NATIONAL – A recent update from the Prison Policy Initiative Updates, by Emily Widra and Dr. Emily Lupez, sheds light on a troubling reality within prison healthcare: the widespread imposition of medical copays—fees required to access health services such as physician visits, medications, dental care, and more.
These $2–$5 copays, while seemingly modest, have been labeled predatory by advocates and researchers alike. According to the Prison Policy Initiative, these fees often act as significant barriers to healthcare for incarcerated individuals, many of whom earn less than a dollar an hour—if they are paid at all.
Widra and Dr. Lupez analyzed the copay policies of every U.S. state, building on earlier findings that suggest copay waivers are not functioning as intended. Their research found that in states where copays are charged, people with chronic conditions were “substantially more likely to have never seen a doctor since admission” compared to those in states without such fees.
Dr. Lupez noted that while exemptions exist on paper, they are frequently applied inconsistently, retroactively, or left to the discretion of individual healthcare providers or correctional staff. As reported by the Prison Policy Initiative, these exemptions are often unclear or unknown to the incarcerated individuals who rely on them.
Nearly all state prison systems list some exemptions for healthcare services, but Widra and Lupez found alarming disparities. In 16 state prison systems, the cost of a single medical visit exceeds the average weekly wage earned by incarcerated individuals who hold jobs while in custody.
The issue is compounded by systemic staffing shortages. According to Widra and Lupez, these shortages are a leading barrier to timely and adequate care, especially during emergencies. In fact, only 27 prison systems explicitly exempt emergency medical treatment from copays—and even then, the determination of what qualifies as an emergency is typically made by healthcare staff, not the person experiencing the emergency.
The data also show that people in state prisons suffer disproportionately from chronic health conditions compared to the general U.S. population, and financial barriers to treatment only worsen the already poor health outcomes associated with incarceration.
Pregnancy-related care is also affected. As of 2016, roughly 4% of individuals in women’s prisons—about 3,500 people, disproportionately women of color—were pregnant at the time of admission. Many did not receive basic prenatal services such as obstetric exams, medications, special diets, testing, or pregnancy education. Only three states explicitly exempt postpartum care from copays.
Menstrual health presents yet another area of disparity. Only 25 state prison systems are legally required to provide menstrual products, and just 18 of those are required to provide them free of charge. Many incarcerated women must not only pay for these products but also cover the costs of any healthcare resulting from inadequate access to them.
Substance use treatment, widely recognized for its rehabilitative value, remains financially out of reach for many incarcerated individuals. Widra and Lupez note that people are often charged for the initial appointment with a healthcare provider, even if it results in a referral to treatment. Many may not even know how to seek treatment without incurring such charges.
Vaccination access is similarly limited. Only about 25% of prison systems waive copays for vaccines, and it remains unclear how requests for vaccines not widely offered—such as HPV, pneumococcal, or Hepatitis B—are handled.
Ultimately, Widra and Lupez argue that copay exemption policies do little to mitigate the harm caused by the copay system itself. “These exemptions simply give cover to prison systems that limit access to care and prioritize their bottom lines by imposing medical fees on a largely poor, medically vulnerable population with no other options,” they write.
The Prison Policy Initiative has called on prison systems nationwide to eliminate medical copays entirely.
