Senate Budget Sub5 — 2026-04-09

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 Capitol, 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 reentry, and medical and mental health services account for over $4 billion 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 on 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.

Senator Richardson. 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. McRae Poole. We have Orlando Zavala, who's with the Legislative Analyst's Office, and then Ms. Cervantes and Mr. Weinberg, who are both with the Department of Finance. You can begin our Inspector General.

Thank you very much.

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 authorities now codified in the penal code. And we carry out this mission by evaluating the quality of the medical care each of California's 31 prisons provides. 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 six-month period or during significant events. And we've, for the first time in cycle seven, 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 7 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 8 of those 31 institutions passing that component. We will be, in the next few weeks, publishing our Cycle 7 summary report, which will, for the first time, contain analysis of both those cross-institution trends in Cycle 7. 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. And 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 nine will be less than three years. Thank you for your time this morning, and I'm available to answer any questions you may have.

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

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

Thank you. Thank you, Madam Chair. I have some questions on the intake processing unit. The complaints doubled in two years. So which of the types of complaints are driving it's over 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?

but considering you gather that information what are the types of complaints that you can see are driving this double this 100% increase what types of complaints the two greatest numbers of complaints we get our issues with conditions conditions at the prisons and staff misconduct okay and so are you Are you identifying any systemic, are these systemic? If you don't classify them as either systemic or just one individual complaints, then how do you move forward with solving the problems?

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

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

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

the there's there's the least number are passing with proficient correct

You can see fewer inadequate ratings for individual indicators over the three cycles,

what are the barriers that are they are facing so it's actually currently three

a matter of time or are we really facing more serious issues in those three

of other information they use and we have no control over that okay thank you

a little bit of our complaint load, because it is exploding, as the Senator has said. Do you keep track of what percentage of those complaints actually have validity to them? Because I know when we have an anonymous complaint or, you know, 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 how much of that is part of that complaint load?

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?

So 90 of the complaints could be trivial at the end of the day I hesitate to say yes but no I don believe that 90 are trivial Let's not use 90%, let's use 50%.

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, wow, 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 whoever.

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 in a more robust process, and the ones 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 some problems with 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 CDCR employees are monitored and disciplined and all that, we kind of need to know what, you know, how much of this is valid versus 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 identifying a real problem with our personnel Whereas if a lot of it just retaliatory type of stuff that tells us that they are doing the job and a lot of what they dealing with is 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, that happens with patients when you're dealing with a fire service or police misconduct or any of that. So I think we owe it to our employees to ensure that we are just not taking in all these complaints and treating them, or not having the work done to determine that, hey, this is not true.

So you do the intake specialist part and then let them do the investigation part. Okay, another question. This is kind of 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 to monitor how SB 132 has affected our female populations for our female prisons? Is that in your land or is that in somebody else? Because there are complaints.

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.

Okay. But you are responsible for the complaints that are generated from that program?

Okay.

Okay.

I have a couple questions. 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 health care 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?

Okay. So let me give you an example. Unfortunately, I've spent more days more lately 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 nurse is, 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, they have a little cart thing that produces out the medication, and it really helps to expedite some of the process.

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 going to 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 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 mr. Ciardo was saying you know and I've been in a few in my oversight capacity want to 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 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 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.

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 their person's cell area. So I think we really, it is warranted to have a little more information, and I concur with both my colleagues that that's needed.

resolve all complaints within 30 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 handled right away some of the ones that are lower priority like a priority three if I didn't receive my quarterly package those but everything is responded to within 30 days okay and I understand 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 where their phone email letter and then the Department of Corrections has their own process where people can submit citizens complaints or the incarcerated population can file a complaint via the 602 form that 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.

you say are in your priority one category I do not have that information

process is written in our statute so we are statutorily required to provide this service forever.

Thank you. Alright we'll now move to issue number two which is the healthcare overview with the following panelists. We're going to have Dwayne Reeder, Deputy Director of of fiscal management of the section of the California Correctional Health Care Services. We have, is it Jeanine 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.

You think you have challenges.

Tipped the cap there.

That's looking to save us $10 million this year is what we're projecting in savings due to the rebate program in pharmacy. and so we really you know 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 the big efforts in the receivership was the healthcare facility improvement program, HICFIP. That should be completed in the first half of 2027. We have three institutions left to complete. So making progress and that, you know, that was a big thing for the early receivership was getting our facilities and our clinics up to modern standards and 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 3rd, is a huge medical facility. I don't know if you've been out there, but it has over 1,000 inpatient beds. It's really our healthcare institution, if you will. And we were California health care facility in Stockton. And so delegating that was really, I want to say impressive, but I don't want to pat myself on the back. But it was a big leap for us to get the health care facility delegated. That was a big institution for us. So we have three more to go, and we're hoping...

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 HICFIP coming to an end is a big milestone So the receivership continues to progress And after we delegate the last institution there 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 the CalAIM program. So Janine is the deputy director of the CalAIM program, and so she's going to give you an update on CalAIM.

L.A.O. 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 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 20 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 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 kind of heard we're getting close and close, 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 facility. As of now, the mental health receivership, 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. 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. Senator Durazo? Questions?

I'm not sure I understand the question, why is it taking longer?

So the institutions have to be inspected. They have to raise their operations above that inadequate. As Orlando mentioned, there are other factors beyond the OIG that the receiver considers for delegation. But essentially, it's getting them to the standard that they need to be at in order to be delegated. So it's taken longer at a few institutions as they are challenging environments. When you look at CSPSAC 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 you know ensure that they're operating at the level that the receiver requires.

