$5 medical copays cost a week of prison wages, deterring sick inmates

Forty states charge incarcerated people copays of $2-$13 per medical visit, but prison wages range from $0.04-$0.40/hour, meaning a single $5 copay can represent an entire week of labor. A 2024 study published in JAMA Internal Medicine found that higher copays are directly associated with reduced healthcare access in prisons. The people harmed most acutely are the 40% of incarcerated people who have chronic conditions like diabetes, hypertension, and hepatitis C. Twenty-two percent of people with chronic physical conditions had not seen a provider during their first year of incarceration, and 33% of the 400,000 people with chronic mental health conditions had received no mental health treatment. So what happens is that untreated conditions worsen -- a diabetic who skips visits to avoid copays develops complications that cost the state far more in emergency care. When these individuals are released, they enter the community sicker than when they went in, driving up Medicaid costs and emergency room utilization. This persists because copays were introduced as a cost-saving measure to deter 'frivolous' sick calls, but the savings are illusory: the administrative cost of collecting $2-$5 from indigent inmates often exceeds the copay revenue, while deferred care generates far higher downstream medical costs borne by the state.