Senate Budget and Fiscal Review Subcommittee No. 5 on Corrections, Public Safety, Judiciary, Labor and Transportation

The Senate budget subcommittee on corrections, public safety, judiciary, labor, and transportation will now come to order. I should have banged the gavel earlier, so we'll make it official there. Good morning to all of you, we're holding our committee hearing here in the state capital, and I ask that all members of the subcommittee be present in Room 112, so we can establish a quorum and begin our hearing. Today's hearing includes the office of the inspector general, and the California Department of Corrections and Rehabilitation.

It will focus on the correctional health care and re-entry, and medical and mental health services account for over 4,000,000,000 of the CDCR's budget. Both programs are under federal receivership due to the lack of compliance with the court orders in decades old litigation. We will hear updates on these cases and the state plans to reach compliance today. We will also discuss how to care for an aging incarcerated population and cover various parole programs.

We will take public comment and all issues discussed today at the end of the hearing. Colleagues, before we begin, does anyone have anything they'd like to add? Okay. Thank you. So let's establish a quorum. Consultant Nora, would you please call the roll?

Senator Richardson?

Senator Durazo? Senator Zayarto?

Present.

Great. The consultant notes that a quorum has been established. Let's move on to issue number one with the office of the inspector general. The issue before us is the overview of the intake processing unit and an update on medical reviews with the following panelists.

We have our inspector general Singh, we also have chief assistant to the inspector general, Ms.McCray Poole. We have Orlando Zavala, who's with the legislative analyst office, and then Ms.Cervantes and mister Weinberg, who are both with the Department of Finance. You can begin our inspector general.

Alright. Good morning, madam chair and committee members. I'm Amarik Singh, I'm the inspector general and this morning I'm here to provide a brief general overview about the office of the inspector general, the OIG and our request for additional staffing. Chief assistant inspector general Heather Poole will provide a brief overview about our medical inspection unit.

However, in the past 6 years, the OIG received substantial increase in its responsibilities, authority, and staffing. We monitor CDCR's use of force review process, internal affair investigation and discipline process, and the incarcerated person grievance process.

The OIG is an independent state agency that oversees the California prison system. We provide transparency to the correctional system through monitoring various CDCR policies and publicly reporting our observations and findings. The OIG's monitoring responsibilities has fluctuated over the last several years.

Additionally, we evaluate CDCR's provision of medical care by conducting medical inspections at each prison, and we review various prison practices, policies, and procedures by conducting performance audits and special reviews into issues or areas of concern. We have a staff member on call 24 hours per day to respond to critical incidents at the prisons or similar incidents in the community involving correctional or parole staff.

We also maintain a complaint intake process anyone can use to raise concerns of improper activity within the prison system, which is the subject of our budget change proposal, which I will address separately. We also serve as the ombudsperson for complaints related to the sexual abuse in detention and elimination act, most commonly known as the Prison Rape Elimination Act or PREA. With the exception of warden background reviews, which we do, we publicly report all of our findings of our work on our website.

We also publish case summaries on a monthly basis, which include summaries of investigations and critical incidents we've monitored, selected intake complaints where we feel we have made a noteworthy impact, and significant use of force incidents that we've reviewed.

In 2025, we published 28 reports and we published 23 sets of case summaries. That's just a brief summary of what the OIG does and I'll quickly turn to our budget change proposal. This year we are requesting $275,000 general fund, to fund two permanent positions in '26, '27, and ongoing, to address our increased workload in the OIG's intake processing unit, and this will enable the OIG to timely respond to all complaints we receive.

Staff in OIG's intake unit review and respond to each single complaint that we receive. 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, with 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 2024, and from January to March we've already received 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, with 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.

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 authority is now codified in the penal code.

We carry out this mission by evaluating the quality of the medical care each of California's 31 prisons provide, 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 health care 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 6 month period or during significant events. For the first time in cycle seven, we 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 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. 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, 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.

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 9, will be less than 3 years. Thank you for your time this morning, I will be available for any questions you may have.

Thank you very much, both of you. Do we have any comments from the LAO office regarding the presentation?

We have no concerns with the proposals at this time, but here for questions.

Thank you. The Department of Finance.

Hi. Ryan Weinberg, Department of Finance. We have nothing to add, but happy to take questions if you have any.

Thank you. Okay. Members, any questions for the panel? Senator Durazo, you'll be up first today. Thank you.

Thank you, madam chair, I have some questions on the intake processing unit. The complaints doubled in 2 years, so which of the types of complaints are driving? It's over a 100% increase.

And are you identifying systemic issues, not just individual cases, but what could be wrong with the system that's leading to this doubling of complaints?

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 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 basically categorize every single complaint that comes in, the increase we have determined is twofold.

One, we 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 a hold of us as necessary. And when we do see systemic issues, we do share that information with the Department of Corrections.

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?

The two greatest numbers of complaints we get are are, issues with conditions, conditions at the prisons, and staff misconduct.

Okay, and so are you identifying any systemic? Are these systemic? Or how if you don't classify them as either systemic or just one individual complaints, then how do you move forward with solving the problems?

