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The Trump Administration has made a lot of claims about how it will change the criminal legal system. We explain where the president and federal government have full control over the system, where they have some influence, and where their power ends.

by Mike Wessler, June 11, 2025

Sections
By the numbers
Independence of state & local authorities
Federal influence
The president & executive branch
Control over federal spending
Federal policing and prosecutions
Enforcement of civil rights laws
Pardons and commutations
Appointments
The bully pulpit
Congress
Federal courts
These are not normal times
Impacts on state and local governments

There is little question that the President of the United States is the most powerful person on the planet. They can launch military strikes, shake the foundation of the economy, and dramatically alter our international alliances, all with a stroke of their pen. And if you have heard President Trump speak about the criminal legal system lately, you’d likely think the office also has the power to control who is arrested and incarcerated, and what the conditions are like when they get there. The truth, though, is much more complicated.

It is important to remember that the United States doesn’t really have a single, unified criminal legal system. It has thousands of smaller systems, and state and local governments have direct authority over the vast majority of them. However, while the president and the federal government don’t have direct control over most of these systems, they have many tools at their disposal to indirectly impact how they are operated.

In this briefing, we explain the federal government’s traditional role in the United States’ criminal legal system, highlighting where it has direct control, ways it can exert indirect influence, and the relative size and scope of its power. It is important to note that, in this piece, we rely on how our government normally works, when limits on federal power are honored and where the president obeys court orders. We don’t explore every nuance of federal law or possible tools that the federal government could hypothetically deploy.1 Instead, we aim to help you understand the avenues of influence it has traditionally exercised.

Actions and statements from the Trump administration raise serious doubts about whether these limits will be respected. Understanding the contours of power and authority outlined in this briefing can provide clues about what to expect in the future and serve as a helpful barometer of how far actions by the administration have deviated from the standards of recent decades.

The federal criminal legal system: By the numbers

While the president and members of Congress may talk a lot about crime, prisons, and incarceration, the truth is they directly control only a small sliver of the overall carceral system.

Pie chart showing the federal government has direct authority over only about 13% of the incarcerated population.

As we explain in the latest edition of our flagship report, Mass Incarceration: The Whole Pie, there are roughly 2 million people incarcerated in the U.S. on any given day.2 Of those, only a relatively small portion are under the direct control of the federal government:

  • Approximately 204,200 are in federal prisons or jails;
  • Roughly 48,000 are in immigration detention facilities.34

In total, about 13% of incarcerated people — approximately 252,200 people — are under the direct control of the federal government. For context, the federal incarcerated population is only a little larger than the number of people in prisons in jails in the single states of Texas, which has 11% of the national incarcerated population, and California, which has 10%. Those numbers show that, rather than being a massive monolith, the federal carceral system is roughly the same size as the criminal legal systems in some of the larger states in the country.

Make no mistake, 252,200 people under direct federal control is a lot, but it represents only a relatively small portion of the total number of people behind bars on any given day in this country.

So, who has direct authority over the other 87% of people incarcerated in this country? State and local governments.

Independence of state and local authorities

State prisons and local jails hold the vast majority of people who are incarcerated in this country. Those facilities and systems are operated and overseen by state and local governments and are largely independent of the federal government. You should think of state prisons and local jails as systems that operate in parallel (and occasionally overlap) with the federal system, rather than as subsidiaries of it.

State legislators write laws that dictate what actions are considered crimes and the possible punishments for those actions. Police and prosecutors — operated by both state and local governments — enforce those laws by carrying out arrests and prosecutions. County sheriffs operate local jails. And the state government runs the prison system that confines people sentenced to incarceration by state courts.5

Generally speaking, state and local governments hold the vast majority of the control in the criminal legal system, and the federal government plays a relatively small role.

Examining recent progress towards decriminalizing marijuana offers a helpful — albeit unique — example of how state and local governments operate in parallel with the federal government when it comes to law enforcement. Currently, 24 states have made the recreational use and possession of marijuana legal. That means that state and local law enforcement cannot arrest or prosecute someone for simply possessing or using marijuana.6

However, the possession of marijuana remains illegal under federal law. Even if you are in a state that has made recreational use of marijuana legal, the federal government could, in theory, still arrest and prosecute you for it. Usually, though not always, the federal government has respected states’ ability to write their own criminal laws, and in doing so, has avoided prosecutions that are contrary to state law.

Importantly, if someone is sentenced to incarceration, the entity that prosecuted them usually determines where they serve their sentence. If they’re prosecuted under state law, as most people are, they’ll usually serve their sentence in a state prison. If they’re prosecuted under federal law, they’ll likely serve their sentence in federal prison.7

Federal influence over state and local policy

While the federal government has direct control over a relatively small portion of the nation’s criminal legal systems, the president, Congress, and the federal courts have many ways to exert indirect influence over how states and local governments address public safety, prosecute crimes, operate their prisons, and more.

It is essential to recognize that the federal government’s influence and power to shape state and local criminal legal system policy is not inherently good or bad. This power has been used to both shrink and grow the carceral footprint in America. Understanding the contours of these powers can help you see how they’re being used.

The president and the executive branch of the federal government

The president and the executive branch of the federal government likely have the most tools at their disposal to influence how state and local governments operate their criminal legal systems. Some of these mechanisms are direct actions that essentially force the hands of state and local governments by using the promise of providing or eliminating funding or threatening legal action, while others rely on the prominence and prestige of the presidency to exert pressure and encourage specific actions.

Control over federal spending

While Congress controls the amount of money budgeted for various federal government programs,8 the president has immense discretion over how that money is spent and how laws are implemented. From the money allocated by Congress, presidents can often direct money to their own priority programs, while offering fewer resources to programs that are less important to them. These choices can dramatically impact state and local criminal legal systems.

A prime example of this is the Department of Justice’s Office of Justice Programs. This office provides millions of dollars in grants to state and local governments, as well as other organizations that provide services related to the criminal legal system. How this money is spent and what programs receive money have huge impacts on state prison populations and local police activities.

Under President Biden, many of these grants were awarded to organizations and programs designed to keep people out of the criminal legal system, reduce violence, and support victims of crime. However, shortly after taking office, the Trump administration cancelled roughly $820 million in Biden-era grants, indicating that they didn’t align with the administration’s priorities. The administration has said this money will instead be allocated toward programs that align with its focus areas, which many people assume means it will result in more money for policing and prison construction.

Additionally, the Department of Justice provides funding to state and local law enforcement through a series of grants and other programs. Many of these programs require state and local officials to comply with federal policing standards and collaborate with federal authorities on certain criminal investigations and prosecutions. This funding allows federal authorities to expand their reach and exert new pressure on local elected and law enforcement officials.

Another example of how executive branch agencies use money to shape state criminal justice policy is the Justice Reinvestment Initiative, which is partially funded by the U.S. Department of Justice. This program connects state leaders with experts to help them develop strategies to reduce crime, improve services for people with substance use disorder and mental health issues, and reduce spending on prisons and jails. Through this model, the federal government helps to lay the groundwork for state policy reforms. This framework allows the federal government, despite not having a direct voice in the decision-making for states, to influence state policies.

While the president cannot directly instruct states on how to operate their criminal legal systems, making funds available for specific uses can push them to take actions that the president wants. The money can motivate officials to follow the federal government’s lead, and conversely, when money dries up, force them to abandon strategies that aren’t in line with the president’s priorities.

Federal policing and prosecutorial power

The president appoints the attorney general of the United States to head the Department of Justice. Over the last fifty years, presidents have generally respected the independence of their attorneys general, based on the recognition that law enforcement should not be influenced by politics or personal grievance. The Trump administration has made clear it will no longer respect that independence.

While the attorney general is generally considered the top law enforcement official in the nation, they only have direct policing and prosecutorial power over allegations that federal crimes have been committed. As we explained above, this has traditionally been a relatively small portion of the total criminal cases around the country, with state and local governments maintaining jurisdiction over the vast majority.

It is important to note that the attorney general has incredibly wide discretion over which cases the Department of Justice pursues. There are a lot of actions that are criminalized by both the state and federal governments. However, in the vast majority of these cases, state and local authorities take the lead on arrests and prosecutions.

In theory, however, an attorney general could direct federal law enforcement to take primary authority over far more cases than it has traditionally pursued. This would swell the federal prison population and the federal government’s role in the criminal legal system. The fear of federal intervention in the criminal legal system can be used to coerce states to more aggressively pursue prosecutions that the president and federal government have prioritized.

Enforcement of civil rights laws

One of the most powerful ways that the federal government has positively impacted state and local law enforcement and prisons is through the enforcement of civil rights laws.

Even when state or local officials are responsible for policing or incarceration, they must still abide by civil rights protections in the U.S. Constitution. If they don’t, the U.S. Department of Justice can bring a federal lawsuit against the prison, police department, or other government body. These lawsuits often focus on things like racist policing practices, inhumane prison or jail conditions, and police brutality.

Often, these cases are resolved by consent decrees, in which the state or local government entity agrees to take specific actions to resolve the practices that violated federal law. In a break with the past, the Trump administration has announced that it is abandoning many of these efforts to rein in abuse in prisons and jails and by law enforcement.

Pardons and commutations

Presidents have the power to pardon or commute the sentences of people convicted of federal offenses. A pardon absolves a person of their criminal conviction, ending any remaining time in prison or on probation and wiping the conviction from their record, like it never happened. A commutation, on the other hand, reduces a person’s sentence, but doesn’t remove the conviction from their criminal record.

It is important to note that a president can only grant pardons and commutations to people convicted of federal crimes. They have no power to change the criminal sentences of people convicted of state crimes, which means most criminal convictions in the country are outside of their reach.

Appointments to courts, agencies, commissions, and more

The people who run the day-to-day operations of the federal government matter, and the president appoints a significant number of judges, agency heads, and members of regulatory boards that shape criminal legal system policy in this country.

The president nominates people to fill vacancies in federal courts,9 including the United States Supreme Court. By nominating people who share their worldview on public safety, prison conditions, crime, and other issues, the president indirectly shapes how federal courts rule on these issues for decades to come. Importantly, these courts will also regularly be asked to weigh in on whether state or local policies violate the U.S. Constitution, giving them considerable influence on what and how criminal legal system policies are implemented.

Presidents also appoint the heads of most federal departments and most agencies in the executive branch. The people appointed to these positions are the ones managing the day-to-day operations of the federal government, making the specific choices about how money is spent, where staffing resources are focused, and how the administration implements federal laws.

Finally, the most overlooked appointments that presidents make are to the various rule- and regulation-making boards and commissions scattered throughout the government. These bodies are tasked with filling in the details of how specific legislation is implemented, giving them immense power to shape both the federal and state criminal legal systems. Recent examples include:

  • The Federal Communications Commission: In 2022, Congress passed the Martha Wright-Reed Just and Reasonable Communications Act, which tasked the Federal Communications Commission with issuing new regulations reducing the cost of phone calls from prisons and jails. The Commissioners took sweeping action to do just that. This impacted nearly every prison or jail in the country, regardless of whether it was run by the federal, state, or local government.
  • The Federal Trade Commission: Under President Biden, the commission took action to address junk fees that private companies charge to incarcerated people — even those not in federal custody. While the final proposed rules didn’t go nearly far enough to protect people in prison and jail, they demonstrate the far-reaching impacts of actions by this body.
  • The Postal Regulatory Commission: Postal mail remains a critical way that incarcerated people stay in touch with their loved ones on the outside. This commission sets the cost of postage and other rules around this service.

The bully pulpit

When all else fails, the president can also use their prominence in government, ability to garner media coverage, and public platform to influence how the public views and thinks about issues, even if they have no direct power over those issues. This is sometimes referred to as “the bully pulpit.”

There are few people more famous than the person sitting in the Oval Office. They have hundreds of media outlets clamoring for interviews. They can give speeches and statements that directly reach the public. And they usually have social media followings that reach hundreds of millions of people in the U.S. and worldwide.

While they don’t directly dictate policy, these are powerful tools, and when the president wants to, they can use them to raise awareness of issues they care about, pressure officials to take specific actions, or shift public sentiment and thinking broadly.

President Obama and President Trump have both used their bully pulpits — in far different ways — to discuss policing and influence the actions of local law enforcement:

  • In a 2014 speech, after a grand jury failed to indict a police officer who killed Michael Brown, President Obama gave a speech encouraging calm in the wake of that decision, giving voice to the frustration that communities of color feel with police, and encouraging local law enforcement to work to build public trust by improving their practices. President Obama had no direct say over the practices of local police departments, but by using the bully pulpit, he helped to draw public attention to the need for improvement in policing.
  • Meanwhile, during his first term, President Trump was speaking before a group of police officers in New York when he appeared to encourage more violence by law enforcement and urged them not to “be too nice” to people who are arrested. Again, President Trump had no authority over the specific policing practices of local departments, but his words provided a permission slip to officers to be more violent towards people in their custody.

Presidents have little direct authority over how local police officers do their jobs, but by using their bully pulpits in drastically different ways, one called on police to be part of a solution that improves trust in law enforcement, and the other encouraged more police violence. Both remarks helped to sway public opinion and police actions.

