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October 2017 Advocacy Update - The Future of the Maddy Fund
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11/22/2017 at 7:39:44 PM GMT
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October 2017 Advocacy Update - The Future of the Maddy Fund

The Future of the Maddy Fund

By Elena Lopez-Gusman & Kelsey McQuaid-Craig, MPA  

As we discussed in the September Issue of Lifeline, the Chapter has been hard at work to expand implementation of the Maddy Emergency Medical Services (Maddy) Fund in those counties that have not fully implemented it. The Maddy Fund was established to reimburse providers, hospitals, and emergency medical services for uncompensated care.

Funding of the Maddy Fund was initially provided through the passage of SB 12 (Maddy). The law permits counties to levy an additional penalty upon every fine, penalty, or forfeiture imposed and collected by the courts in violation of the Vehicle Code. Each county may elect to assess up to $2 per $10 in fines, penalties, or forfeitures for purposes of supporting emergency medical services. The passage of SB 1773 (Alarcón) in 2006 enacted Government Code §76000.5 to allow county boards of supervisors to levy an additional penalty of $2 for every $10 upon every fine, penalty, or forfeiture imposed and collected by the courts involving a violation of the Vehicle Code. In total, counties can collect up to $4 per $10 in fines to fund emergency medical services.

The Maddy Fund is just one of many programs that relies on penalty assessments for funding; a point of much debate in the Legislature.  

Not only is Governor Jerry Brown opposed to penalty assessments in general, but the Legislature has been exploring ways to eliminate penalty assessments over the past two years.

Governor Brown has made clear his dislike for penalty assessments to pay for programs that he feels should be paid for by taxpayers generally, not just those who pay traffic fines, though he has also expressed support for the goals of the programs themselves – including emergency care funding.

In 2011, Governor Brown took the unusual step of allowing AB 412, which was sponsored by California ACEP and renewed the Santa Barbara County Maddy Fund, to become law without his signature. The Governor even went so far as to send a message to the Legislature to accompany his “action”, which is normally reserved for vetoes, in which he stated his support for the Santa Barbara Maddy County Fund program but not the funding mechanism. Again in 2013 and 2016, Governor Brown signed our sponsored legislation to extend the SB 1773 portion of the Maddy Fund, but expressed his dislike of the funding mechanism.


In 2016, the Legislative Analyst’s Office (LAO) released a report entitled Improving California’s Criminal Fine and Fee System. According to their research, over $1.9 Billion in fine and fee revenue was deposited into state and local funds in 2013-14. Approximately 42% of that revenue went to funds administered by local governments, including the Maddy Fund. Similarly, the State received over half of the revenue, $1 Billion in 2013-14. Since 2010-11, the amount of fine and fee revenue distributed to state and local governments has declined by approximately $200 Million. An additional $11.2 Billion in fines and fees went unpaid in 2013-14, many because the cost of collection would outweigh the original amount to be collected. The LAO report paints a startling picture of the fine and fee system in California.

Outside organizations, like the Lawyers’ Committee for Civil Rights of the San Francisco Bay Area (Lawyers’ Committee), have evaluated the impact of California’s fine and fee system. In a report entitled Paying More for Being Poor: Bias and Disparity in California’s Traffic Court System, the Lawyers’ Committee analyzed the impact of numerous programs to reduce fines and fees based on ability to pay. They found that a well-designed system based on ability to pay brought in more money than the traditional flat fee system. The California Traffic Tickets/ Infractions Amnesty Program, which is no longer in operation, collected nearly three times more delinquent debt per case than court-ordered collections. California counties reported the proportional sanctions and reasonable installment plans resulted in greater collection.

The Lawyer’s Committee also looked at pilot programs in Maricopa County, Arizona and Staten Island, New York. The Maricopa County pilot was randomized and showed that more people in the pilot paid on time; within one year of the fine being issued, 52.7% of defendants in the pilot had paid in full compared to just 10% of defendants in the traditional system. On average, pilot program participants paid approximately $355 more toward their fine than did those in the traditional system.

While other programs have shown success, it is unclear how many Californians would take advantage of a fee reduction program, if the results in other states can be replicated, and what impact it would have on the Maddy Fund.



The Legislature’s dislike for penalty assessments became evident during the 2015 Legislative Session. Senator Jim Beall authored SB 326 to renew penalty assessments under the Emergency Medical Air Transportation Act, which augments emergency medical air transportation reimbursement payments made through the Medi-Cal program. The Assembly Committee on Appropriations forced the following amendments into the bill:   The Legislature finds and declares all of the following:

(a) Penalty assessments have been used to fund an increasing number of programs that should properly be funded by broad-based financing mechanisms.

(b) The ever-increasing reliance on penalty assessments to fund core state programs is a regressive financing mechanism, and is particularly harmful to individuals who can least afford these assessments. High fines and assessments can perpetuate a cycle of poverty and inequality, given that individuals with lower incomes are more likely to miss payments and suffer the consequences.

(c) It is in the state’s interest to ensure funding for emergency medical air transportation is sufficient to maintain access to these critical services for Medi- Cal beneficiaries and all individuals in California.

(d) Therefore, it is the intent of the Legislature to identify alternative funding sources for emergency medical air transportation and cease reliance on penalty assessment revenue to fund these services.

(e) Accordingly, it is the intent of the Legislature to cease the collection of penalty assessments on January 1, 2018, pursuant to the Emergency Medical Air Transportation Act.

The amendments by the Assembly Committee on Appropriations make clear the hostile environment in the Legislature concerning penalty assessments.

During the 2017 Legislative Session, Senator Bob Hertzberg introduced sweeping reforms in SB 185, which was an attempt to address the high cost of tickets for moving violations, specifically the large number of fees and fines that are added on to the original cost of the ticket. The bill allowed people to petition the court to have their fine reduced and the bill mandated that the fine be reduced if the person met certain income levels.

In all, there are 23 county administered funds and 57 state administered funds that rely on penalty assessments.

Ultimately, SB 185 was held on the Assembly Appropriations Suspense File and is now a two year bill. This means it can be brought back up during the 2018 Legislative Session. We must analyze the impact the bill will have on penalty assessments and what it will mean for the Maddy Fund.



According to the LAO, deposits in the Maddy Fund dropped from $93.3 million in 2009-10 to $86.1 Million in 2013-14. We do not have more recent numbers from the State.

As you well know, despite the implementation of the Affordable Care Act (ACA), visits to the ED are up, and millions of Californians remain uninsured. Millions more remain under-insured by Medi-Cal, making it difficult to adequately finance the emergency care system. The Maddy Fund is critical to maintaining access to quality emergency care for all Californians and it is imperative that we maintain a steady funding stream.

While we would like to know the impact SB 185 (Hertzberg) will have on penalty assessments and what it will mean for the Maddy Fund, the nature of similar efforts illustrates how difficult it is to determine the precise consequences. What is clear is that the Chapter must maintain a dialogue with the Legislature about possible consequences for the Maddy Fund.


If you have any questions, please contact us at or by calling the Chapter office at (916) 325- 5455.

Kelsey McQuaid-Craig, MPA
Director of Policy and Programs
California ACEP

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Last edited Thursday, January 4, 2018
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