COVID looks like it may stay. That means prison medical copays must go.

Forty states and the federal prison system continue to charge incarcerated people unaffordable copays for medical care.

by Tiana Herring, February 1, 2022

In 2017, our analysis of medical copays in prisons across the country brought to light the common but utterly backwards practice of charging incarcerated people unaffordable fees for their health care. At that time, only eight states did not charge medical copays: Missouri, Montana, Nebraska, New Mexico, New York, Oregon, Vermont, and Wyoming. While several other states have since added themselves to this list, the vast majority have still not eliminated medical copays. With a new legislative session starting in many states, we reviewed each state’s policy — and any temporary changes they’ve made in response to the COVID-19 crisis — to identify places where repealing these fees should be on the agenda. (Looking for your state’s policies? See the appendix tables.)

 
 

40 states & the federal prison system still need to eliminate medical copays

Since 2017, two additional prison systems — California and Illinois — have eliminated medical copays, and, for the last two years, Virginia has suspended medical copays as part of a pilot program. Texas reduced its exorbitant $100 yearly health care fee to a less atrocious, but still out-of-reach, $13.55 per-visit fee. Idaho also reduced its medical copays in prison from $5 to $3 in 2018.

Even a $3 copay, though, is unaffordable for most incarcerated people, given the obscenely low wages that incarcerated people earn. For people earning 14 to 63 cents an hour in prison (and many earning nothing at all for their work), a typical $2-5 copay is the equivalent of charging a free-world worker $200 or $500 for a medical visit.

Unaffordable copays in prisons and jails have two inevitable and dangerous consequences. 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 or when diseases are carried by correctional staff back to their homes. Second, illnesses are likely to worsen as long as people avoid the doctor, which means more aggressive (and expensive) treatment when they can no longer go without it. Medical copays encourage a dangerous waiting game for incarcerated people, correctional agencies, and the public, with little payoff in terms of offsetting medical costs and reducing “unnecessary” office visits. In fact, when evaluating the costs versus benefits of charging copays, the Oregon Department of Corrections concluded, “copay systems do not seem to lower overall health care costs,” and “triage on a case-by-case basis is more cost effective than implementing system-wide copayment plans.”

 
 

Policy changes made during the pandemic are already being rolled back

In the face of COVID-19, we’ve found that many prison systems relaxed their medical copay policies to avoid disincentivizing people in prison from seeking necessary medical care. Before these changes, medical copays in prisons typically ranged from $2 to $5. Twenty-eight states modified their policies during the first few months of the pandemic, and, ultimately, all but one state — Nevada — temporarily changed their policies. Of the states that do charge medical copays as a matter of policy, only 10 completely suspended these fees at some point in the pandemic. The federal Bureau of Prisons, on the other hand, did not modify their copay policy until March 2021, and only suspended copays for COVID-19 related care for three months before the waiver expired.1

Most states that have modified their copay policies during the pandemic only suspended copays for respiratory, flu-related, or COVID-19 symptoms. But these limitations ignore the facts that not all COVID-19 symptoms fall within these vague categories, and many people don’t display symptoms at all.

A map showing that only 10 states have ended copays for incarcerated people Our survey of all 50 state prison systems found that a handful of states have already returned to their pre-COVID-19 medical copay policies, disincentivizing people from seeking early and frequent medical care behind bars, despite the continued pandemic.

As states stop publishing data about COVID-19 in prisons and start rolling back basic policies that do the bare minimum to protect incarcerated people, it’s important to remember that the pandemic is still ongoing and cases, hospitalizations, and deaths continue to rise. Five states — Alabama, Arkansas,2 Idaho,3 Minnesota, and Texas — rolled back their COVID-19 copay modifications at some point during the pandemic. Alabama went from suspending all copays to reinstating them for all cases in December 2020. Similarly, Minnesota and Texas had modified copays to accommodate people with COVID-19 symptoms, but reinstated all copays in December 2020 and September 2021, respectively. We confirmed that 22 states4 continue to operate with their COVID-19 copay policy changes in place, but in 15 states5 we were unable to confirm whether these modified policies remain in place.

Copays never make sense behind bars, particularly during a highly contagious viral pandemic. They are cruel, counterintuitive, and disincentivize people from seeking medical care when they need it. As our nation enters the third year of dealing with a virus that has ravaged prisons and jails — and increasingly looks endemic — it is urgent that lawmakers take action to permanently eliminate copays for incarcerated people.