Congress

The president isn’t the only one with the power to influence the broader criminal legal system. Congress, through its control of federal spending, can pressure state and local governments to adopt its preferred policies on crime, policing, and incarceration. While it generally doesn’t have the power to tell state and local governments exactly what to do, it regularly uses federal funding to both incentivize actions it wants and punish actions it doesn’t.

The most infamous example of this is the 1994 Crime Bill.10 While this measure took many steps to expand the federal criminal legal system, arguably its most notorious impact was how it incentivized states to lock up more people for longer periods of time. The bill included financial payments for states that adopted so-called “tough-on-crime” policies. States that adopted these misguided policies were given billions of dollars to fund the construction of new prisons.

This is far from the only time Congress has flexed its financial power to get state governments to make their criminal legal systems harsher. Other examples include:

  • A 1991 law that threatened to withhold billions of dollars of federal highway funding for states that didn’t automatically revoke the drivers’ licenses of people convicted of drug offenses.11
  • A 1996 law that permitted the federal government to enter into agreements with local law enforcement agencies to enforce federal immigration law, with a pot of money available to entice government officials to join this effort.

Congress has also used this power for good by incentivizing or otherwise encouraging state and local governments to take meaningful steps to promote alternatives to incarceration, improve their criminal legal systems, and make their prisons and jails safer and less deadly:

  • The Prison Rape Elimination Act is a bipartisan law that sought to end sexual assaults against incarcerated people. It not only established standards for the elimination of sexual assault behind bars, but it also offered financial incentives for prisons and jails to comply with those standards and to report data on their progress to the federal government. Finally, and unrelated to money, the law mandates that it be publicly announced which states are complying with the law and which are not, which serves as an additional motivation for states.
  • The Deaths in Custody Reporting Act sought to bring transparency to the deaths of incarcerated people by threatening to reduce federal funding to states that did not report certain information to the federal government when someone dies in one of their facilities.
  • The Juvenile Justice and Delinquency Prevention Act offered financial incentives to stop states from incarcerating young people for “status offenses” such as curfew violations, stop states from incarcerating young people with adults, and address racial disparities in the incarceration of young people. States that comply with the law receive additional federal funding.

While Congress’s power to directly change state and local policy is limited, it understands that many cities, states, and counties rely on federal money to function. This provides Congress with a powerful tool to exert its influence far beyond Capitol Hill.

Federal courts

Federal courts — including the U.S. Supreme Court — have jurisdiction over a relatively small number of criminal cases, and they only directly adjudicate the guilt or innocence of people accused of federal crimes. Despite this, their rulings can have reverberations throughout state and local criminal legal systems.

That’s because federal courts have the authority to rule on whether state laws violate the U.S. Constitution or other federal laws.

During the latter half of the 20th century, federal courts regularly used their authority to make the criminal legal system fairer and less harsh, telling states they cannot:

These rulings have been particularly impactful because federal court decisions are binding on all levels of government, including presidents, governors, and all lower courts. Presidents and other government officials are constitutionally bound to follow these orders.

In recent years, however, the Supreme Court in particular has become increasingly reluctant to exercise this authority and has become more likely to defer to the executive branch to answer questions in this realm, rather than acting as a true check on its power.

These are not normal times

It is important to remember that everything written in this piece reflects how things normally operate. Anyone who has been paying attention since the start of the second Trump administration knows that we are living in decidedly not-normal times.

For example:

These unprecedented times make it hard to predict what is going to happen in the criminal legal system and in the numerous gray areas where the authority of different parts of the government overlaps. In normal times, it’s possible to guess how some of these conflicts would play out, but at a time when one branch of government is seeking to the trample the powers of the other branches and of the individual states — and those other branches and the states are largely letting it happen — all the normal bets are off.

What does this mean for the criminal legal system at the state and local level?

While the federal government has many tools at its disposal to influence policies related to crime, policing, and incarceration, the truth is that most of the power over these issues is in the hands of state and local officials.

As the Trump administration works to expand its reach in the criminal legal system, it is easy to feel that we’re helpless. That couldn’t be further from the truth.

By recognizing that state and local leaders make most of the decisions in this area, advocates can push them to stand up to the pressures of the federal government. They can urge them not to cooperate with unconstitutional and immoral actions by federal law enforcement. They can ask them to forgo funding that federal officials might use as leverage to coerce them into implementing harsh and misguided policies. And they can take action to work to make the criminal legal system fairer, smaller, and less punitive, even if the federal government has abandoned that cause.

State and local leaders are not powerless in these situations. It may be up to us to remind them of this fact.

Footnotes

  1. One area we do not cover that is of particular concern to many is the use of the Insurrection Act of 1807. This is an intentional choice because of rare use of this law, and its complexities and vagueness. To learn more about this measure, we encourage you to review this explainer from the Brennan Center for Justice.  ↩

  2. For consistency, in this explainer, we’re referencing numbers from the most recent edition of our report, Mass Incarceration: The Whole Pie 2025. This is important because, since that report was released there has likely been significant changes in the number of people in custody of the federal government for immigration-related reasons. Because of this, the numbers in this report related to immigration are almost certainly an under-count.  ↩

  3. In this briefing, we don’t discuss the immigration system in detail. This is intentional. We at the Prison Policy Initiative are quite familiar with the criminal legal system, but are not experts on immigration policy. If you want to understand how the immigration system has changed under the Trump administration, we have put together a guide of organizations and resources to jumpstart your research.  ↩

  4. It is worth noting that some of these people, while under the jurisdictional control of the federal government, are physically held in local jails that have rented space to Immigration and Customs Enforcement (ICE) or other federal law enforcement agencies.  ↩

  5. Some people sentenced to incarceration for shorter times are held in local jails, instead of prisons.  ↩

  6. It is worth noting that most states have rules around the possession and use of marijuana, and violating those rules could still get a person in trouble with the law. Most commonly, these rules ban the use of marijuana in public places. For example, in most states, smoking pot in a public park could still result in criminal arrest or citation.  ↩

  7. If you’re not sure whether a prison is run by the state or federal government, it can be helpful to look at the facility’s name. If the name contains the letters FCI (Federal Correctional Institution) or USP (United States Penitentiary) it is a federal prison. While the vast majority of federal facilities start with these acronyms, there are some federal facilities whose names don’t include these letters.  ↩

  8. We dive deeper into this later in this piece.  ↩

  9. We discuss the role and influence of federal courts in the criminal legal system later in this piece.  ↩

  10. It is worth noting there is considerable debate about the impact this law had on state prison construction. The subsidies for prison expansion weren’t massive, and academics dispute whether states would have made their sentencing laws harsher anyway (and some states claim that the subsidies had no effect). And the 1991 highway bill, which is mentioned below, both threatened to withhold a significant amount of money from states and made it incredibly simple for them to opt out of the requirement without losing their funds. But in both cases, Congress clearly expressed an opinion as an attempt to exert some influence on state governments.  ↩

  11. In one of our earliest campaigns, Prison Policy Initiative worked to end this practice. Learn more about this practice and our efforts on our driver’s license suspension campaign page.  ↩


Moving people between prisons can improve their access to treatment, programs, and visitation — but transfers can also be deeply traumatizing, disruptive, and destabilizing. In this briefing, we use transfer records and interviews with dozens of formerly incarcerated New Yorkers to examine how often people are moved, why they’re moved, and how this little-discussed aspect of prison life impacts them.

by Iolanthe Brooks, June 5, 2025

Most people imagine incarceration as confinement in one place. Yet few incarcerated people serve their sentence in just one facility. Many are transferred repeatedly — sometimes dozens of times — before release.

Transfers require incarcerated people to pack their belongings, undergo invasive strip searches, and take long trips while restrictively shackled — what one person described as “the worst experience of my life.” When a transfer bus arrives, its passengers might find themselves closer to loved ones or at a prison hundreds of miles from them. Each move upends nearly every aspect of an incarcerated person’s life, including peer networks, familiarity with officers, institutional culture, rules, housing configurations (e.g., cells vs. dorms), and program and job opportunities.

In some cases, transfers are beneficial. They can move someone to a prison with a lower security classification, more programs, or a safer culture, as well as one closer to home. Such transfers can boost program access and visitation, both of which research has shown to contribute to well-being and reentry preparedness. In other cases, transfers can have the opposite effect, severing program participation and introducing a person to a stressful new environment. Regardless, transfers always bring changes. As one person told me, “Once you become acclimated to a prison… you know how to exist in that prison… But once you transfer, that no longer holds any thread to your daily living. You’ve got to start from scratch all over again. People hate that — it’s nerve-wracking.”

An animation showing all prison transfers in New York State between 2021 and 2022, animated by week. Over the course of a sentence, many incarcerated people are made to zig-zag between prisons across their state due to prison transfer practices. The above animation shows all transfers in New York State between 2021 and 2022, animated by week.

Despite their importance, transfers are a fact of prison life that few non-incarcerated people think about and that have received limited attention from policymakers and researchers. How often do transfers happen? Why do prisons transfer people? Most importantly, what impacts do transfers have for incarcerated people?

To answer these questions, I interviewed 52 New Yorkers who left prison in the last few years1 and created a novel quantitative dataset, generated by linking together administrative transfer records obtained by public records requests. Although I focus on New York, reporting suggests that transfers are similarly common and consequential in other state prison systems and in the Federal Bureau of Prisons.2

Recent legislative efforts in New York and a handful of other states encourage transfers closer to home for parents with young children. These policy reforms show how prison transfer systems could be reoriented to support success upon release. However, my research reveals that, for most people, transfers remain a harmful and all-too-frequent disruption.

Transfers are common, even during public health emergencies

The chart below shows New York’s total monthly transfers from 2020 to 2022. Before the pandemic, the New York state prison system made over 3,000 transfers a month. At the onset of COVID-19, transfer rates dropped precipitously amid concerns — later actualized in New York and other states — that transfers would spread the virus. By June 2020, however, transfers had resumed at close to pre-pandemic levels.3 After a year of starts and stops, an internal staff email in July 2021 reported that transfers had returned to full capacity, despite ongoing COVID-19 surges.4

By 2022, New York was making an average of 3,167 transfers a month, with a total of just under 38,000 transfers in 2022. As I explore more below, only a small number of these transfers were to move incarcerated parents to prisons closer to their children under the new law implemented in late 2021.

A chart showing how New York prison transfers rose and fell in response to COVID-19 policies and proximity laws. Public records obtained from the New York Department of Corrections and Community Supervision show the ebb and flow of transfers between December 2019 and December 2022, as the department responded to the COVID-19 pandemic and new proximity laws.5

While some incarcerated people move often, others spend decades in a single prison

Over the course of their sentence, an incarcerated person can move multiple — even dozens — of times. In 2022 alone, two New Yorkers were transferred ten times each. Of everyone transferred that year, about half moved more than once.

Of course, not everyone transfers this often. Interviews with formerly incarcerated New Yorkers showed varied transfer histories. As Felix summarized, “People’s incarcerations take different trajectories… You can land in a spot [and] stay there for a long time.” Or, as he experienced, you can get “transferred all over the place.”

Felix’s 22 transfers were largely for disciplinary reasons, especially early in the two decades he spent incarcerated. He described seeing the same people transferred from one maximum security prison to another. “Every time I’d go to the box, it’s all of us going to the box… It was like, ‘oh, you back? Oh, you here?’… Like, 10 years of just sitting on buses… Not staying in any one place — unless it’s solitary confinement — for any longer than a year.”

A map of New York State with lines showing how Felix was transferred to prisons around the state. The above graphic illustrates Felix’s 22 transfers over the 21 years he spent incarcerated. After criss-crossing the state, Felix was eventually released and returned to his family in the Hudson Valley.

Meanwhile, Alexander found himself stuck in one maximum security prison for over 15 years. In his words, “You get used to people leaving — being transferred… and you sitting there. It was troubling, because some of the people that’s leaving helped you get through your stress, and y’all was there for each other… Now, I’m alone… like, damn, everybody who was here with me before is gone. [And] the officers don’t know me now, so I’m being mistreated.”

A map of New York State with lines showing how Alexander was transferred across the state. Alexander was transferred just 5 times in 28 years, eventually returning home to Brooklyn, NY.

Felix and Alexander represent two trajectories through a prison sentence, marked by different levels of movement.

On the one hand, Alexander felt stuck in place. Even without moving, his relationships with other incarcerated people and staff were uprooted as others transferred around him and staff moved on to new jobs or different prisons. People who spent long stretches in a prison like Alexander often wished they could access programs and opportunities elsewhere, move closer to loved ones, or follow mentors who had transferred out. Yet many reported being reluctant to submit transfer requests, since they could not control where the prison system would choose to move them, including to a worse, less safe, or more distant facility.6 Others were grateful to stay put, having no interest in transferring.