What we do is we also identify which prison that the complaint is coming from. So we are able 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 as having, we've received multiple complaints about visiting. So we reach out to that individual prison and identify for them, "Hey, we're getting these types of complaints".

We make sure that the the the warden, 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.

Which I assume then would lead you to how to fix or how to address the problems the complaints.

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.

Okay. On the medical inspections, something very similar. You just completed the seventh cycle. What, are the most significant trends on the medical side?

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 4 individual tests that tracked different types of emergency preparedness, such as making sure treatment cards 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.

We also noted that there are several of the indicators where almost all 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 the compliance indicators. But we also saw on the compliance side that there were only 1 out of 31 institutions passing two of our indicators, medication management and health care environment. So those are probably the most significant of the the findings specific to the cycle.

And you have, there's adequate, inadequate, and proficient?

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.

So that the least is in, lowest passing is in the proficient?

The highest pass- the well, I'm sorry. The

There's, the least number are passing with proficient.

Correct. Correct. None of the institutions were ultimately rated proficient overall for, any of the indicators.

Is that something that you intend to work on to

So with each of our reports, we provide recommendations that will hopefully increase. And if you look at the cross cycle trends on the back side, 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 case, or with the compliance side, we do see a little bit of more of a mixed performance, but we are seeing indicators that are improving over time.

And then, final, 4 prisons have not yet had medical care delegated back to this to the state. What are the barriers that they are facing?

So it's actually currently 3 institutions that have not been delegated, CHCF was the most recent delegation. The 3 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.

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?

The delegation issue is something that the receiver handles, it's not the inspector general's office. It's up to the 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.

Okay. Thank you. Thank you.

Thank you, Senator. Senator Seyarto.

Because I know when we have an anonymous complaint or, 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?

Thank you. I wanna go back to a little bit of our complaint load because it is exploding, as the Senator said. Do you keep track of what percentage of those complaints actually have validity to them?

We don't assess the 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's presented to us.

And we either respond to the complainant with, you know, here's some avenues that you need to address in order to have your complaint addressed, through the Department of Corrections or we will guide them to another state entity 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.

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?

We don't keep track of that.

So

We take everything

90% of the complaints could be trivial at the end of the day.

I hesitate to say yes, but no. I don't believe that 90% are trivial. Just

Okay let's not use 90%. Let's use 50% because I, you know, have some dealings in complaints, receiving complaints, and especially in the anonymous complaint world. A lot of complaints are meant to get people in trouble, and after they've been investigated and investigated and they've 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 that's 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.

Absolutely, I agree. We do review each complaint, and our staff member looks at what the allegation is. If hypothetically speaking, 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 gather all of that and we respond accordingly. If we find it to not pan out, we will address the complainant and say you either need to provide us more information, or 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.

And but at the end of the day, we don't have statistics to show that we have a lot of these versus a lot of these?

No. We don't.

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.

Okay. Why not?

Because I would think if we knew kind of what was going on, that we could put additional measures in place that would help the valid ones get addressed with more, in a more robust process and the invalid, the ones that aren't, 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 problems with how they're, what they're doing with the system. In other words, we need to identify those.

We need to know how much of this is real and how much of it isn't. If we're going to come up with a program to redefine how CDC, our employees are monitored and disciplined and all that, we kind of need to know what, you know, how much of this is valid versus, you know, if we have 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, you know, people trying to get them 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 employment world, that happens, you know, it 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 or not having the the work done to and determine that, "Hey. This is not true."

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 prison, we send it to the warden, the hiring authority, and we let them know this is what

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 a full investigation to determine the validity of the complaint.

Okay.

Okay.

has been reported, and then a complete investigation is done by the Department of Corrections.

So you do the intake specialist part and then let them do the investigation part?

Yes.

Okay, another question. This is kinda cropped up in my district, actually. I was reading the other day that in Chino, the women's prison, some women's inmates have actually now filed a suit against the state with regard to SB 132. Whose oversight is that?

Didn't monitor how SB 132 has affected our female populations for our female prisons.

That is

Is that your is that in your land, or is that in somebody else's? Because there are complaints.

There being, there are complaints coming from there. And now the DOJ, 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 if there's a problem with that program that that created, then we probably need to address it.

Right.

We are not responsible for monitoring the implementation of SB 132.

Okay, but you do, you are responsible for the complaints that are generated from that program?

Yes. We do monitor the complaints and any investigations that are related to those complaints.

Yes. If

Okay.

Okay. Thank you.

Thank you.

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?

So with the health infer the health care 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 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 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 as those those missed attention to details, but we do have, one of the 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.

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.

Okay. So let me give you an example. Unfortunately, I've I've spent more days, more lately, you know, 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, you know, they have in the computer system when a person is due, they're scanning.

When I've been in the hospital with family members, you know, they're scanning their wrist thing, you know, the 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, I want to get back to both senators. I'm gonna 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 10 thou are 6,000 of them use of force or only five? It really does help us to determine are we seeing success here, or what really is the issue?

If the issue I think what mister Searto was saying, you know, and I've been in a few, in my oversight capacity. I wanna 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, you know, causing me harm kind of thing, or are these, you know, really legitimate, complaints that are being put forward?

