BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 1433 (Mitchell) - Incarcerated persons:  contraceptive  
          counseling and services
          
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          |Version: April 7, 2016          |Policy Vote: PUB. S. 5 - 1      |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: May 2, 2016       |Consultant: Jolie Onodera       |
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          This bill meets the criteria for referral to the Suspense File.


          Bill  
          Summary:  SB 1433 would provide specified incarcerated persons  
          in state prisons or local detention facilities with access to  
          contraceptive counseling services and birth control, as  
          specified.


          Fiscal  
          Impact:  
           State prisons  :  Future annual costs potentially in the range  
            of $630,000 to in excess of $1 million (General Fund) for the  
            California Correctional Health Care Services (CCHCS) to  
            provide the counseling services and methods of birth control.  
            Annual costs would fluctuate based on the inmate population  
            trends and volume of requests for services and materials. The  
            estimated costs assume 50 percent to 75 percent of eligible  
            female inmates of reproductive age will be served. The 2016-17  
            Governor's Budget includes funding of $632,000 for these  
            services. To the extent the posting of information required by  







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            this bill results in greater awareness and participation, and  
            the provision of services is not restricted to female inmates,  
            future costs could increase significantly above the budgeted  
            amount. 

            Local detention facilities  :  Major costs potentially in the  
            millions of dollars statewide, potentially state-reimbursable  
            (General Fund) to provide detainees in local detention  
            facilities, including county jails, with access to  
            contraceptive counseling and the birth control method of their  
            choice. For county jails alone, the latest Jail Profile Survey  
            (April-June 2015) indicates an average daily population of  
            over 9,600 females, and the provisions of this bill are not  
            specifically restricted to females. Staff notes any increase  
            in overall costs to local jails could potentially be subject  
            to the provisions of Proposition 30* in lieu of mandate  
            reimbursement.

            Proposition 30  :  Exempts the State from mandate reimbursement  
            for realigned responsibilities for "public safety services"  
            including the managing of local jails and the provision of  
            treatment, services and supervision of juvenile and adult  
            offenders. However, legislation enacted after September 30,  
            2012, that has an overall effect of increasing the costs  
            already borne by a local agency for public safety services  
            apply to local agencies only to the extent that the State  
            provides annual funding for the cost increase. The provisions  
            of Proposition 30 have not been interpreted through the formal  
            court process to date, however, to the extent the local agency  
            costs resulting from this measure are determined to be  
            applicable under the provisions of Proposition 30, local  
            agencies would not be obligated to provide the level of  
            service required by the bill above the level for which funding  
            is provided by the State.  


          Background:  Existing law provides that any female confined in a local  
          detention facility or state prison be allowed to continue to use  
          materials necessary for personal hygiene with regard to her  
          menstrual cycle and reproductive system, as well as birth  
          control measures as prescribed by her physician. Additionally,  
          each female confined is to be furnished with information and  
          education regarding the availability of family planning  
          services. (Penal Code §§ 3409, 4023.5.)








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          The CCHCS recently established a Women's Health Care Initiative  
          that is responsible for ensuring that the health care of  
          incarcerated female patients meets community standards. Among  
          other findings, it was determined that family planning services  
          at the California Institution for Women, the Central California  
          Women's Facility, and the newly established Folsom Women's  
          Facility needed enhancements in this area. As a result, the  
          pharmaceutical budget proposed in the 2016-17 Governor's Budget  
          includes $632,000 in funding for birth control and contraception  
          services for female patients who would benefit from their use.  
          Effective use of family planning services will help to reduce  
          the risks of unwanted pregnancies as a result of conjugal  
          visits, as well as provide services for women nearing parole who  
          are seeking assistance.


          This bill seeks to codify the services provided in the 2016-17  
          Governor's Budget and thereby make access to these services  
          permanent. This bill additionally extends access to these  
          services to incarcerated females in local detention facilities.