On the other hand, Felix moved constantly and chaotically — what one person called “ping-ponging” from prison to prison, and another called the “I Love New York State tour.” Moving frequently meant he could rarely complete programs or build long-lasting relationships. As incarcerated writers often report, friendships not only afford a sense of safety and stability in a prison’s unpredictable environment but can also provide transformative mentorship and deep emotional support. Constant transfers stymied Felix’s access to such relationships, while exacerbating the turbulence and stress of incarceration.

Transfer requests account for only a small portion of movement between prisons

Even though people incarcerated in New York can request transfers, the data show that transfers are not predominantly driven by requests from incarcerated people. For the most part, moves are involuntary.

In New York, incarcerated people can request a transfer provided they have been in their facility for a sufficient amount of time and do not have recent disciplinary tickets.7 In December 2021, the state joined several others in passing legislation mandating the department to allow parents of children under 18 years old the opportunity to transfer closer to home. Between June 2021 and May 2022, almost 6,000 people submitted requests under this program alone.

Although the data show an increase in transfers by request in 2021-2022, these moves were overshadowed by transfers for other causes. Indeed, 92% of transfers in 2022 were for reasons other than incarcerated people’s requests. Mainly, transfers were recorded as happening for programming, “general confinement,” and disciplinary reasons. For instance, individuals might be moved to a facility that offers a certain treatment program — or they might be transferred to solitary confinement or restricted (disciplinary) housing units for breaking prison rules, or even as a retaliatory punishment for speaking out about conditions.

Three bar charts for years 2020, 2021, and 2022 showing that prison transfers for administrative, disciplinary, and other reasons overshadowed those done at the request of incarcerated people. The percentage of transfers recorded as happening by the request of the incarcerated individual increased between 2020 and 2022, but was greatly overshadowed by the percentage of transfers for all other reasons.

Research shows that visitation — especially with one’s children — reduces misconduct, bolsters mental health, and is an important part of successful reentry. When transfers are done to achieve these ends, they play an important role in reducing the harm of incarceration. Conversely, when done for punitive or arbitrary reasons, transfers can exacerbate those problems. Recent legislative efforts to allow parents to transfer closer to their children are important first steps toward expanding incarcerated people’s voice in housing determinations. The data show, however, that more work is needed to shift the balance of coercion and agency in prison placement.

Transfers to different security levels are relatively rare

Another reason prisons might transfer people is to respond to security classification changes. Prisons are typically assigned a security level, while incarcerated people’s classifications shift over time. As a result, transfer rates could be driven by changes in security classification. Transfer records from 2021 and 2022, however, show that only one-third of transfers moved people to different security levels. Most transfers shuffle people laterally between prisons of the same security level. Of transfers between security levels, the majority moved people from maximum security prisons down to medium ones.

Two stacked bar charts showing how most prison transfers are between the same security classification levels, and those between different levels are primarily for people stepping down from maximum security. Most prison transfers happen within security classification levels (for example, between medium-security facilities) or to step down from the maximum security level. Otherwise, transfers to different security levels are relatively rare.

Overall, these findings suggest that prison administrators use transfers for a variety of reasons other than changes to security classifications.

Transfer-driven population turnover creates mass instability

Transfers substantially affect prison populations. Some facilities transfer people in and out more often, but — as my recent article shows – all are implicated in prison-to-prison moves and the turnover it brings. Over the course of 2022, over 70% of New York’s prisons transferred the equivalent of 50% or more of their January populations to other facilities. Of those, nine prisons (18%) had turnover of over 100% of their start-of-year population size.

A bar chart showing that half of New York prisons transferred out 60 percent or more of their populations each year, with another 9 prisons averaging more than one transfer per person. Half of New York’s prisons transferred the equivalent of 59% or more of their January populations to other facilities. While the other half transferred smaller proportions of people, most still had turnover rates between roughly 20-60% of their January populations.

Constant population turnover from transfers combines with that of prison releases and new entries, making everyday life in prisons unstable and uncertain. Interview participants, for example, described realizing a friend had transferred when they didn’t show up to breakfast or a standing basketball game. Meanwhile, they recounted fearing who might arrive on daily transfer buses.8 As one person put it, “You never knew, that bus coming in could be from hell.”

Transfers do not do enough to bring incarcerated New Yorkers closer to home

When a person is incarcerated far from home, they are less likely to receive visits, which have been linked to everything from mental health benefits to reduced recidivism. On average, transfers in 2021 and 2022 originated about 175 miles from the transferee’s county of conviction, which I use as a proxy of their home area.9

While requested transfers brought incarcerated New Yorkers an average of 147 miles closer to home, most transfers have little impact on distance from home. People transferred by request started farther from home than for other transfers, an average distance of 225 miles compared to 169 miles. Their transfers brought them much closer to home — 78 miles away on average, compared to 199 miles for all other transfers. Aside from transfers by request, all other transfers brought incarcerated people an average of 29 miles farther away from their conviction county, an increase of 17% from their average starting distance.

Transfers and Distance from Home

All transfers Transfers by request Transfers not by request
Sending prison’s average distance from conviction county (median) 175 miles
(159 miles)
225 miles
(229 miles)
169 miles
(147 miles)
Receiving prison’s average distance from conviction county (median) 187 miles
(191 miles)
78 miles
(65 miles)
199 miles
(207 miles)
Average change in distance from conviction county (median). Positive values indicate moving farther from conviction county, and negative values indicate moving closer. 12 miles
(9 miles)
-147 miles
(-162 miles)
29 miles
(20 miles)

People transferred by request started farther from home than those transferred for other reasons, and typically ended up closer to home. All other transfers brought incarcerated people an average of 29 miles farther away from their conviction county.

Harrowing journeys, with long-term impacts

For incarcerated people, transfers can be harrowing. As documented by journalists and academics alike,10 they often involve long trips with circuitous routes, including stops at multiple prisons and breaks for corrections staff. During transfer trips, incarcerated people have little access to food or bathrooms, and recount uncomfortable seats and painfully restrictive shackling. As Hugo put it, “By the time you get off the bus, you either got a cut or your leg is swollen [with] black and blues.”

For Linda, who is in her mid-sixties, transferring was “the worst experience of my life,” adding that, “You’re on this bus, you’re shackled to somebody else.” To avoid needing to use the bus bathroom while shackled to a stranger, Linda decided not to drink anything and to skip eating the bagged bologna sandwich she was given for lunch. Her bus left “early in the morning” but didn’t arrive at the next prison “until late evening,” despite it being about a six-hour drive away. Overall, she felt that “[the officers] don’t care about you. They don’t care if you use the bathroom. They don’t care if you’re going to eat. They just want to make sure they get you from one location to another.”

Because transfers upend nearly every aspect of incarcerated life, the first few weeks in a new prison can be especially difficult — and even dangerous. Recently transferred people need to restock possessions lost during transfers, requiring them to spend their often limited funds on exorbitantly expensive commissary goods. They also have to learn the rules of their new facility, including formal policy differences and informal “politics.” Without this know-how, recently transferred individuals are prone to disciplinary tickets and victimization.11

Overall, the destabilization of a transfer often proves challenging. As two participants commented:

It was hard. Don’t get me wrong, I was furious because my whole life was planned out and everything was just taken away. And that’s kind of what these transfers do: they disrupt your life. What little life that we had in there, they just broke it up. So, when you have a plan, and you want to get these programs… they take it all away and you got to start all over.

— David, incarcerated 25 years and transferred 6 times.

It’s designed to break you…They move you from plantation to plantation. You lose people, you lose property. You lose so much through a transfer… In prison because of all the violence, who’d want to get moved? You want to be in the hell you already know, the hell that you already got comfortable in. Now they’re sending you to another man-made hell that you got to start all over [in]… No one wants that.

— Wyatt, incarcerated 29 years and transferred 9 times.

In the long term, transfers disrupt relationships that are essential to prison safety and stability. These relationships can not only provide mentorship and care but also a helping hand during reentry, and are the crucial building blocks of incarcerated organizing.

While transfers create disruption and loss, they can also have enormous positive potential. They can bring incarcerated people closer to their loved ones, move them to prisons with the specific programs they are interested in, remove them from dangerous situations, and add variety to the monotony of a long sentence. Policymakers have the opportunity to balance the positive potential of transfers against their negative impacts.

Expanding incarcerated people’s agency in transfer decisions

Transfers are a common part of prison life with dramatic effects on incarcerated people’s well-being. From suddenly-severed friendships and arduous bus rides to the constant turnover they produce, transfers are often stressful and destabilizing experiences. As they upend incarcerated people’s lives, they have the opportunity — and risk — of bettering or worsening their access to loved ones, programs, jobs, and safety.

Rather than continuously shuffling incarcerated people, transfers should be used to prioritize stability and autonomy. Policymakers can mitigate the punishing aspects of transfers without undermining their positive potential, following in the footsteps of recent legislative reforms.12 For instance, existing legislation is tailored to parents of minor children but could be expanded to people with aging family members, adult children, or indigent loved ones who cannot afford long journeys to visit. Likewise, giving incarcerated New Yorkers the opportunity to “veto” the prison that the state determines for them following a request might diminish fearfulness around submitting them. Above all, incarcerated people should have the opportunity to stay in place if they prefer, particularly if they have no disciplinary issues and are succeeding in their programs, jobs, and relationships.

Methodology

Data Sources

This research uses two quantitative data sources, both shared by the New York Department of Corrections and Community Supervision (DOCCS) through Freedom of Information Law requests. The first is a summary of every transfer record in 2020-2022, with the sending and receiving facilities and its cause. I used text parsing tools to digitize these records into a spreadsheet. Using this data, I calculated detailed statistics about transfers, including how many happened, their causes, and per-person transfer counts by year. Reflecting this data source, I operationalize “a transfer” based on how DOCCS defines them; for example, the data does not include transfers between prisons and jails, temporary transfers for court visits, or temporary medical transfers to outside hospitals.

The second data source is 24 files, one for each month of 2021-2022. Each file provides the population under custody for the first of that month, with information including each person’s unique identification number and county of conviction. I linked these records by unique ID to generate a list of the conviction counties of every person incarcerated in the 2021-2022 period. Finally, I merged this conviction county information into the transfer records described above, so that each transfer record included the conviction county of the person transferred. With this information, I was able to calculate distance changes from home.

Data Cleaning

Working with the above administrative datasets required significant data cleaning. I constructed several variables, including:

  • Transfer cause: I consolidated two of the codes for transfer cause into the category of “transfers by request”: “Area Of Preference” and “Area Of Children.”
  • Distance variables: I used United States Census data to geocode the centroid of New York’s counties and Google Maps’ coordinates to geocode each of New York’s prisons. Then, I used ArcGIS Pro to calculate the highway mileage of the quickest route for 1) the distance between the sending prison and the conviction county centroid and 2) the distance between the receiving prison and the conviction county centroid. I use an individual’s conviction county as an imperfect proxy of their “home” region. In doing so, I join other researchers who use the same proxy.
  • Facility security levels: The security level of each prison is based on the DOCCS website.
  • Facility population size: Each facility’s starting population size is based on DOCCS’s publicly reported data for the facility population on December 31, 2021 (see page 10 in the linked report). I calculated the proportion of the population transferred by dividing the total number of transfers “out” (i.e., where the given prison was the “sending” facility) by the starting population size.

Qualitative Data

The quotes included here come from interviews with 52 formerly incarcerated New Yorkers about their transfer experiences. Interviews were conducted in June 2023-August 2024 and participants were recruited through reentry nonprofits based in New York City. As part of the interview, participants recalled their transfer histories; Felix’s and Alexander’s transfer history maps are based on this self-reported data. All names used in the above are pseudonyms. This study was approved by the Northwestern University Institutional Review Board.