And I understand your role is not to determine what happens, but there you do have a role if you're receiving complaints and something you know, 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, but it would be very helpful for us to understand of these 6,000 complaints, are 6,000 of them, you know, 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, you know, these can be taken in multiple ways, and we have to make sure that all the information is being, you know, fairly evaluated.

So we'll 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, and I would have to think that you're giving to the wardens and department of corrections some sort of level of saying, you know, hey. This is a serious issue.

This is a staff complaint versus someone saying the microwave is, you know, causing me harm that's not even in in their person's cell area.

So I I think we really it is warranted to have a little more information, and, 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?

We 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 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 days.

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?

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 citizen's 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.

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?

I do not have that information at this point, but I believe my staff would be able to get that information for you.

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.

The complaint intake complaint process is written in our statute. So we are statutorily required to provide this service forever.

Alright. Okay. Those are all my questions. Thank you for participating and being here.

Thank you.

Alright. We'll now move to issue number two, which is the healthcare overview with the following panelists. We're gonna have Duane Reeder, deputy, director of fiscal management of the section of the California correctional healthcare services. We have, is it Janine? Del Mundo, deputy director of California Advancing and Innovating Medi Cal program.

We have again, our same representatives from the LA office, and I believe also from Department of Finance. Okay. So, please begin.

Good morning, madam chair and members. I'm Duane Reeder, deputy director of fiscal services for California Correctional Healthcare. I'd like to provide a little bit of an overview of the health care budget. There are many challenges in a health care budget.

You think you have challenges?

Well, yeah. I know. Tipped the cap there. But health care costs continue to rise as well as we have an aging population. If you look at the SB 108 report, which we'll talk about in a future item, you can see that our 55 population is kinda 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 a man on the street, and they can see that their health care costs continue to to elevate. So we have 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 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 they develop these hiring events, and it it really expedites the 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 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 has 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 via email, and 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 licensed marriage family therapist to to help cover, licensed clinical counselors. So a couple new classifications to help come in and and fill those vacancies as, you know, especially in mental health. Healthcare staffing is 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 to 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 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, reducing our reliance on more costly position coverage. We are a 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 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 costly for us is contract medical. Contract medical costs, are for a lot of outside services.

We look to to, you know, do our best with contract medical. A lot of the 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 in our TTA's versus having to send them out to an emergency room. Some of those costs don't help health care. It really, you know, is our transportation and guarding costs that it that it helps out with, which is always a challenging budget. We have a lot of emergent unscheduled transports. And so, you know, if it can benefit CDCR, it can benefit the state.

We're gonna look to see what we can do. Another big cost area is pharmacy. Our pharmaceuticals tend to go up and down. We do look to generics whenever possible. We are gonna 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, you know, one of one of the big efforts in the receivership was the healthcare facility improvement program, HCVIP. That should be completed in the 2027. We have three institutions left to complete. So making progress and that, you know, that that was a big thing for the early receivership was getting our facilities and our clinics up to modern standards and, you know, community standards. And so we're very close on that, which is encouraging.

As the OIG mentioned, we're down to three institutions to delegate. CHCF, 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 inpatient beds. It's it's really, you know, our our health care institution, if you will. And we're California health care facility in Stockton.

And so delegating that was really in I I wanna say impressive, but I don't Wanna Pat myself on the back. But but it 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

Sorry. I don't mean to interrupt you, but I wanna 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 the term delegated.

So so 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. So delegating the health care facility was a big milestone for us.

HCVIP coming to an end is a big milestone. So the receivership continues to, you know, 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 Janine Del Mundo.

Another area we've been trying to get additional reimbursement and additional federal funding is CalAIM, is is the CalAIM program. So Janine is the deputy director over the CalAIM program, and so she's gonna give you an update on CalAIM.

Good morning, Madam chair and committee members. So as Dwayne said, Janine Del Mundo, Deputy Director over Special Projects, which includes CalAIM. So I wanna thank this legislative body for its continued support of the department's rehabilitative programs, your commitment and support of the CalAIM initiative, and your focus on enhancing pre release and reentry services for the populations we serve.

Thanks to our partnerships with the Department of Healthcare Services and collaboration with managed care plans and county behavioral health departments and community based providers, I'm pleased to announce, you know, 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, 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 pri providers who are, and 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 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 Medi Cal activated at the time of release, which is a forty percent increase prior to CalAIM.

Eighty seven percent of our patients have an 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. They're that person that's gonna help them navigate once they release, to get them their health care services up to a year. So since implementation, the department has submitted a 169,000 claims, and we received approximately 14,700,000.0 in reimbursements.

As CalAIM 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 the county 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'm happy to answer any questions you may have.

Orlando Sanchez of all of 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 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 kinda heard we're getting close and close, and and so 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, on 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 and 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. I'm happy to take questions.

Thank you. Department of Finance?

I nothing to add at this time, but happy to take any questions if you have have them.

Thank you. Senator Durazo? Questions?

Thank you. Thank you very much. Good to see you all. Now 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?

I'm not sure I understand the question. Why is it taking longer?

Yeah. We In other words, why have it?

