. Whereas if a lot of it's just retaliatory type of stuff That tells us that.
They are doing the job and a lot of. What they're dealing with is Is you know people trying to get him in trouble sometimes and I'm not trying to defend people that do and I'm not saying everybody's perfect But I am saying in the in the employment world That happens you know happens with patients when you're dealing with the fire service Or police misconduct or any of that So we I think we owe it to our employees to ensure That we are just not. Taking in all these all these complaints and and treating them are are not having the the work done to and determine that hey this is not not true.
Speaker 3
Just to be clear we get the complaint we do our preliminary work we provide the information to the department of corrections so that they can do and right investigation to determine the validity of the complaint. On and that's how it works so we're not actually saying that the person engaged in misconduct because we got this complaint. We do the preliminary work we send it to the- to the prison we send it to the warden the hiring authority. And we let them know this is what we've
Speaker 3
has been reported and then a complete investigation is done by the department of corrections
Speaker 10
you do the intake specialist part and then let them do the investigation part.
Speaker 10
okay another question this is kind of cropped up in my district actually- I I was reading the other day that that. In the Chino the women's prison some what women's- inmates have actually now filed a suit. Against the state- with regard to SB one thirty two whose oversight is that. Didn't monitor how SB one thirty two has affected our female populations for female prisons.
Speaker 10
is Is that in your land or is that in somebody else's? Because there are complaints.
Speaker 10
They're being they're complaints coming from there and and now the DOJ, the the federal DOJ is investigating it. And now we have a lawsuit. So something's going on- and that's been in place since- 2021 I believe. And and if there's a problem with with that program. That that created then we probably need to address it.
Speaker 10
okay. But you do you are responsible for the complaints that are generated from that program.
Speaker 3
Yes if okay if yes we do monitor the complaints and any investigations that are related to those complaints okay. Thank you.
Speaker 1
There we go. My first question is you mentioned a little bit about in the report that you're seeing issues with medication management and healthcare environment indicators. Could you describe more thoroughly what you mean by there being inadequate and getting worse? And are there newer technologies that can help in this process that maybe aren't being used in the Department of Corrections?
Speaker 4
So with the healthcare environment, that's mostly what we're observing when we are on-site. Excuse me. Looking for compliance with just various cleanliness requirements, sanitation, and then medication management. We're looking for how medications flow from the provider's order to the pharmacy, to the nursing staff who actually delivers it. And a lot of the inadequacies are coming from just a missed attention to detail because when we're testing compliance, we're testing to the exact letter of the health care department operations manual.
So if something's missed as a compliance factor, it will be a fail. Whereas on the case review side, we're really looking for the overall quality of care. And so with the medication management and healthcare environment, what we really just saw is those missed attention to details, but we do have one of the lowest scoring tests in the healthcare environment was our emergency bag preparedness. That's going to be removed out of that indicator and placed into this new emergency services indicator. So we do generally expect the healthcare environment passing rate to go up.
And then with medication management, I believe that CDCR is trying, at least the last time I spoke with them, are trying to implement some new technologies, but I am not able to speak intelligently about those.
Speaker 1
Okay, so let me give you an example. Unfortunately, I've spent more days, more lately, in hospitals with family. And it's quite common, you have a family member there who's not feeling well, And they're in a lot of pain. It's like, hey, I asked so and so, you know, where's the medication? And you're waiting, you're waiting.
Oh, the nurses, you know, on their break and they're waiting. And I can see how complaints, you know, might be submitted. You know, I had to wait an hour for my medication. When the patient may or may not, because of this situation, not have family present. It may not have been an hour, it may have been five minutes.
But to the person you're in pain, I'm like, I asked five minutes for this. So we'll follow-up on our end, but I would be curious, particularly with the medication management. Nowadays there's newer technologies of how they have in the computer system, when a person is due, they're scanning. When I've been in the hospital with family members, they're scanning their wrist thing. They have a little cart thing that produces out the medication, and it really helps to expedite some of the process.
So we'll follow-up on our end about getting more detail, and if you can provide more detail of what you were looking at regarding the medication management piece, so that we can see if there's any current systems that hospitals and different systems are using to improve with that. My next question, want to get back to both senators. I'm going to make the request that going forward, your reports include a little more information. So I think it's absolutely appropriate that we would have a document that would tell us of the 6,000 complaints, are 6,000 of them use of force, or are only five? It really does help us to determine, we seeing success here, or what really is the issue.
If the issue, I think what Mr. Ciardo was saying, you know, and I've been in a few, in my oversight capacity, I want to make sure to clarify that. I've been to, you know, a few prison locations and, you know, are we, what he was getting at is, is a person saying the microwave that I hear is causing me harm kind of thing. Or are these really legitimate complaints that are being put forward? And I understand your role is not to determine what happens, but you do have a role if you're receiving complaints and something, it could be a mental health issue, whatever it is, I understand that that complaint is still legitimate and needs to be logged in and someone checking.
Speaker 2
But it would be very helpful for us to understand, of these 6,000 complaints, are 6,000 of them people who are really saying they're being retaliated against, there's sexual misconduct, there's a staff complaint, there's use of force, or is it someone who is on their tablet and saying, I'm complaining because the officer is coming by and flashing a light into my cell. Well, the reason why they're flashing the light is now they're required to identify that the person is well and able. So these can be taken in multiple ways, and we have to make sure that all the information is being fairly evaluated. So I'll find out from my end what discretion or direction we have. But I will just give you a heads up that I think we do need more information that you're able to provide.
Speaker 1
And I would have to think that you're giving to the wardens in Department of Corrections some sort of level of saying, hey, this is a serious issue. This is a staff complaint versus someone saying the microwave is causing me harm that's not even in their person's cell area. So I think we really, it is warranted to have a little more information. I concur with both my colleagues that that's needed. The other question is, how long does it typically take you to resolve not resolve, but process is maybe a better word the complaints that are coming in.
Are they typically thirty days, sixty days, one day? What's the time frame?
Speaker 3
We try and resolve all complaints within thirty days. When a complaint is initially received, we prioritize it and we give it a one, two, or three. If it's something that's very serious, we get we handle that immediately. So, priority one, safety, security, mental health concerns, those are things that we handle right away. Some of the ones that are lower priority, like a priority three of I didn't receive my quarterly package, Those, but everything is responded to within 30.
Speaker 1
Okay. And I understand the court case required that we have an objective, body that's evaluating the complaints and that certainly makes sense. However, does the Department of Corrections have the same positions on their end? Meaning, are we duplicating originally did the Department of Corrections and Wardens have three people, you know, per prison or whatever that were there to evaluate the complaints that come in?
Speaker 3
So, some complaints are duplicative. The incarcerated population or members of the public or family may send us a complaint through our intake complaint process, whether phone, email, letter. And then the Department of Correction has their own process where, people can submit citizens complaints or the incarcerated population can file a complaint via the six zero two form, that's the form number process. Some are duplicative. My staff, as soon as they see something that is already being processed by the Department of Corrections, we will send a letter to the incarcerated person or the family member saying, please let the process play out.
And if you're not happy with how it ends, please reach out to us again. But we ask them that so we other than just researching and sending a quick letter saying, let the Department of Corrections finish what they're doing, and then reach out to us if we can assist you further.
Speaker 1
Okay. So, for example, for me, being on the budget committee, it would seem to me if we could eliminate some of this duplication, that might help us in terms of additional positions, being needed. Maybe you have the positions and positions over here aren't needed if you're in fact processing ultimately what they're getting. My next question is, can you give us an idea of I understand what you were saying, you don't resolve. But do we have any idea of these 6,000 how many would you say are in your priority one category?
Speaker 3
I do not have that information at this point, but I believe my staff would be able to get that information for you.
Speaker 1
Okay. So if you could provide it to the committee. I think that's what we were asking. And then my last question is, based upon the court case, how long is the independent review required? Is this going forward, we always have to have an independent review process?
Or was this something that was ordered for a limited period of time or what was the requirement because if we're bringing in positions these are ultimately permanent positions.
Speaker 3
The complaint intake complaint process is written in our statute. So we are statutorily required to provide this service. Forever. All
Speaker 1
right. Okay, those are all my questions. Thank you for participating and being here.
Speaker 1
All right we'll now move to issue number two which is the healthcare overview with the following panelists we're going to have to Wayne reader. Deputy director of fiscal management of the section of the California correctional health care services. We have a is it Jeanine. Del Mundo deputy director of California advancing and innovating medical program. We have again our same representatives from the LA office and I believe also from department of finance.
Okay so please begin.
Speaker 8
Good morning madam chair and members I'm doing reader deputy director of fiscal services for California correctional health care. I'd like to provide a little bit of an overview of the health care budget There are many challenges in a in a health care budget
Speaker 8
Well yeah. To the cap there But health care costs continue to rise as well as we have an aging population. If you look at the S. B. One way report which will talk about in a future item You can see that are 55 population is kind of from seven percent to twenty one percent.
You can also see that the cost for care rise significantly after 60 and even 50 So we're dealing with an aging population we're also dealing with just health care costs in general continue to rise I think all of us can. Look around the table and talk to man on the street and they can see that their health care costs continue to elevate so. Have We a lot of challenges in our budget As far as our budget goes 80 per over 80% of our budget is personal services. So the bulk of our our funding is for staffing If we can manage our vacancies we can read reduce reliance on overtime and contracted staff which come at more of a premium And so in response to that we've done hiring events For the last few years our HR In an effort to get More staff to come in they did they develop these hiring events and it it really expedites the hiring process. The state hiring process can can be anywhere up from four.
Four months or more And so these hiring events they do a lot of the background and they can even give tentative offers. So they're they're shaving off a few months plus we're getting candidates that maybe. You know the process to Apply online and things like that can be challenging. So having staff there to be hands on and help them through some of those processes is has really been beneficial. So to address vacancies you know we've been doing these hiring events we've also been Advertising a lot on social media and leveraging social media we have a presence on all the major platforms To to do additional outreach To these folks For some of our More executive type positions we we do offer Help to candidates that maybe have trouble navigating the system they can reach out The email and we'll reach back out to them and and you know connect with them and help them get through the hiring process if they're having challenges or issues.
So we're really trying to focus on reducing vacancies. In the mental health program in the last few years we've introduced the license marriage family therapist to to help cover Licensed clinical counselors So a couple new classifications to help come in and fill those vacancies as. You know especially in mental health health care staffing is really challenging Especially in the psychology area Which we have a lot of authority so The Coleman courts also did Introduce a primary care clinician Which allows us to hire. You know one in the two three different classifications into that primary care clinician so before it was just authority in each of the specific classifications. Now with this primary care can clinician we can fill that with a variety of classes to help Bring down those vacancies.
So we're really you know focused on filling vacancies and you know we're reducing our reliance on more costly Position coverage. We are twenty four seven environment. Which creates challenges we do have over 7,000 posted positions. In our system in nursing- so you know it it's a complex dynamic environment that we work in- a lot of dedicated staff working really hard out there serving an underserved population- so. A lot of passion there Another area that that's causing forces contract medical.
Contract medical costs Are for a lot of outside services. We look to do to. You know do our best with contract medical lot of the rates that we pay are contracted But we do try and avoid sending patients out to the community we've been doing a lot more services on-site we have on-site clinics. So we don't have to transport the patients. We also looked at some of our more frequent emergency room send outs A few years ago which was tied to overdose chest pains.
So we introduced some new protocols. To keep those patients. In our TTAs versus having to send them out to an emergency room. Some of those costs don't help healthcare. It really, you know, is our transportation and guarding costs that it helps out with Which is always a challenging budget we have a lot of emergent.
On schedule transports and so You know. If it can benefit CDCR can benefit the state we're gonna look to see what we can do Another big cost areas pharmacy Our pharmaceuticals Tend to go up and down We do look to generics whenever possible. We are going to use generic versus brand. We started a pharmaceutical rebate program last year that's looking to save us $10,000,000 this year is what we're projecting in savings tied to the rebate program In pharmacy And so we really you know are are trying to manage those costs the best we can. And you know we leverage the DGS contracting You know to get Better costs for our pharmaceuticals.
So We're doing our best to to manage those costs and To keep them within reason. As far as the receivership know, one of the big efforts in the receivership was the Healthcare Facility Improvement Program, HCFIP. That should be completed in the 2027. We have three institutions left to complete. So making progress and that was a big thing for the early receivership was getting our facilities and our clinics up to modern standards and community standards.
And so we're very close on that which is encouraging. As you I G. Mentioned We're down to three institutions to delegate. C. C.
F. Which we delegated April 3. Is a huge medical facility I don't know if you've been out there. But it's a it. It has over a thousand in patient beds.
It's it's really. You know our our health care institution if you will. And we're California healthcare facility in Stockton. So delegating that was really I want to say impressive, but I don't want to pat myself on the back. But it it it was a big leap for us to get The health care facility delegated that that was a big institution for us.
So we have three more to go And we're hoping.
Speaker 1
Sorry I don't mean to interrupt you But I want to make sure I'm understanding you when you say delegated what do you mean Is it like a dedicated facility for people who need I don't understand the term delegated. So
Speaker 8
delegation is when they delegate the facility back to the state. So it's under the receiver's purview until it's delegated. Okay. Yeah. Delegating the health care facility was a big milestone for us.
HCFIB coming to an end is a big milestone. So the receivership continues to progress. And you know, after we delegate the last institution, there's a year of monitoring and then hopefully possibly an end to this court case. So that's the ultimate goal of the receiver. With me today is Jeanine del Mundo another area we've been trying to get additional reimbursement and additional federal funding is calling.