Read the entire methodology

Footnotes

  1. Interviews were conducted between June 2023 and August 2024, and participants were recruited through reentry nonprofits. As part of the interview, participants recalled their transfer histories; the transfer history maps included here are based on this self-reported data. All participant names are pseudonyms. This study was approved by the Northwestern University Institutional Review Board.  ↩

  2. The limited multi-state research that does exist, summarized on pages 3-5 of this 2016 Comment letter from the Prison Policy Initiative to the Census Bureau, finds that (1) “Nearly 75% of incarcerated people are moved between facilities before they go back home,” (2) “30% of people in federal and state prisons have been at the current facility for less than six months,” and (3) median length of stay at a given facility ranges from less than 6 months to just under a year across Georgia, New York, and Massachusetts, with similar findings in Washington, Oregon, and Nebraska. Elsewhere, the Prison Policy Initiative reports that “12% of people serve time in at least five facilities before returning home.”  ↩

  3. These included transfers of at-risk elderly New Yorkers to a prison in far-upstate New York, in an effort by the state to protect them from the virus. A class-action lawsuit filed on behalf of the men transferred argues that the moves instead exposed them to COVID-19.  ↩

  4. June-August 2021 was the height of the surge of the Delta variant of COVID-19.  ↩

  5. At the onset of the COVID-19 pandemic in late March 2020, the New York Department of Corrections and Community Supervision briefly paused transfers (per an internal email, obtained by public records request). In June 2020, they announced that transfers will “slowly resume.” Later, an internal email obtained by public records request shows that in early/mid-July 2021, the department informed superintendents that transfers had resumed at 100% capacity and that everyone transferred was being screened for COVID-19 symptoms and must wear a mask. Beginning in December 2021, the department implemented a law requiring them to allow parents of children under 18 to request a transfer closer to home.  ↩

  6. In New York, incarcerated people can submit a transfer request for a specific “hub” and list the facility they would like to transfer to, but they are not guaranteed placement there. Interview participants described fearing transfers farther from home (concerns a “hub” request can mitigate) and to more dangerous prisons.  ↩

  7. Based on their understanding of prison rules, interview participants reported varied lengths of time they had to be in a prison prior to submitting a request. In an email in April 2025, New York corrections department staff confirmed that, as of April 2025, in order for an incarcerated person to request a transfer, “a maximum-security incarcerated individual must be in the Department for at least one year and in their current facility for six months with an acceptable disciplinary record. Medium security incarcerated individuals must be within a hub and positively programming for a period of two years and must demonstrate favorable disciplinary adjustment. Cases are reviewed semiannually to determine transfer eligibility. Should they meet transfer eligibility requirements, their assigned Offender Rehabilitation Coordinator will advise them at their first semiannual review.”  ↩

  8. Participants explained that New York aims to account for this, transferring people only to prisons where they do not have a “no contact” or listed “enemy.”  ↩

  9. Although research suggests that the majority of arrests occur in the arrestee’s county of residence and, on average, take place close to their home address, conviction county is an imperfect proxy for home region.  ↩

  10. See: Brooks, Iolanthe, and Asha Best. “Prison fixes and flows: Carceral mobilities and their critical logistics.” Environment and Planning D: Society and Space 39.3 (2021): 459-476; Turnbull, Sarah, and Dawn Moore. “Understanding carceral mobilities in and through lived experiences of incarceration.” Punishment & Society 26.5 (2024): 948-966; and journalism including, I Got the Prison Transfer I Fought For. My Feelings Were Surprisingly Mixed and For a Prison Transfer 45 Minutes Away, I Spent 12 Days in Hell.  ↩

  11. In an extreme example, Robert Brooks, a Black man, was beaten to death by Marcy Correctional Facility officers in December 2024, just 30 minutes after a transfer from nearby Mohawk Correctional Facility. The New York Times, summarizing the Onondaga County district attorney, described the attack as appearing “to have been a sort of violent initiation into life at Marcy Correctional Facility. He called the attack a ‘welcome to Marcy,’ and said it was ‘emblematic of the problems here and throughout the system.’” While recounting much less severe stories, participants in my research described guards making bombastic and threatening speeches to new arrivals, “letting you know,” as Elijah put it, “that this is not your house, this is our house, and we [correctional officers] do what we want to do,” including “roughing up” incarcerated people.  ↩

  12. Emma Kaufman makes a similar argument about the need for oversight and consent in her writing about interstate transfers, advocating for “[trying] to build prisoners’ views into the assessment of whether or not a transfer is going to be legal” and to “bring prisoners’ experiences and their family members’ preferences into this legal regime.”
     ↩


Please welcome our new Senior Researcher, Jacob Kang-Brown!

by Danielle Squillante, May 27, 2025

Jacob Kang-Brown

We’re excited to announce that Jacob Kang-Brown has joined our team as a Senior Researcher. In this role, he’ll research and write briefings and reports, help develop new projects, and provide additional support for the research team’s use of large datasets and quantitative analysis.

Before joining Prison Policy Initiative, Jacob was a Senior Researcher at the Vera Institute of Justice where he specialized in analyzing incarceration trends. His work has appeared in The Lancet Public Health, The New York Review of Books, Contexts, SSM-Population Health, The Atlantic, Dissent, USA Today, and American Jail Magazine, in addition to the Vera Institute of Justice. He holds a PhD in Criminology, Law & Society from the University of California, Irvine and bachelor’s degree from Wheaton College (Ill). Jacob has also worked for Physicians for Social Responsibility-Los Angeles and the L.A. County Commission on Human Relations.

Welcome to the team, Jacob!


Our review of copay policies show that exemptions are so limited, ill-defined, and inconsistent that they fail to make the copay system less harmful for incarcerated people.

by Emily Widra and Dr. Emily Lupez, May 15, 2025

In most states, people incarcerated in prisons must pay medical “copays,”1 which are essentially fees to access health care including physician visits, medications, dental treatment, and other health services. While these fees may seem reasonable at two or five dollars, research shows they actually act as barriers to health care for incarcerated people who typically earn less than a dollar an hour, if they are paid at all. Prison administrators claim these fees deter the “overuse and abuse” of limited health care resources,2 and have countered critiques by including waivers and exceptions in their copay policies and insisting that no one is denied care because they can’t afford to pay. However, our review of these policies and evidence from a recent study show that these exemptions are so limited, ill-defined, and inconsistent that they fail to make the copay system fairer and less harmful for incarcerated people. Instead, these exemptions lend a veneer of rationality to prison medical fee policies — which are known to limit access to care — ultimately helping to perpetuate them.

We reviewed each state’s prison copay policy, including any waivers or exemptions, to build upon the initial findings of Dr. Lupez and her colleagues, which indicated that copay waivers are likely not working as intended. They found that, despite two-thirds of states that charge copays having chronic condition waivers, people with chronic conditions in states charging copays were substantially more likely to have never seen a doctor since admission compared to those in states without copays.3 If copay waivers were being applied routinely and consistently, we would expect people without a chronic condition (i.e., people ineligible for a chronic condition waiver) to be more likely to have never seen a doctor since incarceration, but this was not the case, implying that these waivers are not promoting healthcare access for some of the most vulnerable people in prison.

bar chart showing the percentage of pregnant people not receiving an obstetrical exam and the percentage of people with chronic medical conditions who have not seen a medical provider in state prison by relative expense of medical copays compared to average prison wages In research published in 2024, Dr. Lupez and her colleagues found that among people incarcerated in state prisons for any amount of time, more unaffordable copays were associated with worse access to the necessary healthcare, like obstetrical examinations for pregnant people and seeing a medical provider for people with chronic medical conditions. For more details, see New research links medical copays to reduced healthcare access in prisons.

To better evaluate how copays and copay exemptions function in prison systems, we analyzed policies from all states charging medical copays and the federal Bureau of Prisons. While we cannot estimate the frequency with which care is actually exempt from copays, our analysis of the various policies reveals that copay waivers are inevitably inconsistently4 or retroactively applied,5 unclear to incarcerated people,6 and frequently left up to the discretion of a single healthcare provider, administrator, or other correctional staff.7 This helps explain why incarcerated people may expect to be charged a burdensome fee every time they seek medical care, regardless of potential exemptions, and in turn, how that fee functions as a significant barrier to healthcare access.

Key findings from our study of prison copay policies

Almost all state prison systems charging copays have policies outlining exemptions for some healthcare services for some incarcerated people. Among the 40 prison systems still charging these fees, the exemptions can be based on any number of factors including how the care was requested,8 the specific health condition,9 the type of medical care required,10 and the circumstances leading to treatment.11 Ultimately, we find that copay waiver policies frequently rely on the discretion of individual healthcare providers or correctional staff and are far too limited and have far too many caveats to meaningfully counteract the harmful deterrent effect of copays on healthcare access.

map of the united states showing which prison systems charge medical copays greater than one week's wages, those that charge copays less than one week's wages, and those with no copays

Below, we highlight the most striking examples from our analysis that illustrate why waivers or exemptions still fail to ensure appropriate and equitable access to the care people need.

Staff-initiated versus patient-requested care. In most states (33), incarcerated people are expected to pay a fee if they request their own medical care, but medical care requested or initiated by healthcare staff, correctional staff, or facility administrators is exempt from fees.12 In some cases, this reflects standardized or systems-based visits like mandatory tuberculosis testing, which is more aligned with the priorities of the carceral system (i.e., infection control) than patient needs. Staff-initiated visits force incarcerated people to rely on the prison medical system to monitor when preventative care or chronic health condition follow-ups are due, a process likely hindered by staffing shortages and the absence of sufficient medical record systems.13 Exemptions for care initiated by correctional staff — such as a request for a mental health evaluation — require incarcerated people to depend on correctional staff to access healthcare services, compromising patient privacy — when medical information has to be shared with non-medical staff — and establishing a system where staff exert control over who gets seen by medical providers, undermining patient autonomy.

Medical emergencies. Only 27 prison systems include an explicit exemption for emergency treatment, and in most of those states, the emergency is defined by either healthcare providers14 or departmental staff,15 not the person actually experiencing the medical emergency.16 In seven states with medical fees, incarcerated people are required to pay the fee for emergency medical care if the injury or illness is determined — by medical staff, correctional staff, or in a disciplinary hearing17 — to be self-inflicted.18 An additional two states specify that care provided for self-inflicted injuries are subject to copays (although do not specifically mention emergency medical care). At least one state (Michigan) requires the incarcerated person to pay all costs associated with the treatment of injuries and illnesses determined to be self-inflicted, which is inevitably above and beyond the initial fee for health services; essentially, such policies use medical fees as additional punishment for accidents, self-harm, and mental illness.19 In our survey of state policies, we only found two states with policies specifying that people with serious mental illness could be exempt from the fees associated with medical care for self-harm20 and only one other state (Texas) that exempts medical treatment for all self-inflicted injuries from medical fees. Policies charging fees for medical care needed for self-inflicted injuries are particularly cruel given the mental health harms caused by incarceration itself. In states that punish self-harm this way, incarcerated people not only have to suffer these injuries — they must also financially pay for them.

Work-related injuries. Almost half of prison systems that charge copays (17) have some exemption for medical care associated with work-related injuries. In some prison systems, only the initial medical treatment for a work-related injury is exempt,21 and in others, the treatment for work-related injuries is exempt from the medical fee only if it is a medical emergency.22 In some prison systems, the treatment for work-related injuries is only exempt if it was reported at the time of the injury and is verified by an incident report (filed by correctional staff).23 Like the exemption for emergency care, this exemption relies entirely on the accuracy and timeliness of staff reporting workplace incidents. It’s also worth noting that incarcerated workers generally do not have the workplace health and safety protections that people do outside of prisons (such as those enforced by the Occupational Safety and Health Administration or similar state programs). They are also often exposed to dangerous work conditions. So it’s remarkable that when incarcerated people are injured under work conditions controlled by the prison system itself, they are often still assessed medical fees and experience lost wages, given the lack of standard labor protections like sick leave.

Chronic health conditions. While most states (26) have exemptions related to care for chronic health conditions like cardiovascular disease, diabetes, HIV, or mental illness, many (17) of these exemptions only apply if the appointment is scheduled by a health care provider or as a part of a recurring “clinic,” not if the individual seeks additional care outside of previously scheduled appointments.24 Someone who meets the exemption criteria may also need to pay copays for the initial two or three nursing sick call visits before clinicians identify them as someone who should be exempt from copays.25 In Alaska, for example, people with chronic conditions are charged a $5.00 fee for their initial provider visit and $5.00 every year “for ongoing treatment of the chronic condition.” At least three states (Georgia, Indiana, and Oklahoma) mention an exemption for fees associated with prescriptions for chronic conditions, but do not exempt chronic condition-related provider visits or other treatments from the fee.26 People in state prisons suffer disproportionately from chronic health conditions when compared to the total U.S. population, and financial barriers to treatment will only exacerbate the poor health outcomes of incarceration.27

bar chart showing how many prison systems have exemptions for menstruation-related healthcare, treatment for substance use, vaccinations, hospitalization, and pregnancy-related healthcare

Pregnancy-related care. In 18 prison systems, some or all of the care related to pregnancy is exempt from copays. In some states, like Arizona and New Hampshire, they are only exempt from copays for pregnancy-related medical care (i.e., they would not be exempt from copays for treatment for a non-pregnancy-related illness or injury).28 Five states and the federal Bureau of Prisons only exempt prenatal care (care while pregnant) with no mention of delivery-related care or postpartum medical care.29 At least three states explicitly exempt postpartum medical care from copays.30 About 4% of people (or 3,500) in women’s prisons in 2016 — disproportionately women of color — were pregnant at admission, and many of them did not received the basic prenatal care you would expect, like an obstetric exam, medication, special diets, testing, or pregnancy education. Given that many prison systems seem to have limited or no policies exempting pregnant people from medical copays, many may not seek care during their pregnancy. Combined with a lack of robust healthcare resources in prison to identify people in need of care, it’s no wonder many pregnant people are not receiving necessary medical care.

Menstrual health. Only one state’s copay exemption policy makes any mention of menstrual health: in Arizona, people “who require additional feminine hygiene products due to medical issues” can complete a form and submit it to Health Services, and the copay is waived for the subsequent medical appointment. Only half of state prison systems (25) are required by law to provide menstrual products, and only 18 of those systems are obligated to provide those products for free.31 Not only do many women have to pay for their menstrual products, but they also must pay for any healthcare related to problems caused by inadequate access to menstrual products. For the more than 85,000 women in prison in 2023, inadequate access to period products and reproductive healthcare can have serious health consequences, and almost every single prison copay policy fails to even address menstrual health.