 
 

Appendices

Appendix Table 1. COVID-19 copay policy changes

This table details medical copay policy changes during the COVID-19 pandemic since March 2020.
Prison system Original, pre‑pandemic medical co‑pay policy Initial COVID‑19 co‑pay response and date Subsequent COVID‑19 response and date Sources
Alabama Charged medical co-pays. Suspended all medical co-pays on March 18, 2020. Reinstated all medical co-pays in December 2020. Initial response: ADOC Press Release. Subsequent response: States of Emergency report.
Alaska Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 13, 2020. Co-pay modifications are still in place as of December 2021. Initial response: Anchorage Daily News article. Subsequent response: Email exchange with Alaska DOC in December 2021.
Arizona Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Unclear if modifications remain in effect. Initial response: AP News article.
Arkansas Charged medical co-pays. Suspended all medical co-pays on March 23, 2020. Reinstated co-pays for non-COVID-19 related symptoms on May 1, 2020. Unclear if modifications remain in effect. Initial and subsequent responses: KUAR news article
California Did not charge medical co-pays.
Colorado Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 23, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with CDOC in March 2020 and December 2021.
Connecticut Charged medical co-pays. Suspended all medical co-pays on March 11, 2020. Co-pay suspensions are still in place as of December 2021. Initial response: Hartford Courant news article. Subsequent response: Email exchange with CT DOC in December 2021.
Delaware Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms. Co-pay modifications will remain in place unless Delaware changes their permanent co-pay policy (Policy Number E-01). Email exchange with Delaware in April 2020.
Federal Charged medical co-pays. Stopped charging for flu, respirator, or COVID-19 symptoms on March 10, 2021. Reinstated all medical co-pays on June 20, 2021. Since then, the Bureau of Prisons has shifted COVID-19 evaluations and monitoring to become part of overall preventative health screening and monitoring, which are non-chargeable according to Program Statement 6031.02 (“Inmate Copayment Program”). Email exchange with the Bureau of Prisons in January 2022.
Florida Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 13, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with FDC in March 2020 and December 2021.
Georgia Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 13, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with GDC in March 2020.
Hawaii Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on May 20, 2020. Co-pay modifications are still in place as of December 2021. Initial response: Honolulu Civil Beat article. Subsequent responses: Email exchange with Hawaii DPS in December 2021.
Idaho Charged medical co-pays. Suspended all medical co-pays on March 13, 2020. Reinstated co-pays for non-COVID-19 related symptoms by December 2020. Co-pay modifications are still in place as of December 2021. Initial response: IDOC Press Release. Subsequent responses: Email exchanges with IDOC in December 2020 and December 2021.
Illinois Did not charge medical co-pays.
Indiana Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms in March 2020. Co-pay modifications are still in place as of December 2021. Initial response: IDOC COVID-19 Preparedness and Response Plan. Subsequent response: Email exchange with IN DOC in December 2021.
Iowa Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with IA DOC in March 2020 and December 2021.
Kansas Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 26, 2020. Unclear if modifications remain in effect. Initial response: KDOC Press Release.
Kentucky Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 23, 2020. Unclear if modifications remain in effect. Initial response: Phone call with KY DOC in March 2020
Louisiana Charged medical co-pays. Suspended all medical co-pays on March 16, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with LA DPS&C in March 2020.
Maine Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 13, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with ME DOC in March 2020.
Maryland Charged medical co-pays. Suspended all medical co-pays on March 31, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with MD DOC in March 2020.
Massachusetts Charged medical co-pays. Suspended all medical co-pays on April 21, 2020. Co-pay modifications are still in place as of December 2021. Initial response: MA DOC COVID-19 Q&A. Subsequent response: Email exchange with MA DOC in December 2021.
Michigan Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with MI DOC in March 2020 and December 2021.
Minnesota Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Reinstated all medical co-pays in December 2020. Email exchanges with MN DOC in March 2020 and December 2020.
Mississippi Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 19, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with MS DOC in March 2020.
Missouri Did not charge medical co-pays.
Montana Did not charge medical co-pays.
Nebraska Did not charge medical co-pays.
Nevada Charged medical co-pays. No change to co-pay policy.
New Hampshire Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 13, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with NH DOC in March 2020 and December 2021.
New Jersey Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 26, 2020. Suspended all medical co-pays by December 2020. Co-pay suspensions are still in place as of December 2021. Email exchanges with NJ DOC in March 2020, December 2020, and December 2021.
New Mexico Did not charge medical co-pays.
New York Did not charge medical co-pays.
North Carolina Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with NC DPS in March 2020 and December 2021.
North Dakota Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with ND DOCR in March 2020 and December 2021.
Ohio Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 12, 2020. Unclear if modifications remain in effect. Initial response: ODRC tweet
Oklahoma Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on April 7, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with OK DOC in April 2020.
Oregon Did not charge medical co-pays.
Pennsylvania Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 12, 2020. Co-pay modifications are still in place as of December 2021. Initial response: WITF news article. Subsequent response: Email exchange with PA DOC in December 2021.
Rhode Island Charged medical co-pays. Suspended all medical co-pays on March 27, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with RI DOC in March 2020 and December 2021.
South Carolina Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with SC DOC in March 2020 and December 2021.
South Dakota Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 19, 2020. Unclear if modifications remain in effect. Initial response: SD DOC Tweet.
Tennessee Charged medical co-pays. Suspended all medical co-pays on March 16, 2020. Unclear if modifications remain in effect. Initial response: TDOC COVID-19 FAQ.
Texas Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 20, 2020. Reinstated all medical co-pays in September 2021. Initial response: Press Release from Governor Abbott. Subsequent response: Email exchange with TDCJ in December 2021.
Utah Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 31, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with UT DOC in March 2020 and December 2021.
Vermont Did not charge medical co-pays.
Virginia Did not charge medical co-pays.6
Washington Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Unclear if modifications remain in effect. Initial response: Email exchange with WA DOC in March 2020.
West Virginia Charged medical co-pays. Suspended all medical co-pays on March 17, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with WV DCR in March 2020 and December 2021.
Wisconsin Charged medical co-pays. Stopped charging for flu, respiratory, or COVID-19 symptoms on March 16, 2020. Co-pay modifications are still in place as of December 2021. Email exchanges with WI DOC in March 2020 and December 2021.
Wyoming Did not charge medical co-pays.