You know, I'll go back and maybe share. 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.

I mean, that's at the point where they actually connect. 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.

So 59% have had warm handoffs with the community, with the enhanced care managers. CDCR or CCHCS, we do an embedded model. So we are able, prior to CalAIM, we connected patients to the community providers as well. And so we're doing that. I think mainly there's some capacity issues in the community that we're working with. 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.

Yeah, we continue to look at federal funding opportunities. We look at our own policies that possibly could be driving additional costs. We've been doing a lot of review over the last few years with the downturn in the budget. We have been really scrubbing our financials, scrubbing our operations, and looking at things. As far as patients in the community, we had 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 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 levels that can cause concern when folks move to the community as well. So there's some layers in there. But we do try and look at alternatives to housing them within since it's so costly.

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 It averages to $550,000 each a year, including an admin support position that's $312,000 a year. So that's $5.5 million that we're paying for receiverships. These lawsuits were filed in 1990, in 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?

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

Okay. I'm kind of picking up what you're meaning. 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 $8.2 million a year. And that's, for me, it's like, okay, so the Coleman one was, what, 2021, we finally wound up with a receivership. So they had almost 20-some-odd years to address it, and they didn't, 30 years. Yeah, I know one of the major goals or one of the major issues has been vacancies.

I think I might go apply 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 I would think somebody would be telling us every year hey this is a court order we have to get these things done 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 what?

I'm talking about the people before the receivers. Oh, people before?

This is just like super inefficient. 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 when we just kick the can down the road, we wind up with receiverships like this. They're horribly expensive. Where we could be putting those dollars into either the projects to correct the problems or whatever. we shouldn't be paying somebody eight hundred and seventy thousand dollars to be the overseer of the receivership that ridiculous so hopefully we get some honesty from our get some better action as far as what we need to do and how much it going to be and when we can get it done by so that we can kick these folks back out of the state I want us to be able to run our own stuff and do it the right way. So thank you.

Thank you very much.

About 31?

When CRC closes in the fall, it'll be 30. Okay.

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

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, 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 Sacramento 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.

There's 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 722 inpatient beds.

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

Dr. Kanan is over the clinical operations. She's the director of her clinical operations, so we'll let more of an expert. Good morning.

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. 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 teeth and eyes and all of that stuff. However, if we have 10 prisons that are providing care for approximately 9,000 to 10,000 people, and if each prison holds approximately 3,000 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

Yeah, perhaps.

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.

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

Thank you, which also would apply to Next issue. Yes. Okay. I had another question. You talked, Mr. Reeder, about the process of contracts, these special contracts of bringing people in due to your vacancies.

maybe they can also assist. 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.

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?

Correct.

Okay, thank you. Yes ma Senator DeRosso A quick question maybe it for the LAO or anyone else Have we ever done a report on what these three legal cases have cost us an additional cost

What additional, you know how 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?

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, Duane. Good morning. My name is Alyssa 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. Nuscent civil suit, a federal court appointed a receiver in September of 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 with NCDCR in a fiscally responsible manner. And with that, I look forward to answering any questions you may have. Thank you.

No, I have nothing specific to add, but I'm happy to answer any questions about the Telemental

That's it? Sorry, sorry could you repeat the question? I just said we had a pretty

VCP I wasn't sure if Dwayne was going to to walk through it similar to the

to hear that no sorry it cut out okay I also can only see myself so I apologize

Yes, I did. And I happy 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 Yes please if you could

So the BCP request, $33.9 million for 2026-2027 from the Mental Health Special Deposit Fund. It primarily includes two parts. So one, as referenced previously, was the receiver's office, which are non-civil service positions. That totals $8.2 million 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 will be 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 $25.3 million to make bonus payments permanent per court order, dated on August 27, 2025. And again, none of the funds being requested are from the general fund for 2026. They would all be coming from the special deposit fund that was an accumulation of fines.

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 150 million collected fines from the state's general fund. And that's what's being used now to pay for 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 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, they've submitted budget requests to this committee, and they've made modifications 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 second, we also recommend tracking the progress towards exiting. And then it could do so through annual updates, these budget hearings, as well as the mental health receivership extent. It's important to exit this receivership because it shows that the state continues to be out of compliance and it's not providing constitutional levels of care. And the state cannot have full autonomy yet of that delivery. In addition, it's likely that costs could go up beyond the current estimate we have in the current proposal. For example, the mental health receiver has indicated potentially 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. We call them health care facility improvement projects or HICFIP. Those totaled about $1.5 billion over and are still ongoing, those projects. And given that the state is facing multi-year budget deficits, these newly incurred costs would exasperate that budget problem. We also want to highlight that under the existing timeline for the mental health receivership, they're projecting about five to seven years to implement its goals and plans. But we want to be cautious about that. It could extend longer. The clearest example we have is on the medical side. In the past 20 years, we've heard at various stages that it could be coming to an end. And some of these timelines can extend further because of the challenges. And this court case has already been 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 third we also recommend the legislature Direct CDC are 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 for the legislature and in there we we have some of the recommendations you've already alluded to which increase recruitment from out-of-state for licensed 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 tele-mental 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 want to highlight for the legislature to monitor the impact of the salary increases, for example, and how effective they are. Right now under this proposal, it's about $25 million making those permanent. This can be done by tracking how effective 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 the staff But as of now in our report we highlight that the legislature can has the ability to increase salaries even beyond that But 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 tele-mental health piece, either now or at a later time. But thank you.

Yeah.