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 it's getting them to the standard that they need to be at, in order to be delegated. So it's taking longer at a few institution institutions as they are challenging environments.

When you look at CSP SAC and you look at 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 health care 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 and, you know, ensure that they're operating at the level that the receiver requires.

Just as was mentioned also, what is the current timeline for those three institutions?

You know, I'll I'll, you know, go back and and maybe share. It it it's 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.

Okay. And you mentioned CalAIM, twenty five percent of the patients that went from, you know, the high sixties, and then it dropped down to twenty five percent had the warm handoff with the external manager release. So what why do you think that gap exists? It's right. That's 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.

Yes. So fifty nine percent have had warm handoffs with the community, with the enhanced care managers. CDCR and or CCHCS, we do an embedded model. So so we are able prior to CalAIM, we connected patients to, 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.

Okay. Well, that's that's good to know. The cost the health care 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, it 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 in in health care.

Yeah. We we continue to look at federal funding opportunities. We look at our own policies that that possibly could be driving, you know, additional costs. 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 financials, 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 reimbursement 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 to 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.

Okay.

Okay.

Thank you.

Thank you. 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 position is $312,000 a year. So that's just $5,500,000 that we're paying for receiverships. These lawsuits were filed in 1990 and 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 what has taken so long?

So we're going to talk with the mental health receiver's office here in the next item.

Yeah. I I saw that. I was just trying to cover this so I don't have to ask it again and again.

So we had 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 kinda picking up what you mean. It didn't it didn't it 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 allocate the appropriate amount of money to get those things done in an appropriate amount of time.

So we don't have to have receiverships that cost us $8,200,000,000 or $1,000,000 a year.

And and that's for me, it's like, okay. So the the Coleman one was what? 2021, we finally wound up with a receivership. So they have almost twenty some odd years to to address it, and they didn't. Thirty years.

Yeah. I know one of the major goals or one of the 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 have improved 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 but they were ordered.

I think I might go reply because that's a lot. 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 because I would think somebody would be telling us every year, hey. This is a court order. We have to get these things done, and 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 were they just trying to appease the legislature or or what?

No. The receiver's relatively new. Came on last August, and so they're still finding their footing and they're still

I'm talking about the people before the

Oh, people before? Yeah. I'm I'm not sure why the special master wasn't more engaging.

This is just, like, super inefficient. And 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 and and when we just kick the can down the road, we wind up with receiverships like this that are 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 or get some better action as far as what we need to do and how much it's gonna be and when we can get it done by so that we can kick these folks back out of the state. I want I want us to be able to run our own stuff and and do it the right way. So thank you.

Thank you.

Thank you very much. How many I you may be aware. How many total persons are there? About 31?

Right now, there's 31. When CRC closes in the fall, it'll be 30.

Okay. And how many of those are health facilities or dedicated to health or or any?

All institutions have health care. All institutions have clinics. They provide services at at all of those locations.

Okay. Coming back to Senator D'Orazo's question, do we have any that are specifically only dedicated to people who have more extended health challenges?

I would say 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 institutions that are close to centers of care.

And so we sacrament and here, you know, California State Prison, Sacramento, San Diego, LAC, 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.

How many beds are at the health care facility in Stockton?

There's 700, 1,722. 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 inpatient. But on the main facility, it's it's 722 inpatient beds.

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?

No. We have programs throughout the state. I mean, CHCF is not unique and, you know, can only care for these patients. We we do provide services at the other institutions for these high risk patients.

Okay. So let me say my my question maybe with a better example. So out of, let's say, 90,000 inmates in 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 we don't have that.

Doctor Kanan is over the clinical operations. She's the deputy director of our clinical operations. So Okay. We'll let more of an expert

Good morning. Yes, ma'am. Good morning.

Can you hear me?

Thank you for being here.

Thank you for having me. Yeah. So Duane is explaining it very well. And and so, you know, the Pareto principle is there's a small proportion of people who disproportionately drive our drive our clinical risk and our 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, mister 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 CHCF, 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 tele specialty, and we provide emergency, response and and hospitalizations as as needed. But there are absolutely institutions where we, if a patient needs hospice care or 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. 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 some of those institutions.

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, you know, focus more on these individuals, how many are, you know, 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 at 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 and diagnostic and

Primary care.

Teeth and eyes and, you know, all of that stuff. However, if we have 10 prisons that are providing care for approximately nine 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?

Well, I 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 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 we have this gigantic matrix. And for every person, we have to sort of figure out given, you know, 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.

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, family members and, you know, access and visitation and all of that. So that would certainly have to be kept in mind as well, especially given the nature of what we're talking about.

But I really do think further thought should be on this, because, you know, for example, an elderly, you know, location, you know, mental health, you know, 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, you know, 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 Well,

we'll give you we'll give you some information. If you need more, we're happy to 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 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 I'm happy to provide that and maybe some additional information and let us know if you need more.

Okay. And, if you could still remain, I have one more question. Did you have something, sir?

108 as well.

Thank you. Orlando

Sanchez with the LAO. If I may, we also did not in this context, but we did a report on 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 needs, security needs, rehabilitative needs. So just wanted to provide that additional context.

Thank you. Which also would apply to our next issue. Yes. Okay. I had another question.