See all COVID-19 copay policy changes

 
 

Appendix Table 2. State and federal prison copay policies and sourcing information

This table details medical copay policies for visits with health care providers charged to incarcerated people in state and federal prisons, along with sourcing information available as of January 3, 2022.

The original version of this table was published as an appendix to the April 19, 2017 blog post “The steep cost of medical copays in prison puts health at risk.”

We welcome additional or updated information.

Prison system Medical co-pay for visits What if the patient can’t afford to pay? Sources
Alabama $4 co-pay. For exceptions, see pages 5-6 of policy PDF. Patients who maintain a balance of less than $20 in their personal accounts for the prior 90 days are considered indigent and are not assessed a co-pay. For those who are not indigent but have inadequate funds, the unpaid balance remains payable until sufficient funds are received. DOC Admin. Reg. 703
Alaska $5 co-pay. Treatment for chronic conditions is charged the $5 co-pay once per year. For exceptions, see page 4 of PDF. If a patient does not have sufficient funds, a debt is established. DOC Policy 807.07
Arizona Up to $5 health care fee. For exceptions, see pages 21-22 of PDF. If a patient does not have sufficient funds to pay the health care fee, a “hold” is placed on his or her account for future debiting when funds become available. DOC Dept. Order 1101 and ADCRR’s Glossary of Terms
Arkansas Up to $5 co-pay. The amount of the assessment may not reduce the inmate’s account below $5. Any unpaid balance would remain as a lien on the account until it could be satisfied without reducing the balance below $5 DOC Policy AR 0893
California No co-pay or fee. Cal. Penal Code S 5007.5 (2020)
Colorado $3 co-pay. For exceptions, see pages 3-4 of PDF. DOC Regulation 700-30
Connecticut $3 fee. For exceptions, see page 2 of PDF. If a patient does not have sufficient funds at the time of service, an obligation is established on his or her trust account. Subsequent funds are credited against the obligation until it is paid. DOC Administrative Directive 3.12
Delaware $4 co-pay. For exceptions, see page 2 of PDF. DOC Policy E-01.1
Federal $2 co-pay. For exceptions, see page 3 of PDF. A patient is considered indigent if he or she has not had a trust fund account balance of $6 for the past 30 days. The fee is not charged to indigent patients. For a patient who is not indigent but does not have sufficient funds, a debt is established and incoming funds are applied against this debt until it is paid. BOP Program Statement 6031.02
Florida $5 co-pay. For exceptions, see statute. If a patient does not have sufficient funds, 50% of each deposit into his or her account is withheld until the total amount owed has been paid. 2016 Fla. Stat. S 945.6037
Georgia $5 fee. For exceptions, see page 16 of PDF. If a patient is unable to pay, the charge is recorded as an outstanding debt against his or her account. GDC Orientation Handbook for Offenders
Hawaii $3 co-pay. For exceptions, see page 3 of PDF. If a patient has less than $10 in his or her account at the time the charge is posted, he or she is considered indigent and a debt is created until the account has over $10 and enough to pay the co-pay. If there is less than $10 but more than the total co-pay owed, the difference will be deducted from the account. DPS Corrections Administration Policy COR.10.1A.13
Idaho $2 co-pay ($10 for people with work release jobs). For exceptions, see page 4 of PDF. DOC Procedure Control Number 411.06.03.001
Illinois No co-pays. 730 Ill. Comp. Stat. 5/3-6-2(f) (2021)
Indiana $5 copay. For exceptions, see pages 3-4 of PDF. Co-pays are paid from Inmate Trust Funds before commissary orders are processed. If there are insufficient funds to cover health co-pays, a hold is placed on the account for 30 days. A patient is not authorized to make any purchases or take money from his or her Inmate Trust Fund until outstanding health care co-pays are paid. If a patient does not receive sufficient funds to cover the co-pay within 30 days, any available funds up to the co-pay amount will be deducted and the hold will be removed at the end of the 30 day period. 210 Ind. Admin. Code Article 7
Iowa $3 co-pay. For exceptions, see page 4 of PDF. If a patient’s account balance is not sufficient to cover the charges, his or her balance will be reduced to $0 and a lien will be placed against the account. The balance owed will be deducted from any deposit received. The debt will remain outstanding until paid, for as long as the sentence is in effect. DOC Policy HSP-505