Is the is the calling program. So Jeanine is the deputy director of the calling program and so she's going to give you an update on calling.
Speaker 27
Good morning madam chairman committee members so as going said Jeanine del Mundo deputy director of a special projects which includes calling. So I want thank this legislative body for its continued support of the department's rehabilitative programs your commitment and support of the cal aim initiative. And your focus on enhancing pre release and reentry services for the populations we serve. Thanks to our partnerships with the Department of Health Care Services in collaboration with Managed Care Plans and County Behavioral Health Departments and community based providers, I'm pleased to announce we went live on 02/03/2025, which was a year earlier than projected. We started with claiming reimbursements for medications within ninety days of release.
Speaker 11
And post release on 04/01/2025. We went live with care management services. This includes the warm handoffs for patients to meet their community providers prior to releasing so they get a face face to face via a telehealth call to meet their pride writers who are in assigned by the managed care plans. And in July 2025 we bank we began claiming for some targeted medical services. For clinical services such as laboratory services radiology services and a limited set of dirt durable medical equipment.
While there's still work to do we have made significant progress to date. With data showing that on average eighty nine percent of our patients have medical activated at the time of release which is a forty percent increase prior to calming. Eighty seven percent of our patients have an assigned managed care plan prior to release and eighty eight percent of patients are released with a reentry care plan. Fifty nine percent of our patients have had warm handoffs with the community enhanced care managers There that person that's going to help them navigate once they release to get them their health care services up to a year. So since simple implementation the department has submitted a 169,000 claims and we received approximately 14,700,000.0 in reimbursements.
As CaliAM is a voluntary program, we continue to work on process improvements to reduce patient refusals through education and communication. We continue our collaboration with the department of health care services the managed care plans and accounting behavioral health departments to increase leakages to the community providers. And we continue to evaluate and update our billing systems for additional expansion opportunities for reimbursements. I am happy to answer any questions you may have.
Speaker 5
Orlando Sanchez Zavala with the LAO. I'll just provide a little bit more context to set the stage for this item and the next item. The kind of the delegation process we've been hearing about, that's something that was established through the Plata case or the medical receivership. So this through this process, this is something when the federal receiver was established, the state lost control over providing medical care. So now as the court has gone on about getting close to twenty years here with the federal receivership, specific steps have been identified on how the state can regain that control.
And the delegation process is one of those. So each facility needs to meet a certain threshold, and the OIG's medical inspections are one component that the receiver evaluates among several other components. And yes, we're down to the final three, and these could be the most challenging facilities, so it's not clear yet when the state will reach those thresholds. Over years, we've kind of heard we're getting close and close, and some of these things are some of the more challenging to facilitate. But reaching compliance is the goal the state should move towards to try to exit this this facility.
As of now, the mental health receivership that we have two active receivers that's on the Coleman case, That one doesn't yet have a delegation process established. It's not clear if it will. It depends on how that court case develops, but we do have right now the goals of that receiver and what they plan, the changes they plan to make. So just wanted to provide that context on making that distinction for this item and items to come. Thank you and happy to take questions.
Speaker 6
Hi, nothing to add at this time but happy to take any questions if you have them.
Speaker 7
Thank you. Thank you very much. Good to see you all. Maybe I'll start in reverse since we were last talking about the platter receivership. Why is it taking longer to get to these last three institutions?
Speaker 8
So the institutions have to you know be inspected they have to raise their operations above that inadequate As as Orlando mentioned there are other factors beyond the OIG that the receiver considers for delegation But essentially it's getting them. To the standard that they need to be at in order to be delegated so it's taken longer at a few institution institutions. As they are challenging environments. When you look at CSP sack and you look at C. Salinas valley.
They're high EOP populations they're level four institutions. And you know that creates you know some challenges and you know. In the healthcare program. So it's taken a little more time to get them up to standards, but we continue to work with OIG and internally to prepare them for delegation and, you know, ensure that they're operating at the level that the receiver requires.
Speaker 7
Just as was mentioned also, what is the current timeline for those three institutions?
Speaker 8
You know, I'll you know, go back and maybe share. It's challenging to put an exact time to it, but maybe we can look at the progress we've made, and we can provide a response in writing on that.
Speaker 7
Okay. And you mentioned CalAIM. Twenty five percent of the patients that went from, you know, the high 60s and then it dropped down to twenty five percent had the warm handoff with the external manager release. So why do you think that gap exists? It's right.
I mean, that's at the point where they actually Yes. Connect. Correct. After they're released, they have a connection, and you would think with all the work that was done prior to them getting released, that more, a higher percentage.
Speaker 11
Yes. So 59% have had warm handoffs with the community with the enhanced care managers. The CDCR and CCHCS, we do an embedded model. So we are able prior to Cali, we connected patients To add to the community providers as well and then so we're doing that. I think mainly there's some capacity issues in the community that we're working with there's there's still the managed care plans are still bringing on new enhanced care managers so depending on.
The county, there's more availability in other counties. And then so we will still connect them, but they may not get that warm handoff if there's not the capacity in the community at that time.
Speaker 7
Okay. Well, that's good to know. The cost, the healthcare cost is enormous, and every year the health care cost is getting higher and higher. I'm just wondering if you've looked at policies that could result in more general fund savings. So just as an example, if we move the elderly and the medically fragile people into community settings for their care, they would still be under CDCR custody, but we would qualify for Medi Cal with 90% federal reimbursement.
And this could free up our general fund for other Medi Cal priorities that cannot be reimbursed by federal dollars. I'm wondering if you're looking at other policies that could get us more funding so we could make available for these increased costs health care.
Speaker 8
Yeah. We continue look at federal funding opportunities. We look at our own policies that that possibly could be driving. You know additional costs We we've been doing a lot of review over the last few years with with the downturn in the budget we you know. Have been really scrubbing our financial scrubbing our operations and and and looking at things.
As far as patients in the community We had. You know medical parole and basically we were sending patients out to a long term care facility in the community. And we didn't get federal free immersion because they didn't have freedom of movement they were locked down essentially they weren't allowed to leave the facility. And they didn't have internet access. And so.
We weren't able to get federal reimbursement and so we had enough empty beds in the system we said this the contract isn't making sense let's bring them back in. So there are some challenges to pushing more folks out to the community. There's also sentencing. You know and and and levels. That can cause concern when when folks move the community as well so there's.
There's some layers in there, but we do try and look at at alternatives to housing them within since it's so costly.
Speaker 10
So I'm trying to get a little bit of a handle on this receivership issue, because I'm looking at what we're paying 10 people, in the receiver's office. And it's like it averages to $550,000 each a year. Including the admin support positions $312,000 a year so that's just that's $5,500,000 that we're paying For receiverships. These lawsuits were filed in 1990 in 2001 I believe it is. And so the Coleman was 1990.
It's taken that long to identify what we need to do to comply with that. Order or or what has taken so long
Speaker 8
So we're gonna talk with the mental health receivers office here in the next item
Speaker 8
So we have an office of special master that was Working with us to get us in compliance with the court That effort. Okay I'm I'm kind
Speaker 10
of picking up your mean it didn't it didn't wasn't fruitful. Yep because it seems to me if we know what we need to do. That we would at least have a plan and a dollar amount that needs to be invested in doing that So that when we do our budget process We can We can allocate the appropriate amount of money to get those things done in appropriate amount of time. So we don't have to have receiverships that cost us. 8,200,000,000.0 our million dollars.
$8.08 a year and that's at for me it's like okay so that the Coleman one was by 2021 we finally wound up with the receivership so that almost twenty some odd years to. To address it and they didn't. Thirty years.
Speaker 8
Yeah I know one of the major goals are one of major issues has been vacancies and so we've we've put a huge effort into that over the last few years and I I think our vacancy rates of. Proof considerably So we are trained as far as the salaries the salaries were court ordered I'm not sure how the court determined those salary levels but they were ordered
Speaker 10
and I think I might go reply because that's a lot. Eight are you guys afraid to tell us what needs to be done so we can pay for it and get it over with or because it because I would think somebody would be telling us every year a this is a court order we have to get these things done. And this is how much it's going to cost so every year we need this amount of money to do this and then we wouldn't be in the position we're in. So are they just trying to. The appease the legislature or what.
Speaker 8
No the receivers relatively new came on last August and so they're still finding their footing and they're still
Speaker 8
real people before. Yeah I'm not I'm not sure why the special master was a more engaging.
Speaker 10
This is just like a super inefficient. And part of it I get you know nobody wants to give us the bad news or give the governor the bad news. That hey we have to do these things and this is how much they cost And M. And when we just kick the can down the road we wind up with receiverships. Like this.
They're horribly expensive where we could be putting those dollars into either the projects to correct the problems or or whatever We shouldn't be paying somebody $870,000. To be the overseer of the receivership. That's ridiculous. So Hopefully We get some honesty from our our get some better action as far as what we need to do and how much it's going to be and when we can get it done by so that we can kick these folks back out of the state. And what I want us to be able to run our own stuff.
And do it the right way so thank you.
Speaker 1
Thank you very much How many. I'm you may be aware how many total persons are there. About 31
Speaker 1
okay. And how many of those are health facilities. Are dedicated to health or any
Speaker 8
all institutions have health care all institutions have clinics they provide services at all of those locations
Speaker 1
okay. Coming back to senator Drazos question do we have any that are specifically only dedicated to. People who have more extended health challenges.
Speaker 8
I would see the health care facility in Stockton concentrates a lot of those- more challenging age population- That is kind of our health care facility So there are are you know a good portion of them concentrated there We also try and put our more Unhealthy patients at. Stitutions that are close to centers of care. And so we Sacramento and here you know California papers in Sacramento San Diego. L. A.
C. The institutions that have centers of care around them we try and concentrate because we know these patients will be going out to the community. So we we try and you know concentrate the. More unhealthy patients At those locations where we know that they can get services More easily in the community.
Speaker 8
There's seven hundred seventeen hundred and twenty two. And then they also have a facility E. Which I believe has about another 1,100 patients on it that are not beds they're not impatient But on the main facility it's 722 Inpatient beds.
Speaker 1
Okay so we have approximately over 9,000 inmates so are you saying to me that only 1,700 of them approximately need. More additional care.
Speaker 8
No we have programs throughout the state I mean. C. C. F. Is not unique in you know can only care for these patients we do provide services at the other institutions for these high risk patients
Speaker 1
okay so let me say my question maybe with a better example. So out of let's say 90,000 inmates. Would you and 31 prisons Are you saying to me that we don't have out of those 30 prisons, maybe three that are dedicated to people who are either seniors or terminal illnesses or significant ADA requirements or whatever? We don't have that.
Speaker 8
Doctor Keenan is over the clinical operations she's a doctorate director of our clinical operations so.
Speaker 1
Good morning yes ma'am good morning. Can you have thank you for being here.
Speaker 9
Thank you for having me. Yeah, so Dwayne is explaining it very well. And so, you know, the Pareto principle is there's a small proportion of people who disproportionately drive our clinical risk resources and that happens in our system as well. And so those nine or 10,000 people are concentrated at about a third of our prisons. And those are the prisons that we call intermediate, what Mr.
Reeder was describing. And they tend to be near urban areas where, you know, we can get specialists more easily, and we have tertiary hospitals nearby. So CHF, the facility in Stockton is absolutely our flagship for some of the most complicated patients. But again, we have about a third of the institutions that really concentrate our most complex, clinically complex patients. And at those facilities, everywhere we provide 20 fourseven nursing primary care.
We provide medications and allied health things like labs and x rays. And we have the ability to provide specialty services, sometimes through telespecialty. And we provide emergency response and hospitalizations as needed. But there are absolutely institutions where we, if a patient needs hospice care, our skilled nursing facility, the one we have is at the women's prison in Chowchilla. We have memory care units that we have had to create over the last few years.
We have assisted living housing units that we are standing up as well. And again, that's related to our aging population, who of course just like older people, and I'm one of them now, but you know, you tend to have more chronic conditions, more advanced diseases, your cancers, your dementia, you need dialysis. And so, we have some additional services at some of those institutions.
Speaker 1
Okay. So, could you please provide to the committee the various 31 prisons that we have? How many are in those various categories? So of the 31 prisons, if approximately you said one third, that means 10. If approximately 10 of them focus more on these individuals, How many are chronic care or terminal issues, memory care issues, whatever.
And that would be really helpful to us. Sure. Let me do a little rough math. And rough math doesn't always work, but I'll do my best in it. If we have, for example, 10 potential locations that are providing more extensive care.
I get it, we need care at all prisons for broken legs,
Speaker 1
Teeth and eyes and Emergency. All of that stuff. If we have 10 prisons that are providing care for approximately nine thousand to 10,000 people, and if each prison holds approximately three to 4,000 people, to me, my quick math tells me that we could have instead three prisons that would focus on more additional focus, whatever care, and have those three focus be close to high medical facility areas. And maybe we could potentially work on the cost in that way. Is there a reason why we would not consider that kind of scenario?
Speaker 9
Well, think we we have consolidated, but I think you're suggesting we continue to consolidate more. And there are some advantages to that, right? In terms of sort of centers of excellence, particularly if you're able to recruit, you know, your professional staff. The challenge is, I don't know if we could get to three, maybe we could, it could be less than 10. But the challenges are that in addition to sort of the medical and nursing needs of the patients, You know, we've got our mental health mission.
And there isn't complete alignment when somebody is very complex from a mental health perspective and a medical perspective. And they've got some disabilities, physical disabilities, so there's an Armstrong litigation as well. And by the way, they've got some really complicated custodial factors, so they need to be at a level four prison. And so literally we have this gigantic matrix. And for every person we have to sort of figure out given all of their different custodial and clinical needs and all of sort of the litigation compliance kind of requirements to figure out where they go.
