BILL ANALYSIS Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair 1399 (Leno) Hearing Date: 05/17/2010 Amended: 05/11/2010 Consultant: Jacqueline Wong-HernandezPolicy Vote: Public Safety 5-2 _________________________________________________________________ ____ BILL SUMMARY: SB 1399 establishes procedures and requirements for a medical parole program for certain state prison inmates, as specified. This bill requires the Department of Corrections and Rehabilitation (CDCR) to: 1) Enter into memoranda of understanding (MOU) with the Social Security Administration and the State Department of Health Care Services (DHCS) to facilitate prerelease agreements to help inmates initiate benefits claims; 2) pay the state share of Medi-Cal costs for inmates that have been granted medical parole; 3) reimburse providers for the medical treatment and long-term care costs of inmates granted medical parole who have not retained medical insurance, at a rate no lower than the Medi-Cal rate until a parolee retains alternate health care coverage; and 4) reimburse counties for costs associated with providing an inmate granted medical parole with a public guardian. This bill specifies a medical evaluation process, and requirements for the Board of Parole Hearings (BPH). This bill also requires DHCS to seek any necessary waivers from federal rules or regulations to allow CDCR to pay the state share of Medi-Cal costs. _________________________________________________________________ ____ Fiscal Impact (in thousands) Major Provisions 2010-11 2011-12 2012-13 Fund MOUs Minor and absorbable; one-time workload General Administration Minor and absorbable BPH costs General Potentially substantial prison cost reduction Federal waiver Potentially significant DHCS workload General Federal _________________________________________________________________ ____ STAFF COMMENTS: This bill may meet the criteria for referral to the Suspense file. This bill establishes a procedure for medical parole, based on an inmate's medical condition and whether he or she would pose a reasonable threat to the public. This bill would provide that an inmate who suffers from a significant and permanent condition, disease, or syndrome resulting in the prisoner being physically or cognitively debilitated or incapacitated shall be granted "medical parole" if BPH determines that the conditions under which the prisoner would be released would not reasonably pose a threat to public safety. Medical parole would not apply to any inmate sentenced to death, any inmate sentenced to life in prison without possibility of parole or any inmate who is serving a sentence for which medical parole is prohibited by any initiative statute. This bill provides that when a physician employed by CDCR who is the primary care provider for an inmate identifies an inmate that he or she believes meets the criteria for Page 2 SB 1399 (Leno) medical parole, as specified, the primary care physician shall recommend to the chief medical officer of the institution where the prisoner is located that the prisoner be referred to the BPH for consideration for medical parole. Within 30 days of receiving that recommendation the chief medical officer shall make a determination of the prisoner's eligibility for medical parole and, if he or she concurs in the recommendation of the primary care physician, refer the matter to BPH. If the chief medical officer does not concur in the recommendation, he or she shall provide the primary care physician with a written explanation of the reasons for denying the referral. If referred to BPH, the board would decide whether the inmate reasonably poses a threat to public safety, after reviewing all information and a parole plan. The provisions of this bill described previously, do not appear to incur significant new costs. Currently, inmates receive medical care; the inmates potentially affected by this bill likely already see doctors frequently, either in their institutions or in hospitals where some are housed. There are also a small number of inmates likely to qualify for medical parole; Prison Healthcare Services has identified 32 inmates who are likely to qualify for medical parole as outlined in this bill. The increased BPH caseload of medical parole hearings is likely to very small.BPH considers parole release and establishes the terms and conditions of parole for all persons sentenced in California under the Indeterminate Sentencing Law, persons sentenced to a term of less than life under Penal Code Section 1168 (b), and for persons serving a sentence of life with possibility of parole. BPH also, at the Governor's request, investigates and makes recommendations on all applications for reprieves, pardons and commutations of sentence, including death penalty commutations. Even if all 32 inmates who might currently be eligible were referred to BPH, they would go through a truncated BPH process conducted by two-person panels consisting of at least one commissioner. The matter will only referred to the full board for a decision in the event of a tie vote. This bill requires CDCR to enter into MOUs with DHCS and with the Social Security Administration, to determine eligibility for federally funded medical care, such as Medicare and Medi-Cal, and assist medical parolees in obtaining coverage. CDCR has had an MOU with DHCS in place since January 2008 implementing a pre-parole process for inmates that identifies and formalizes procedures for determining eligibility and accessing Medi-Cal benefits. This MOU applies to all inmates immediately prior to parole, and would include medical parole. The potential cost state cost comes from a directive in the bill that DHCS "shall seek any necessary waivers from federal rules or regulations and any other approvals necessary to enable the Department of Corrections and Rehabilitation to pay the state share of Medi-Cal expenditures associated with inmates granted medical parole pursuant to Section 3041 or 3550 of the Penal Code." There is no federal law prohibiting CDCR from paying (from the General Fund) the state portion of Medi-Cal for medical parolees, and it is unclear why DHCS would need to seek out waivers and approvals for this process. Federal law requires the state to pay a share of Medi-Cal, but money that comes from the General Fund is state money, regardless of the departmental budget it Page 3 SB 1399 (Leno) comes from. Writing and managing federal waivers of Medi-Cal law is a work-intensive process, and this bill could create a new workload for DHCS to the extent that the department assigns staff to seek out waivers and approvals. Staff recommends this provision (Section 4 of the bill) be removed, to eliminate any cost pressure to DHCS. Under this bill, as in current law, BPH will decide whether inmates will be granted parole. To the extent that medical parole is granted to individual inmates, there will be a substantial savings to CDCR. The inmates who would likely be eligible for medical parole receive a high level of medical attention and supervision while living in secure custody. Those who live in prisons cost more than $100,000 per year in medical care, medical guarding, and transportation to numerous medical appointments. Inmates must be guarded the entire time they are outside of the prison facility, and those are costs linked to individual inmates. A very few inmates who cannot be served in prisons, reside permanently in hospitals with which CDCR has contracted services. These inmates receive constant nursing care, and are guarded by two correctional officers 24 hours a day. Guarding and transportation alone cost the department $2,078 per day, per inmate in a hospital. Added to the contract rate of $3,500 per day for hospitalization, each of these inmates cost more than $2,000,000 (General Fund) to care for and guard. If one hospitalized inmate were granted medical parole, CDCR would save $758,470 in custody costs alone. The department would realize further savings depending on Medi-Cal eligibility, hospital contract negotiation (for inmates who are not Medi-Cal eligible) inmate family participation, and various other factors.