Health Care Jail Prison

Costly Co-Pays for Health Care in Lock-up

Taylor Walker
Written by Taylor Walker

In California and across the nation, inmates are charged medical co-pays for doctor’s visits, medications, and other health services.

While the co-pays generally range between $2.00 and $5.00, the fees can be prohibitively costly for inmates who make pennies on the dollar working jobs in lock-up. These charges are aimed at weeding out unnecessary medical visits and repaying local and state governments for inmate medical care. Unfortunately, the co-pays can also discourage incarcerated individuals from getting the care they need for chronic or contagious illnesses, according to a report from Prison Policy Initiative’s Wendy Sawyer.

The Prison Policy Initiative (PPI) report compares the cost of medical co-pays for inmates and those on the outside, adjusting for each population’s wages.

In California, the co-pay fee is $5.00, and the minimum wage for a prison job is $0.08 an hour. At that hourly wage, it would take an inmate 62.5 hours to afford one co-pay. In comparison, the cost of a medical co-pay took a non-incarcerated person (making the state minimum wage of $10.50 per hour) 62.5 hours to pay for, the co-pay would be a whopping $656.25.

Of course, not all inmates make the state minimum wage. California prison wages range from $0.08 to $0.37 per hour for non-industry jobs, and $0.30 to $0.90 per hour for inmates working jobs in state-owned businesses. In CA, the pay rate for an unskilled laborer is on the low end of the $0.08 to $0.90 spectrum, for example, while inmate fire-fighters land on the highest pay grade.

The average co-pay nationally was $3.47, with a inmate minimum wage of $0.14, and a state minimum wage of $8.30. With these numbers, it would take an incarcerated worker 24.75 hours to afford a co-pay—the equivalent of $205.40 for a person on the outside making minimum wage.

In California and in other states, inmates are not charged for certain medical treatments, like emergency health care, mental health services, and follow-up doctor visits.

Not every state charges inmates co-pays for medical visits, either. Eight states either do not charge co-pays, or do not have a co-pay policy. Five states were unable to give any wage data to PPI. (Be sure to read the report over at PPI for the full state co-pay breakdown—with helpful graphs.)

The worst offenders, according to PPI, are the states that charge co-pays, but do not pay inmates an hourly wage for work—Alabama, Arkansas, Florida, Georgia, Mississippi, South Carolina, and Texas.

In Texas, inmates have to pay a $100 yearly flat fee for health care. And some state officials are working to increase the fee to $200 per year, the Houston Chronicle reports.

Inmates generally pay these co-pays through their commissary accounts, which are funded by their prison job wages and/or contributions from loved ones. So, in states that do not pay inmates for their work, the health care fee burden is passed on to the inmates’ families.

The National Commission on Correctional Health Care (NCCHC) points out that while states cannot deny inmates medical care when they are unable to pay, “inmates are almost always in an ‘indigent’ mode,” relying on cash-strapped family members to fund their commissaries. And inmates often must use their commissary money for other needs like toiletries, over-the-counter medications like antacids, and feminine hygiene supplies. (The NCCHC also argues that inmates often have limited health literacy, and may not understand that they cannot be denied health services if they can’t pay.)

Aside from money charged by state and local governments, contractors gouge inmates’ families with outsized fees for phone calls, money transfers, and other necessary services that can add up to hundreds of dollars a month—far beyond the means of many low-income families. Some states also charge “room and board” fees for prison stays.

Moreover, states may avoid paying for “frivolous requests for medical attention” by triaging sick calls, having “a lower level of qualified staff see the complaining inmate first, with referral to higher levels of staff only as medically indicated,” the NCCHC says.

Photo: Wellness GM, Flicker.


  • Let’s not forget that when “contractors gouge inmates’ families with outsized fees for phone calls, money transfers, and other necessary services” they have not necessarily been awarded the contract because they submitted the most cost efficient bid, but rather because their bid offers the highest total guaranteed annual remittance back to the prison authority as a percentage of the fees gouged from the inmates.

  • For inmates serving sentences of life without possibility of parole or longer, the most lucrative returns await CA prison administrators as result of prudent retirement planning.

    The lifers who have jobs stamping license plates or folding towels in the prison laundry need to be classified as state employees and enrolled in CALPERS.

    The wage rate for their jobs should range from$80-$120/hr. at the top end.

    The wardens need to schedule maximum overtime hrs. to the inmate in the final 16 months before retirement and cash-out accrued vacation/sick time.

    If done properly, the warden can juice the inmates CALPERS retirement to $150,000 – $250,000/annual.

    Don’t worry that society’s most gruesome criminals will enjoy lots of fun money.
    They won’t see a penny after direct costs of room, board, prison guard services are charged back to the lifer’s account.

    On the issue of medical visits and preventative health care, the lifers will get top-notch service.
    The exorbitant CALPERS pension check is the incentive to never let them die.

  • One can only hope that honchos running the show at California D.O.C.(or whatever its called now) don’t have their heads stuck in the gulley of 8 cent/hr. wages for prison labor while the tax/retirement protocol gold rush passes by.

    The prison administration should be doing what every prolific financial planner/tax advisor does out in the real world –
    minimize taxation/maximize returns by participating in every available program and qualifying for every available loophole which advances the goal.

    Set inmate wages according to I.R.S. regulations for maximized Earned Income Credit and any other potential tax credits which are refunded or can be sold/traded.

    Then prepare and file the inmates annual tax return.
    The prison authority can confiscate the inmates refund to cover room and board.

    In addition, room and board fees will be deducted from the inmates wages – so even if we pay them $15/hr for work, the net cost to the prison system is still only 8 cents/hr.

    Although that state will incur some extra costs for F.I.C.A. contributions calculated on prisoner wages, in the long-term we will have retirement age prisoners and/or parolees who qualify for Social Security.

    The monthly SSI check can either be confiscated to pay cost of incarceration or garnished to cover costs of parole/probation services.

    The benefits from this prudent planning will begin to flow to CA prison authorities even sooner than retirement age for may of the inmates.

    There is no better place to find people who can qualify as permanently physically or mentally disabled from participating in gainful employment than our prison population.

    Permanently disabled inmates will get approx. $1,100/month direct-deposit into their commissary account from S.S.I. which then automatically gets deducted to cover delinquent medical co-pays, etc.

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