Substance use. Only eight states and the federal Bureau of Prisons explicitly exempt substance use related healthcare from medical copays. Even when healthcare providers refer people to substance use treatment, incarcerated patients are frequently charged for their initial request for an appointment with the provider, and many incarcerated people may not know how to access treatment without being charged copays and fees. Any perceived barrier to accessing substance use treatment behind bars has serious consequences for the more than half-million people in prison who reported a substance use disorder in the year before their admission.32

Vaccinations. About one-quarter of prison systems with copays (13) waive them for vaccinations explicitly. Even when vaccinations are exempt from copays, there are often additional caveats: in West Virginia, the waiver only applies to vaccinations and preventative care “provided or made available to all inmates.” While these exemptions may clearly apply to the distribution of the COVID-19 vaccine in 2021, it is unclear how this may play out when an incarcerated person requests a specific vaccine that may not be offered to the entire facility population, like the HPV vaccine,33 the pneumococcal vaccine,34 or Hepatitis B vaccine.35

In addition to these highlighted findings, we have categorized the state copay policies we found according to the conditions or types of medical care that are exempt (and under what circumstances) and compiled this information in our appendix table.

Conclusion

“Copay” fees for medical care in prison are unaffordable at prison wages. They deter necessary care for an incarcerated population that faces many medical conditions — often at higher rates than national averages — and that routinely receives inadequate health services behind bars. The copay waiver policies ostensibly meant to “fix” this problem of copays deterring necessary care are, in many states, extremely limited with only a handful of care types or medical conditions exempted. Oftentimes, the exemptions are so ill-defined and inconsistent that it is hard to imagine any fair, consistent implementation of these policies. Many incarcerated people may be unaware that such waivers exist at all; even if they are aware, the complexity of the waiver criteria makes it nearly impossible for them to determine whether, when, or how a waiver might apply to their care.

Ultimately, we conclude that these copay exemption policies fail to make the copay system any less harmful for incarcerated people, especially the large number of incarcerated people with chronic medical needs. Instead, 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.36 Rather than tinkering with the edges of these policies through waivers and exemptions, prison systems should drop copays altogether.

Appendix Table

Jurisdiction Copay amount Intake or transfer Routine Vaccinations Communicable diseases Chronic conditions Diagnostics Pregnancy-related Sexual-assault related treatment Mental health treatment Substance use Emergency Staff-initiated Prescription medications Medical or mobility devices Infirmary, hospitalization, and/or inpatient care Work-assignment related Other notable exemptions Relevant legislation Sources
Alabama $4.00 Intake only (includes mental health and dental) Yes (includes dental) Yes (includes sexually transmitted infections) Yes, in chronic care clinic if staff-initiated If on-site Pregnancy-related or postpartum care If on-site If on-site If “non-self-inflicted” (includes dental) Yes Some (chronic condition refills) Infirmary Yes (if not subject to workers compensation or job insurance) Missed appointments (for some reasons) DOC Admin. Reg. 703 (2023)
Alaska37 $5.00 Intake only Yes Yes, but initial visit subject to copay and must pay $5.00/year for ongoing treatment of chronic condition after first year Pregnancy-related care Assessments and screenings Some (communicable diseases, psychiatric) Medication line visits DOC Policy 807.07 (2016)
Arizona $5.00 (maximum) At reception centers or when returned to custody Only Hepatitis C-related (in ADCRR) or HIV/AIDS related (in ADCRR and contracted beds) Yes Pregnancy-related care If serious mental illness is present (in ADCRR and contracted beds); if ASPC-Phoenix psychiatric hospital or mental health center Yes (includes people requiring administrative examinations like “response to suicide prevention/watch”) People with developmental disabilities; people “who require additional feminine hygiene products due to medical issues;” minors DOC Dept. Order 1101 (2018) and Glossary of Terms
Arkansas $5.00 (maximum) Intake only (includes dental) Yes (includes dental) Only if related to testing/prevention Yes, in chronic care clinic Yes Yes Yes (includes dental) DOC Policy AR 0893 (2005)
Colorado $3.00 Intake only Yes If instituted by department for public health reasons or related to a state/national emergency Yes (includes initial sick call requested later determined to be due to chronic condition) Yes, unless “no-show” Pregnancy-related care Yes (includes mental health) Intake screenings, emergencies, in residential treatment program, or if serious mental illness is present If related to chronic care condition Yes (includes dental) Infirmary Comfort and/or end-of-life care; disability status screenings; medical care related to a “vision, hearing, or lower extremity mobility disability”; “A $5.00 co-pay fee will be charge dfor self-declared emergencies that may or may not require transport outside of the facility” Proposed legislation to end medical copays in prison (Colo. H.B. 25-1026 (2025)) DOC Admin. Reg. 700-30 (2024)
Connecticut $3.00 If scheduled Yes If necessary per staff Yes (includes dental) If court commitment conflicts with specialty appointment DOC Administrative Directive 3.12 (2020)
Delaware $4.00 Intake only Yes Yes, in chronic care clinic (includes mental health) Yes Yes Yes Yes Some (psychiatric) Glasses (first pair) Infirmary Health assessments required by policy; “Co-pays will not be charged when seen by one or more providers for the same problem three times in a seven-day period.” DOC Policy E-01.1 (2021)
Federal $2.00 Yes For chronic infectious diseases If staff-approved Prenatal care Yes Yes Yes Yes BOP Program Statement 6031.02 (2005)
Florida $5.00 Intake only If follow-up routine care If instituted by department for public health reasons, requires medical action to protect others from a communicable disease, or is a voluntary HIV test request If staff-initiated Yes Yes Care that is “provided in connection with an extraordinary event that could not reasonably be foreseen, such as a disturbance or a natural disaster” 2024 Fla. Stat. S 945.6037
Georgia $5.00 Intake only Yes (excludes “minor infections such as a cold or influenza”) Prenatal and obstetrical care Yes Yes38 Yes Some (communicable diseases, chronic conditions, antibiotics) If “deemed necessary” by staff Examination following use of force DOC Policy 507.04.05 (2022)
Hawaii $3.00 Yes (includes mental health and dental) Yes (includes sexually transmitted infections) Yes Pre- and post-natal care Yes (includes patient-initiated) Infirmary Yes “Special needs incarcerated individuals with mental health disabilities or disorders that interfere with the ability to carry our normal activities are exempt from the copayment plan. This includes, but is not limited to, instances of self-mutilation, suicide attempts or incarcerated individuals in special holding or therapeutic housing units.” DOC Policy COR.10.A.11 (2024)
Idaho $2.00 Yes (includes dental) Only tuberculosis prophylaxis Yes, in chronic care clinic Yes Yes Yes Yes Yes Glasses (once every two years with prescription) Infirmary for chronic condition Yes DOC Procedure Control Number 411.06.03.001 (2018)
Indiana $5.00 Yes Yes (annual) Yes If instituted by department for public health reasons Yes Yes Yes Yes Yes Some (psychiatric, chronic, neuroleptic) Glasses, dentures, ostomy supplies, stockings, braces Yes “The service is provided as a result of an injury received while in the custody of the department” 210 Ind. Admin. Code Article 7 (2025)
Iowa $3.00 Yes (includes mental health and dental) Yes (includes eye exams) Sexually transmitted infections testing and prophylaxis If staff-initiated (includes mental health) or if civilly committed For emergency care, forensic medical examinations, and STI prophylaxis Intake screenings or if staff-initiated If determined by staff Yes Some (see policy) If not associated with patient negligence Skilled care; exposure to chemical agents “not associated with patient negligence” DOC Policy HSP-505 (2020)
Kansas $2.00 Intake only Yes If staff-initiated or for group sessions Yes Yes Infirmary Evaluations requested by the Prisoner Review Board Kan. Admin. Regs. S 44-5-115c (2024)
Kentucky $3.00 Yes Yes, in chronic care clinic Yes DOC Policy 13.2 (2025)
Louisiana $2.00 Yes Yes (annual) Yes If instituted by department for public health reasons or patient-initiated requests related to “pandemic threat” Yes (includes DNA testing) Prenatal care PREA assessments If provided by mental health staff If provided by mental health staff Yes Some (communicable diseases, psychiatric) Glasses, prosthetics, dentures, Durable Medical Equipment (DME) Yes (as determined by the warden) “Any other instance the Secretary deems appropriate, expressed in writing.” DPSC Dept. Regulation No. HCP14 (2024) via email
Maine $5.00 All care while pregnant Only if serious mental illness or developmental disability is present39 or if inpatient at a state-funded mental health facility If necessary per staff (includes dental) Yes Proposed legislation to raise the copay maximum to $25.00 (L.D. 18 (132nd Legis. 2025)) 34-A ME Rev Stat S 3031 (2024)
Maryland $2.00 Yes Yes Yes Yes PREA assessments Yes Yes Yes DOC Executive Directive OPS.130.0001 (2015) and Md. Code, CS S 2-118 (2024)
Massachusetts $3.00 Intake only (includes mental health and dental) Yes (includes pre- and post-test HIV counseling) Yes Yes Prenatal and delivery care Yes Yes Yes (includes dental) Yes Yes Yes Care for terminally ill patients; care for patients hospitalized more than thirty (30) days successively during their incarceration; care for minor; “non-compliance counseling including counseling regarding medication compliance” Proposed legislation to end medical copays in prison (Mass. H.2372 (2023)) 103 DOC 763 (2024)
Michigan $5.00 Testing only (includes sexually transmitted infections) Yes If medical care is received or referred “within one hour” and is not “an intentional self-inflicted injury” Yes (with incident report) DOC Policy Directive 03.04.101 (2022)
Minnesota $5.00 Yes Yes If staff-initiated Yes Yes40 Yes Some (chronic conditions) Yes (with incident report) Initial evaluation and treatment of injuries from an assault DOC Policy 500.100 (2018)
Mississippi $6.00 Yes Yes If instituted by department for public health reasons Yes, in chronic care clinic or if “felt non-chargeable by the medical staff” Yes Prenatal care Yes (includes patient-initiated) Yes Yes Missed appointments (for some reasons) Inmate Handbook (2023)
New Hampshire $3.00 At reception centers or in first 14 days of incarceration If staff-initiated Pregnancy-related care If emergency, secure psychiatric unit or if serious mental illness or developmental disability is present If staff-verified (includes dental) Yes Sick-call visit for medication refills Initial prosthetics or functional aid devices determined to be medically necessary Inpatient Care for minors; people in maximum security and “punitive segregation” unless they request medical care NH DOC Policy Dir. Health Services 6.16 (2009) via email and NH Rev Stat S 622:31-a (2024)
New Jersey $5.00 Yes Yes If instituted by department for public health reasons Yes (includes patient-requested HIV testing) Yes Yes If requiring emergency transport to hospital Yes (includes dental) Some (psychiatric) Infirmary Medication provided immediately during a medical visit N.J.A.C. 10A:16-1.5 (2025)
North Carolina $5.00 Intake only Yes Yes Yes Yes, in chronic care clinic if staff-initiated If staff-verified If occurring within 14 days of initial visit Yes and residential facilities (including for mental health) Yes (with incident report) Medical examinations or treatment required following use of force, automobile accidents, fire and smoke incidences, and extraordinary events such as a riot or natural disaster; people in private substance abuse treatment centers, county jails, “safekeepers”41, out-of-state facilities, community transition center, or assigned to residential mental health, inpatient mental health, medical infirmary, or medical inpatient. DAC Policy S.1300 (2023)
North Dakota $3.00 Yes “Pre-existing conditions must have been diagnosed within the past 60 days to quality for exemption from the co-pay, unless the 60-day time frame is waived by DOCR medical or by appeal;” “Pre-existing conditions are subject to co-pay at least every 60 days” DOC Handbook (2021)
Ohio $2.00 Yes Yes If “an actual emergency exists” Yes (includes services following staff reports of sexual assaults and use of force) Medication refills (even if through sick-call) Yes Yes, for accidents Dental services DRC Policy 68-MED-15 (2022)
Oklahoma $4.00 Intake only Yes Yes If prescribed for public health reasons Yes Prenatal, perinatal, and postpartum care Yes Yes Yes (includes dental) Some (chronic conditions) Yes, initial acute treatment DOC Policy OP-140117 (2024)
Pennsylvania $5.00 Yes (includes mental health and dental) If requested by department (includes dental and mental health) Yes If prescribed for public health reasons If staff-initiated Yes Prenatal care Yes Yes Unless “self-inflicted” (as determined by staff) Yes Some (chronic conditions, psychiatric) Glasses, dentures, prosthetics (excludes customized items and orthotics) Yes42 Yes “Long-term care for an inmate who is not in need of hospitalization, but whose needs are such that they can only be met on a long-term basis or through personal or skilled care, and who needs the care because of age, illness, disease, injury, convalescence or physical or mental infirmary.” DOC Policy DC-ADM 820 (2021)
Rhode Island $3.00 Yes Yes, for people 40+ years of age (annual) Yes If instituted by department for public health reasons If staff-initiated (includes mental health) If on-site Prenatal care If on-site Yes If provided in an emergency room/urgent care center (includes emergency transportation) Yes Some (chronic conditions) Initial prosthetic limbs, “essential” mechanical aids as determined by department Annual dental cleaning; people who have applied for Medical Parole, but were denied for non-medical reasons; missed appointments (for some reasons) DOC Policy No. 2.28-3 (2007)
South Carolina $5.00 Yes Yes If instituted by department for public health reasons or during a known public health disease outbreak Yes, in chronic care or infectious disease clinic Yes Yes Some (psychiatric)43 Infirmary Yes (with incident report or if sent by supervisor) Hospice care DOC Policy HS-18.17 (2023)
South Dakota $3.00 Intake only If instituted by department for public health reasons Yes, in chronic care clinic Yes Pregnancy-related care Yes (includes mental health) Yes If resulting in hospital admission (includes dental) Yes (includes referrals to external specialty health care services) Medical housing unit Hospice or end-of-life care; disability status screenings DOC Policy 700-30 (2024)
Tennessee $3.00 Yes (includes mental health and dental) Yes Only tuberculosis testing/screening Yes, in chronic care clinic if staff-initiated Yes Yes, excludes initial visit for pregnancy test Yes (includes mental health) Yes Yes Yes (includes dental) Infirmary Yes DOC Policy 113.15 (2020)
Texas $13.5544 Yes (includes mental health and dental) Yes (annual) Yes Yes, in chronic care clinic (includes mental health) As part of intake process Prenatal care (includes counseling) Yes Yes (includes mental health and dental) Yes (includes dental) Yes Infirmary Physical evaluations following use of force incidents; procedures or testing ordered by a court or pursuant to state law; testing on behalf of third parties (paternity tests, compatibility for donation tests); medical treatment of self-inflicted injuries; no copay charged for “no-shows” because a visit did not occur Tex. Gov’t Code S 501.063 (2023) and DOC Admin. Dir. AD-06.08 (rev. 7) (2019) via public records request
Utah $5.0045 Utah Code S 64-13-30 (2024) and UT Division of Correctional Health Services FAQ
Washington $4.00 Intake only Yes (includes mental health) In residential treatment units or if staff-initiated If staff initiated and not for “self-induced injury” Yes (includes dental) Yes (with incident report) Medication distribution; court ordered evaluations DOC Policy 600.025 (2023)
West Virginia $3.00 If provided or made available to total custody population Yes Yes Treatment for severe mental illness Unless “self-induced” Yes Some (chronic conditions) Care required by state law DOC Policy Dir. 424.01 (2023)
Wisconsin $7.50 Intake only (includes dental) If determined by staff (includes dental) Yes (includes dental) Yes Medical, dental, or nursing care for people in juvenile correctional facilities who do not have “the opportunity to earn wages” Wis. Admin. Code DOC 316.04 (2024)

