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Recent Report Compares California Inmate Health Care Costs to Rest of Nation


Analysis of California’s Physician-Supervision Requirement for Certified Nurse Midwives

March 11, 2020 - In an effort to ensure safety and quality, California state law places occupational licensing restrictions on who may provide childbirth and reproductive-related health care services to women. These restrictions include a requirement that nurse midwives may only practice under the supervision of a licensed physician. At the request of a member of the Legislature, this report analyzes whether this requirement is meeting its intended safety and quality objectives, without significantly increasing cost or decreasing access to health care services. Drawing on national research—that compares health care outcomes in states with and without a similar physician-supervision requirement for nurse midwives—we find that California's requirement is unlikely to improve safety and quality for low-risk pregnancies and births. Moreover, we find that the requirement could limit access to nurse-midwife services, and potentially health care services for women overall, while also raising the cost of care. We recommend that the Legislature consider removing the state’s physician-supervision requirement, while adding other safeguards to ensure safety and quality. Such safeguards could include, for example, requiring nurse midwives to maintain appropriate referral and consultative relationships with physicians and requiring that they maintain medical malpractice insurance.


The 2010-11 Budget: Prison Receivership Proposals Pose Significant Financial Risks

March 16, 2010 - In February 2006, the federal court in the Plata v. Schwarzenegger case pertaining to inmate medical care appointed a Receiver to take over the direct management and operation of the state’s prison medical health care delivery system from the California Department of Corrections and Rehabilitation (CDCR). In this brief, we (1) provide a status report on the Receiver’s actions, (2) present an overview of state spending on inmate medical care, (3) analyze the various requests contained in the Governor’s budget for the Receiver, and (4) identify issues and recommendations for legislative consideration. Specifically, we recommend that the Legislature: require the administration to present at budget hearings a detailed plan on how its proposed $811 million in savings will be achieved; withhold action on staffing requests pending the submission and our review of the above plan; and, fund only the most critical IT projects in the budget year and delay funding for the less critical projects.


Providing Constitutional and Cost-Effective Inmate Medical Care

April 19, 2012 - In 2006, after finding that California had failed to provide a constitutional level of medical care to its inmates, a federal court appointed a Receiver to take over the direct management and operation of the state's inmate medical care program from the California Department of Corrections and Rehabilitation (CDCR). Since that time, the current and prior Receiver have taken a variety of actions to revamp CDCR's medical program. In this report, we (1) provide a status report on the Receiver’s actions, (2) describe how these actions have impacted inmate medical care spending and outcomes, (3) discuss the experiences of other states that have faced problems similar to California’s in delivering inmate medical care, and (4) provide recommendations for delivering a constitutional level of inmate medical care in the most cost-effective manner as possible in the long run. These recommendations include establishing an independent oversight board, taking steps to address current operational efficiencies to bring state expenditures to a more sustainable level, and establishing a pilot project to contract for medical care services.


The 2014-15 Budget: Governor's Criminal Justice Proposals

February 19, 2014 - In the report we provide an analysis of the Governor's budget proposals for state criminal justice programs, including the judicial branch, California Department of Corrections and Rehabilitation (CDCR), and various proposals related to local public safety. The report reviews the most significant proposals in these departments and offers corresponding recommendations for the Legislature's consideration. For example, we recommend that the Legislature take several actions to improve the administration’s approach to trial court funding, including the current trial court reserves policy. In addition, we review the administration’s proposals related to correctional relief staffing and overtime and make a series of recommendations to reduce spending on staffing and overtime and make CDCR's staffing process more cost-efficient.


California's Criminal Justice System: A Primer (2013)

January 17, 2013 - In recent years, the state has passed various laws altering the state's criminal justice system. Most notably, in 2011, the state shifted--or "realigned"--responsibility to house and supervise tens of thousands of adult felons from the state to local governments. Major policy changes such as the 2011 realignment, as well as others, are likely to raise numerous questions from policymakers, practitioners, and the public regarding those policies' impacts on public safety and costs. Consequently, we are releasing an updated version of our 2007 report California's Criminal Justice System: A Primer. This report includes key statistics on crime rates, adult and juvenile arrests, prosecutions in the criminal courts, and state and local corrections in California. Where possible, this information is provided through 2011, providing readers with a picture of the state's criminal justice system prior to the full implementation of the 2011 realignment, against which they can evaluate how the system changed following realignment (such as in terms of crime rates, court caseloads, and correctional populations). This report also includes in-depth discussions of some of the most important criminal justice issues likely to face policymakers in coming years.