But I think your point is could we look at consolidating further? Yeah, perhaps.
Speaker 1
Okay. Thank you for your frankness. And that's something we'll certainly follow-up with. Because it would just seem to make sense that, you know, if and I get also the point you didn't mention, but I'm sure you thought of, you know, I'm sure people would also say, well, members and access and visitation and all of that. So that would certainly have to be kept in mind as well, given the nature of what we're talking about.
But I really do think further thought should be on this because, for example, an elderly location, mental health, just would help us maybe to trim the cost. So thank you for being here. We'll certainly be following up. If you could get us that information of a better idea of where these categories are in these roughly one third. I realize that there may be some outliers and it might be more than one third or
Speaker 9
We'll give you some information if you need more we're happy to give you more. I will say we have a public dashboard that does provide quite a bit of information on the populations, and gives lots of chronic conditions, the numbers, people with various types of disabilities, age groups, And we also do the clinical risk, right? If they're clinically high risk, one, two, medium, or low statewide and across them, across each institution. But happy to provide that and maybe some additional information and let us know if you need more.
Speaker 1
Okay. And, if you could still remain, I have one more question. Did you have something,
Speaker 5
Thank We're Leni Sanchez with the LAO. If I may, we also did, not in this context, but we did a report addressing mental health vacancies options that the legislature can enact, and one of our recommendations is similar flavor to this discussion is concentrating the mental health population, or we call it clustering, that being an option and for the department to report provide a report on the feasibility of doing that and factoring in all these challenges that have been discussed, like closeness to family, medical security needs, rehabilitative needs. So, just wanted to provide that additional context.
Speaker 1
Thank you. Which also would apply to our next issue. Yes. Okay. I had another question.
You talked, Mr. Reeder, about the process of contracts, these special contracts of bringing people in due to your vacancies. Last year, Senator Menjivar had a bill and it had to do with the hospitals being required to have a registry of nurses, I believe was the topic. Nurses in a particular area, so that if a vacancy did occur or someone was out sick or whatever it was, that they had a, the hospitals would have a group of people that they could call, particularly before they went to this out of state contractor kind of thing. Do you have such a registry, or do you have such a relationship with your labor union that provides or represents a large amount of your staff in this category.
I think it was marriage and therapy therapists area. Do you have such a relationship where you have a pool of people that if you have a vacancy, maybe they can also assist? I applaud you for your outreach and doing your job fairs and all of that. But do we have such a registry where if this particular union, for example, might have workers at a another hospital or a different type of facility where we could have a registry that we could pull from of these individuals Before we were seeking the out of state option
Speaker 8
We currently don't have a registry are an internal registry Our labor folks do speak with the unions quite often And I could follow-up to see if they've had any specific conversations In the realm of registry We're certainly willing to explore options To fill vacancies and cover posts and so I can reach out to my labor folks and and ask that question and get back to you.
Speaker 1
Okay did you have something you wanted to add. No okay my next question is Is it true and we always have to test understanding I get that is it true that in some of the out of state folks that you're considering to engage may not be required to have a license, a California license, is that correct?
Speaker 8
We cannot bring in non licensed folks at this time that was a suggestion by the LAO that we don't require California licensure we accept their licensure from. You know whatever state they're providing services from. But there's a statute around that That would need to be adjusted for us to circumvent California licensure at this time.
Speaker 1
So currently you're not following that recommendation of bringing people out of state who do not have a California license.
Speaker 8
Correct the only the only folks we would be bringing in from out of state is ones. You know that we're gonna hire. Then that are gonna go through the process of being licensed and they they they have a period of time to get California licensure. When they start work and then if they don't have it with it I don't I don't remember if it's like one year or two years. And if they don't get license your then we have to let him go but- we do recruit out of state to fill service so service but we do require them.
To obtain licensure. Early on in their employment if they don't already have it.
Speaker 7
A quick question maybe it's for the LA or or anyone else. We ever done report on what these three legal cases have cost us in additional cost? The Coleman case, the Plata case, and the Armstrong case. What additional you know how we we do for high speed rail? How much is it costing us up until now?
What have these three cases cost us beyond what a prison's expenses are?
Speaker 5
We Orlando Sanchez with the Elliott, we haven't done an analysis such like that. Some of the challenges with that is some of the changes that are happening require getting the state to a constitutional level of care. So there's an argument to be made would the state have done those on its own, yes or no, or would continuing to operate at inadequate levels remain and that's something that's difficult to predict. But what we do know is that at least on the Plata case, we know that on a per person basis since the establishment of the receiver, it's increased cost by four times the cost we were prior spending. That's not including the staff, the receiver staff itself.
That's just where we added a lot more positions and people get better care. But we haven't done kind of tracking all these three and those are some of the challenges is what would the state have done had it not been under court oversight? And then some of these are just should it have been doing those because we were out of constitutional levels of care. And that's some of the challenges. But we do know since the receivership on the plot case that total costs have ballooned two times more in the past twenty years and that's even after accounting for inflation.
On healthcare in Armstrong, So now that we have a receiver, it seems likely that cost could continue to go up as the receiver the new receiver that was established last year on the mental health side pursues their new plan. And as of now, that cost is projected to be about 40,000,000 per year, which includes the cost of staffing just for their office.
Speaker 7
Okay. I mean, it had to be pretty bad for it to be considered a deliberate, cruel and unusual punishment. So maybe we can consider, madam chair
Speaker 7
Asking for that because every year that these things don't get brought up, the conditions don't get brought up to a legal standard, we're having to pay extra. So thank you.
Speaker 1
Exactly. Thank you all for your participation and also for your frank ness, I might say. I know in your position, sometimes you're really not supposed to ask. Some people would view or not tell, but we really do need the frankness so we can make some progress. And our job is oversight.
So I appreciate your participation today. Thank you very much. We'll now move on to issue number three, which is the mental health proposals. We will be joined by the following panelists for this issue. The first one is Alyssa Challenger, Chief of Staff to the Coleman's Receivers Office.
Interesting about the discussion Senator D'Arrazzo just had about the cost. Also, we have Doctor. Tony Martiolo hopefully I didn't butcher that assistant deputy director of Telemental. Health programs then we still have our same individuals here for the LA office and department of finance And Mr reader you're still here
Speaker 8
yes I'm still here thank you- good morning again doing reader. The mental health proposals we have two of them for consideration one is the receivership BCP. Which is Requesting 33,900,000.0 in the special deposit fund not general fund the special deposit fund. To pay for the receivers office staff as well as to continue bonuses that were initiated last summer In addition we have a telemental health staffing augmentation BCP. So we've continued to grow our our mental our Telemental health program.
And so we're asking for additional positions and funding For that additional growth With me today Is Alyssa challenger from the receivers office is the chief of staff and I also have doctor Tony Martello who's over the tellmental health program to help with questions on that. And alternate over to Alyssa. To give an opening statement.
Speaker 13
Thank you, Dwayne. Morning. My name is Alyssa Challenger. I am the chief of staff for the office of the Coleman Receiver. And today, I represent the receiver, Colette Peters, as well as the receiver's team.
For background, as some of you may know the Coleman v. Neuson civil suit, a federal court appointed a receiver in September 2025 to oversee the operation of CDCR's mental health delivery system and approve the receiver's action plan to move the system towards constitutional compliance. The receiver and her team, including myself, look forward to working with legislature and the joint goal of improving mental health care within CDCR in a fiscally responsible manner. And with that, I look forward to answering any questions you may have.
Speaker 14
No, have nothing specific to add, but I'm happy to answer any questions about the Telemental Health BCP. Okay. Let's see.
Speaker 1
Ms. Challenger, we have a pretty extensive report here. That's it? Sorry?
Speaker 1
I just said we had a pretty extensive report here. That was all you had to share?
Speaker 13
I'm happy to go over the BCP. I wasn't sure if Duane was going to walk through it similar to the medical request?
Speaker 1
In light of the questions we just had, I think someone should. Keeping in mind the discussion, you may want to just focus on those points, but I think quite a few members expressed some interest concerns understanding staffing where people are place steps.
Speaker 8
Okay I don't know if she could hear us when she was waiting. Were you able to hear, Celissa? Were you able to hear the
Speaker 13
I also can only see myself, so I apologize if I can't pick up on any nonverbal cues.
Speaker 1
So his question was, did you hear the discussion of the panel that we had
Speaker 13
Yes, prior to I did. Yes. And I'm happy to address those questions specifically, or to also walk through the specifics of the BCP request and then take questions then?
Speaker 13
Okay, of course. So the BCP request, 33,900,000.0 for twenty twenty six, twenty twenty seven from the mental health deposit fund. It primarily includes two parts. So one, as referenced previously, was the receiver's office, which are non civil service positions. That totals 8,200,000.0 for the receiver's leadership team and includes salaries for the receiver, deputy receiver, senior advisers, and attorneys.
Speaker 18
It also includes salaries for key expert positions, such as a human resource expert, custody, mental health, as well as costs for our external counsel, travel, and office operations. As mentioned, these were all civil service positions and will be employed by the receivers corporation consistent with the court order that appointed the receiver. It also includes approximately 350,000 per consultant cost to assess staffing challenges, clinical fear, programming, and accreditation. And these will be positions that will be contracted by the receivers corporation and limited in the scope to their program area. And all of these positions are consistent with the court approved action plan that was implemented when the receiver was appointed.
Speaker 13
The other aspect of the request is to make the bonus payments permanent. So that is the bulk of the request. It's 25,300,000.0 to make bonus payments permanent per court order dated on 08/27/2025. And, again, none of the funds being requested will are from the general deposit fund are from the general fund within for 2026. They would all be coming from the special deposit fund that are that was an accumulation of fines.
Speaker 5
Thank you, madam chair. Orlando Sanchez with the LAO. In regards to this proposal, we wanted to provide some high level viewpoints for the legislature as it grapples with this new receivership that was established last year. Prior to the establishment of the receivership, the state had chronic levels of mental health vacancies, meaning wasn't able to hire enough providers, retain them, or recruit them. So that totaled about 150,000,000 collected fines from the state's general fund, and that's what's being used now to pay for this plan that we're discussing.
So there will be no general fund impact in the budget year because that was already from previously collected fines. So through the establishment of this receivership, we recommend the legislature continue to exercise oversight over prison mental health care. This establishment will result in a significant loss of autonomy for the state in delivering mental health care. But despite this, the legislature retained some key abilities that it should continue to do. For example, on the medical side, they've submitted budget requests to this committee, and they've made modifications as needed and worked with the legislature.
And the legislature should continue to oversee and conduct oversight to ensure that it can exit this receivership in a timely manner. The second, we also recommend tracking the progress towards exiting. And then it could do so through annual updates, these budget hearings as well as the mental health receivership extends. It's important to exit this receivership because it shows that the state continues to be out of compliance and is not providing constitutional levels of care and the state cannot have full autonomy yet of that delivery. In addition, it's likely that cost could go up beyond the current estimate we have and the current proposal.
For example, the receiver the mental health receiver has indicated potentially looking at the adequacy of office space and mental health treatment space. So, if new construction projects are ordered as a result, that could increase costs on the medical side. That did happen, and we heard about it on we call them health care facility improvement projects, or pick fit those totals about 1,500,000,000.0 over and are still ongoing those projects. And given that the state is facing a multi year budget deficits these newly incurred costs would exasperate that budget problem. We also want to highlight that under the existing timeline for the mental health receivership, they're projecting about five to seven years to implement its goals and plans, but we want to be cautious about that.
It could extend longer. The clearest example we have is on the medical side. In the past twenty years, we've heard at various stages that it could be coming to an end, and some of these timelines can extend further because of the challenges that and this court case has already been going on for decades. So it seems plausible that the remaining issues are complex and may take longer than some of these estimates assume. And then third, we also recommend the legislature direct CDCR to take additional steps to address mental health vacancies.
This is based on our report we recently released this spring where we analyzed several options. One of the key contributors to this mental health receivership was vacancies, and that's what led to the fines. And so addressing that will be a priority for both the receivership but also for the legislature. And in there, we have some of the recommendations you've already alluded to, which increased recruitment from out of state for licensed people that are licensed in those states, removing the requirements for those providers to have California licenses if they're already licensed in their home state, increasing the use of telemental health to the thresholds that the court allows, and reducing unneeded inpatient beds capacity. There's more capacity than needed at the moment based on the projections.
Speaker 11
And then studying the feasibility of concentrating the mental health population at prisons that are easier to recruit or easier to hire. And then fourth, we wanna highlight for the legislature to monitor the impact of of the salary increases, for example, and how effective they are right now under this proposal, about 25,000,000 making those permanent. This can be done by tracking how effective the part the department was recruiting and retaining those staff before and after the salaries took effect. And also would help track what impact this has on other departments that also hire the staff. But as of now, in our report, we highlight that the legislature can has the ability to increase salaries even beyond that, but right, we asked not to do across the board.
Speaker 5
We recommend not doing across the board increases in this area given all of the changes that are happening actively from the receiver. And then finally, we recommend approving this action plan. We find that it appears to be a reasonable starting point in moving the state toward compliance. Thank you and happy to discuss also the telemental health piece either now or at a later time. You.
Speaker 1
Did you have anything? I mean, you might as well do Yeah. The telehealth piece
Speaker 5
Okay. Happy to. We recommend approving portions of this proposal as it may help fill vacant mental health positions. So, this is about 8.9 million in twenty six-twenty seven, growing to about 13,000,000 in the out years and ongoing. And this would redirect about 100 positions at the prisons to become tele providers.
