BILL ANALYSIS
AB 2232
Page 1
Date of Hearing: April 20, 2010
Chief Counsel: Gregory Pagan
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Tom Ammiano, Chair
AB 2232 (Nielsen) - As Amended: April 14, 2010
SUMMARY : Requires that a $5 fee bee charged by the California
Department of Corrections (CDCR) for each inmate-initiated
medical visit of an inmate confined in the state prison, rather
than merely authorizing the fee, extends the fee to dental
visits, and requires that inmates be charged for medically
directed follow up visits. Specifically, this bill :
1)Requires that a $5 fee be charged for each inmate-initiated
medical visit of an inmate confined in the state prison,
rather than merely authorizing the imposition of the $5 fee.
2)Extends the $5 fee charged by CDCR for each inmate-initiated
medical visit dental visits, and commencing with the 2011-12
fiscal year requires the Department of Finance to annually
adjust for inflation the fees charged to the inmates.
3)Deletes existing provisions of law that provide that an inmate
shall not be charged for the visit if the inmate has no money
in his or her personal account and requires that if the inmate
does not have sufficient funds in his or her account to cover
the fee the account shall be debited and may carry a negative
balance. Any amounts owing must be paid before spending on
other items is permitted and shall be subordinate only to
court-ordered restitution.
4)Deletes existing provisions of law that prohibits the charging
of a fee for any follow up medical visits at the direction of
medical staff, and requires that follow up medical or dental
visits be charged to the inmate in an amount equal to 25% of
the fee initially charged to the inmate.
5)Provides that any negative balance associated with an inmate's
prison account shall be discharged from the trust accounting
system at the time of the inmate's release. The balance shall
be billed to the inmate and shall be due six months from the
AB 2232
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date of release. Any unpaid balance shall be reinstated into
the trust accounting system if the inmate returns to custody.
EXISTING LAW :
1)Provides that the Director of Department of Corrections is
authorized to charge a fee in the amount of $5 for each inmate
initiated medical visit of an inmate confined in the state
prison. [Penal Code Section 5007.5(a).]
2)States that the fee shall be charged to the prison account of
the inmate. If the inmate has no money in his or her personal
account, there shall be no charge for the medical visit, and
the inmate shall not be denied medical care because of a lack
of funds in his or her prison account. [Penal Code Section
5007.5(b) and (c).]
3)Provides that the medical provider may waive the fee for any
inmate-initiated treatment and shall waive the fee for any
life-threatening or emergency situation, defined as those
health services required for alleviation of severe pain or for
immediate diagnosis and treatment of unforeseen medical
conditions that if not immediately treated could lead to
disability or death. [Penal Code Section 5007.5(d).]
4)Prohibits inmates being charged for follow up medical visits
at the direction of medical staff. [Penal Code Section
5007.5(e).]
5)Requires that all moneys received by the Director of
Department of Corrections, upon appropriations by the
Legislature, be expended to reimburse the Department of
Corrections for direct provision of inmate health care
services. [Penal Code Section 5007.5(f).]
FISCAL EFFECT : Unknown
COMMENTS :
1)State Auditor Recommends Co-Payment Program Be Eliminated :
The California State Auditor found that the costs of
administering the co-payment program could not be justified by
the revenue it creates. [See California State Auditor,
California Department of Corrections: Utilizing Managed Care
Practices Could Ensure More Cost Effective (2000) at 30-31.]
AB 2232
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The State Auditor explained, "State law authorizes the
department to charge inmates a $5 co-payment for each medical
visit they request. Beginning in November 1994, the
department began charging inmates the co-payment, although the
fee is waived if inmates do not have any funds in their trust
accounts. The fee is not charged for certain services, such
as emergency, mental health, follow-up, inpatient care, and
diagnosis or treatment of communicable diseases. Despite
initial estimates that the co-payment program would generate
$1.7 million each year, actual collections have averaged
$654,000 per year over the past four years. The department
could not explain how it estimated $1.7 million in revenue or
give us a current estimate of the cost to administer the
program. However, in December 1993, it estimated that the
annual costs to operate the co-payment program would be $3.2
million.
"Based on these figures, we conclude that the program would need
to reduce health care visits sufficient to offset its
operating cost to be cost-effective. Since its inception,
however, the department has not collected information to help
it make that determination. Before implementing the program,
the department completed and analysis that suggested that
requiring co-payments would reduce inmate visits by 50
percent. That analysis further estimated that inmates
averaged about 0.9 health care visits per month. If the
co-payment program actually has reduced visits per month, or
about 5 or 6 visits per year. The department is unable to
demonstrate that it calculates the number of current visits or
that the program has reduced health care visits-in short, that
it can justify the program at all-so we believe the program
should be abandoned."
2)Argument in Support : According to the Howard Jarvis Taxpayers
Association , "AB 2232 would increase fees for inmate initiated
medical and dental visits, and would require that the inmate
be charged even if they insufficient funds to cover the fees.
In that even, any outstanding medical bills would have to be
paid before spending could happen on other items.
"Corrections spending is one of the fastest growing areas of
state government. California spends nearly three times more
per inmate than Texas, which has almost the same number of
prisoners. Much of this difference is due to prison
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healthcare programs. At a time when California is facing a
$20 billion deficit and inmates are being let out of prison
early, we should be doing everything possible to ensure that
our budget difficulties do not intrude upon enforcing law. AB
2232 ensures that inmates take some responsibility in paying
for their own health coverage. This is one of the many good
proposed solutions to lower the astronomical $49,000/year we
currently spend per inmate."
3)Arguments in Opposition :
a) According to the American Civil Liberties Union , "The
Eighth requires that prison officials provide a system of
ready access to adequate medical care. We are very
concerned that the new payment requirements of this bill
will have the effect of inhibiting prisoners from seeking
medical care. This is problematic from a health
perspective, since it acts as a disincentive for prisoners
to seek treatment for communicable disease. It also has
cost implications if inmates to do not seek care the early
stages than and wait until the condition or illness
progresses and requires more intensive and thus expensive
care. We urge reconsideration of this proposal."
b) According to Legal Services for Prisoners with Children ,
"We oppose AB 2232 because it discourages prisoners from
accessing health services, inhibits medical staff from
identifying and intervening into health problems before
they become more acute and potentially much more costly to
treat and unfairly discriminates against prisoners who tend
to have significant health needs and few financial
resources. Additionally our organization has concerns
regarding CDCR's ability to properly manage funds generated
from this co-payment program and, ultimately, questions
whether this bill will actually lead to any significant
reduction in prison health expenditures."
4)Related Legislation : AB 1487 (Hill) would have increased the
fee charged for each inmate-initiated medical visit by an
inmate confined in a county or city jail from $3 to $6, and
required that the $3 fee increase be deposited in the county
inmate welfare fund. AB 1487 was amended into an unrelated
subject matter in the Senate.
REGISTERED SUPPORT / OPPOSITION :
AB 2232
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Support
Howard Jarvis Taxpayers Association
Opposition
American Civil Liberties Union
California Attorneys for Criminal Justice
California Public Defenders Association
California Coalition for Women Prisoners
Family Council
Friends Committee on Legislation
Life Support Alliance
Prison Law Office
Taxpayers for Improving Public Safety
15 private individuals
Analysis Prepared by : Gregory Pagan / PUB. S. / (916)
319-3744