          Proposed Law:  
           This bill would require any incarcerated person in state prison  
          or a local detention facility who menstruates to, upon request,  
          have access and be allowed to use materials necessary for  
          personal hygiene with regard to their menstrual cycle and  
          reproductive system. Additionally, this bill:
                 Requires any incarcerated person who is capable of  
               becoming pregnant to, upon request, have access and be  
               allowed to obtain contraceptive counseling and their choice  
               of birth control methods, as specified, unless medically  
               contraindicated.


                 Provides that all birth control methods and emergency  
               contraception approved by the United States Food and Drug  
               Administration (FDA) shall be made available to  
               incarcerated persons who are capable of becoming pregnant,  
               with the exception of sterilizing procedures prohibited  
               under existing law.


                 Requires the CCHCS or the local detention facility to  








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               establish a formulary consisting of all FDA-approved birth  
               control methods that shall be available to incarcerated  
               persons. If a birth control method has more than one  
               FDA-approved therapeutic equivalent, only one version of  
               that method is required to be made available, unless  
               another version is specifically indicated by a prescribing  
               provider and approved by the chief medical physician at the  
               institution. Specifies that persons shall have access to  
               nonprescription birth control methods without the  
               requirement to see a licensed health care provider.


                 Provides that any contraceptive service that requires a  
               prescription, or any contraceptive counseling, provided to  
               incarcerated persons who are capable of becoming pregnant  
               provided, shall be furnished by a licensed health care  
               provider who has been provided training in reproductive  
               health care and shall be nondirective, unbiased, and  
               noncoercive. These services shall be furnished by the  
               facility or by any other agency which contracts with the  
               facility. 


                 Requires health care providers furnishing contraceptive  
               services to receive training in the following areas:
                  o         The requirements of this section.
                  o         Providing nondirective, unbiased, and  
                    noncoercive contraceptive counseling and services.
                 Exempts from the training above any providers who attend  
               an orientation program for the Family Planning, Access,  
               Care, and Treatment Program.


                 Requires any incarcerated person who is capable of  
               becoming pregnant to be furnished by the facility with  
               information and education regarding the availability of  
               family planning services and their right to receive  
               contraceptive counseling and services. Requires each  
               facility to post this information in conspicuous places to  
               which all incarcerated persons who are capable of becoming  
               pregnant have access.


                 Requires contraceptive counseling and family planning  








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               services to be offered and made available to all  
               incarcerated persons who are capable of becoming pregnant  
               at least 60 days, but not longer than 180 days, prior to a  
               scheduled release date.


                 Defines "local detention facility" to mean any city,  
               county, or regional facility used for the confinement of a  
               person for more than 24 hours.


                 Repeals existing PC §§ 3409 and 4023.5. 




          Staff  
          Comments:  The 2016-17 Governor's Budget includes $632,000  
          (General Fund) to support the provision of contraceptive  
          counseling and birth control materials to inmates in state  
          facilities. This funding level is estimated to support  
          approximately 1,900 female inmates, which represents 50 percent  
          of the female inmate population that is of reproductive age. The  
          estimated future annual costs to serve inmates in state  
          facilities would be dependent on the population trends for  
          inmates in state prisons, the number of inmates electing to  
          receive services and materials, and the cost to provide these  
          services and medications. To the extent the eligible population  
          remains fairly constant, annual costs would potentially increase  
          above the budgeted amount both due to higher participation  
          resulting from greater awareness of the availability of these  
          services, as well as the potential for the cost of services and  
          medications to increase over time.
          As indicated in the Fiscal Impact section of this analysis, this  
          bill creates a significant mandate on local detention facilities  
          to provide specified services and materials, as well as requires  
          the establishment of a formulary and training. While the fiscal  
          impact cannot be estimated with certainty and would vary widely  
          by county, the potential impacts are substantial given the  
          number of local detention facilities that would be required to  
          have this process in place. Staff notes the provisions of these  
          services could potentially result in major future cost savings  
          to the extent more positive long-term health outcomes result.  









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