You talked, mister 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 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 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?

We currently don't have a registry or 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 ask that question and get back to you.

Okay. Did you have something you wanted to add? No? 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?

We we cannot bring in non licensed folks at this time. That was a suggestion by the LAO that we don't require a California licensure, and 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.

So currently, you're not following that recommendation of bringing people out of state who do not have a California license.

Correct. The only the only folks we would be bringing in from out of state is ones, you know, that we're gonna hire and 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 within I don't I don't remember if it's, like, one year or two years. And if they don't get licensure, then we have to let them go.

But we we do recruit out of state to fill civil service, but we do require them to obtain licensure early on in their employment if they don't already have it.

Okay. Thank you. Yes, ma'am. Senator DeRosa.

A quick question. Maybe it's for the LAO or or anyone else. Have we ever done a a a 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?

We, Orlando Sanchez with the LAO, 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 that'd be made whether the state have done those on its own, yes or no, or would continuing to operate at inadequate levels remain, and 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've added a lot more positions and people get better care, but we haven't done a kind of tracking all these three. And and those are some of the challenges is what would the state have done had it not been under court oversight? And, 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 Plata case, that total costs have ballooned two times more in the past twenty years and that's even after accounting for inflation.

On the healthcare and 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.

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 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.

Exactly. Thank you all for your participation and also for your frankness, 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 Receiver's Office. Interesting about the discussion Senator D'Orazzo just had about the cost.

Also, we have Doctor. Tony Martiello, hopefully I didn't butcher that, Assistant Deputy Director of Telemental health programs, then we still have our same individuals here for the LAO office and department of finance. And mister Reeder, you're still here.

Yes. I'm still here. Thank you. Good morning again. Dwayne Reeder.

The mental health proposals, we have two of them for consideration. One is the the receivership BCP, which is requesting 33,900,000.0 in the special deposit fund, not general fund, but special deposit fund to pay for the receiver's office staff, as well as to continue bonuses that were initiated last summer. In addition, we have a tele mental health staffing augmentation BCP. So we've continued to grow our our mental our tele mental health program. And so we're asking for additional positions and funding for that additional growth.

With me today is Alyssa Challenger from the receiver's office. She's the chief of staff, and I also have doctor Tony Martello, who's over the tele mental health program to help with questions on that. And I'll turn it over to Alyssa to to give an opening statement.

Thank you, Dwayne. Good morning. My name is Alisa 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. Nuisance civil suit, a federal appoint 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 the 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.

Thank you. Anything further, that you wanted to add?

No. I have nothing specific to add, but I'm happy to ask answer any questions, about the Tele Mental Health PCP.

Okay. Let's see. So, miss Challenger, we have a pretty extensive report here. That's it?

Sorry? Sorry. Could you repeat the question?

I just said we had a pretty extensive report here. That was all you had to share?

I'm happy to go over the BCP. I wasn't sure if if Dwayne was going to to walk through it similar to the medical request.

In light of the questions we just had, I think someone should.

Okay.

Keeping in mind the discussion, you may wanna just focus on those points, but I think quite a few members expressed some interest, concerns, understanding staffing, where people are placed, steps.

Okay. I don't know if she could hear us when she was waiting. Were you able to hear us, Alisa? Were you able to hear the

No. Sorry. It cut out.

Okay.

I also can only see myself, so I apologize if I can't pick up on any, nonverbal cues.

That's so his question was, did you hear the discussion of the panel that we had prior

to Yes. I did. Yes. And I'm happy to to address those questions specifically, or to also walk through the specifics of the BCP request and then take questions then

Yes. If you could do that. Reference. Yes, please. If you could.

Okay. Of course. So the BCP request, 33,900,000.0 for 2026, 2027 from the mental health special deposit fund. It primarily includes, 2 parts. So 1, 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 advisors, and attorneys. 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 are the positions that will be contracted by the Receivers Corporation and limited in the scope to their specific program area.

And all of these positions are consistent with the court approved action plan that was implemented when the receiver was appointed. 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 within for 2026, they would all be coming from the special deposit fund that was an accumulation of fines.

Okay. Thank you. Alright. The LAO, if you have any comments you'd like to share.

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 a 150,000,000 collected fines from the state's general fund, and that's what's being used now to pay for this 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 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, the they've submitted budget requests to this committee, and they've made modifications, as 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 2nd, we also recommend tracking, the progress towards exiting, and then it could do so through annual updates, these budget hearings, as well as the, the mental health receivership extent 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 of that delivery. In addition, it's likely that cost could go up beyond the current estimate we have in the current proposal.

For example, the receiver the mental health receiver has indicated potentially the, 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 call them health care facility improvement projects or HCVIP. Those totaled about 1,500,000,000.0 over and are still ongoing those projects. And given that the state is facing multi year budget deficits, these newly incurred costs would that budget problem. We also wanna highlight that under the existing timeline for the mental health receivership, they're projecting about 5 to 7 years to implement, its goals and plans, but we want to be cautious about that. It could extend longer.