And then in that we find that the equipment and the staff requested appear reasonable and could help the state improve their recruitment. But we also recommend that CDC the legislature to direct CDC to reduce the request and CDCR's baseline. Right? We find that the request is based on a previous telemental health ratio system where it's a one to one and there's one provider, for example, a psychiatrist or psychologist, and they have one person at the prison who helps. While it's not clear that each provider needs a full time medical assistant person because it's possible that a different ratio could work out in this scenario.
We know that mental health providers often have to are not serving patients directly. They'll have to do clinical notes or review, and in those times, we think a different ratio than the one to one makes sense to cover those bases. We also recommend CDCR to take steps to increase telemental health. Based on our estimate, the governor's proposal would increase it to about 30% of current staff, and the court allows up to 50%. It's so far that what the department has shared with us is that these folks are easier to staff, they're easier to keep, and they're easier to recruit.
And and we also recommend directing the department to expand it in a strategic manner. And this would entail having identifying the prisons with the greatest staffing challenges and the greatest needs. And another potential possibility is starting telehealth with those at the lowest levels of care and then slowly ramping up till it reaches those, since those might be more amenable to this modality. And then taking steps to increase telemental health. This would entail having the working with the Coleman Court to allow providers from out of state to provide services as I already discussed and greater out of state recruitment.
These folks are already licensed in their respective states and that's a recruiting effort that the state can expand in. And finally, we recommend the legislature monitor the effects of the expansion of telemental health. It's plausible that those people that remain on-site have the most challenging patients and those with the greatest needs. So, may be some need to have some different types of pay for the folks that remain at the prisons compared to the ones that work. Thank you and happy to provide any more context on either of those or any other questions.
Thank you.
Speaker 25
Hi. Ryan Weiburg, Department of Finance. We have two comments in response to the LAO recommendations. First, we'd like to note that it would establish a new precedent and require significant trailer bill language to authorize out of state providers to work from out of state and utilize licensing requirements from other states while working in the California state prison system. It may create legal liability for CDCR or oppose other operational issues with different standards of licensure.
Speaker 6
We'd also like to note that with regards to the ratio of, in this case, medical assistance to providers, but really any staffing ratio related to mental health, any changes to those ratios would need to be subject to approval of the mental health receiver. So that's not something that the CDC could implement on its own. With that, happy to take any questions.
Speaker 1
Thank you. Before we get to member questions, Mr. Reeder, Ms. Challenger, or Ms. Martiello?
Speaker 1
Martiello. Martiello. Thank you for correcting me. Do you have any comments based upon the LAO or Department of Finance's report?
Speaker 13
I don't have any additional comments at this time beyond what was already expressed. No. Go
Speaker 13
any additional. Oh, I don't have anything additional to add beyond what was already expressed at this time.
Speaker 13
If possible, would like to get back to you with that, understanding that there are complexities legally beyond just concurrence to allow for out of state licensures.
Speaker 1
Okay. All right. If you could forward to the committee, and actually I'm going to suggest we probably need a follow-up meeting on this particular section to delve down a little more. Did either of you have any comments That you wanted to provide. Mr reader.
Speaker 8
No I didn't have anything additional except you know. We did see that recommendation by the LAO and we are we are discussing internally About the MA issue But once again as do have mentioned that will have to work with the receivers office to do any adjustments to that that ratio.
Speaker 8
Thank you madam chair So the state accumulated a 160,000,000 plus in fines. For failing to keep vacancy rates below 10%, and that was only in a year and a half period, April 23 to October. And, I see in a letter from the California Association of Marriage and Family Therapists, they say that there are thousands of qualified licensed marriage and family therapists in California ready to work for CDCR to provide the
Speaker 8
We post our positions and have a civil service process. License marriage family therapists can fill. You know multiple roles within our system and so we're happy to maybe have some conversations are to reach out for further information. On where these resources are. But we're definitely interested To get more for folks on board and if they you know if they have a pool of resources are an avenue we're we're happy to explore that.
Speaker 7
Yeah I mean it just it just makes me wonder. How. What what's the effort? I'm not saying people aren't trying, but what's the strategy to fill these vacancies? I mean, a $160,000,000 in fines.
It it it says, I guess it's primarily or mostly for failing to keep these rate vacancy rates below 10%. Am I understanding this right?
Speaker 8
Yes. Correct. We we had a 90% fill rate, And we were not achieving that in multiple classifications and so we were being fine for the amount of vacancies we had. And they they find this double the monthly salary. So it did.
Reach up to the 160,000,000 but then we appealed. And they reduced that to just the monthly salary which brought the fine amount down to I believe around a 120,000,000.
Speaker 7
To fill positions for jobs that at least one source says they're available. So I'm not getting what there's something wrong with the picture as to something where especially now, filling these positions with people who need good paying jobs, which they are good paying jobs.
Speaker 8
What Yeah. Certainly can follow-up with this group. But we're we're doing outreach we're like I mentioned we're advertising on all the major platforms social media. We're doing hiring events throughout the state at our hard to recruit locations. So you know I we constantly are are looking for all.
You know folks to fill these vacancies so happy to have some additional conversations if there's a pool resources that were missing.
Speaker 5
And be happy to add a little bit more context the marriage and family therapist as well as clinical counselors are relatively new position to the state that were added last year and were approved through the Cullman court. When we were preparing the report we published in the spring at the time, it was about a dozen that were employed statewide. So this is like a position that's just starting to ramp up and it's relatively new access to the prison system, which prior to this was was not allowed prior to last year. And the the other yeah. I just wanted to add that piece of context.
Speaker 7
Okay. The receivers action plan, as you said, was five to seven, projected to take five to seven years. So what are the benchmarks that will be used to measure progress towards exiting the receivership so we don't end up the way that we have?
Speaker 13
Yes. Absolutely. Thank you. Can everyone hear me all right? Yes.
Yes? Okay. Thank you. So in the receivers action plan, it lays out six specific goals, which also have objectives and benchmarks, timelines that the receiver along with the court and the party's councils are working towards. And so using those goals and specific objectives to address the 12 deficiencies that the 1995 court found, that is how we determine that it will be a five to seven year outlook for the receivership.
Speaker 7
So so we have we have we can get what the action plan is and what the benchmarks are gonna be?
Speaker 7
Okay. Great. Thank you. And then CDCR is operating hundreds more inpatient mental health beds than needed, and that's at a cost of $400,000 per bed annually. Has the receiver been engaged in on a plan to align capacity with the actual need, and how much will that save us?
Speaker 13
Yes. The receiver's office is actively working on that. We just brought on this week, actually, a mental health expert. And as far as cost savings, that'll be something that I think is yet to be determined, but happy to provide that to you once we have a clear picture of what that looks like.
Speaker 8
We did take down so we had 256 psychiatric inpatient beds Salinas Valley. And we did take down half of those beds In response To having vacant beds and I can share the savings with you or what that generated I don't have it with me I apologize So we started there they're also looking at CHF and CMF units And the system wide need so we can adjust beds down to closer to what what. You know what our need is yeah so that evaluations happening by the receiver's office- and as they complete that evaluation we will come back with proposals to a to adjust that funding appropriately.
Speaker 10
thank you So kind of want to go back to the recruitment issue you're having Have you guys done any Studies to figure out. Why people aren't applying for positions or don't want the job because usually if you ever recruitment problems because people either don't want to work there it doesn't pay enough. Or for whatever other reasons. Yeah we do a reasons
Speaker 8
we do exit surveys are are human resources department does exit surveys and so maybe I could share some of that information on
Speaker 8
on what we're hearing but I. You know environment pay. You probably hit the top two.
Speaker 10
Is I realize sometimes state pay doesn't equal especially when you're looking at these these. Not state. Pays they don't really the salary is not as much And it's probably not as fun to work working at in in a prisoner incarceration environment But I you know I'm I'm kind of. You know with the- issue about. There being a lot of marriage and family counselors out there.
Is that what we need. Because it seems to me the mental health issues- when you go into a. Not that I've been there I know one though- a- an office that has several mental health visit and you know professionals. They all do different things. One is an expert in the marriage and family counseling another might be an expert in psychotherapy and others might.
What do they need in the prison. Because you can't you can't just bring anybody in there and say start. Doing your counseling magic just so you can get to the numbers so they'll stop finding you. Because that just that to me it's not fixing the problem it's just. Making numbers.
Speaker 8
It was allowed by the courts. So I assume they meet the mission, but I don't know, Tony or Alyssa, if you guys have any additional information as I'm not a mental health clinician.
Speaker 13
I I don't have additional information on those positions specifically. I can add, though, that part of the funding that's being requested on that consultant piece, the 350,000, directly addresses some of the the questions that you raised, such as staffing challenge assessment, to bring on a consultant expert to look at the staffing challenges. For instance, why you know, how can we achieve and retain well qualified mental health workforce, as well as clinician fear, which is another concern that was raised regarding working environments and compensation. Those are also two objectives that directly come from the receiver's action plan.
Speaker 10
It just seems absurd to me to to be finding, our agencies for not being able to recruit people and hiring enough people or keeping enough people A. N. You know it and I'm glad to hear that the money actually kind of goes back into the problem. That's good but we can do that We just need to know what we need to know. For the recruitment part and if we have to up salaries or whatever it is for these particular type of positions then that's the stuff we need to know Because that's part of the budget process and then there we can cut out the part where it goes into that pot.
And then it goes into this pot and it goes into the. It that's kind of absurd. So it looks like you're just way anxious to answer a question.
Speaker 5
If I may senator we did a report and kind of discussed with people on the field as we putting this report together. And, yeah, some of the issues you highlighted, we heard as well. One that I'll highlight that we that wasn't brought up in this discussion yet is that there's limited pool of providers already where prisons are located. They tend to be in more either rural or remote areas, and those are areas that already have shortages as defined by other agencies that have done surveys that some of those areas already struggle with hiring enough. So, prison system would be competing with those as well and make this problem a lot difficult.
And this report, we also have other recommendations outside of that could address some of these challenges, like telemental health could be option if there aren't enough providers there. You can recruit from all over the state or other states even, as we recommend, our options to hire these psychiatrists that are highly trained, and psychologists and marriage and family therapists as well.
Speaker 10
So the the part of the problem isn't that the prison system itself doesn't want to hire people so they can get fined?
Speaker 5
to do that. This is how it's reached these chronic levels of Okay. They can see.
Speaker 8
One one thing that senator- the fines are no longer active so we're no longer being fine for vacancies just for you
Speaker 1
going to go through a few questions, and then I'll make a comment. I believe in the prior session, we asked the question, has the CDCR explored the state registry to fill mental health vacancies. I think the answer was we don't have a formal registry but we're going to look into something like that is that correct.
Speaker 1
okay the next question is can the tunnel tell a mental health. Program be expanded further? It was stated that we're allowed to do 50%, but we're doing 30. Has the receiver explored this idea thus far?
Speaker 14
And I can speak to that a little bit as well. I apologize for not introducing myself earlier. I'm Toni Martell, the Assistant Deputy Director of Telemental Health for CDCR. So we do have a fantastic group of clinicians in the Telemental Health Department, we have enjoyed success in hiring civil servants within the state. We are still evaluating what the final size of the program will be because it really depends on the needs at the institutions.
While our clinicians can do a lot of things and do it well, there are some tasks that just, either by nature of the task or by policy, have to be done on-site. And so, we have to look at how many staff are needed on-site at any given institution. It varies by institution, depending on the size, the complexity. And so and our policy is very clear also that there are particular tasks that need to be done on-site. So, we are evaluating what the final size will be and if we can continue to expand, but we have added over at least 200 clinicians to the CDCR pool within the past two years.
Speaker 14
It's still an ongoing discussion with the receiver and with the institutions. We do look at it honestly on a continual basis. The staffing adjustment is done every twice a year. So the next one will be in July. That will be the next point where we look at how many additional positions to allocate to Telemental Health.
Speaker 1
Okay. So if you could provide to the committee the last two previous reports, your assessments that you did, and then maybe the one in July. Could you also explain why a one to one ratio of telepresenters to providers is needed? That was one of the questions, I believe, asked by Elio.
Speaker 24
Sure, I can speak to that. So, at the moment, we're hiring with our current model, which is also consistent with the court approved methodology for calculating fill rates for MAs. And that is consistent with the previous budget request we have done for telemental health, but we are open to exploring other models. Right now, we essentially need the number of telepresenters required to support the number of clinicians seeing patients statewide at any given point. So, while there may be downtime where they are doing other administrative tasks or something, there are generally clinic times at the institutions where patients are being seen, and so we need enough telepresenters to be able to support them during those times, during those peak times.
Speaker 1
I get that, but I don't think that that's a consistent model in this non space. I actually know an individual who provides tele, you know, counseling, and they don't have one client.
Speaker 14
Yes, I completely understand it's not exactly the same as in the community. We are looking at it. I will say that in terms of being able to share a medical assistant, for instance, between multiple providers, it really comes down to space as well, which you would need the providers to be co located at the institutions, and the places where they're seeing patients vary widely depending
Speaker 1
on the institution. But we're talking about telehealth, so they're not physically there, right?
Speaker 14
No, but they still need a place to confidentially see the patient at the institution. So they're still using an office to see a patient on the institution side. And that is really the limiting factor of being able to share the telepresenter, because if you have like one person on one yard and another person on a different yard, there's no real way to share those telepresenters. But if they're co located, potentially. And so, we are evaluating that.
Speaker 1
Okay. We're going to need an additional meeting to delve into this a little bit better. Of the thirty five thousand plus inmates who may have a mental health issue, Has there been an assessment of what the level is? If a person, know, has anyone clinically evaluated all these individuals and confirmed that everyone's like a type one mental health issue.