A handful of states have ended their use of copays and are therefore not included in this appendix table: California, Illinois, Missouri,46 Montana,47 Nebraska, Nevada, New Mexico, New York, Oregon, Vermont, Virginia,48 and Wyoming.

Definitions

Intake or transfer
Assessments and/or screenings that occur on admission, during the intake process, or when transferring between units or facilities.
Routine
Assessments or screenings that occur annually or on another routine basis.
Communicable diseases
Testing and treatment of communicable diseases (also known as infectious or transmissible diseases).
Chronic conditions
Treatment of chronic conditions including heart disease, cancer, diabetes, hypertension, osteoporosis, and asthma.
Diagnostics
Includes lab testing and provider-ordered x-rays.
Pregnancy-related
Healthcare related to pregnancy, including pregnancy testing, prenatal care, delivery and perinatal care, and postpartum care.
Sexual-assault related treatment
Healthcare for people after experiencing sexual-assault.
Mental health treatment
Assessments, screenings, and treatment of mental health conditions and disorders.
Substance use
Assessments, screenings, and treatment of substance use disorders.
Staff-initiated
Healthcare initiated by medical, correctional, or administrative staff including follow-up visits and referrals.
Medical or mobility devices
Devices and prosthetics to assist with disabilities, injruies, or chronic health conditions, as well as assistive devices like glasses, dentures, hearing aids.
Infirmary, hospitalization, and/or inpatient care
Treatment provided in an infirmary unit in a hospital, infirmary unit, or inpatient unit.
Work-assignment related
Injuries or illnesses related to a work-assignment.
Relevant legislation
Legislation pending regarding copays in prisons, as of publication in May 2025.

Footnotes

  1. Unlike non-incarcerated people, people in prison do not have a choice about their medical coverage, nor how “cost sharing” applies to them. There is no “insurance” system that covers them, so the term “copay” is a misnomer for the fee they are charged to request a medical appointment or to obtain a prescription. As the organization Voice of the Experienced argues, the use of this term legitimizes these unaffordable fees, which deter people from seeking needed medical care. They suggest more descriptive terms such as “medical request fees” or “sick call fees.”  ↩

  2. Of note, the National Commission on Correctional Health Care (NCCHC) argues that abuses of sick call can be managed with “a good triage system,” without imposing fees that also deter necessary medical services. And although providers must treat people regardless of their ability to pay, incarcerated people with “low health literacy” may not understand this right. The NCCHC warns that co-pays may actually jeopardize the health of incarcerated populations, staff, and the public.  ↩

  3. See eAppendix: Additional Material on Copayment Policies and Waivers.  ↩

  4. A 2010 qualitative study found that formerly incarcerated women frequently reported that copays hindered access to timely, quality healthcare when they were incarcerated. Participants reported inequitable administration of copays, including being charged copays that, based on policy, should have been waived for care related to contagious conditions, mental health, and follow-up visits. The participants also described the significant financial burden of copays and many ultimately decided to forego necessary medical care because of the expense.  ↩

  5. For example, in Delaware, copays are not charged when an individual is seen by healthcare providers for “the same problem three times in a seven-day period.” However, at the time of the initial sick call request, an incarcerated patient must expect to be charged a copay, because they cannot possibly predict that they will be seen three times in a seven-day period for the same problem and the copay will therefore be retroactively applied after those subsequent visits.  ↩

  6. For example, Oklahoma, incarcerated people must complete a form requesting health services that requires them to agree to a statement that “I will be charged $4.00 for each medical service I request and a charge of $4.00 for each medication(s) dispensed to me, with the exceptions noted in the above-reference operations memorandum. There is no charge to the offender for mental health services and/or mental health medications.” There is no mention of other types of care which are exempt — according to the waiver policy — from copays, like medications for asthma, pregnancy-related care, vaccinations, tuberculosis testing, or x-rays. It is easy to see how an incarcerated person might expect the $4.00 copay to apply to those services — regardless of the exemption policy — based on the mandatory request form. In addition, prisons do not consistently provide information to incarcerated people about what medical care is exempt from copays. A 2008 audit of the Nevada Department of Corrections found that five Nevada institutions provided no clear instructions on what types of visits were exempt from copays, and orientation manuals from West Virginia and Georgia informed incarcerated people that copays may apply to visits, but did not include information regarding which visits would or would not qualify for a waiver.  ↩

  7. For example, in Massachusetts, the Health Service Administrator or designee completes a “Weekly Self-Initiated Sick Call Log” indicating the total billable services provided, with no guidance or details about what services are “billable” or subject to a copay included on that log.  ↩

  8. For example, in Massachusetts, incarcerated people “shall be charged for a self-initiated sick call,” but any medical treatment initiated by health staff, correctional staff, the Department of Corrections, statute, or courts is exempt from the $3.00 fee.  ↩

  9. For example, in North Carolina, chronic care clinic visits for cardiovascular disease are exempt from the $5.00 fee.  ↩

  10. For example, in Mississippi, the $6.00 fee is waived for any lab work and x-rays ordered by a medical provider.  ↩

  11. For example, in Wisconsin, any medical, dental, or nursing services that are provided because of an injury sustained at an institution work assignment are exempt from the $7.50 fee.  ↩

  12. For example, in Connecticut, incarcerated people are charged $3.00 for “each inmate-initiated visit to the Health Services Unit,” but appointments initiated by health services staff or any Department of Corrections personnel are exempt from the fee  ↩

  13. Some prisons are still using paper medical charts and the electronic medical records for those systems not on paper can vary in sophistication. Processes for preventative care reminders or flags for patients being overdue for follow-up care for chronic conditions (which are fairly standard in non-carceral electronic medical records) are not always present in prison systems, requiring manual tracking by medical teams that are often understaffed. Even when appropriate follow up intervals are well tracked, the chronic shortage of staff faced by prisons often results in delayed, canceled, or never-scheduled follow-up appointments. This reliance on staff- and system-initiated healthcare for copay exemptions is not an appropriate way to facilitate access to necessary care.  ↩

  14. For example, in Maine, “emergency treatment as determined by the facility’s medical or dental staff” is exempt from the $5.00 fee.  ↩

  15. For example, in New Hampshire, copays are waived for “incidents of staff verified emergency visits.”  ↩

  16. For example, in South Dakota, the health care fee is charged for medical care related to “self-declared emergencies that do not require transport outside the facility.”  ↩

  17. For example, in New Hampshire, patients “will be charged the actual costs for all willfully or accidentally caused injuries to themselves or others, if they are found guilty of a rule infraction after a disciplinary hearing,” and in Alabama, any health care rendered to a patient “found responsible (through the Disciplinary Hearing process) for injuries to self or another individual” will incur a copay charge.  ↩

  18. For example, in South Dakota, people will be charged $3.00 for “care provided for self-harm/self-inflicted injury.” In Hawaii, “incarcerated individuals are required to pay the co-payment fee when treated for self-induced injury. This includes, but is not limited to: a. Instigated fights with other incarcerated individuals or staff, or deliberately punching, kicking, hitting, banging, etc., movable or immovable objects; b. Recreational injuries. c. Accidental injuries.”  ↩

  19. For example, in Michigan, incarcerated people receiving medical care related to an “intentional self-inflicted injury” are responsible for the “full cost of the medical care provided, including transportation costs.”  ↩

  20. In Georgia, fees associated with medical care for self-inflicted injuries are the default, but are “subject to review for appropriateness by mental health staff.” In Michigan, if a mental health professional’s determination that an individual “was mentally ill at the time of the self-injury, and either lacked substantial capacity to know right from wrong or was incapable of conforming their conduct to Department rules,” the fee and costs of medical care may be waived.  ↩

  21. For example, in Oklahoma, the “initial acute care treatment rendered for an on-the-job injury” is exempt from the copay, with no mention of subsequent follow-up care.  ↩

  22. For example, in Georgia, treatment for “injuries sustained on a work detail” are exempt only if they “meet the definition of an emergency.”  ↩

  23. For example, in Minnesota, treatment “for work related injuries verified by an incident report and reported at the time of the injury” is exempt from the copay.  ↩

  24. For example, in South Carolina, only chronic clinic visits “initiated by the [Department of Corrections] to monitor the applicable disease process on a routine basis” are exempt from the $5.00 fee, excluding from the exemption any ad hoc requests for medical care made by the patient.  ↩

  25. As correctional health expert Dr. Homer Venters explains: “many chronic care problems aren’t detected when a person arrives [at the jail or prison], so to get treatment… requires the sick call process… Many [correctional] systems have a practice of requiring two or three nursing sick call encounters before a person sees a doctor.”  ↩

  26. Notably, Georgia is one of several states that charge medical copays but do not pay incarcerated people for their labor.  ↩

  27. Research has found that incarceration is a catalyst for worsening health, is associated with limited access to adequate and routine healthcare even after release, and is associated with a number of poor health outcomes including higher rates of morbidity and mortality.  ↩

  28. In Arizona, copays are waived for “pregnant inmates (for pregnancy related issues).” In New Hampshire, “pregnant inmates whose illness relates to the pregnancy” are exempt from copays. In Maine, copay waivers apply when “the client: is pregnant.”  ↩

  29. In Louisiana, Mississippi, Pennsylvania, Rhode Island, Texas, and the federal prison system, “prenatal care” is listed as the only pregnancy-related copay exemption.  ↩

  30. For example, in Oklahoma, “prenatal, perinatal, and clinically indicated postpartum care” are exempt from the $4.00 copay.  ↩

  31. Importantly, laws regarding access to menstrual products do not automatically result in sufficient access to products for all incarcerated people. For more information on state laws around menstrual products in prisons, see the regularly updated The Prison Flow Project and the ACLU’s 2019 report, The Unequal Price of Periods.  ↩

  32. Medication-assisted treatment — often referred to as the gold standard of substance use treatment — in prison is associated with significant reductions in post-release overdose deaths.  ↩

  33. Incarcerated women face increased prevalence of cervical cancer compared to the general population. The vaccine is recommended for women under 26 and at least 6% of women in state prison in 2021 were under 24 years old.  ↩