On the the clearest example we have is on the medical side. And in the past 20 years, we've heard at various stages that it could be coming to an end and and some of it some of these timelines and are can extend further because of the challenges that and this court case has already been going 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 3rd, 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 increase recruitment from out of state for license 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, 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 is about 25,000,000 making those permanent.

This can be done, by tracking how the effective the part the department was at 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 these staff. But as of 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. 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. But thank you.

Did you have anything I mean, you might as well do the telehealth piece now.

Yeah. Okay. Happy to. We recommend approving portions of this proposal as it may help fill vacant mental health positions. So this is about 8,900,000 in 2627, growing to, about 13,000,000 in the out years and ongoing.

And this would redirect about a 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 CDCR 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 1 to 1, and there's. 1 provider, for example, a psychiatrist or a psychologist, and they have one person at the prison who helps.

While it's not clear that each provider needs a full time medical as medical assistant person, because they it's possible that a different ratio could could work out in this scenario, because 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 1 to 1 makes sense to cover those spaces. 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 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, and then slowly wrapping 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 there may be some need to have some different types of pay for the folks that remain at the prisons compared to the ones that that work. So thank you and happy to provide any more context on either of those or any other questions. Thank you.

Thank you. Department of Finance.

Hi. Ryan Weinburg, 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 CBCR or post other operational issues with different standards of licensure.

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 CBCR could implement on its own. With that, happy to take any questions.

Thank you. Before we get to member questions, Mister Reeder, Miss Challenger, or Miss Martiello?

Martello.

Martello. Thank you for correcting me. Do you have any comments based upon the LAO or Department of Finance's report?

I don't have any additional comments at this time beyond what was already expressed.

Yeah. Go ahead.

Shouldn't have any additional

comments. Alright. That was Alyssa Challenger. Apologies.

I didn't understand what you said.

Oh, I said I don't have anything additional to add beyond what was already expressed at this time.

So do you concur with the LAO's comments and recommendations?

I would 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.

Okay. Alright. If you could forward to the committee, and actually, I'm gonna 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, Mister Reeder?

No. I didn't have anything additional, like, except, you know, we did see that recommendation by the LAO, and we are discussing it internally, about the MA issue. But once again, as DOF mentioned, we'll have to work with the receiver's office to to do any adjustments to that that ratio.

Okay. Thank you. Alright. Members, Senator Durazo, you're first up.

Thank you, madam Chair. So the state accumulated a 160,000,000 plus in fines. We're 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 care. So what about that?

We post our positions and have a civil service process. Licensed marriage family therapist can fill, you know, multiple roles within our system. And so, we're happy to maybe have some conversations or to reach out for further information on where these resources are. But we're definitely interested, to get more folks on board. And if they, you know, if they have a pool of resources or an avenue, we're we're happy to explore that.

Yeah. I mean, it just makes me wonder how 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 that says, I guess, it's primarily or mostly for failing to keep these vacancy rates below 10%. Am I understanding this right?

Yes. Correct. We we had a 90% fill rate, and were not achieving that in multiple classifications. And so we were being fined for the amount of vacancies we had. And they they fined us 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.

Okay. That's still a very

Oh, significant. Yes.

To fill positions for jobs that at least 1 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.

What Yeah. We we certainly can follow-up with this group. But 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, we constantly are looking for all, you know, folks to fill these vacancies. So happy to have some additional conversations if if there's a pool of resources that we're missing.

And I'd be happy to add a little bit more context. The marriage and family therapists, as well as clinical counselors, are a relatively new position to the state that were added, last year and were approved through the Coleman 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 not allowed, or prior to last year. And the other yeah. I just wanted to add that piece of context.

Okay. The receiver's action plan, as you said, was projected to take 5 to 7 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?

Alisa, would you like to take that one?

Yes. Absolutely. Thank you. Can everyone hear me alright?

Yes.

Yes? Okay. Thank you. So in the receiver's action plan, it lays out 6 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 would be a 5 to 7 year outlook for the receivership.

So we can get what the action plan is and what the bed benchmarks are gonna be?

Yes, ma'am. We're happy to provide that.

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?

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.

Anything you wanna add to that?

We did take down so we had 256, psychiatric inpatient beds at 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 CHCF and CMF units, and the system wide need, so we can adjust beds down to closer to what, you know, what our need is. Yeah. So that evaluation is happening by the receiver's office. And as they complete that evaluation, we will come back with proposals to to adjust that funding appropriately.

Thank you.

Senator Seyarto.

Thank you. So I 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 have a recruitment problem, it's because people either don't want to work there, it doesn't pay enough or for whatever other reasons. Yeah.

We do ex reasons.

We do exit surveys. Our human resources department does exit surveys, and so maybe I could share some of that information on Okay. On what we're hearing. But I you know, environment, pay, you probably hit the top 2.

Because I realized sometimes state pay doesn't equal, especially when you're looking at these not state pays. They don't really the salary is not as much, And it's probably not as fun to work in a prison or incarceration environment. But I you know, I'm kinda 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.

An office that has several mental health you know, professionals, they all do different things. 1 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 just bring anybody in there and say, start doing your counseling magic just so you can get to the numbers so they'll stop fining you. Because that just to me, it's not fixing the problem. It's just making numbers.