Happy to. We recommend approving portions of this proposal, as it may help fill vacant mental health positions. So this is about 8.9 million in 26-27, growing to about 13 million in the out years and ongoing. And this would redirect about 100 positions at the prisons to become teleproviders. 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 directs CDCR to reduce the request and CDCR's baseline. We find that the request is based on a previous telemental health racial system where it's a one-to-one. And there's one provider, for example, a psychiatrist or psychologist, and they have one person at the prison who helps. While it's not clear that each provider needs a full-time medical assistant person, because it's possible that a different ratio could work out in this scenario, we know that mental health providers often 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 one-to-one makes sense to cover those bases. 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 then slowly ramping up until it reaches those since those might be more amenable to this modality. And then taking steps to increase telemental health. This would entail 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 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 work So thank you and happy to provide any more context on either those or any other questions.

Hi, Ryan Weinberg, 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 pose 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 CDCR could implement on its own. With that, happy to take any questions.

based upon the LA or Department of Finances report I don't have any additional comments at this time beyond what was already expressed all right I

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

I, 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.

No, I didn't have anything additional 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 do any adjustments to that ratio.

Thank you, Madam Chair. So the state accumulated $160 million plus in fines for 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 therapists can fill you know multiple roles within our system

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, $160 million in fines, it says, I guess it's primarily or mostly for failing to keep these vacancy rates below 10%. Am I understanding this right?

That's still a very significant money to fill positions for jobs that at least one 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.

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 prior to last year. And the other, yeah, just wanted to add that piece of context.

Alyssa, would you like to take that one?

So we have, we have, we can get what the action plan is and what the benchmarks are going to be?

Okay, great. Thank you.

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.

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 what you know what our need is yeah so that evaluations happening by the receivers office and as they complete that evaluation we will come back with proposals to adjust that funding

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 exit surveys.

Because I realize 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, you know, I'm kind of, 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 professionals, they all do different things. One is an expert in the marriage and family counseling. Another might be an expert in psychotherapy. 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 stop finding you because that just to me it not fixing the problem it just making numbers um it was allowed by the courts um so i assume they meet the mission but i don

It just seems absurd to me to be fining 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 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. That's kind of absurd. So it looks like you're just way anxious to answer a question.

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 end meant and psychologists and

vacancies. One thing to add, Senator, the fines are no longer active, so we're no longer being fined for our vacancies. That's good to hear. Thank you.

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.

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

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.

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

We're going to need an additional meeting to delve into this a little bit better. Of the 35,000-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 1 mental health issue? In the appropriate level of care? Type 3?

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.

I can provide, in looking at this through our report, Orlando Sanchez with the LAI. I CDC are kind of separates people that have a diagnosed mental health need into kind of two parts. There's the now patient. 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 then there's the inpatient setting. and that's where folks may require 24-hour supervision for various reasons and more intensive supervision for their mental health need. And the majority, over 90%, I believe, I don't have the exact breakout, but it's in the outpatient setting and a smaller portion are in the inpatient setting at the prison. That hopefully provides some context.

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 share that information once I connect with them. Well, I'm not just talking about the evaluations.

They're really taking over for the Office of Special Master. The Office of Special Master was around for 20-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 kind of 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.

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

allocation. For 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 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?

The legislature previously approved about $3 million. How many?

That was specific for staffing for the Office of Special Master. I'd like to note that the receiver's proposal includes additional costs associated with benefits for bonuses being made permanent for the actual clinicians doing work. But that funding was added to CDCO's budget. It was viewed as part of the legal cost at the time. So it's currently still part of CDCO's budget. Since the Office of the Special Master is going away, that will be addressed as part of a proposal as part of the mayor's vision to reallocate that funding.

So we 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...

Totally understand.

Okay. Seeing that, that we finish issue three, I'm told that the subsequent issues are going to go 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. Dr. Kanan, 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? All right. Thank you. Thank you. And Mr. Reeder is still here with me. Thank you.

All right. I appreciate it. Okay. The floor is yours.

Oh, yes. Yeah, it was quite a while. Here we go.

Thank you.

Thank you. Thank you so much. Did you have anything you wanted to add, Mr. Reeder?

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

Would you like to provide us with those other costs are?

Thank you. Department of Finance.

Okay. Thank you. Senator Durazzo.

Health care services manages our federal reimbursement and so we've spoken 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 get any we had no success is that not something that the state could change It federal Medi is federal reimbursement It from the federal government

Well, there's federal and then there's state. Yes, there is some Medi-Cal, but essentially we'd be seeking federal reimbursement for these folks in the community, similar to what we do when they're in the hospital for 24 hours. So we collect if they're in the hospital for over 24 hours We can get federal reimbursement for some of those services and some of the stay So we we collect over 40 million dollars and federal reimbursement each year for over 24 hour stays But it does not apply to this population

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. 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 dollar amount. And we could go back to 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.

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

Excuse me? Eventually it could cost less.

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

Well, again, what we're currently doing, I can tell you on our health care side, and 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, 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 no longer posing a risk to society we are still challenged often finding post placement for

sentences that got reduced. I think we'd need to analyze that in terms of, you know, sort of the risks and the benefits by changing any kind of sentencing requirements or age. Thank you.

Absolutely. 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 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 the labor costs related to custody and some of the additional staffing requirements we have 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.

So you know I agree with you but I think currently in our situation when you 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

Again, it's the misnomer. 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.

That's what I'm getting at is and if those are the avenues that we need to look at,

Well, that also means that there's less risk of them doing the things inside the prison walls that we need all of the guards and the custody officers and all of the infrastructure needed for, say, a level four.