  34. The U.S. Centers for Disease Control and Prevention recommends the pneumococcal vaccine for adults 50 years and older (at least 16% of people in state prisons in 2021 were over the age of 55) and in at least one study of people released from prison in Washington state, the most frequent infectious disease-related cause of death after release from prison was pneumonia.  ↩

  35. The Hepatitis B vaccine is recommended for all adults aged 19-59, meaning that the bulk of the prison population is eligible for this vaccine if they’ve not already received it. Some estimates suggest that between 12% and 39% of people with Hepatitis B or Hepatitis C (which does not have a vaccine, but can be prevented and treated) were released from jail or prison in the prior year.  ↩

  36. Some people may suggest increased funding for correctional healthcare, but because the carceral system was never designed to provide medical treatment (and already spends billions of dollars on medical treatment annually), we recommend decarceration and investment in community-based healthcare.  ↩

  37. “Prisoners are responsible to cooperate with the Department in seeking funding for medical procedures and hospitalizations that may be paid for from other sources, e.g. Medicaid.”  ↩

  38. “Self-inflicted injuries will be charged subject to review”  ↩

  39. “For the purposes of this paragraph, “a person with a serious mental illness or developmental disability” means a client who, as a result of a mental disorder or developmental disability, exhibits emotional or behavioral functioning that is so impaired as to interfere substantially with the client’s capacity to remain in the general prison population without supportive treatment or services of a long-term or indefinite duration, as determined by the facility’s psychiatrist or psychologist. The exemption under this paragraph applies only to supportive treatment or services being provided to improve the client’s emotional or behavioral functioning.”  ↩

  40. “Co-payments are not assessed in the following instances: Report of an alleged sexual assault, abuse, or harassment.”  ↩

  41. Medical services “resulting in non-charge” includes “infirmary care in a Department facility (with the exception of an inmate determined to be on a behavioral/volitional hunger strike, as opposed to refusing to drink/eat due to medical/mental health diagnosis. He/she will be charged a co-pay for every medical encounter)”  ↩

  42. In North Carolina, “safekeeper” refers to an individual in county jail custody who is housed in a prison.  ↩

  43. “No co-payment will be charged for certain medications. A list of these medications…will include: medications used exclusively for the treatment of mental disorders unless the inmate fills the prescription and then refuses to take the medication.”  ↩

  44. “An inmate confined in a facility operated by or under contract with the department, other than a halfway house, who initiates a visit to a health care provider shall pay a health care services fee to the department in the amount of $13.55 per visit, except that an inmate may not be required to pay more than $100 during a state fiscal year.”  ↩

  45. “For services provided outside of a prison facility while in the custody of the department, the offender is responsible for 10% of the costs associated with hospital care with a cap on an inmate’s share of hospital care expenses not to exceed $2,000 per fiscal year.”
    “There is a cap on the inmate’s share of expenses of $2,000 per fiscal year. An inmate with assets exceeding $200,000 upon entry into the Department’s custody is responsible to pay costs of all medical and dental care up to 20 percent of the inmate’s total asset value. After receiving medical and dental care equal to 20 percent of the inmate’s total asset value, the inmate will be subject to the normal co-payments.”  ↩

  46. In 2017, a bill was introduced in the Missouri state legislature to establish a 50 cent fee for correctional medical services, but it appears this legislation was not enacted.  ↩

  47. According to the Montana Department of Corrections, they do not charge copays, although the Department is authorized in statute to charge copays: “The department may, consistent with administrative rules adopted by the department, use a portion of the funds in an inmate’s account to: pay for the inmate’s medical and dental expenses and costs of incarceration” (MT Code S 53-1-107, 2024).  ↩

  48. According to a memo sent by the Virginia Department of Corrections dated March 1, 2023, the state ended their use of healthcare copays in prisons completely, after temporarily suspending copays in 2020.  ↩

See the appendix table and footnotes


Learn how advocates are responding to shifting arguments for new jail construction.

by Emmett Sanders, May 14, 2025

For decades, calls for new jail construction were largely accompanied by “Tough on Crime” rhetoric that ignored the fact that jails often house the most precariously situated members of our society. While these dehumanizing narratives persist, in many places jail construction has taken a carceral humanist turn that depicts cages as places of care and compassion and the jail as a service provider for those with mental health or substance use support needs.

This is just one of the ways in which arguments for new jail construction have evolved over time, leading communities to spend millions and sometimes even billions of dollars on new jail construction, even as public safety initiatives are being viciously defunded. Fortunately, those on the frontlines who oppose new jail construction have evolved their own arguments and have developed new strategies to push back.

On June 11, 2025, Prison Policy Initiative brought together a panel of activists who have pushed back against jail expansion in communities from Atlanta, Georgia, to Sacramento, California, all the way to Oahu, Hawai’i. We discussed how arguments for new jail construction have shifted over time, went over some useful strategies and tools for responding to these arguments, and talked about how our advocacy department can help support efforts to challenge new jail construction in your area.

Panelists included:

Watch the full webinar:

Webinar Resources

Additional Resources


The proposals before the Texas legislature would dramatically increase the state's already bloated jail populations.

by Sarah Staudt, May 14, 2025

This week in Texas, Governor Greg Abbott and conservative lawmakers are trying to change the state constitution to enshrine the worst features of the current bail system. These proposals, if passed and then approved by voters, would cause a rise in Texas’ already bloated jail populations. As a result, more people will be detained in private prisons out of state, taxpayers will be saddled with huge expenditures, and public safety and public health will get worse.

Disturbingly, proponents of these measures are calling them “bail reform” when in fact they are the exact opposite. “Bail reform” generally refers to the effective policies enacted around the country to make bail processes fairer and to reduce pretrial jail populations. A system of wealth-based detention that determines who should be in jail based on how much money they have in their bank accounts is an illogical and ineffective policy. Efforts to change or eliminate these money bail systems in Illinois, New Jersey, and elsewhere have been highly successful, have not led to rises in crime, and have saved communities countless millions of dollars in bail payments.

Texas conservatives are proposing to do the opposite. The proposals would make it mandatory in many cases for judges to hold people until their trials without bail, and in other cases would require the use of monetary bail in situations where people are currently being released without needing to pay any money. It is vital that Texas legislators and voters oppose these regressive policies, and that activists around the country understand the negative impacts of these kinds of changes to bail systems.

Overusing pretrial jailing undermines fairness and harms public safety and public health

Decades of research shows that growing the pretrial jail population is a mistake that will harm the justice system, public safety, and public health. There is ample evidence that lower jail populations do not harm public safety. Moreover, the overuse of pretrial jailing destabilizes both the individuals who are incarcerated and their communities, stoking the root causes of crime and harming public safety in the long run.

Individuals in custody are affected in a variety of negative ways by pretrial jailing. People incarcerated pretrial are more likely to:

Overuse of pretrial jailing also harms the fairness of the criminal legal system as a whole by worsening racial disparities and disproportionately impacting women. People in poverty and Black and brown people are less likely to be able to afford bail, and bails are set at higher rates for Black and Latino people. Women are also less likely to be able to afford monetary bail when it is set (even though bail is set at lower amounts for them). Black people are less likely to be released on their own recognizance and more likely to be detained without bail. Texas already imprisons Black people in jails at disproportionate rates, and expanding pretrial jailing is likely to worsen that problem.

A deeper dive into the regressive bail package

The package of regressive measures being pushed in the Texas legislature consists of three parts (known as SJR 5, SB 9 and HB 75, and SJR 1). The exact language of these measures has been changing daily, but the core problems of each provision remain the same.

SJR 5 expands no-bail jailing without due process

SJR 5 would change the Texas constitution to allow detention without monetary bail for a wide variety of charges. The United States Supreme Court has been clear for decades that detention before trial, particularly without bail, should be a “carefully limited exception.” The federal government and states that have reduced or eliminated monetary bail, like Illinois and New Jersey, have tried to ensure that no-bail detention is “carefully limited” by restricting the charges for which it can be used and enshrining important due process protections in the law. However, Texas’ recent proposals would expand jailing without these careful limitations.

Although the exact provisions of SJR 5 are changing almost daily, many of the drafts have lacked key due process protections. It is vital that any version of SJR 5 that advances includes basic provisions that ensure that detention decisions are fairly made and that jail is only used as a last resort. Some of those key provisions would include:

  • Limiting the availability of no-bail detention only to serious, violent cases, rather than allowing it in broader categories of charges;
  • Ensuring that everyone who may be jailed without bail has access to counsel.
  • Ensuring that prosecutors be held to a high standard of proof that a person will pose a danger to others — “clear and convincing” evidence, rather than simply a “preponderance” of evidence.
  • Requiring that detention based solely on risk of fleeing the jurisdiction hinges on whether someone is likely to willfully flee prosecution. If no-bail detention is allowed based solely on whether someone is likely not to appear in court through no fault of their own, it will increase the unnecessary detention of poor and unhoused people, who sometimes struggle to find transportation and other resources necessary to appear for their court dates.
  • Requiring that jail only be used if there is no less restrictive set of conditions that could protect the public. No-bail jailing should always be a last resort, and should only be used if there are no other alternatives.

Without these key due process protections, increasing no-bail detention is likely to lead to more people being held in jail longer, increasing jail populations without improving public safety.

SB 9 and HB 75 entrench the use of monetary bail

While SJR 5 seeks to increase the number of people held without bail, SB 9 and HB 75 seek to use monetary bail even more often than it’s currently being used. These bills would undo progress that has been made in reducing the use of monetary bail in Texas localities like Harris County.

SB 9 and HB 75 would require the use of money bail in many cases, including misdemeanors. Currently, people are often released on these charges without having to pay money. A particularly disturbing set of cases included in SB 9 and HB 75 are so-called “terroristic threat” cases. Although these charges sound very serious, they actually include any threat to people or property that causes an official or volunteer emergency agency to respond. This can include misdemeanors that often are charged against school-aged children because of social media posts. Including these non-violent charges in the set of charges where money bail will be required will do nothing to improve public safety — but it will ensure that poorer accused people are stuck in jail more often.

These bills also create procedural barriers that will prevent people from being released pretrial in a timely fashion. As we have noted, even one day in jail can lead to a range of negative outcomes. First, the proposals restrict the ability of magistrates and law hearing officers to set bail, and these kinds of decision makers play a key role in how large municipalities make bail decisions quickly. Second, it allows prosecutors to unilaterally prolong detention even when a judge intended to set an affordable bail. Prosecutors would be allowed to appeal these decisions, claiming that bail was set too low, and strand people in custody while the appeal is pending.

SJR 1 targets immigrants with mandatory jailing

The last provision in this regressive bail package combines the harms of the immigration system with the harms of the criminal legal system, requiring no bail detention for a group of people the proposal refers to as “illegal aliens.” The definition of “illegal aliens” has changed in various drafts of the proposal, but includes DACA recipients (so-called “dreamers” who entered the United States as children) and asylum seekers. Because criminal legal system statistics are not broken up by immigration status, it is impossible to estimate how many people this will affect, but it will certainly have a disproportionate impact on Texas’ Latino residents.

Because the proposal requires detention even in non-violent cases, judges will be barred from considering individual facts and circumstances. As a result, they will end up detaining people who do not pose a threat to anyone or who are charged with weak cases that are unlikely to lead to a conviction. Even when a judge decides that a person can be safely released to await trial in the community, the law will overrule that judgment and require them to send the accused person to jail. In other words, the measure ties the hands of the very people who are entrusted with the responsibility of ensuring that the criminal legal system is administered fairly. Judges hearing individual cases — not legislators in Austin — should make these decisions.

SJR 1 would also unnecessarily burden Texas taxpayers and local governments with the cost of incarcerating undocumented people who, under current law, would instead be detained by the federal government. Under federal law, many undocumented people charged with a wide variety of crimes are already required to be held in immigration detention. By requiring no-bail detention in their criminal cases as well, SJR 1 shifts the burdens and costs of incarcerating those people from the federal government to local jails — all without providing any additional funding to localities to absorb these costs.

Regressive bail policies will worsen Texas’ already out-of-control pretrial jailing crisis

Texas cannot afford to adopt these regressive policies. The state is already well above the national average for incarceration rates overall, and its pretrial jail population has been rising steadily for decades. This creates a serious overcrowding problem in Texas jails; 41% of Texas counties already send incarcerated people to other counties or states while awaiting trial. Harris County alone spends more than $50 million per year on out-of-state jail contracts. These expensive arrangements are often made with private prison companies, costing Texas taxpayers more money while enriching private corporations. To be clear, this problem cannot be solved by building bigger jail facilities — in most cases, it is a lack of staff, not a lack of bed space, that leads counties to outsource pretrial incarceration.

Expanding pretrial jailing will also cost lives. Deaths in jails are on the rise across Texas, and the situation is worsened when people are sent out of state, since those facilities do not have to follow standards set by the Texas Commission on Jail Standards, nor do they have to follow death reporting and investigation rules.