It was allowed by the courts. So I assume they meet the mission, but I don't know, Tony or Alisa, if you guys have any additional information as I'm not a mental health clinician.

I I don't have additional information on those positions specifically. I can add though that part of the funding that's being requested, 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, what 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.

And those are also 2 objectives that, directly come from the receiver's action plan.

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. And, you know, I'm glad to hear that the money actually kind of goes back into the 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 we can cut out the part where it goes into that pot and then it goes into this pot and it goes into that's kind of absurd. So it looks like you're just way anxious to answer a question.

If I may, Senator, we did a report and kind of discussed with people on the field as we were 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 the those are areas that already have shortages, as defined by, other agencies that have done surveys, that some of those areas already struggle with it hiring enough. So what the prison system would be competing with those as well and make this problem a a lot difficult.

And in this report, we also have other recommendations outside of, that could address some of these challenges like telemental health could be an option if there aren't enough providers there. You can recruit from Right. All over the state or other states even as we recommend. Our options to hire these psychiatrists that are highly trained on the and meant, and psychologists and marriage and family therapists as well.

So part of the problem isn't that the prison, system itself doesn't wanna hire people so they can get fined?

It's a mix of Yeah. They don't wanna do that. This is how it's reached these chronic levels of Okay. Vacancies.

One thing to add, Senator. The fines are no longer active, so we're no longer being fined for our vacancies just for That's

That's good to hear. Yeah. Thank you.

Well, I'm gonna go through a few questions and then I'll, 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 gonna look into something like that. Is that correct?

That's correct.

Okay. The next question is, can the tunnel tele 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?

Yes. The receiver is exploring that idea.

And I can speak to that a little bit as well. I apologize for not introducing myself earlier. I'm Tony Martel, the assistant deputy director of Tele Mental Health for CDCR. So we do have a fantastic group of Clinicians in the Tele Mental Health department, and 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.

So when will you have that assessment done, you think?

I it's still an ongoing discussion with the receiver and with the 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 telehealth.

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 LAO.

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 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.

I get that, but I don't think that that's a consistent model in the non this non space. I actually know an individual who provides tele, you know, counseling, and they don't have one client.

Yes. I 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 on

the But we're talking about telehealth. So they're not physically there. Right?

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 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 to share those telepresenters. But if they're co located, potentially.

So we are evaluating that.

Okay. We're gonna need a an additional meeting to delve into this a little bit better. Okay. 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 you know, has anyone clinically evaluated all these individuals and confirmed that everyone's, like, a type one mental health issue.

In the appropriate level of care.

Type three.

Yeah. I believe there's 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.

I can check. I would have to get back to you on that, specifically.

Okay. I can provide in looking at this through our report, Orlando Sanchez with the LAO. CDCR kinda separates people that have a diagnosed mental health need into kinda 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 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, smaller portion are in the inpatient setting at the prison. That hopefully provides some context.

Okay. So mister Reeder, 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 CDCR who were supposed to be doing some of this stuff?

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 review, so I can I can share that information once I connect with them?

Well, I'm not just talking about the evaluations. I'm talking about the work that she said 200 people are doing, and all of this, you know, two deputy receivers, a senior adviser, attorneys, paralegals.

They're they're really taking over for the office of special master. The office 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 Kinda doing the day to day work and, you know, kind of the state work. And then you have these oversight groups that are overseeing us.

They're an oversight, basically, to ensure that we're elevating our mental health care to their standards or to the court standards.

Okay. And does the office of the special master still exist now that we have the receiver office?

The office of special master is no longer. So so the court ordered, the end of the special master and the implementation of a receiver.

And what was their budget allocation?

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 you some mis misinformation?

I would say between yourself and the Department of Finance, if you guys could provide us what was their budget. And how has their budget, now that they no longer exist, has that folded into this request, or how does that work?

Ryan Weinburg, Department of Finance. The legislature previously approved about $3,000,000 General

How many?

$3,000,000.

$3,000,000 compared to their request of a whole lot more?

That was specific for staffing for the Office of Special Master. I'd like to note that the Receivables proposal includes additional costs associated with benefits for bonuses being made permanent for the actual Clinicians doing work. But that funding was added to CBCL's budget. It was viewed as part of the legal cost at the time. So it's currently still part of CBCL's budget.

Since the Office of Special Master is going away, that will be addressed as part of a proposal as part of the May revision to, reallocate that funding.

Okay. So 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. But and so I'll certainly review that and be requesting a subsequent meeting. And any members of the committee who wanna 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 Let Has has the attorney general has anyone looked at this to say

So we will work with the attorney general in this case. Obviously, we're 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

Yeah. Who was involved? What was asked? Do we have any further repair, you 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 gonna pay this amount at these levels for the next five to seven years, it just seems, you know, I don't know why it would take us five to seven years to figure out how to address our vacancies.

It just 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, you know, for 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.

You know, I don't 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 gotta figure out how to tighten this a bit, would be my general comment.

Totally understand.

I'm glad you understand. Okay. Yeah. Any further questions?

Okay. Alright.

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. 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. Kainan 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?

Alright.

Thank you.

Thank you. And mister Reeder is still here with me. Thank you.