Kansas $2 fee. For exceptions, see section 4.c.1 thru 4.c.12. Kan. Admin. Regs. S 44-5-115c (2016)
Kentucky $3 co-pay. For exceptions, see page 5 of PDF. A patient who maintains a balance in his or her inmate account of $5 or less for 30 days prior to requesting indigency status is considered indigent. Indigent patients are not charged co-pays. DOC Policy 13.2. For definition of indigency, see DOC Policy 15.7.
Louisiana $3 co-pay. I could not find a state-wide policy, but according to an In These Times article, when a patient can’t afford a co-pay, a debt is created that can follow him or her even after release from prison. DOC guide, “Time in Prison: The Adult Institutions.” See page 5 of PDF. See also: Katie Rose Quandt and James Ridgeway, “At Angola Prison, Getting Sick Can Be a Death Sentence,” In These Times, December 20, 2016.
Maine $5 fee. For exceptions, see statute paragraph A. A patient is not charged if they have less than $15 in a facility account and have not received additional money from any source for 6 months following the medical service. Maine Rev. Stat. tit. 34-A S 3031 (2)
Maryland $2 copay. According to the Department policy, Maryland state law permits correctional agencies to assess a maximum of $4 as a medical co-pay, but the Department currently assesses $2. For exceptions, see pages 2-3 of PDF. DPSCS Executive Directive OPS.130.0001
Massachusetts $3 co-pay. For exceptions, see pages 6-7 of PDF. Co-pays are deducted from available earned funds or from savings funds if no earned funds are available. If a patient has no available earned funds, he or she is not charged a co-pay unless he or she voluntarily agrees to pay the co-pay from unearned funds by using a charge slip. 103 DOC 763
Michigan $5 co-pay. For exceptions, see pages 1-2 of PDF. If a patient does not have sufficient funds to pay the fee, the fee is considered an institutional debt and at that time, all available funds will be collected to go toward payment of the debt. When future funds are received in the account, 50% will be put toward the debt until the debt is paid. DOC Policy Directive 03.04.101. For information on institutional debt, see DOC Policy Directive 04.02.105. See page 6 of PDF
Minnesota $5 co-pay. For exceptions, see Directive Procedure B. The co-pay charge is logged into the patient’s account with a negative balance until funds become available to cover partial or total cost of care. DOC Directive 500.100
Mississippi $6 co-pay. For exceptions, see “Do I (inmate) have to pay a co-pay every time?” on Medical Concerns FAQ page. If a patient does not have sufficient funds, the balance will be paid upon receipt of future funds into his or her account. DOC Medical Concerns FAQ web page
Missouri No co-pay or fee. DOC Guide for Family and Friends. See pages 20 and 38.
Montana No co-pay or fee. By statute, incarcerated people are obligated to pay for “reasonable costs” of medical care. However, a 2016 Legislative Audit found that the department is not yet charging for medical treatment. DOC 2019 Budget Analysis Summary. See page 4 of PDF (D-137 of document). For the relevant statute, see Mont. Code Ann. S 53-1-107(6) (2021).
Nebraska No co-pay or fee. NCS Health Services Inmate Health Plan (2018).
Nevada $8 co-pay. For exceptions, see page 12 of Initial Orientation Handout PDF and page 73 of Audit Report PDF. I could not find a policy addressing insufficient funds or indigency, but the Audit Report found that “Inmates were not charged for visits due to insufficient funds to make co-payments in 40 (18%) of the visits reviewed.” DOC Initial Orientation Handout (2010). See page 12 of PDF. See also: DOC Inmate Programs, Grievances, and Access to Health Care Audit Report (2008). See page 72 of PDF.
New Hampshire $3 co-pay. For exceptions, see pages 2-3 of PDF. A patient with a negative account balance will be charged. When he or she receive funds, the negative balance will be paid off before any other charges can be incurred. DOC Policy and Procedure Directive 6.16, obtained via email from NH DOC.
New Jersey $5 co-pay. For exceptions, see Admin. Code and page 55 of Inmate Handbook. N.J. Admin. Code S 10A:16-1.5 (2017). Free access available via Lexis Nexis. See also: New Jersey Inmate Handbook. See page 55 of PDF.
New Mexico No co-pay or fee. Email exchange with NMDC on December 28, 2021.
New York No co-pay or fee. New York State Assembly staff.