[PDF] MOU Fiscal Analysis: Bargaining Unit 16 (Physicians, Dentists, and Podiatrists) and Bargaining Unit 19 (Health and Social Service Professionals)

August 4, 2006 - We provide a fiscal analysis of proposed MOUs with Units 16 (physicians, dentists, and podiatrists) and 19 (health and social service professionals). The administration's estimate of costs resulting from the MOUs in 2006-07 is reasonable, but the estimate for 2007-08 is likely too high by $6 million due to a high estimate of inflation. We estimate that total compensation costs would rise to about $579 million in 2006-07 for a cost increase of over 10 percent. More than 40 percent of this increase results from factors other than the MOUs, such as court-ordered pay increases. In 2007-08, we estimate that costs would increase an additional 6 percent to about $610 million. In addition to these costs, we expect that future court orders related to correctional and mental health programs will increase pay for some members of these units by an unknown amount.


Cal Facts: 2014

December 4, 2014 - With a state as big, as populous, and as complex as California, it would be impossible to quickly summarize how its economy or state budget works. The purpose of Cal Facts is more modest. By providing various "snapshot" pieces of information, we hope to provide the reader with a broad overview of public finance and program trends in the state. Cal Facts consists of a series of charts and tables which address questions frequently asked of our office.


[PDF] Analysis of the 1999-00 Budget Bill, Judiciary and Criminal Justice Chapter

February 16, 1999 - Analysis of the 1999-00 Budget Bill, Judiciary and Criminal Justice Chapter


[PDF] Overview of Adult Correctional Health Care Spending

March 18, 2010 - Senate Budget Subcommittee No. 4 On State Administration Hon. Mark DeSaulnier, Chair


[PDF] Analysis of the 2005-06 Budget Bill, Judiciary and Criminal Justice Chapter

February 24, 2005 - Analysis of the 2005-06 Budget Bill, Judiciary and Criminal Justice Chapter


[PDF] The 2013-14 Budget: Governor's Criminal Justice Proposals

February 15, 2013 - The Governor’s 2013-14 budget for criminal justice programs is relatively flat. It contains few major proposals for the judiciary or corrections compared with recent years when the state budget included significant budget cuts to programs, as well as major policy changes. In total, the Governor's budget provides $13.2 billion for criminal justice programs in 2013-14. This is an increase of about 2 percent over estimated current-year expenditures. In this report, we review the Governor’s 2013-14 budget proposals for criminal justice programs, including the judicial branch, California Department of Corrections and Rehabilitation, Board of State and Community Corrections, and the Department of Justice. We identify concerns with several of the proposals and make recommendations for legislative consideration. In some cases, we identify proposals that we think should be rejected or modified, resulting in several million dollars of General Fund savings. We also identify several issues that we think would benefit from additional legislative oversight. These include (1) how trial courts will implement budget reductions in coming years, particularly in the absence of reserves beginning in 2014-15, (2) the new staffing methodology being implemented by the federal court-appointed Receiver currently managing the state’s inmate medical system, and (3) efforts by the Board of State and Community Corrections to meet its statutory mission to assist local agencies improve criminal justice outcomes through technical assistance and data collection.


A More Rational Approach to Setting Medi-Cal Physician Rates

February 1, 2001 - Our analysis indicates that no rational basis exists for setting Medi-Cal physician rates, and that current rates are lower than those paid by the federal Medicare Program and others. Commencing in 2002-03, we recommend that the state adjust rates based upon a comprehensive analysis of access to physician services and the quality of care provided to beneficiaries.


State Correctional Spending Increased Despite Significant Population Reductions

February 4, 2020 - In this brief, we find that the major reasons why CDCR’s costs did not decline in line with the substantial decrease in the populations are: (1) costly operational changes to comply with various federal court orders, (2) increased employee compensation costs, and (3) the payment of costs that were deferred during the state’s fiscal crisis. However, we note that had the inmate population not declined over this period, CDCR spending would have increased by billions of dollars more than it actually did.