And we do have that continuum of care, right, particularly at some of the institutions we were talking about, where people sort of age in place, and we do have that continuum.

Okay.

Look forward to it.

Okay.

Thank you very much.

So I'm not an accounting expert, so maybe Mr. Reeder can help me.

So this isn't even the other costs, but health care related costs. And so I think if you start from left to right, it's probably not shocking. You know, that very light blue, the custody, guarding and transport that is going to go up right as you get older, because they're transporting you to the emergency department, hospitals and specialty specialty services and consultation. So as you get older, it absolutely correlates with more costs there. And then patient-specific claims like specialty services, ED services, ambulance, hospital, and pharmaceuticals, of course, that is also going to go up as you age. So then moving to the health care beds, that also is going to go up because these individuals, as they age, disproportionately use our health care beds, and that's the labor costs, right, of running those assisted living, the memory care units, the hospice, what we call CTCs, correctional treatment centers, which are licensed under Title 22. So that also makes sense, I think. And then other health care labor costs, it doesn't go up quite so much. And then there's really this health care overhead. and you know essentially that is non direct patient care labor costs by by and large at the institution region and headquarters so admin executive staff really non direct patient care and essentially as your kind of direct costs go up and so this this group of people contribute a fairly large percentage of the direct costs and so that's applied to the overall overhead costs and so it

acute you know center where those same services are provided so if you could

Well, look, I know when we looked at expanding medical parole, we did some comparisons to the community and the contracting, but that was a few years ago, so let us see what we have,

Certainly.

Yeah, I can circle back with our health team, see if they've done or have any access to any costs related out in the community, and maybe some of those could be compared to these figures here in this AB 108 or SB 108 report.

oh I don't have that type of specifics I'm just aware of the case

But I'm happy to take some questions back and get you some responses.

From my perspective, I think the examples that the report really illustrated were more people who, just with the current laws and regulations that we have, qualify for compassionate release. They're absolutely appropriate because they are going to die in months to a year, and they are frail and don't pose a risk, or they're permanently medically incapacitated, or the board has determined that they are suitable and do not pose a significant public safety risk. But again, the challenge that I highlighted over and over is, even if these are appropriate, without changing the age or how long they've served their term. And just within the rules that we have, we cannot find places for them because of residential restrictions, GPS monitoring, and we don't have the incentives for these community providers to take these justice-involved folks.

With that being said, we're going to move to issue number five, which is the community reentry programs for supervised persons. were joined today. Mr. Reader, are you sneaking out? We still have three more. Are you done? All right. Or I think we have two more. No, three. We have five, six, and seven, potentially. So we have Ms. Bebe? How do I say it? Bebe. Bebe. Okay. We have Ms. Bybee, Ms. McLean, and then we have our regular individuals who have been really hanging in here. Make sure you let me know if you need a five-minute. We would certainly comply. With that, we'll go ahead and get started. Good afternoon, members.

Thank you. Do you have any comments from the LAO's office?

