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
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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.
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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
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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
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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
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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.