North Carolina $5 co-pay. For exceptions, see page 4 of PDF. Co-pays are deducted from trust fund accounts, regardless of indigent status. However, co-pay fees deducted will not take the account balance below $2. If there is not enough money to pay the co-pay, the charge remains as a lien on the account. When deposits are made, up to 50% of a deposit will be taken to pay the co-pay balance. Co-pay charges remain liens against the account until release or parole. DOC Policy AD III-1
North Dakota $3 co-pay. For exceptions, see page 68 of PDF. If a patient does not have sufficient funds at the time of service, the balance will be deducted from future pay and money received from outside sources. Facility Handbook (2021). See page 68 for co-pay amount and page 59 for debt policy.
Ohio $2 co-pay. For exceptions, see pages 2-3 of PDF. A patient is considered indigent if he or she has earned or received less than $12 and his or her balance has not exceeded $12 at any time in the 30 days preceding the co-pay request. Indigent patients are not charged co-pays. DRC Policy 68-MED-15
Oklahoma $4 co-pay. For exceptions, see pages 5-6 of PDF. DOC Operating Procedure OP-140117. See page 5 of PDF.
Oregon No co-pay or fee. According to the DOC Issue Brief, Or. Admin. Rule 291-124-0085 allows, but does not mandate, the DOC to collect a co-pay. The DOC currently charges co-pays only for eyeglass exam visits, elective procedures, items that become the patient’s property (e.g., glasses, dentures, prosthetics), and non-essential self-care items (e.g. medicated shampoos and supplements). See Or. Admin. Rule 291-124-0085 for those charges. Or. Admin. R. 291-124 “Health Services (Inmate)”. For the reasoning behind the Department’s decision not to charge co-pays for most services, see DOC Issue Brief “Inmate Copays for Healthcare” (2012).
Pennsylvania $5 co-pay. For exceptions, see pages 7-9 of PDF. If a patient does not have sufficient funds to pay the co-pay fee, his or her account will be debited and the fee recouped from future deposits by collecting up to 25% of the account balance, unless the balance is less than $10. DOC Policy DC-ADM-820. For information about the collection of co-pay debts, see DOC Policy DC-ADM 005. See page 17 of PDF.
Rhode Island $3 co-pay. For exceptions, see pages 2-3 of PDF. If a patient does not have sufficient funds to pay the co-pay amount, all but $10 will be withdrawn from his or her account, and the balance owed will be charged as a debt to the account. Half of all subsequent deposits are used to pay the debt until the it is paid in full. Any remaining debt at the time of release is considered a legal debt and is subject to civil remedy by the state. If an individual returns to DOC custody before repayment of the debt, his or her account will reflect the unpaid debt from prior incarceration(s.) DOC Policy 2.28-3 DOC
South Carolina $5 co-pay ($12 for people with work release jobs). For exceptions, see pages 2-3 of PDF. Co-pays are charged to patients regardless of indigent status. DOC Policy HS-18.17. See page 3 of PDF.
South Dakota “$2 co-pay ($10 to see a physician for people with work release jobs). For exceptions, see page 3 of PDF. DOC Policy 1.4.E.10
Tennessee $3 co-pay. For exceptions, see pages 2-4 of PDF. DOC Policy 113.15
Texas $13.55 co-pay. Tex. Gov’t. Code Ann. S 501.063
Utah $5 co-pay. DOC web page “Inmate Health Care”
Vermont No co-pay or fee. Vermont Prisoners’ Rights Office
Virginia On January 1, 2020 Virginia DOC stopped charging co-pays as part of a pilot program. As of January 2022, this change is not permanent. Any medical co-pay debts incurred before this change are not affected. DOC Operating Procedure 720.4
Washington $4 co-pay. For exceptions, see pages 2-3 of PDF. Co-pays are collected from the patient’s trust accounts, but will not draw the balance below $10. The remaining balance will be collected from subsequent deposits. DOC Policy 600.025. For information on indigency, see Policy 200.000 Attachment 3 and Wash. Rev. Code S 72.09.015
West Virginia $5 co-pay for doctor’s visit, $3 co-pay for nurse visit. W. Va. Code caps co-pays at $5 for any billable service and explains exceptions. Lakin Correctional Center Inmate Handbook (2014). See page 45 of PDF. The Handbook references a state-wide DOC Policy Directive 424.01 “Inmate Medical Co-Payments,” but that policy is not available on the DOC website. See also: W. Va. Code S 25-1-8.
Wisconsin $7.50 co-pay. For exceptions, see Wis. Admin. Code. If a patient does not have sufficient funds to pay the co-pay amount, a debt will be applied to his or her general or trust account. Wis. Admin. Code DOC S 316.04
Wyoming No co-pay or fee. DOC staff