And without this study, it's difficult to assess which programs are most successful and how to target funds. As such, we recommend requiring CDCR to evaluate all of its parole rehabilitative programs, including the ones that are not being funded by this proposal, to determine whether they merit continued support or need to be restructured to be effective. We also recommend the legislature consider funding on a three-year limited term basis instead of ongoing. This would provide enough time for an evaluation to be conducted and also making programs that were previously funded also limited term to maintain consistency. And then this would position the legislature at that time to have better information on whether it wants to continue funding these programs based on the results of those studies. Thank you and happy to take questions. Thank you. Department of Finance. I'll to go to my colleague on this item. Thank you. Thank you. So, I'm sorry. Good afternoon. Hi. Josh Whitmer's house, Department of Finance. Good afternoon, Madam Chair and members of the committee. We just want to address the two recommendations by the LAO in this proposal. The first one being their recommendation to require external evaluation of all parole programs these specific contracts with external researchers are not included in the governor's budget but we look forward to any conversations with the legislature on potential avenues for evaluating cost-effectiveness with these programs as we continue through the budget process we also wanted to address the recommendation to consider limited-term funding for these programs we'd like to note that parolee or parolee community reentry programs are operated through multi-year contracts and And uncertainty around the continuation of funding for these programs may prevent CDCR from renewing contracts, continuing to provide programming. The LAO noted the potential for disruption of services. And ongoing funding for these programs and the methodology that we've presented to this proposal, we presented the same methodology last year in the 2024 Budget Act as well. This methodology is restoring confidence in the providers for these rehabilitative programs. and limiting funding to three years would potentially jeopardize the department's ability to secure future contracts and exercise the ability to utilize the additional years of signed contracts with these providers. Happy to answer any additional questions. Thank you. That's an interesting perspective. I think a lot of providers would be happy with a three-year contract. That's an interesting perspective. have the programs always been no limitations at all Sorry, can you repeat the question? You just made a comment that you felt that by having three years, it might hinder individuals for wanting to provide the service. And I said to you that from, you know, nonprofits and people that I work with, a three-year contract is not a bad thing. And so my question to you was, has it always been an infinite period of time? Or were there ever times where there were terms? So baseline funding for these programs has existed. I'm not sure exactly when the programs began and when funding began for these programs, but it's been a long time since we right-sized the funding for these programs. As costs of operations have increased over time, we developed a methodology to attempt to catch these programs up, and that's what this proposal is for. But didn't I just hear you say the LAO recommended that the term be three years versus ongoing? And so you said that you didn't agree with that. And so I'm saying, why do you think three years? I mean, I heard what you just said, but, you know, three years isn't a short period of time. So often these programs, and my colleague from CCR can chime in if they want to. Thank you, Teresa Bybee, Deputy Director of Division Rehabilitative Programs. Most of our contracts are three-year terms with optional one-years. I think where the challenge of the limited-term funding comes in is that a lot of contractors may not want to bid on our programs if they don't feel as if there could be an ongoing consistency or ongoing funds for the programs that they are providing. A lot of times there's cost incurred to find facilities that meet the needs of our requirements. And in order to get maybe lower costs for those upfront costs that they're incurring for these facilities, if there's a potential that this program could go away with no other option, we may find ourselves in the same position where we do not receive any viable bids moving forward. Okay. All right. Not sure if I agree, but okay. Thank you for the answer. I appreciate it. It helps to clarify. Thank you. Mr. Ciardo, did you have any questions or comments? No. No? Oh, wow. Okay. I had one for Senator Durazzo. She had to grab her flight. Does the CDCR and DRP contract with for-profit providers like GEO Group and Y and for which programs? Good afternoon. Yes. At times we do, we follow the state contracting requirements, which has the department secure the most viable bid at the lowest cost or request for information, so proposals. And if by chance one of those for-profit entities is the lowest viable bidder, or in some cases the only bidder, then they would in fact receive the contract. And earlier the question, this is now my question. earlier the LAO discussed the fact of evaluating how effective these programs are it would seem odd to me that you would be having contracts going out to bid and not evaluating the success of the programs is that not correct or do you have a process maybe you could describe for us what your process is so within the department our office of research has conducted recidivism reports specifically for our stop program which has shown a much reduced recidivism rate for those who completed one of the modalities within. So it does show that within these post release programs that they have been successful in reducing that recidivism and therefore successful. In addition to that our division consistently works with the community providers and looks at program successes potential modifications to create even more efficiencies we look at participant data and things like that on an ongoing review basis to ensure that we're always modifying the program for anything that could enhance those success rates so mr. Savala could you explain what then other than what she just said you're suggesting that they would provide right and I don't mean to put people on the spot but I'm the kind of person is of if you say something and you say something let's just get to the end of it move on I don't want to keep going on and on and on so it's not personal it's just I like to deal with it so I can move we're aware of the recidivism reports and what they show so one of the deficiencies or what makes it hard to review those reports is that they don't have a comparison group that's comparable that are receiving these services it could be for reasons that people self-select into these programs that are already not going to recidivate and these evaluations recidivism reports don't tease that out and and that makes it difficult if you're getting kind of the best performers enrolling in these programs completing them and it also doesn't have how many people complete the programs which ones don't and and And some of those make it challenging to know if a person would have completed the program, what outcomes would have been achievable on average? And we think partnering with an external researcher that has had experience in doing evaluations like that would be useful for the state as it invests more money in these programs to know which programs are more effective. Are there some that work better than others? are they leading to the outcomes we desire or in some cases a simple comparison between those who participate and those who don't aren't able to tease out kind of those nuances that we might want to invest in and look towards. Okay, that makes sense. So you heard his response. If you could provide back an answer of whether you do or you don't meet those other factors that he's saying is not available, and if you don't, tell us why, or if you do, how you do. Is that possible? Yeah, I think working with the administration, the LAO may be gaining a better perspective of the very specific points he's looking to gather information on, may be helpful to provide additional information on the specific points or populations that he's looking to get information on. I know for a lot of our programs, it's those with an identified need that are placed in these programs for success, not necessarily the best performers. I'd have to get more information on specifics. The reduced recidivism amounts are against the general population that releases, so against the total population that complete these modalities. And within the report on our website is if you fully completed a modality, if you partially completed one for the various modalities, what the success rate was per type. And so I can absolutely provide that information as well but willing to have those conversations again with the administration and the LAO to get more specifics on what the intended purpose of the research would be Okay So if you all could do that and then get back to the committee with the answers Thank you. Okay. Seeing no further questions. Okay. Thank you. With that, that concludes issue number five. Issue number six we have is the California Sex Offender Management Board Operational Budget Augmentation. We're joined by several people here, the ones in front we've seen, but Dr. Heather Boulds, and again, Director McLean. Good afternoon. Again, Madeleine McLean, Director, Division of Administrative Services for CDCR. We are requesting $450,000 ongoing to maintain operations