Charging incarcerated people medical co-pays forces them to make difficult choices

Medical co-payments for prisoners nationwide could be doing more damage than good, according to a recent report from the Prison Policy Initiative (PPI).

Wendy Sawyer, author of the PPI report, compared the cost of medical co-pays in prisons and jails to what people on the outside pay, relative to their wages. 

“A $2 to $5 medical co-pay in prison or jail may not seem expensive on its face. But, when we consider the relative cost of these co-pays to incarcerated people who typically earn 14 to 63 cents per hour, it’s clear how they can be cost-prohibitive,” stated the report.

In most states, prisoners pay medical co-payments for physician visits, medications, dental treatment and other health services.

Sawyer calculated how many work hours it would take an incarcerated worker in each state to make a co-payment. She converted the hours of the low-paid incarcerated worker to the minimum wages earned by a non-incarcerated worker in the same state.

“Fees are … meant to deter people from unnecessary doctor’s visits”

In California, prisoners pay a $5 medical co-payment and earn as little as eight cents an hour. It would require 62.5 hours of work to afford one co-payment. The equivalent co-pay for a free Californian earning $10.50 at the state’s minimum wage would be $656.25.

A single doctor visit for an incarcerated West Virginian who makes $6 dollars per month would cost almost an entire month’s pay. The equivalent co-pay, based on that state’s minimum wage and the same 125 hours to earn, would cost $1,093.

“People incarcerated in these states must rely on deposits into their personal accounts — typically from family — to pay medical fees. In most places, funds are automatically withdrawn from these accounts until the balance is paid, creating a debt that can follow them even after release,” reported the PPI.

Sawyer found that 13 states charge medical co-payments that are equivalent to charging minimum-wage workers more than $200.

Texas does not pay incarcerated people for their work; however, it charges a flat $100 yearly health services fee, and some officials are actually trying to double it to $200, said the report.

Alabama, Arkansas, Florida, Georgia, Mississippi and South Carolina also don’t pay prisoners for work but do charge inmates co-pays for medical services.

“Fees are … meant to deter people from unnecessary doctor’s visits. Unfortunately, high fees may be doing more harm than good: deterring sick people from getting the care they really do need,” the PPI report said.

The National Commission on Correctional Health Care (NCCHC) said abuses of sick calls can be managed with “a good triage system,” without imposing fees that also deter necessary medical services.

Charging incarcerated people medical co-pays forces them to make difficult choices, said the report. NCCHC warns that co-pays may actually jeopardize the health of incarcerated populations, staff and the public.

“First, when sick people avoid the doctor, disease is more likely to spread to others in the facility — and into the community, when people are released before being treated. Second, illnesses are likely to worsen as long as people avoid the doctor,” said the report.

This could mean more aggressive and expensive treatment when they can no longer go without it.

“Correctional agencies may be willing to take that risk and hope that by the time people seek care, their treatment will be someone else’s problem,” said the report.

Nevertheless, providers must treat people regardless of their ability to pay. Incarcerated people with “low health literacy” may not understand this right, said the report.

PPI’s “Correctional Control: Incarceration and Supervision by State” is the first report to aggregate data on all types of correctional control nationwide.

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