Speaker 8
Yeah, I believe there's been some mental health evaluations. Alyssa, I don't know if the receiver's office is beginning some of those level of care assessments.
Speaker 5
Okay. I can provide in looking at this through our report, Orlando Sanchez with the LAI. CDCR kind of separates people that have a diagnosed mental health need into kind of two parts. There's an outpatient. This is a person that can live in a housing unit typically, receive medication, and function with their daily activities of a prison yard.
And then there's the inpatient setting, and that's where folks may require twenty four hour supervision for various reasons and more intensive supervision for their for their mental health need. And the majority, over ninety percent, I believe I don't have the exact breakout, but it's are in the outpatient setting and a smaller portion are in the inpatient setting at the prison that hopefully provide some context.
Speaker 1
Okay so Mr reader help me understand. If the receivership is doing all this and has all these positions, who are the people that you have? And again, comes back to my previous question of duplication. Didn't you have people in CDC are who were supposed to be doing some of the stuff.
Speaker 8
Yes yes We have program folks And I know that they've done these evaluations I don't know. When the last time they did a level of care reviews I can I can share that information once I connect with them?
Speaker 1
Well I'm not just. About the evaluations I'm talking about the work that. She said 200 people are doing and- all of this you know to deputy receivers a senior adviser attorneys paralegals.
Speaker 8
They're they're really taking over for the office of special master the offers of special master was around for. Twenty plus years I believe and had. Multiple staff Associated with it and so we've always kind of had this like. Court oversight group that we've worked with you know we have our state program folks that are kind of doing the day to day work and you know kind of the state work. And then you have these oversight groups that are.
Overseen us there an oversight basically to ensure that we're- elevating our mental health care to their standards are to the court standards.
Speaker 1
Okay and does the office of the special master still exist now that we have the receiver office.
Speaker 8
Office of special masters no longer. So the court ordered- the end of the special master and the implementation of a receiver.
Speaker 8
Through the office of special master. I think I know the number but can I get back to you just so I'm not? Giving some sentiments misinformation
Speaker 1
I would say between yourself and the department of finance if you guys could provide us what was their budget. And how has budget now that they no longer exist has that folded into this request or how does that work.
Speaker 6
Ryan we both the public finance the legislature previously approved about $3,000,000 general how
Speaker 6
That was specific for staffing for the Office of Special Master. I'd like to note that the receiver's proposal includes additional costs associated with benefits for bonuses being made permanent for the actual clinicians doing work. But that funding was added to CDC's budget. It was viewed as part of the legal cost at the time. So it's currently still part of CDC's budget.
Since the Office of Special Master is going away, will be addressed as part of a proposal as part of the May revision to reallocate that funding.
Speaker 1
Okay. Help me understand. We had this case. The judge made a ruling of what we need to do going forward. The receivers put together a proposal, which the court approved.
Did the department of finance or attorney general or anyone. Say you know we know we need to do these things but- is all of this in order? I understand from our consultant that some report might be available to answer that question for me. And so I'll certainly review that and be requesting a subsequent meeting. And any members of the committee who want to participate in that meeting will make sure that you're aware and you'll have the ability to participate.
Have we thought about any pushback at all? I'm just looking at this and I don't know of anybody who has a deputy receiver, you know, is making $700,544 Hello has has the attorney general has anyone looked at this to say.
Speaker 8
So we work with the attorney general in this case Obviously with the plaintiffs in the case I know that there was some hearings on some of these things so let me reach out to legal and let you know if there was any sort of pushback or
Speaker 1
yeah who was involved What was asked do we have any further, know, avail, you know, to look at this? Because, I mean, certainly we have to comply, and I don't have a problem with complying. Apparently, there are 12 points that we needed to address. I guess the largest one has to do with vacancies. And in the previous panel, we also talked about vacancies.
So it just seems to me if vacancies is a large part of it, why can't we focus on figuring out how to do that and to think that we're going to pay this amount at these levels for the next five to seven years? It just seems, I don't know why it would take us five to seven years to figure out how to address our vacancies. So we'll set up a subsequent meeting. You're getting the sense of where our questions are. If you could assist us in better understanding how we got here and how we need to get out of this.
Because for the truth of, I said the same comment when the commissioner came. You know, we have a responsibility of the state of California if we're paying for, you know, regarding prisons and we're not being able to offer people health care. This is really out of sync. If we're doing this and we're not putting enough money in education, I mean it just seems five to seven years to be figuring out that we need to hire more people. At least for the time that I'm in this position, I don't know from an oversight perspective.
And I'm open to meeting with the governor's office, the Department of Finance, whoever. But it just seems we've got to figure out how to tighten this a bit, would be my general comment.
Speaker 1
I'm glad you understand. Okay. Yeah. Any further questions? Okay.
All right. Thank you for your participation today. And by the way, when we have the meeting, I hope that the person, the receiver who's looking to make $812,781 will be present in addition to deputies if we've already hired them. The least they could do is be present. Okay.
Seeing that, that we finish issue three, I'm told that the subsequent issues are going to go much faster. So thank you everyone for your patience here. Issue number four, is the presentation of the alternatives to incarceration for the aging population report. We will be joined by the following panelists for this issue. Doctor.
Canin, deputy director of medical services, And then we have the same individuals who've been hanging out. Do you guys need a bio or a drink break? Are you okay? All right. Thank And Mr.
Reeder is still here with me. Thank you.
Speaker 9
Yeah. So I'm back. Renee Canin, Deputy Director of Medical Services, CSCR. So the request was to provide a high level overview for the SB one zero eight report that we submitted last month to the legislature. So I'm here to answer questions as well, but if you're okay with it, I would like to sort of provide some overview and really make about three points before we open it up to questions.
Speaker 1
I think that'd be helpful, especially since I'm the newbie of the group. Could stand for, did you see the movie Educating Rita by any chance?
Speaker 9
So again, there's three points and there's several sub points under the first one. But I think it's important to sort of tee up the population, understanding the population, and really some of the current challenges that we have with the alternatives to incarceration that are already available to us. Because that really helps us figure out what some of the solutions might be to the leveraging the current alternatives as well as some new alternatives that we might need to consider. Okay. And so you've heard some information already about our population in general and then this focused population.
But essentially when I started in the department back in the day, we had almost 180,000 incarcerated individuals. And now it's about half of that, right? And yet despite that, the number of older, sicker, more costly individuals, right, really make up a much larger proportion of our population. And we had some statistics in the report and you heard some of them already that because of really sentencing, our sentencing system in the state, as well as really significant limitations to our post release options for housing, healthcare, and other services. We've really sort of disproportionately collected these older, sicker, more costly individuals.
And just between 2010 and now, as you've heard, the individuals that are 55 years and older have tripled and they now make up more than twenty percent of our inmate population. Now the focus population, you've already read the report, you know that it's little bit more than 9,000 individuals. And so that's about 10% of our population, but they make up really over 20% of the costs
Speaker 9
healthcare. And then a couple of other statistics, it's really important to think about what are the alternatives available now and perhaps in the future. For this 9,000 individuals, twenty eight percent of them have determinate terms, so they are going to be released. But sixty percent of them actually have indeterminate sentences, which means that they're potentially individuals who could be released, but they have to go before the board of paroles. And that includes elderly parole.
And then only twelve percent are actually life without parole or condemned. So it's only twelve percent. And then another thing, obviously these individuals because of sentencing have committed some very serious crimes. But since their incarceration, the vast majority, over 90%, have not had any serious infractions. In fact, most of them have not had any infractions.
And it's also important to know that the focus population is 9,000. Right now, the majority of them are not eligible for compassionate release or elderly parole. And there's a variety of reasons for that. But I think I want you to understand why we're not even able to leverage our current alternatives. So the second point, we're going to talk about some challenges just trying to take advantage of compassionate release in elderly parole.
And I don't know if you read the report, at least the patient stories, but I think the three stories that we provide are illustrative of the pretty common situations that we encounter. So the first patient story, it's an elderly person, very severe advanced dementia. They don't know their name. They're bedridden and they need absolute complete support for all of their activities of daily living. So they need help toileting, eating, showering, transferring, really pretty much everything.
Somebody that would be in a nursing home with complete care. And although the patient is eligible for compassionate release because they are permanently medically incapacitated. The court denied the compassionate release because there was no place that we could find to put this individual post release. We needed a nursing home and really because of some parole requirements, you know, that require GPS monitoring. There's often restrictions on where these folks can reside post release related to, you know, the sex offense registry requirements.
So even though they qualified, we could not take advantage of that. The other story is again another elderly patient, multiple chronic conditions, lots of complications, they're on dialysis. And they actually have a family that's willing to care for them. Okay?
Speaker 9
that's not the typical case. But this person does not qualify for compassionate release or elderly parole. So they don't qualify for compassionate release because they don't have an end of life trajectory. They're not going to die in the next year or so. And they're also not permanently medically incapacitated.
Lots of chronic conditions on dialysis, but they are able to do their activities of daily life. And they're not, you know, they're over 50, but they haven't served necessarily twenty years or more, so that in terms of elderly parole. So that's another situation. The first one is eligible for compassionate release, Court denied because there is no place to put them. Okay, post release.
This case, quali they don't qualify for compassionate release or elderly parole. The last case is an individual, cognitive impairment, diabetes, they've got Parkinson's disease, they're on dialysis as well, they fall a lot, they've had multiple fractures, multiple costly hospitalizations, and the patient is eligible for elderly parole, right? Over 50, served more than fifty or twenty years, but again no post release placement options. Again because often because of the restrictions in the resident, know, where they can reside. So many 2,000 feet, you know, from schools and parks.
There's often other restrictions as well. Nursing homes don't like people with GPS monitors, even if they're bedridden. It's just, you know, kind of puts a damper sometimes on, you know, other clients wanting to come and family members of other, other, patients. So, you know, we talked a little bit about the population and some of the challenges just leveraging compassionate release and elderly parole. And so, know, really in the end, how do we take advantage of what we can already do and potentially open up other alternatives, right, like repurposing reentry programs, pre and post release for example, and perhaps increasing the capacity out in the community to take care of these very complex patients.
Well, it kind of boils down to funding and other incentives for community providers to take these individuals. And really, some of them need some additional resources to be able to care for them once they're accepted. And then really the other the other thing that needs to happen potentially or at least we need to consider beside resources and other incentives is exploring, you know, the the issues now that currently restrict individuals from from where they can reside after release, as well as requirements for GPS monitoring, especially for those who need skilled nursing care. So we are committed to taking care of these patients and helping them transition. We do welcome the opportunity to collaborate with you and with all of our stakeholders to figure out how we can address this really complex costly challenge while maintaining public and patient safety and really being good stewards of public resources.
And then the last thing I would say is if you have not come out to see any of our institutions, I'm happy to tour you. If you want to see CHF or CMF, I think it would be worthwhile to see our memory care units, our assisted living, palliative care, our hospice, and some of the other areas in the institutions. So thank you, and I'm happy to take questions.
Speaker 1
Thank you. I really appreciate your presentation of telling us what the problem is, how we could potentially fix it, your openness. It really means a lot. Thank you. Thank you so much.
Did you have anything you wanted to add Mister reader.
Speaker 5
Orlando Sanchez the LA we don't have direct comments on this we just wanted to flag that the cuts represented there are health care costs there's other costs in the prison system that are not captured by these numbers just. Yeah just wanted to flag that.
Speaker 1
Would you like to provide us with those other costs are not necessarily today but you can provide them to the committee. Okay thank you. Department of finance
Speaker 7
Under medical parole, the state bears the full cost because the individual is still considered incarcerated and ineligible for Medi Cal reimbursement. Has CDCR have you all evaluated revising that medical parole statute to allow federal cost sharing and what statutory changes would be needed? Either one.
Speaker 8
Health care services manages our federal reimbursement, and so we've spoken to the to them. But it's very difficult to get the feds to change statute that's going to cost them more money essentially so we have had conversations with health care services But we've been getting these we had no success is
Speaker 8
It's a it's it's federal medicals federal reimbursement. Some of the federal government
Speaker 8
Yes there is the medical but- essentially that we'd be seeking federal reimbursement for these folks in the community similar to what we do when in the hospital for twenty four hours. So we collect if they're in the hospital for over twenty four hours we can get federal reimbursement for some of those services and some of the stay. So we collect over $40,000,000 and federal reimbursement each year for over twenty four hour stays. But it does not apply to this population.
Speaker 7
Thank you. The legislature could explore incentives for long term care facilities to accept justice involved patients, which again goes back to Medi Cal funding. Do you are the barriers that you think would what would a meaningful incentive structure look like?
Speaker 8
I'm not sure I have an answer for that today. I think that's something we'd have to, you know, maybe speak to some outside providers or to speak to some of these facilities that could provide some of these services and what type of incentives they would need in order to take on some of these patients? I mean
Speaker 9
there are some models in other states and there you know there may be sort of a sweet spot in terms of a dollar amount and we could go back to the stakeholders. Did meet with a number of the stakeholders. But in other states, there is sort of this additional amount that has incentivized some long term care facilities to accept justice involved individuals.
Speaker 7
I mean if we could get ideas from Norway, we can get ideas from another state.
Speaker 9
Well, and California has their good ideas as well. Right? That's what we wanna see. People follow us, right? Other states.
Speaker 7
Yeah. Then just finally, given that 60% of the focus population is serving indeterminate sentences, what changes to elderly parole or border parole hearings policies have you considered to better account for this declining public safety risk and and at the same time elevated health care costs?