for the California Sex Offender Management Board, known as CASOM, and the state-authorized risk assessment tools for offenders review committee, known as Serratso. Both CASOM and Serratso provide certification, training, and compliance audits for sex offender treatment programs. and this funding will support the maintenance on operation of the provider certification system and cover rising costs for training travel and public meetings that are required by law joined with me is dr. Heather bolds deputy director for division of parole operations here to answer any questions that you may have okay thank you did you have anything you wanted to add or you're with finance okay perfect ma'am did you have anything you wanted to add even without us asking questions because this is our last issue so okay got it all right laos office thank you madam chair Orlando Sanchez again with the LAO we recommend approving on a one-time basis to maintain services in addition In order to reduce the general fund cost of these agencies, we recommend directing them to provide a new funding plan by next year, describing how they could restructure their operations and registration fees in order to avoid the need for the ongoing requested amount, require less than their current general fund baseline, or require no general fund support. the information the legislature needs to reassess the level of general fund support these agencies need when the temporary funding would expire under our recommendation it's our understanding that the fees haven't been revised for some time they were established in about 2010 so it's not clear to us whether that's a viable option as of now thank you point well taken department thank Thank you, Kyle Gaiman, Department of Finance. We certainly appreciate the LAO thinking about fund sources and ways to relieve pressure on the general fund. We have thought about this as well. And I'll provide just a couple more points on our thinking as to why we disagree with the one-time funding approach or requirement to put forth a formal plan. First to start the program, which I'll note too, the program is very, very small. It's only five people in this program that run it for the whole state. So they run very lean and we're trying to help them find ways to support their travel costs with this. The program has already committed to discussing provider fee increases with the boards with the case on the Saratso boards who are the ones who need to approve that. And because that's already in progress and finance has already requested that they report to us on how those discussions go We happy to provide that information to the legislature as we receive it without requiring this very small program to go through a formal plan process We think we can get the information we need more informally And then on the potential for fee increases to help offset general fund, it's very unlikely they can be raised to the level to cover $450,000 a year. Right now they generate about $50,000 a year to help offset some costs, and they would have to be raised nearly tenfold from the current levels to be self-supporting. I'll note, too, there's nothing in the history we looked into that KSOM and SRATs were ever supposed to be self-supporting types of programs. They provide work as required by statute, just like other areas of CDCR working on sex of 100 programs, and those are all general fund-based programs. And to give the committee just a little sense on what fees could possibly be raised to, if we were to raise them in line with CPI, they could generate potentially another $25,000 a year, somewhere in that range, maybe upwards of $50,000 if there's justification for raising them further. so these could certainly be used to offset some costs or potentially used for items that are less structural in nature things like research projects education efforts that they try to do on a every other year or so but are not required to be done by statute every single year so lastly I'll just note that the program when we spoke with them again they run very lean they do a lot of work and they have done what they can in recent years to control their costs but like every agency they're getting to the point where it's difficult for them to hold the required trainings and the amount of travel and support the boards in the way they need to per statute and that's why we are proposing ongoing general fund for them. Thank you. Thank you. Mr. Well that was finance. Mr. Ciardo. Real quickly we've had some issues recently related to sex offenders especially offenders that were targeting minors and they've been paroled and I think everybody's read about it. How do we get better decision making and also what do we need to do? I think it's not decision making. I think the last panel framed this very well. They were working within the framework that we have given them. We can't have a framework that allows somebody who admits to still having fantasies about molesting children to be eligible for parole because he's got some kind of internal management program that he states. So what do we do to reform the state's elderly parole process to ensure that the offenders who continue to pose a threat, based on their own admissions, don't wind up being released because we have to, or because it's within the guidelines of what the state has put forth? I'm hoping that this board can make some recommendations to the legislature, because otherwise you're going to get a bunch of bills with their own darn recommendations. But something has to change, especially in those type of specific cases where elderly parole is not appropriate for those type of individuals. and so hopefully we can get some Some recommendations from you guys about what needs to be tightened up on our end so that you're able to do the job appropriately or whoever is making those decisions can do the job appropriately. I didn't mean you. I mean the decision that gets made that allows them to go out like that. That's what we need to work on. Thank you. Did we get an affirmative response that someone would work on that? Good afternoon, Dr. Heather Bulbs, Deputy Director of the Division of Adult Parole Operations. In terms of the board, what I can do is take that back to the CASOM staff as a suggestion for a topic to be discussed. The board is a begly keen open to the public, and so we do need to make sure it's part of an agenda. Thank you. My only question would be, I don't believe that the LAO suggested a 100% fee increase, but a possible fee increase might be considered. So if you could come back with what might be deemed reasonable or maybe there would be some sort of tiered, you know, something we could implement. But even $25,000 is more than what we have and is more than what could go in another area. So we certainly, I don't think anyone is suggesting all programs are self-sufficient. We realize that that's not the case. That's why we exist. But certainly if there's any help that could be reasonably done, that wouldn't impact people being able to actually take advantage of the service should be considered. So if you could come back maybe with something you might want to suggest that could be included. And I did see the note about the trailer bill language and all that, which we will be doing. So had you had any thoughts about that of what might be able to be considered? The CASOM staff is currently doing market research with other agencies that provide certifications. They're putting together those proposals, which will then be taken in front of the CASOM board for them to discuss and ultimately vote on. And then at that point, we would be able to have discussions and know what those fees would be and next steps in terms of trailer bill language. There's a recognition that those were put into place in 2010. Obviously, things have changed. I'll just say that one of the things that KSON wants to very thoughtfully think about is even with knowing that an increase needs to occur, we want to be mindful of making sure that it's still available to all potential providers, large and small, to not limit any resources. Agreed. Of course, we always have to find that balance. When do you think you're going to have that information? Is it going to be in time for us to incorporate in our trailer language as we do operate on a calendar schedule? The next board, it's not on the agenda for the next board, and then they, I think, have a couple of months off. So I'm thinking that it's a couple of months out before the board will be able to hear this issue. Is there a reason why it can go on the current agenda? Are you still within your time frame of reporting? I can take that back to the ASOM staff. Thank you. Thank you. All right. Any further questions? Okay. Seeing none, we're good? Yes. We're going to now go to public comment. Thank you all for your patience in participating with us. Before we move on to the thank you for your participation all of you Before we move on to public comment do members have any questions or comments on any non items on the agenda Seeing none we going to move forward to the public comment to ensure that everyone has a chance to be heard Please limit your comments to one minute We're going to give you 30 seconds more than sometimes what we do so Hopefully you will keep it to the one minute we will be timing it so because we have everyone has flights and things to do. So I heard that. So please keep it to the one minute time frame. Go ahead, sir. It's nice to see you again. Nice to see you again, too. Thank you, Madam Chair, Senator Sayarto. Just connecting this to issue five of people getting out and participating in programs and their success on parole. We're here to advocate for the right grant, which we talk to about every year. We see it as a way of