Description: 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.