See all state and federal copay policies

 
 

Footnotes

  1. According to the public information office of the federal Bureau of Prisons, evaluations and monitoring for COVID-19 are not subject to copays: “Within the early days of COVID-19, an approved copay waiver was implemented on March 10, 2021, and expired on June 20, 2021. It was implemented to encourage inmates to seek a medical examination, if they developed COVID-19 symptoms, without the concern of an inmate copay charge. As COVID-19 has continued, the Bureau of Prisons shifted COVID-19 evaluations and monitoring to become part of an overall preventative health screening and monitoring. Preventative health and emergency assessments are non-chargeable examinations consistent with Program Statement 6031.02; “Inmate Copayment Program” found here https://www.bop.gov/policy/progstat/6031_002.pdf. If an inmate feels they have been inappropriately charged, they may appeal the charge at the local level through the Administrative Remedy Process.”  ↩

  2. Arkansas originally suspended all copays, but reinstated medical copays for non-COVID-19 related medical care in May 2020.  ↩

  3. Idaho originally suspended all copays, but reinstated medical copays for non-COVID-19 related medical care in December 2020.  ↩

  4. The following states have confirmed that their modifications remain in place: Alaska, Colorado, Connecticut, Delaware, Florida, Hawaii, Idaho, Indiana, Iowa, Massachusetts, Michigan, New Hampshire, New Jersey, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, West Virginia, and Wisconsin.  ↩

  5. We have not received responses in January 2022 from the departments of corrections in fifteen states: Arizona, Arkansas, Georgia, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Nevada, Ohio, Oklahoma, South Dakota, Tennessee, and Washington.  ↩

  6. On January 1, 2020 Virginia DOC stopped charging co-pays as part of a pilot program. As of January 2022, this change is not permanent.  ↩

Tiana Herring is a Research Associate at the Prison Policy Initiative. (Other articles | Full bio | Contact)



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