preparing people to be able to proceed to you know be successful in their post-release programs. So kind of like pre-reentry. Thank you again for your support all along. Appreciate it. Nice to see you too Madam Chair. Nice to see you Mr. Senator Sayardo. Also here to speak on issue number five representing TPW today and the right grants and when When it comes to reentry, definitely it starts with the programs inside. I am a beneficiary of them. I'm a former lifer. I've been home for almost eight years now. I have not reoffended. I have, you know, been an upstanding citizen. And I attribute that to all the programming that I've taken that prepared me for everything. And I also would like to make the point that I came home 15 years early. I saved the state at least two million dollars just myself and I think that you know when you think about all the lifers that have came home you you know invest invest in the right grant you're gonna get a one heck of a return on your investment and thank you good afternoon setters thank you for having us my name is Adrian Torres I'm formerly incarcerated myself I did 26 years in nine days I just got released about three months ago and I'm here representing as a credible messenger for TBW asking that that you would vote on the right grant because the committee-based programs that go inside is what changed my life a group like grip who is also here today was able to show me what my faults were excuse me what the behaviors that I was displaying where they were coming from and as they were able to give me that information and allowed me to grow through them I was able to utilize the other groups that TBW represents through the right grant to be able to build a solid foundation for me to be able to show the board that I was ready and as I did that they were able to release me a person that wasn't meant to be released originally from my crimes but they saw that I had changed they saw that I had value and they saw that I would contribute to the community which I had been doing now I work for organizations I work for organizations that go in there and do the same thing that they did while I was in there and I just ask that you would continue to support and vote on the right grant thank you hi Kasha Hunt here with political solutions I'm here on behalf of the California marriage and family therapists we just wanted to say thank you for having this conversation tying it into issues two and three there is often sometimes confusion about marriage and family therapists and what are they qualified to do And can they only do marriage and family therapy and we like to say that we therapists for everyone We have over thirty nine thousand qualified in-state, California licensed therapists here many of who have had extra Qualifications taken extra courses and are currently working with the jailed population and parolees and we really look forward to expanding that to the CDC are we started communications and are grateful for today so we'll continue those communications and work with the CDC are to share our resources with them and just really grateful for your commitment to continuing to look to the in-state licensed professionals to fill these vacancies rather than looking to the out-of-state professionals thank you good afternoon Courtney Hanson with the California Coalition for women and prisoners really appreciate today's discussion especially around how to incentivize community-based care regarding the high-profile case currently being used to unfortunately further limit elder parole people with sex offenses coming out of the elder parole program have a zero percent recidivism rate so while these topics are obviously extremely sensitive we need to insist that policy and budget decisions be based on data and science and the best budget solution to the crisis of mass incarcerating elders remains bringing more people home and investing in infrastructure and quality jobs outside of the prison system. People age out of crime and people who have served lengthy sentences do extremely well when they come home. And earlier, Mr. Ciardo, you talked about SB 132. I just want to say on the record that trans women are women. Trans women exist and they deserve dignity and safety. And if you're concerned about the grievance process inside being weaponized, Yeah, speak to the chair. You're not supposed to direct any comments to members and please don't refer to him by name. Okay, no problem. But I just want to highlight that issue of grievances being weaponized is a real issue and trans women are a primary target of that. Staff encourage this divisive behavior and staff continue themselves to perpetrate rampant sexual abuse in the women's prisons, which is well documented. Thank you. Thank you for your comments. Good afternoon. Dax Proctor on behalf of California United for Responsible Budget. In response to Issue 5, CDCR's SB 108 report makes clear the implications of the aging crisis in our prison system. Our prisons are becoming nursing homes, burning precious taxpayer resources without any public safety benefit. This current situation is guaranteed to worsen without real budgetary oversight and legislative action. CURB firmly supports truly community-based solutions, not under CDCR's authority to address needs raised in the SB 108 report, including a comprehensive review of each elderly and medically frail prisoner and identifying who can be released immediately. Memory care, assisted living, advanced diseases, and dementia care should all be provided in the community, not inside prisons. we must ask ourselves why are we continuing to lock up these extremely low-risk individuals? We also support investments in accessible housing that can accommodate the aging and medically complex population and ensuring that barriers in existing release programs such as elderly parole, compassionate release, and medical parole are urgently addressed by the legislature. Please summarize. I wholeheartedly agree with Senator Richardson proposal to consolidate the prison system that came up today during issue two Thank you Thank you Good afternoon Good afternoon My name is Jesse Estrada I been almost three years and it took me a little while to get out The first time I went to parole board, I got a tenure denial. The second time I went, it was a three-year denial. And the third time I went, I got it right because I got myself right. And I'm here to represent the Pathway to Kinship, which has allowed me to have critical insight. And I know these programs work because I'm living proof. I've been almost three years, and I'm a substance abuse counselor, and I'm asking you to help us get support for the right grant. Thank you. Thank you, and good luck. Good afternoon, Madam Chair and subcommittee members. My name is Leonard Rubio. I am here to speak on Article 5. I am a former lifer. I have been home over 16 years now. The last eight years, I have been the executive director of the Insight Prison Project, one of four founding organizations of TPW, which now has over 100 organizations that are doing work within the prison system. And the Wright grant has been very beneficial in helping us to be able to continue offering programs inside. And so I want to ask that you please support that. Thank you very much. Thank you. Congratulations on your success. Yes. Good afternoon. Norhan Abulail with transformative programming works. Also strongly urging the legislature's continued support of the right grant. These programs have been proven to be very effective. They have an average recidivism rate of 21 percent compared to 45.6 for those who do not participate. And they're also very cost effective as well. So urge your support. Thank you. Thank you. Good afternoon. My name is Raven McCullough with the California Coalition of Women's Prisoners. And today I really wanted to focus on the elder parole release. One of the folks who are not represented here are some of the women that are currently incarcerated, so I just wanted to read some of their testimonials. And so we have Joan Lisa Red Cloud Featherston. She's 65. She's at the CCWF. And she says, what is health care like in prison? Slow acting. And once you do get a doctor that gets to know your medical needs, they leave. I shouldn't have to worry about my safety here. Let me live the rest of my life in dignity and grace, please, with respect and in peace. This is what most of our elderly want for the remainder of our lives. We also have Stephanie Lazarus, who's currently incarcerated in CIW, age 65. To see many of our elderly struggle to walk into the shower room, child hall, self-help groups, or to church saddens me. It made me question why the California prison system continues to house elderly women in prison when they are no longer a threat to anyone but themselves. The reason to incarcerate an individual is that they are a threat to public safety. Women over 55 have the lowest recidivism rates. Please summarize. The people of the state of California and the state legislator need to seriously consider why we are continuing to incarcerate the elderly. And so I just want to end this with, despite the constitutional right, to care a lot of our elderly parole folks a lot of our elderly incarcerated folks are not retaining the lack of treatment and care that they deserve thank you yes hello my name is Ariana Karp I'm a teaching artist with Marin Shakespeare Company we currently provide in-person pros programming at six different California prisons last evening I asked one of the groups that I work with why community-based programs are important to them, and I'd like to share some of their responses. It gives us the tools to be better people. It empowers us to learn and grow. It allows us a space to practice pro-social skills and collaborate.