Speaker 9
Well, again, what we're currently doing, I can tell you on our health care side, and it's it's been successful, is we are working very closely with the board of parole and the commissioners. We actually provide additional, we call them medical letters, provide additional information to help them make decisions about the suitability for parole. That has given them I think the information that they need particularly around our patients who are demented. Very different from when they were obviously incarcerated, you know, decades before. And so that has increased the grant rates if you will, for subset of our elderly who qualify for parole.
But again, the issue is even if they are eligible sort of from the perspective of no longer posing a risk to to society, we are still challenged often finding post release placement for them. And so if we could figure that out, we'd have more people hopefully going through the board of parole process. So there may be some resources there And we would obviously be supporting them more to get more people through that because we do have a certain number that are eligible for elderly parole. And then I guess we, know, what was it 2011 or so, maybe it was 2014 with the original sort of elderly parole, the age was set higher, right, with longer sentences that got reduced. I think we need to analyze that in terms of, you know, sort of the the risks and the benefits, by changing any kind of sentencing requirements or age.
Speaker 10
Thank you. Why is it so much cheaper to have Persons that are in a situation you say dementia and and essentially needed either assisted living care. Or convalescent type care. If whether they're in the incarcerated environment versus the outside environment. Because I know the outside environment is pretty darn expensive.
Speaker 9
Absolutely. Yeah. I don't think this is about care for older sick individuals, right? Whether they're incarcerated or not, it's just going up. It's costly, right?
But you know, there just are additional restrictions and requirements in the prison setting. You don't have custody officers. Right. For example, we have to run particular types of healthcare services that on the outside they may not necessarily be required sometimes because of litigation. So it's costly, it's just having having the the labor cost related to custody and some of the additional staffing requirements we have for for health care.
And then, you know, contracting with outside providers. You know we do the best negotiation that we can but you know I think it's favorable but it may be more favorable even it you know on the outside.
Speaker 10
It just because it was kind of going back to what my colleague was talking about earlier having facilities that actually- just like any community- where you have- have people that go from here to here to you know end of life- type of- situations. And and why we can't do that within the incarcerated sick incarceration system because- when you're talking about custody officers and all of the things that we require. If somebody is has dementia and they need that lockdown care like the like all dementia patients have. What's the custody officer's job he can't he's not gonna go chase them in case they try to escape.
Speaker 9
I think I think that's a very good point and there's been legislation in the past I mean a number of years ago that you know, allowed us to reduce the number of custody officers if somebody was in the hospital moribund, right, or even brain dead. So, you know, I agree with you, but I think currently in our situation when you're in prison, you know, there are requirements in terms of the number of custody officers, know, that are required, right, for particular incarcerated individuals. Now I will say medical parole, enhanced medical parole or expanded medical parole, again it's the misnomer. It's not parole. But that is a situation where it costs healthcare still to have them, have patients in the outside facilities.
But you did not need custody officers guarding them in these long term or skilled nursing facilities.
Speaker 10
Right. And if you you don't need a custody officer for a skilled nursing facility. That's what I'm getting at. Is and if those are the avenues that we need to look at because really The the consternation that the concern for the public. Is when you're putting an SVP out.
They they all know it's an SVP. They're going in their community. And no matter how old they are, somebody that's a 55 year old SVP, a lot of people don't relate to 55 being elderly and compassionate, needing compassionate, the elderly release program, because they're perfectly capable of doing the same kind of damage they did before. And the other part is the justice for the victims part of it. If you're always looking over your shoulder, I, it's like it seems to me our system should be able to absorb the different stages of life for people.
And as they get older and less, they have less abilities to be hazard to other people.
Speaker 10
Risk, yeah, thank you. Well, that also means that there's less risk of them doing the things inside the prison walls that that we need all of the, you know, the the the guards and the the custody officers and and all of the infrastructure needed for, say, you know, a level four. We should be looking at that avenue as well.
Speaker 10
think there is no a good answer for where do you put them. At a lot of times so where we put them is in a place that is still secured within the system so we don't have to spend as much money on the outside. Because I can't imagine- a assisted living place not charging $8,000 a month for a a person that's
Speaker 9
And we do have that continuum of care, right? Particularly at at some of the institutions we were talking about Okay. Where people sort of age in place and and we do have that continuum. I think what my role at least today and in the report is just to give you enough information to inform your decisions.
Speaker 1
Thank you very much. And I'm also interested in attending as well. So we'll make sure to plan something and probably extend it to other members just in case they have an interest. A couple of questions. We did speak earlier when you very bravely and competently came forward the discussion of clustering.
So we will certainly follow-up with you on that previous item that we discussed. The second question is, can you provide more detail on Figure one of the report and why specifically the cost jumped so significantly from 60 year olds to 70 year olds to 80 year olds?
Speaker 9
So I'm not an accounting expert, but so maybe mister Reeder can help me. But for those who who who have seen figure one, Essentially there's, let's see, five different types of or categories of healthcare related costs. So this isn't even the other costs, but healthcare related costs. And so I think if you start from left to right, it's probably not shocking, you know, that very light blue, the custody, guarding, and transport. That is gonna go up, right, as you get older because they're transporting you to the emergency department, hospitals, and specialty services and consultation.
As you get older, it absolutely correlates with more costs there. And then patient specific claims like specialty services, ED services, ambulance, hospital, and pharmaceuticals. Of course, that is also going to go up as you age. So then moving to the healthcare beds, that also is going to go up because these individuals as they age disproportionately use our healthcare beds and that's the labor costs, right, of running those assisted living, the memory care units, the hospice, what we call CTCs, correctional treatment centers which are licensed under title 22. So that also makes sense I think.
And then other healthcare labor costs, it doesn't go up quite so much. And then then there's really this healthcare overhead. And, you know, essentially that is non direct patient care labor cost by and large at the institution, region, and headquarters. So admin, executive staff, really non direct patient care. And essentially, as your kind of direct costs go up, and so this this group of people contribute a fairly large percentage of the direct costs.
And so that's applied to the overall overhead costs. And so it just sort of adds up that way.
Speaker 1
So if you could provide us in detail of what you just said and then probably a little furthermore. Yeah. The reason why I'm asking the question, if a person has terminal lung cancer, and they're 49 years old, or whether they're 80, the same essential support is required. Now of course, someone 80 may be a little more agile, a little more prone to fall, etcetera. But terminal cancer is, stage four terminal cancer is what it is, unfortunately.
So if you could provide us a little more detail on that. And the reason why it's important, is it helps us really to answer the question, is it in fact cheaper to provide the care within a current prison environment, or is it cheaper to have an acute center where those same services are provided? So if you could provide us more of that detail. And I'm just curious, at some point, there's that old saying, nothing is new under the sun. Was there ever a point that you all have done a report or the LAO has done a report to compare the cost for medical and or mental health, because we're really teetering on both of those subjects.
Has there been a report done about comparing the cost for current in house locations versus if we were to ever do this from an outside provider perspective? And I'm not suggesting bringing these into neighborhoods and things like that. Is there a report that exists already that kind of evaluated this?
Speaker 8
I will look I'd I know when we looked at expanding medical parole we did some comparisons to the community and in the contracting but let it that was a few years ago so let us see what we have if not Maybe an assignment for the LAO to. Compare In house to community
Speaker 1
As the chair of the budget committee I'm trying to avoid asking for a new report that they're gonna give me this charge for that then we have to deal with in appropes and so on. I was just figuring, I'm sure there had to have been some analysis at some point in the last five years, I would think, I would hope, where we have thought about this. And maybe if it's not us, could be another state or something that has kind of looked at this issue. Because with the aging population, clearly everyone, we're kind of facing these same problems. So between the two of you, if you could let us know any information that you might have already either done or reviewed that we could consider, it would be very helpful.
Speaker 5
Okay. Yeah, I can circle back with our health team, see if they've done or have any access to any costs related out in the community, and maybe some of those could be compared to these figures here in this AB108 or SB108 report.
Speaker 1
Okay. And then I seem to recall, and I was going to Google it right quick, but then I got pulled back to the questions here. Recently there was an individual who was released. I think he was maybe in his 60s. He had completed twenty years, so he was getting, I think, an elderly release or something, but people were questioning the age, because it seemed to me he really wasn't that old.
And I'm probably dating myself that I'm older than the double nickel, which means I'm older than 55. But I mean, still at 65, you can cause some damage. So maybe, are you familiar with what talking about? There was a recent case, I think it was in the area. He was in his 60s, got an early release, and had committed some pretty serious crimes.
Are you familiar with what case I'm talking about?
Speaker 8
don't I don't have that type of specifics I'm just aware of the case board of paroles it manages the elderly release program. So they probably best suited to answer some of this but I'm happy to take some questions back and get you some responses
Speaker 1
Okay if you could and then to tie to that question would be. Are there legislative recommendations maybe that we need to consider For example changing the age maybe twenty years of serving your sentence, but only if you're over the age of 70 or 75 or something. Any potential recommendations or things that you think we should consider? Because I'm not so sure that those age limits that tie to elderly parole or medical release maybe are appropriate. And certainly, the public should be concerned.
And again, like I said, the age of this individual, it really seemed to me that that person could still potentially engage in illegal activity.
Speaker 9
From my perspective, I think the examples that the report really illustrated were more people who just with the current laws and regulations that we have, qualify for compassionate release. They're absolutely appropriate because they are gonna die months to a year. And they are frail and don't pose a risk. Or they're permanently medically incapacitated. Or the board has determined that they are suitable and do not pose a significant public safety risk.
But again, challenge that I highlighted over and over is, even if these are appropriate without changing the age or how long they've served their term, and just within the rules that we have, we cannot find places for them because of residential restrictions, GPS monitoring, and we don't have the incentives for these community providers to take these justice involved folks.
Speaker 1
Well, those three points you made very well. And I think certainly if we can figure out we need housing for the homeless and for veterans and so on, and I'm sure that we should be able to figure out working in conjunction with the administration, that this is something we need to certainly look at. And you made the point very clearly, and I appreciate in how you did it. Yes. Okay, with that being said, we're going to move to issue number five, which is the community reentry programs for supervised persons.
We're joined today. Mr. Reeder, are you sneaking out? We still have three more. Are you done?
All right. Or I think we have two more. No, three. We have five, six, and seven potentially. So we have Ms.
Bebe? How do I say it? Bebe. Bebe. Okay.
We have Ms. Bebe, Ms. McClain, and then we have our regular individuals who have been really hanging in here. Make sure you let me know if you need a five minute. We would certainly comply.
With that, we'll go ahead and get started.
Speaker 28
Good afternoon, members. Madeline McLean, Director, Division of Administrative Services. I will make this overview very brief, but CDCR is requesting funding to adjust the community provider contract rates to address inflation and rising operating costs. This is a technical adjustment. It's the third phase of our ongoing increases.
Speaker 18
Community reentry programs, which are administered by the Division of Rehabilitation Programs, are critical to reducing recidivism and supporting successful reintegration through services such as substance use disorder treatment, housing, employment assistance, and life skills training. Without this final funding phase, CDCR risks losing providers, reduced service capacity, and gaps in post release support for tens of thousands of supervised persons each year. Again, with me is Teresa Bybee, who is the Deputy Director for Program Support for Division of Rehabilitative Programs, who is here to answer questions that they may have anyone may have.
Speaker 5
Orlando Sanchez with the LAO. We find that this proposal appears reasonable for two reasons. First, without the proposed increases, there could be disruption to the state's parole core programs. And to the extent that people aren't having their needs met through these services, there could be adverse implications for the state, especially if a person returns to prison. However, we do want to note that these programs haven't been evaluated for cost effectiveness.
While there's there is information out there on how many people participate and other such metrics, there's not been an evaluation that would allow us to determine how effective they are at meeting certain goals. And without this study, it's difficult to assess which programs are most successful and how to target funds. As such, we recommend requiring CDCR to evaluate all of its parole rehabilitative programs, including the ones that are not being funded by this proposal, to determine whether they merit continued support or need to be restructured to be effective. We also recommend the legislature consider funding on a three year limited term basis instead of ongoing. This would provide enough time and for an evaluation to be conducted, and also making programs that were previously funded also limited term to maintain consistency.
And then this would position the legislature at that time to have better information on whether it wants to continue funding these programs based on the results of those studies. Thank you and happy to take questions.
Speaker 2
Josh we ourselves department of finance captain madam chair members the committee we just want to address the two recommendations by the LA on this proposal first one being their recommendation to require external valuation of all parole programs. The specific contracts with external researchers are not included in the governor's budget but we look forward to any conversations with the legislature on potential avenues for evaluating cost effectiveness with these programs as we continue to the budget process. We also want to address the recommendation to consider limited term funding for these programs We'd like to note that parole community reentry programs are operated through multi year contracts, and uncertainty around the continuation of funding for these programs may prevent CDCR from renewing contracts, continuing to provide programming, ELEO noted, the potential for disruption of services. And ongoing funding for these programs and the methodology that we've presented to this proposal, we presented the same methodology last year and the 2024 Budget Act as well. This methodology is restoring confidence in the providers for these rehabilitative programs.
And limiting funding to three years would potentially jeopardize the department's ability to secure future contracts and exercise the ability to utilize the additional years of signed contracts with these providers. Happy to answer any additional questions.
Speaker 1
Thank you. That's an interesting perspective. I think a lot of providers would be happy with the three year contract. That's an interesting perspective. Have the programs always been no limitations at all?
Speaker 1
You just made a comment that you felt that by having three years it might hinder individuals for wanting to provide this service. And I said to you that from non profits and people that I work with, a three year contract's not a bad thing. And so my question to you was, has it always been an infinite period of time? Or were there ever times where there were terms?