I'm still here.

Alright. I appreciate it. Okay. The floor is yours.

Yeah. So I'm back. Renee Kanan, deputy director of medical services, CSCR. So the request was to to provide a high level overview for the SB 108 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.

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

So again, there's three points and and there's several sub points under the 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 focus 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, health care, 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 you read the report. You know that it's, a little bit more than 9,000 individuals. And so that's about 10% of our population, but they make up, really over 20% of, of the costs, for health care.

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. Percent of them have determinate terms. So they are going to be released. But 60% 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, you know, 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.

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 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. Very severe advanced dementia. They don't know their name, their 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. 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 gonna 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. 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, not qualify they don't qualify for compassionate release or elderly parole. The last case is an individual cognitive impairment, diabetes, they've got Parkinson 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, serve more than fifty or twenty years. But again, no post release placement options. Again, because often because of the restrictions in the resident, you 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. Little bit about the population and some of the challenges just leveraging compassionate release and elderly parole.

And so, you 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. Community to take care of these very complex patients. Well, it kind of boils down to, and other incentives for community providers to take these individuals. To happen potentially or at least we need to consider besides resources, and other incentive, is exploring, you know, the the issues now that currently restrict

individuals from, from where

were they can reside, from, from where 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. And 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 CHCF 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.

Thank you. I really appreciate your presentation of telling us what the problem is, how we could potentially fix it, your openness. It it really means a lot. Thank you. Thank you so much.

Did you have anything you wanted to add, mister Reeder?

Nope. Okay. It's a first.

Okay. Did you have anything, sir, LAO's office?

Orlando Sanchez with the LAO. We don't have direct comments on this. We just wanted to flag that the cost represented there are health care costs. There's other costs in the prison system that are not captured by these numbers. So just yeah.

Just wanted to flag that.

Would you like to provide us what those other costs are? Not necessarily today, but you can provide them to the committee. Okay. Thank you. Department of Finance.

I have nothing to add on this item, but happy to take questions as always.

Okay. Thank you. Senator Durazo. Thank you, madam chair.

Thank you for the report. That was very Yes. Under medical parole, the state bears the full cost because the individual is still considered incarcerated and ineligible for medical reimbursement. Has CDCR have you all evaluated revising that medical parole statute to allow federal cost sharing and what chain statutory changes would be needed? Either one.

Health care services manages our federal reimbursement. And so we've spoken to to them, but it's very difficult to get the feds to change statute that's gonna cost them more money, essentially. So we have had conversations with health care services, but we didn't get any we had no success.

Is that not something that the state could

change? It's a it it's it's federal. Medi Cal's federal reimbursement. It's from the Federal Government.

Yeah. I know it's

Well, there's federal and then there's state.

Oh.

Yes. There is the Medi Cal, but, essentially, that we'd be seeking federal reimbursement for these folks in the community, similar to what we do when they're 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 we collect over $40,000,000 in federal reimbursement each year for over twenty four hour stays, but it does not apply to this population.

Okay. Maybe we can do further in terms of what the state can do.

Sure.

Thank you. The legislature could explore incentives for long term care facilities to accept justice involved patients, which, again, goes back to medical funding. Do you what are the barriers, that, you think would, what would a meaningful incentive structure look like?

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? So

I mean, there are some models in other states, and there are, you know, there may be sort of a sweet spot in terms of a of a of a dollar amount, and we could go back to, you know, our the stakeholders. We 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.

Yeah. We can we can be open minded to other ideas.

It it is money though. I mean, it's additional funding. Yeah. Yeah.

Well, eventually, it could be less.

Excuse me?

Eventually, it could cost less.

Yeah. Yes. Yes.

I mean, if we could get ideas from Norway, we can get ideas from another state. Right?

Well, and California has their good ideas as well. Right? That's what we wanna see. People follow us. Right?

Yeah. And then just finally, given that 60% of the focus population is serving the 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 at the same time elevate health care

Other states.

costs? 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, we provide additional information to help them make decisions about the suitability for parole. And that has given them, I think, the information that they need particularly around our patients who are demented. 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 a subset of our elderly who qualify for parole. But again, the issue is even if they are eligible sort of from the perspective of of, no longer posing, a risk to, to society. We are still challenged often finding post release, placement for them.

And and so, you know, 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 we do have a certain number that are eligible for elderly parole. And then I guess we, you know, what was it? Twenty eleven or or so. Maybe it was twenty fourteen 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.

Thank you. Thank you, madam chair. Thank you. Senator Iardo?

Thank you. Why is it so much cheaper to have, persons that are in the 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.

Absolutely. I don't yeah. I don't think this is about, you know, 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, you know, custody officers. For example, we run, you know, we we have to run, particular types of health care 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 costs 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, you know, on the outside.

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, you know, 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 incarceration system.

Because when you're talking about custody officers and all of the things that we require, if if somebody is has dementia and they need the lockdown care like they, 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.

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, you 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 it's not parole, but that is a

situation where it costs health care 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.

Right. And and if you you don't need a custody officer for 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 the concern for the public is when you're putting an SBP out, they they although it's an SBP, and they're going in their community.