Thank you.

Hi, my name is Brenda Bowers. I'm formerly incarcerated. I recently re-entered society five months ago after several 19 years on an 86 year life sentence. I'm here on behalf of the Wright Grant. I'm here to say that the program that I took and both took and facilitated is called GRIP, got enraged into power and it changed my life immensely. It showed me, it taught me victim impact. I was able to meet with victims and understand the effect that we had on them as incarcerated. It showed me how to stop my violence. I embodied mindfulness and I was able to learn emotional intelligence. So I asked that you guys consider the right grant and continue in that program because it has an immense effect on the women It just entered the women institution It only been with the man for the longest So I ask that it continue because it immensely changed my life And I feel like because of that I was able to get out after serving 86 years of life I mean, on an 86 years of life sentence. Sorry. Thank you and good luck.

Thank you.

How are you doing? Thank you for having me. My name is Kevin Sample. I'm a Design and Creative Futures alumni. I'm also in real time, GRIP is in here. It's two people. I was a former GRIP facilitator in San Quentin. I served 27 years off 103 years and three life sentence. I was re-sentenced because they said the sentence should have never happened. But when I paroled, I needed help. They let me out of LA County jail with no paperwork, nothing after 27 years and three months. And Design and Creative and Futures was there to help me understand how to navigate the workforce, what employment was all about, life skills, resume, the five institutions that are set up to help us, whether it's Department of Rehabilitation, EDD, how to get Medicare, how to sign up for all the things I actually needed to be productive without committing another crime to be incarcerated. Two of the things that I heard today was about rough math. I heard you say that, and I also heard a statement about get to it, tell me what we need to do so we can get it done. We need help. Everybody in this world needs help. Design and creating futures needs help. She just gave you some basic numbers, and we need help to continue. I'm just one person, but there's hundreds of us out here in society right now. With their help, I also have my own nonprofit. I also work at the place that I interned at for the last two and a half years. after 27 years and three months, it wouldn't have been possible without the information and help I received from Design and Creative Futures, the education, the training, and the skills they helped me understand, the tools, again, how to use the tools they gave me. Thank you.

Good afternoon, Madam Chair and members. Micah Doctoroff on behalf of Smart Justice California. many of the issues that you've heard about today could be greatly improved by safely reducing the prison population with a focus in particular on medically vulnerable people and elderly people. In furtherance of that goal, we would urge the legislature to fund the right grants and also to create greater access to and remove barriers to existing release mechanisms which have proven effective when they work. I also wanted to draw your attention back to a comment that was made earlier about interest in touring some of the medical facilities Smart Justice has a program called the Get Proximate program which is co by my colleague Phil who you heard from earlier. We help facilitate visits to prisons around the state bringing lawmakers from Sacramento into the prisons. We actually have a visit scheduled at California Medical Facility on April 30th. You are welcome to join, but we are also happy to help facilitate future visits to other facilities to help sort of shed light on some of the issues that you've heard about today. Thank you.

Thank you very much. Well having heard from all members of the public, members, are there any further questions or concerns? Seeing none, thank you all for who participated in the public testimony today. If you were not able to testify, please submit your comments or suggestions in writing to the Budget and Fiscal Review Committee or visit our website. Your comments and suggestions are important to us and we want to include your testimony in the official hearing records. Thank you everyone for your participation. We have concluded the agenda for today's hearing. The Senate Budget Subcommittee No. 5 on Corrections, Public Safety, Judiciary, Labor, and Transportation is now adjourned. And thank you for all of our special services and staff that's been here to support us. The room wasn't freezing today. I won't go home with a cold. So thank you. And of course, our consultant, Nora.

Thank you.