Speaker 9
So, baseline funding for these programs has existed. I'm not sure exactly when the programs began and when funding began for these programs, but it's been a long time since we since we right began, sized the funding for these programs. As costs of operations have increased over time, we developed a methodology to attempt to catch these programs up. And that's what this proposal is for.
Speaker 1
But didn't I just hear you say the LAO recommended that the term be three years versus ongoing? And so you said that you didn't agree with that. And so I'm saying, why do you think three years, I mean I heard what you just said, but three years isn't a short period of time.
Speaker 2
So often these programs, and my colleague from CCR can You can chime if they want to be yet. Thank
Speaker 15
you Theresa by the deputy director division rehabilitated programs. Most of our contracts are three year terms with optional one years I think where the challenge of the limited term funding comes in is that a lot of contractors may not want to bid on our programs if they don't feel as if there could be an ongoing consistency or ongoing funds for the programs that they are providing. A lot of times there's costs incurred to find facilities that meet the needs of our requirements. And in order to get maybe lower costs for those upfront costs that they're incurring for these facilities, if there's a potential that this program could go away with no other option, we may find ourselves in the same position where we do not receive any viable bids moving forward.
Speaker 1
Okay. All right. Not sure if I agree, but okay. Thank you for the answer. I appreciate it.
It helps to clarify. Thank you. Mr. Ciardo, did you have any questions or comments? No.
No? Oh, wow. Okay. I had one for Senator D'Rozo. She had to grab her flight.
Does the CDCR and DRP contract with for profit providers like GEO Group and why and for which programs?
Speaker 19
Good afternoon. Yes, at times we do. We follow the state contracting requirements which I have the department secure the most viable bid at the lowest cost or I'm request for information so proposals. And if by chance one of those are for profit entities is the lowest viable bidder or in some cases the only bidder then they would in fact receive the contract.
Speaker 1
And earlier the question this is now my question Earlier the LEO discussed the fact of evaluating how effective these programs are. It would seem odd to me that you would be having contracts going out to bid and not evaluating the success of the programs. Is that not correct? Or do you have a process? Maybe you could describe for us what your process is.
Speaker 19
Within the department, our office of research has conducted recidivism reports specifically for our STOP program, which has shown a much reduced recidivism rate for those who completed one of the modalities within. So it does show that within these post release programs that they have been successful in reducing that recidivism and therefore successful. In addition to that, our division consistently works with the community providers and looks at program successes, potential modifications to create even more efficiencies. We look at participant data and things like that on an ongoing review basis to ensure that we're always modifying the program for anything that could enhance those success rates.
Speaker 1
So Mr. Savala, could you explain what then other than what she just said you're suggesting that they would provide? Right. And I don't mean to put people on the spot, but I'm the kind of person is of if you say something and you say something, let's just get to the end of it and move on. I don't want to keep going on and on and on.
So it's not personal. It's just, I like to deal with it
Speaker 5
We're aware of the recidivism reports and what they show. So one of the deficiencies or what makes it hard to review those reports is that they don't have a comparison group that's comparable that are receiving these services. It could be for reasons that people self select into these programs that are already not going to recidivate, and these evaluations recidivism reports don't tease that out, And that makes it difficult if you're getting kind of the best performers enrolling in these programs, completing them. And it also doesn't have how many people complete the programs, which ones don't. And some of those make it challenging to know.
If a person would have completed the program, what outcomes would have been achievable on average. And we think partnering with an external researcher that can have the that has had experience in doing evaluations like that would be useful for the state as it invests more money in these programs to know which programs are more effective. Are there some that work better than others? Are they leading to the outcomes we desire? Or in some cases, a simple comparison between those who participate and those who don't aren't able to tease out kind of those nuances that we might want to invest in and look towards.
Speaker 1
Okay, that makes sense. So you heard his response. If you could provide back an answer of whether you do or you don't meet those other factors that he's saying is not available. And if you don't, tell us why, or if you do, how you do. That possible?
Speaker 19
Yeah, I think working with the administration, the LAO may be gaining a better perspective of the very specific points he's looking to gather information on, may be helpful to provide additional information on the specific points or populations that he's looking to get information on. I know for a lot of our programs it says with an identified need that are placed in these programs for success. Not necessarily the best performers. I'd have to get more information on specifics. The reduced recidivism amounts are against the general population that releases, so against the total that complete these modalities.
And within the report on our website is if you fully completed a modality, if you partially completed one for the various modalities, what the success rate was per type. And so, I can absolutely provide that information as well. But willing to have those conversations, again, with the administration of the L. O. To get more specifics on what the intended purpose of the research would be.
Speaker 1
Okay. So if you all could do that and then get back to the committee with the answers. Thank you. Okay. Seeing no further questions.
Okay. Thank you. With that, that concludes issue number five. Issue number six we have is the California Sex Offender Management Board Operational Budget Augmentation. We're joined by several people here.
The ones in front we've seen, but Doctor. Heather
Speaker 18
Good afternoon. Again, Madeline McLean, Director, Division of Administrative Services for CDCR. We are requesting 450,000 ongoing to maintain operations for the California Sex Offender Management Board known as KSAM and the state authorized Risk Assessment Tools for Offenders Review Committee known as Serratso. Both KSAM and Serrato provide certification training and compliance audits for sex offender treatment programs. And this funding will support the maintenance on operation of the provider certification system and cover rising costs for training, travel and public meetings are required by law.
Joined with me is Doctor. Heather Boulds, Deputy Director for Division of Rural Operations, here to answer any questions that you may have.
Speaker 1
Okay. Thank you. Did you have anything you wanted to add? Or you're with finance?
Speaker 1
Okay, perfect. Ma'am, did you have anything you wanted to add even without us asking questions? Because this is our last issue, so.
Speaker 5
Thank you, Madam Chair. Orlando Sanchez again with the LAO. We recommend approving on a one time basis to maintain services. In addition, in order to reduce the general fund cost of these agencies, we recommend directing them to provide a new funding plan by next year, describing how they could restructure their operations and registration fees in order to avoid the need for the ongoing requested amount, require less than their current general fund baseline, and require or require no general fund support. This would provide the information the legislature needs to reassess the level of general fund support these agencies need when the temporary funding would expire under our recommendation.
It's our understanding that the fees haven't been revised for some time. They were established in about 2010 so it's not clear to us whether that's a viable option as of now.
Speaker 20
You. Kyle Gayman, Department of Finance. We certainly appreciate the L. Thinking about fund sources and ways to relieve pressure on the general fund and we have thought about this as well. And I'll provide just a couple more points on our thinking as to why we disagree with the one time funding approach or requirement to put forth a formal plan.
First to start the program which I'll note too the program is very very small it's only five people in this program that run it for the whole state so they run very lean and we're trying to help them find ways to support their travel costs with this. The program has already committed to discussing provider fee increases with the boards with the case some and Serratso boards who are the ones who need to approve that. And because that's already in progress and finances already requested that they report to us on how those discussions go, we're happy to provide that information to the legislature as we receive it without requiring this very small program to go through a formal plan process. We think we can get the information we need more informally. And then on the potential for fee increases to help offset general fund.
It's very unlikely they can be raised to the level to cover $450,000 a year. Right now they generate about $50,000 a year to help offset some costs. And they would have to be raised nearly tenfold from the current levels to be self supporting. I'll note too, there's no nothing in the history we looked into that case omitsurat were ever supposed to be self supporting types of programs. They provide work as required by statute, just like other areas of CDCR working on sex offender programs, and those are all general fund based programs.
Speaker 13
And to give the committee just a little sense on what fees could possibly be raised to, if we were to raise them in line with CPI, they could generate potentially another $25,000 a year, somewhere in that range, maybe upwards of $50,000 if there's justification for raising them further. So these could certainly be used to offset some costs or potentially used for items that are less structural in nature, things like research projects, education efforts that they try to do on a every other year or so but are not required to be done by statute every single year. So lastly, I'll just note that the program, when we spoke with them, again, they run very lean. They do a lot of work. And they have done what they can in recent years to control their costs.
Speaker 20
But like every agency, they're getting to the point where it's difficult for them to hold the required trainings and the amount of travel and support the boards in the way they need to per statute. And that's why we're proposing ongoing general fund for them. Thank you.
Speaker 10
Real quickly, we've had some issues recently, related to sex offenders, especially, offenders that were targeting minors. And, they've been paroled, And I think everybody's read about it. How do we get better decision making and also what do we need to do? I think it's not decision making. Think the last panel framed this very well.
They were working within the framework that we have given them. We can't have a framework that allows somebody who admits to still having fantasies about- molesting children- to be eligible for parole because he's got some kind of internal management program. That he states. So what do we do to reform the state's elderly parole process to ensure that defect the offenders. Who continue to pose a threat- Based on their own admissions Don't wind up being released because we have to or because it's within the guidelines of what the state has Put forth I'm hoping that.
This board can make some recommendations to the legislature because otherwise you're gonna get a bunch of bills With their own darn recommendations But something has to change and especially in that specific are those type of specific cases where elderly parole is not appropriate For those type of individuals. And so hopefully we can get some. Some recommendations from you guys about what needs to be tightened up on our end so that you're able to do the job appropriately or whoever's making those decisions can do the job appropriately. I didn't mean you. I mean, the decision that gets made that allows them to go free or to go out like that, that's what we need to work on.
So
Speaker 1
Thank you. Did we get an affirmative response that someone would work on that?
Speaker 15
Afternoon. Doctor. Heather Boulds, Deputy Director of the Division of Adult Parole Operations. In terms of the board, what I can do is take that back to the case on staff as a suggestion for a topic to be discussed. It is the board is a vaguely keen open to the public.
And so, we do need to make sure it's part of an agenda.
Speaker 1
Thank you. My only question would be I don't believe that the LAO suggested a 100% fee increase but a possible fee increase might be considered. So if you could come back with what might be deemed reasonable or maybe there would be some sort of tiered something we could implement. But even $25,000 is more than what we have. And is more than what could go in another area.
So we certainly, I don't think anyone is suggesting all programs are self sufficient. We realize that that's not the case. That's why we exist. But certainly if there's any help that could be reasonably done, that wouldn't impact people being able to actually take advantage of the service should be considered. If you could come back maybe with something you might want to suggest that could be included.
I did see the note about the trailer bill language and all that, which we will be doing. Had you had any thoughts about that, of what might be able to be considered?
Speaker 3
The case on staff is currently doing market research with other agencies that provide certifications. They're putting together those proposals, which will then be taken in front of the case on board for them to discuss and ultimately vote on. And then at that point, we would be able to have discussions and know what those fees would be and next steps in terms of trailer bill language. There's a recognition that those were put into place in 2010. Obviously, things have changed.
Speaker 15
I'll just say that one of the things that KSAN wants to very thoughtfully think about is even with knowing that an increase needs to occur, we want to be mindful of making sure that it's still available to all potential providers, large and small, to not limit any resources.
Speaker 1
Agreed. Of course, we always have to find that balance. When do you think you're going to have that information? Is it going to be in time for us to incorporate in our trailer language as we do operate on a calendar schedule?
Speaker 15
The next board, it's not on the agenda for the next board. And then they, I think, have a couple of months off. So I'm thinking that it's a couple of months out before the board will be able to hear this issue.
Speaker 1
Is there a reason why it can go on the current agenda? Are you still within your time frame of reporting?
Speaker 1
Thank you. Thank you. All right. Any further questions? Okay.
Seeing none, we're good? Yes. We're going to now go to public comment. Thank you all for your patience in participating with us. Before we move on to the thank you for your participation, all of you.
Before we move on to public comment, do members have any questions or comments on any non discussion items on the agenda? Seeing none, we're going to move forward to the public comment. To ensure that everyone has a chance to be heard, please limit your comments to one minute. We're going to give you thirty seconds more than sometimes what we do. So hopefully you will keep it to the one minute.
We will be timing it. So because we have everyone has flights and things to do. So I heard that. So please keep it to the one minute time frame. Go ahead, sir.
It's nice to see you again.
Speaker 29
Nice to see you again too. Thank you, madam chair. Senator Sarto, just connecting this to issue five of people getting out and participating in programs and their success on parole. We're here to advocate for the right grant, which we talk to you about every year. We see it as a way of preparing people to be able to proceed to, you know, be successful in their post release programs.
Speaker 21
So, kinda like pre reentry. Thank you again for your support all along. Appreciate it. Nice to see you too, Madam Chair. Nice to see you, Mr.
Senator Serrato. I'm also here to speak on issue number five representing TPW today and the Wright Grant. And when it comes to reentry, definitely it starts with the the programs inside. I am a beneficiary of them. I'm a former lifer.
I've been home for almost eight years now. I have not re offended. I have, you know, been a upright, upstanding citizen. And and I attribute that to all the programming that I've that I've taken that prepared me for everything. And I would also like to make the point that, I came home fifteen years early.
I saved the state at least $2,000,000 just myself. And I think that when you think about all the lifers that have came home, you invest in the right grant, you're gonna get one heck of a return on your investment. And thank you.
Speaker 17
Good afternoon, Senators. Thank you for having us. My name is Adrian Torres. I'm formerly incarcerated myself. I did twenty six years and nine days.
Speaker 10
I just got released about three months ago. And I'm here representing as a credible passenger for TBW, asking that you would vote on the right grant. Because the community based programs that go inside is what changed my life. A group like GRIP, who is also here today, was able to show me what my faults were, excuse me, what the behaviors that I was displaying, where they were coming from. And as they were able to give me that information and allowed me to grow through them, I was able to utilize the other groups that TBW represents through the right grant to be able to build a solid foundation for me to be able to show the board that I was ready.
Speaker 17
And as I did that, they were able to release me. A person that wasn't meant to be released originally for my crimes. But they saw that I had changed, they saw that I had value, and they saw that I would contribute to the community, which I had been doing. Now I work for the organizations. I work for organizations that go in there and do the same thing that they did while was in there.
And I just ask that you would continue to support and vote on the right grant. Thank you.
Speaker 19
Hi, Kasia Hunt here with Political Solutions. I'm here on behalf of the California Marriage and Family Therapists. We just wanted to say thank you for having this conversation, tying it into issues two and three. There is often sometimes confusion about marriage and family therapists and what are they qualified to do and can they only do marriage and family therapy. And we like to say that we're therapists for everyone.
Speaker 22
We have over 39,000 qualified in state California licensed therapists here, many of who have had extra qualifications, taken extra courses, and are currently working with the jailed population and parolees, and we really look forward to expanding that to the CDCR. We've started communications and are grateful for today. So, we'll continue those communications and work with the CDCR to share our resources with them. And just really grateful for your commitment to continuing professionals to fill these vacancies rather than looking to the out of state professionals. Thank you.
Good
Speaker 21
afternoon. Courtney Hansen with the California Coalition for Women Prisoners. Really appreciate today's discussion, around how to incentivize community based care. Regarding the high profile case currently being used to unfortunately further limit elder parole, people with sex offenses coming out of the elder parole program have a zero percent recidivism rate. So while these topics are obviously extremely sensitive, we need to insist that policy and budget decisions be based on data and science.
Speaker 23
And the best budget solution to the crisis of mass incarcerating elders remains bringing more people home and investing infrastructure and quality jobs outside of the prison system. People age out of crime and people who have served lengthy sentences do extremely well when they come home. And earlier, mister Ciardo, you talked about SB one thirty two. I just wanna say on the record that trans women are women, trans women exist, and they deserve dignity and safety. And if you're concerned about the grievance process inside being weaponized
Speaker 1
Yeah. To the chair. You're you're not supposed to direct any comments to members. Please don't refer to him by name.
Speaker 23
Okay, no problem. But I just want to highlight that issue of grievances being weaponized is a real issue and trans women are a primary target of that. Staff encourage this divisive behavior and staff continue themselves to perpetrate rampant sexual abuse in the women's prisons, is well documented. Thank you.
Speaker 30
Good afternoon, Dax Proctor on behalf of California's United for Responsible Budget in response to issue five. CDCR's SB 108 report makes clear the implications of the aging crisis in our prison system. Our prisons are becoming nursing homes, burning precious taxpayer resources without any public safety benefit. This current situation is guaranteed to worsen without real budgetary oversight and legislative action. CURB firmly supports truly community based solutions, not under CDCR's authority to address needs raised in the SB108 report, including a comprehensive review of each elderly and medically frail prisoner, and identifying who can be released immediately.
Speaker 24
Memory care, assisted living, advanced diseases, and dementia care should all be provided in the community, not inside prisons, we must ask ourselves, why are we continuing to lock up these extremely low risk individuals? We also support investments in accessible housing that can accommodate the aging and medically complex population, and ensuring that barriers and existing release programs such as elderly parole, compassionate release, and medical parole are urgently addressed by the legislature.
Speaker 24
Wholeheartedly agree with Senator Richardson's proposal to consolidate the prison system that came up today during issue two. Thank you.
Speaker 1
Good afternoon.
My name is Jessie Estrada, I've been almost three years and it took me a little while to get out. The first time I went to parole board, I got it ten years now. The second time I went, I was at three years now. And the third time I went, I got it right because I got myself right. I'm here to represent Pathway to Kinship which has allowed me to have critical insight and I know these programs work because I'm living proof.
Speaker 25
I've been almost three years and I'm a substance abuse counselor and I'm asking you to help help us get support for the right grant. Thank you.
Speaker 4
afternoon madam chair and subcommittee members. My name is Leonard Rubio. I am here to speak on article five. I am a former lifer. I have been home over sixteen years now.
Speaker 26
The last eight years, I have been the executive director of the Insight Prism Project, one of four founding organizations of TPW, which now has over 100 organizations that are doing work within the prison system. And the Wright Grant has been very beneficial in helping us to be able to continue offering programs inside, and so I wanna ask that you please support that. Thank you very much.
Speaker 20
Good afternoon. Norhan Abuleel with Transformative Programming Works. I'm also strongly urging the legislature's continued support of the right grant. These programs have been proven to be very effective. They have an average recidivism rate of twenty one percent compared to forty five point six for those who do not participate.
Speaker 27
And they're also very cost effective as well. So urge your support. Thank you.
Speaker 16
Good afternoon. My name is Raven McCullough with the California Coalition of Women's Prisoners. And today, I really wanted to focus, I wanna talk about the elder parole release, but one converse one, folks who are not represented here are some of the women that are, currently incarcerated, so I just wanted to read some of their testimonials. And so we have Joan Lisa Redd Cloud Featherston. She's 65.
She's at the CCWF. And she says, what is health care like in prison? Slow acting. And once you do get a doctor that gets to know your medical needs, they leave. I shouldn't have to worry about my safety here.
Speaker 12
Let me live the rest of my life in dignity and grace, please, with respect and in peace. This is what most of our elderly want for the remainder of our lives. We also have Stephanie Lazarus, who's currently incarcerated in CIW, age 65. To see many of our elderly struggle to walk into the shower room, child hall, self help groups, or to church saddens me. It made me question why the California prison system continues to house elderly women in prison when they are no longer a threat to anyone but themselves.
Speaker 16
The reason to incarcerate an individual is that they are a threat to public safety. Women 55 have the lowest recidivism rates.
Speaker 16
The people of the state of California and the state legislator need to seriously consider why we are continuing to incarcerate the elderly. And so I just want to end this with despite the constitutional right to care, a lot of our elderly parole folks, or a lot of our elderly incarcerated folks are not retaining the lack of treatment and care that they deserve.
Speaker 16
Hello, my name is Arianna Karp. I'm a teaching artist with Marin Shakespeare Company. We currently provide in person programming at six different California prisons. Last evening, I asked one of the groups that I work with why community based programs are important to them, and I'd like to share some of their responses. It gives us the tools to be better people.
Speaker 28
It empowers us to learn and grow. It allows us a space to practice pro social skills and collaborate. I value how this group has helped with my mental health. It encourages empathy and enriches our lives. Walls come down here.
People connect and change, and it gives us a place to belong. I want to thank you for supporting the Wright Grant, and I would urge you to continue your support. The programs don't just benefit the individuals inside, they lead to safer communities, much lower recidivism rates, and long term savings for taxpayers.
Speaker 14
Good afternoon. My name's Trent Murphy. I'm here representing the California Association of Alcohol and Drug Program Executives. We are the only association in the state that solely represents substance use disorder treatment providers. Most of our providers also engage in the reentry system as well.
Speaker 29
On issue five, we appreciate the administration's continued investment in post release reentry programs like STOP and recognize the critical role these services play in reducing recidivism. Stop contract rates have not kept pace with inflation over time, which has contributed to increasing strain on the workforce. So we want to thank the administration for the proposed cost of living adjustments, which are meaningful step forward to long term sustainability. In addition, we would also welcome the legislature taking a closer look at the state's contracting process, specifically to ensure that contract awards prioritize adherence to evidence based practices and high quality care and not just the lowest cost bid for any given stop region. Finally, we appreciate the legislative analyst's office recommendation to evaluate cost effectiveness, but we caution against delaying long term commitments without also ensuring programs are adequately resourced to succeed.
Thank you.
Speaker 22
Hi, my name is Brenda Bowers, I'm formally incarcerated. I recently reentered society five months ago after serving nineteen years on an eighty six year life sentence. I'm here on behalf of the Wright Grant. I'm here to say that, the program that I took and both took and facilitated is called Grip, God and Rage into Power and it changed my life, immensely. It showed me, it taught me victim impact.
Speaker 30
I was able to meet with victims and understand the effect that we had on them as they incarcerated. It showed me how to stop my violence. I embodied mindfulness and I was able to learn emotional intelligence. So I ask that you guys consider the right grant and continue in that program because it has an immense effect on the women. It just entered the women's institution, it's only been with the men for the longest.
So I ask that it continue because it immensely changed my life And I feel like because of that, I was able to get out after serving eighty six years of life. I mean, on a on a 86 of life sentence, sorry.
Speaker 31
Greetings, my name is Io Lewis, I'm community engagement manager at GRIP Training Institute. I'm speaking on issue number five, I'm here to urge that you continue to support the RITE grant. Grip Training Institute is funded about 30%, through grants like the RITE grant, and it's allowed us to expand it to two diff two new prisons, including a woman's prison, and it has allowed us to also hire our students, our our our Grip alumni and staff. In addition, it helps to create so safer communities of the more than 800 people that have gone through our program, less than 2% have recidivized. And so I just want to continue to advocate for you to support the right grant.
Thank you.
Speaker 12
Good afternoon and thank you for your service. My name is Alma Robinson. I'm the Executive Director of California Lawyers for the Arts. As we all know, access to paid meaningful employment is critical to successful reentry. Our organization has, with the support of the state legislature and a previous budget allocation request, which was $3,000,000, we provided paid internships with arts organizations for two thirty eight people.
Speaker 23
This is compared to 150 that were projected in the contract. So we exceeded the deliverables and if you just give me a moment, I just want to say that of those people, we placed two thirty eight with an 83% completion rate of the paid sixteen week internships. Out of 139 who were employed after the internships, 95 were employed in the creative economy, while 69 were hired by their internship organizations. Additionally, 84 people enrolled in college or meaningful training opportunities. And our recidivism rate, as far as we can tell from our surveys, is less than six percent.
Speaker 12
All right, taking a note from you Senator Richardson for, I think you called it rough math. If we were able to keep 100 people out of prison for one year, and we can surely prove that, we've saved the state $13,300,000 based on the 133,000 a year cost for incarceration. Thank you for your thoughtful consideration. We have a budget allocation request that's in the packet that we distributed. And I want to introduce my friend Kevin Sample who was a successful intern with our program.
Speaker 32
How are doing? Thank you for having me. My name is Kevin Sample. I'm a Design and Creative Futures alumni. I'm also in real time, Grip is in here.
There's two people I was a former for Grip facilitator in San Quentin. I served twenty seven years off one hundred and three years and three life sentence. I was resentenced because they said the sentence should have never happened. But when I paroled, I needed help. They let me out of LA County Jail with no paperwork, nothing after twenty seven years and three months and Design and Creative Futures was there to help me understand how to navigate the workforce, what employment was all about, life skills, resume, the five institutions that are set up to help us, whether it's Department of Rehabilitation, EDD, how to get Medicare, how to sign up for all the things I actually needed to be productive without committing another crime to be incarcerated.
Two of the things that I heard today was about rough math. I heard you say that and I also heard a statement about, get to it, tell me what we need to do so we can get it done. We need help. Everybody in this world needs help. Design and creative futures need help.
Speaker 7
She just gave you some basic numbers and we need help to continue. I'm just one person but there's hundreds of us out here in society right now. With their help, I also have my own nonprofit. I also work at the place that I interned at for the last two and a half years. After twenty seven years and three months, it wouldn't have been possible without the information and help I received from Design and Creative Futures.
Speaker 32
The education, training, and the skills they helped me understand the tools, again, how to use the tools they gave me. Thank you.
Speaker 17
Good afternoon, madam chair and members. Micah Docterhoff on behalf of Smart Justice California. Many of the issues that you've heard about today could be greatly improved by safely reducing the prison population with a focus in particular on medically vulnerable people and elderly people. In furtherance of that goal, we would urge the legislature to fund the right grants and also to create greater access to and remove barriers to existing release mechanisms which have proven effective when they work. I also wanted to draw your attention back to a comment that was made earlier about interest in touring some of the medical facilities.
Speaker 33
Smart Justice has a program called the Get Proximate program which is co led by my colleague Phil who you heard from earlier. We help facilitate visits to prisons around the state bringing lawmakers from Sacramento into the prisons. We actually have a visit scheduled at California Medical Facility on April 30. You are welcome to join but we are also happy to help facilitate future visits to other facilities to help sort of shed light on some of the issues that you've heard about today.
Speaker 6
Thank you. Thanks.
Hi, my name is Jacqueline Iguilar and I'm here with the Center of Restorative Justice Works. So we operate rehabilitative programs across 14 California state prisons. We serve 1,500 participants a year, and the Wright Grant is a lifeline to support our mission. It allows us to provide in person, in prison programming and family reunification services necessary to support the children and the incarcerated parents to break the cycle of incarceration. So without this funding, hundreds of incarcerated loved ones and families would lose access to these transformative services.
Speaker 34
So on behalf of the incarcerated loved ones and our families that we serve, please continue to support the RITE grant. Thank you.
Speaker 1
Thank you very much. Well, having heard from all members of the public, members are there any further questions or concerns? Seeing none, thank you all for who participated in the public testimony today if you were not able to testify please submit your comments or suggestions in writing. To the budget and fiscal review committee or visit our website Your comments and suggestions are important to us and we want to include your testimony in the official hearing records. Thank you everyone for your participation.
We have concluded the agenda for today's hearing. The Senate budget subcommittee number five on corrections public safety judiciary labor and transportation is now adjourned and thank you for all of our- special services and staff that's been here to support us and the room wasn't freezing today I won't go home with a cold so. Thank you and of course our consultant Nora thank you very much.
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