Lawmakers are voting on these proposals in the next few days, and there are real opportunities to stop them from moving forward, or to push for important revisions that strengthen due process protections. There will also be an opportunity for Texans to voice their opposition to SJR 5 and SJR 1 at the polls if they do advance past the legislature. Texas deserves true reform measures that seek to reduce harmful pretrial jailing, rather than so-called “tough-on-crime,” anti-immigrant measures masquerading as “bail reform”.


The Bureau of Justice Statistics published 2023 data on pregnancy prevalence and outcomes in prisons, as well as the prison systems that offer relevant prenatal and postnatal accommodations, supports, and programming.

by Emily Widra and Emmett Sanders, May 7, 2025

A new Bureau of Justice Statistics report offers updated data on pregnancy among people in state and federal prisons. This important new dataset includes the prevalence of pregnancy among incarcerated people, pregnancy outcomes, and some limited data on the types of services, medical care, and support offered to incarcerated pregnant people. The findings from Maternal Healthcare and Pregnancy Prevalence and Outcomes in Prisons, 2023 are based on data collected for the first time in 2024 as a supplement to the annual National Prisoner Statistics survey. While this report is a welcome contribution to a shamefully understudied experience during incarceration, the data it provides raises almost as many questions as it answers.

Women’s incarceration has grown at twice the pace of men’s incarceration in recent decades but there is often too little data to explain this growth or to elaborate the specific effects incarceration has on women and their health, including their experience of pregnancy.1 Previously, the most recent national data on pregnancy in prisons from the Bureau of Justice Statistics was collected in the Survey of Prison Inmates in 2016 and was published in 2021. Since then, researchers from Johns Hopkins University collected detailed data on pregnancy outcomes in a smaller set of 22 state prison systems and the federal Bureau of Prisons from 2016 to 2017 as part of the Pregnancy in Prison Statistics (PIPS) study. Even though the PIPS study covered only about half of state prison systems surveyed by the Bureau of Justice Statistics, the findings offered a closer look at pregnancy outcomes in prison than were available from the Survey of Prison Inmates. In this new publication, the Bureau of Justice Statistics surveyed 50 state departments of corrections and the federal Bureau of Prisons regarding:

  1. the number of pregnancy tests provided and found positive upon admission to prison,
  2. the number of pregnant people in prison at year-end,
  3. the outcomes of the more than 700 pregnancies that ended in prison in 2023, and
  4. the availability of specific kinds of pre- and post-natal support across jurisdictions.

Yet the data raises a series of new questions. There are unexplained differences in the prevalence of pregnancy behind bars compared to the PIPS report, as well as a lack of basic data on the outcomes of live births, and a failure to report how often pregnancy-related services and accommodations are actually used. The report also helpfully touches on services like prison nursery programs; however, crucial details about their implementation are left out — a gap we attempt to fill in this briefing using our own research. This new report is a step in the right direction, but much more work needs to be done to provide an accurate and useful portrait of pregnancy in prison.

Fewer people in prison report being pregnant when entering prison

The prevalence of pregnancy in prisons is measured in two ways: the number of pregnant people admitted to prison over the course of the year and the number of pregnant people in prison on a single day. The Bureau of Justice Statistics reports that 2% of women tested upon admission were pregnant in 2023.2 This is surprisingly low compared to findings from previous data collection. In 2016, twice as many women (4%) admitted to prison each month were pregnant, according to the Pregnancy in Prison Statistics (PIPS) study. Past surveys from the Bureau of Justice Statistics that asked incarcerated women whether they were pregnant at admission (regardless of what year they were admitted) also found higher rates, from 6% in 1991 to about 4% in 2016. While the PIPS project surveyed only 22 state prison systems, it seems unlikely that this difference in the sample would explain the inconsistency in the data.3

bar chart comparing prior Bureau of Justice Statistics survey reports of the share of women who were pregnant when entering state prison to the 2016 results of the Pregnancy in Prison Statistics project and the 2023 BJS report.

We see this same issue in the point-in-time count of incarcerated pregnant people. According to the Bureau of Justice Statistics, on a single day in 2023 , there were 328 pregnant people in state (0.5%) and federal (0.3%) prisons, representing a total of 0.5% of all women in prison. This is much lower than we would expect based on the 2016 Pregnancy in Prison Statistics (PIPS) data, which found there were 350 pregnant people in just the smaller group of state (0.7%) and federal (0.3%) prisons they surveyed, for a total of 0.6% of the combined prison population. In other words, the actual number of pregnant incarcerated people was higher in the PIPS report that covered half as many state prison systems (22 states) as the Bureau of Justice Statistics report. It’s unclear what accounts for this substantial difference in the datasets.

The new Bureau of Justice Statistics report also offers new data on the race and ethnicity of pregnant people in prison on a single day. Compared to the overall population of women in prison,4 white, Black, American Indian and Alaska Native, and Asian women are overrepresented in the population of pregnant people in 2023. Meanwhile, Hispanic and “other” women were underrepresented.

bar chart comparing the percent of women in state and federal prison by race and ethnicity to the percent of pregnant women in prison by race and ethnicity

Certainly, some decline in the number of pregnant people in prison could be expected, given that the national pregnancy rate in the United States has been steadily falling over the past two decades.5 However, this trend does not explain the dramatic reduction in the number of pregnant women in prison between the PIPS 2016 study and the Bureau of Justice Statistics’ 2023 report. Given the limited data available, we do not have any clear understanding of why there are so many fewer pregnant people reported in this Bureau of Justice Statistics publication.

First national data on pregnancy outcomes in prisons

This Bureau of Justice Statistics report is significant in that it offers the first national data on pregnancy outcomes in prisons — a welcome if overdue development. More than 700 pregnancies ended while the mother was in custody in 2023, and almost all of these were live births (91.5%),6 with 6.5% ending in miscarriage and 2.1% ending in abortion.7 Additionally, there were four stillbirths and ectopic pregnancies. These percentages are largely consistent with the outcomes of pregnancies reported in the Pregnancy in Prison Statistics (PIPS) study from 2016, however the counts are once again surprisingly low: in 2016, PIPS found 816 pregnancies ended in 22 state prison systems and the federal Bureau of Prisons, but in 2023, the Bureau of Justice Statistics reported 89 fewer pregnancies ending in prison (727 total) across the federal system and 48 state departments of correction.

Nationally, data on pregnancy outcomes regularly includes information about the outcomes of live births, including if they were preterm, early term, C-sections, or low birthweight, as well as if there was neonatal death (within 28 days) or maternal death following the birth. Although the U.S. Centers for Disease Control and Prevention regularly collects and publishes these data for non-incarcerated people, the Bureau of Justice Statistics survey did not request this information from correctional authorities, despite our recommendation during the public comment period. Basic national statistics on pregnancy in prison can and should include these outcomes. Elevated rates of chronic and infectious diseases – as well as substance use disorders – and limited access to necessary healthcare among incarcerated people make more detailed data about live births critical to understanding the experience of pregnancy in prison. Such data can also inform the interventions and medical treatments required to promote health before, during, and after birth for this population.

Some prisons fail to provide even the most basic prenatal and postnatal care

Pregnancy poses a number of short-term and long-term risks to health. Globally, the United States has one of the highest rates of pregnancy-related complications among developed nations,8 with a disproportionate burden falling upon women of color and low-income women.9 Addressing such risks is particularly important in prisons, where women already face higher rates of chronic health conditions, substance use disorders, and mental health conditions, as well as a history of poor healthcare access. Decarceration is the most important tool we have to address these risks, however as long as our society incarcerates pregnant people, prisons must be prepared and equipped to provide them with adequate healthcare and support before, during, and after delivery.

Most prison systems reported they train staff to care for pregnant people (88%) and have an onsite infirmary (96%) or 24/7 or on-call medical care (98%). The majority of prison systems also reported that they provide medical appointments to pregnant people within two weeks of a positive test (96%), routinely throughout the pregnancy (100%), and within three weeks of delivery (96%). Prison systems claimed that these services are available, however there is no information in the report about their actual utilization. Does every pregnant person have an appointment within two weeks of a positive pregnancy test and within three weeks of delivery? Do all staff receive training regarding pregnancy, or only healthcare staff? These questions are arguably more important than whether these services and practices technically exist.

It is particularly troubling that six state prison systems (Alaska, Hawaii, Iowa, Maine, Nevada, and Washington) reported that they do not provide any staff training regarding pregnant people in prison. No state prison system is immune from admitting a pregnant person, and these six states accounted for around 5% of the almost 50,000 women admitted to prison in 2021.10 At the very least, corrections and healthcare staff should receive training regarding emergency responses that may be required with a pregnancy.

Postpartum depression is another serious risk facing pregnant people. Nationally, postpartum depression diagnosis rates have been climbing: across all racial and ethnic groups, the rate of diagnosis increased from 9% in 2010 to 19% in 2021. Undoubtedly, this trend persists behind bars, where women face a number of risk-factors for postpartum depression. This includes previous mental illness diagnosis,11 a lack of social support, poor prenatal and perinatal healthcare, separation from the newborn, and experiencing partner violence. In one study of 58 people who gave birth while in prison, researchers found that more than one-third of participants met the diagnostic criteria for moderate to severe depression during pregnancy or postpartum. Yet four state prison systems (Alabama, Iowa, Massachusetts, and Washington) said they do not provide depression screenings during pregnancy or postpartum. Not screening for depression at all during pregnancy and the postpartum period is a failure to meet the most basic standards of pregnancy-related care.

  • Map of the united states highlighting the six state prison systems that do not offer pregnancy-related emergency training for staff
  • map of the united states highlighting which prison systems fail to provide extra pillow(s), pregnancy-specific diets, or social workers, psychologists, or doulas for pregnant people.
  • Map of the united states highlighting the four state prison systems that do not conduct depression screenings during pregnancy or postpartum
  • Map of the united states highlighting which prison systems fail to provide basic postpartum supports like breast pumps and specific diets
  • Map of the united states highlighting the six state prison systems that do not offer pregnancy-related emergency training for staff
  • map of the united states highlighting which prison systems fail to provide extra pillow(s), pregnancy-specific diets, or social workers, psychologists, or doulas for pregnant people.
  • Map of the united states highlighting the four state prison systems that do not conduct depression screenings during pregnancy or postpartum
  • Map of the united states highlighting which prison systems fail to provide basic postpartum supports like breast pumps and specific diets

The Bureau of Justice Statistics report also provides information about which state prison systems provide certain accommodations and support services to people before and after delivery. Prison systems universally reported furnishing at least two accommodations for pregnant people: lower bunk placement12 and prenatal vitamins.13 Most (but not all) prison systems offer a special diet during pregnancy (86%) and consultation with social workers (92%) or psychologists (88%). Prenatal diets require increased calories and a particular balance of nutrients that are likely not met by the typical prison diet. Accessible, appropriate mental health services for pregnant people behind bars are also vitally important, and most standards for pregnancy-related health care in correctional settings emphasize the need for counseling and psychosocial support.

Other extremely basic accommodations are less common in prison systems. These include a special postpartum diet (60%), doula support (35%),14 extra pillows during pregnancy (69%), and breast pumps (78%). These relatively simple interventions can have a tremendous impact during pregnancy and postpartum. For instance, the recommended postpartum diet is associated with fewer symptoms of postpartum depression and can positively impact infant health. People in prison are regularly issued only one pillow, but pregnant people may require more to be comfortable and avoid sleep deprivation, which has been associated with longer labor, elevated perception of pain and discomfort during labor, higher cesarean rates, preterm labor, and other adverse outcomes. While policies may be in place for breast pumping accommodations in most prison systems, the actual accessibility and utilization of breast pumps may be a different story. Some prison systems operate lactation programs that allow incarcerated people to pump breast milk for their babies. However, these programs often have onerous requirements for the incarcerated person’s friends and family, who have to apply for approval to visit and collect the milk. In Florida, for example, incarcerated people are only eligible for this program if there is an approved guardian for the child and the child is not placed in state custody. Reports suggest that when there is no lactation or pumping program, incarcerated people are sometimes not allowed to breastfeed after giving birth,15 and are not provided with anything to help manage an unused milk supply or information about what to expect.

It’s undoubtedly helpful to know which jurisdictions offer these services, but there is once again no information regarding their actual utilization. In 2016, self-reported data from incarcerated people revealed that half of people pregnant upon admission had not received prenatal care in the form of special testing, dietary changes, or childcare instruction. It’s great that prison systems have policies in place to provide these necessary services, but it is not clear at all how they are being implemented and how many pregnant people actually receive them.

Only 11 states and the federal system operate prison nursery programs where newborns can reside with their parents in custody

The Bureau of Justice Statistics reported that ten states and the federal Bureau of Prisons run prison nursery programs, which are residential programs where people can live with their newborns. Although reducing the incarceration of pregnant people is the best approach to this issue, prison nurseries can be another option that allows incarcerated mothers to avoid separation, and to be with and care for their newborn children. Since the data collection period ended for this report, an eleventh state — Missouri — opened their prison nursery program. Even though there were 665 live births in prisons across the U.S. in 2023, only 86 people were participating in prison nursery programs at the end of the year. In Nebraska and West Virginia, there were no nursery program participants at the end of the year.

”map

There are a number of details about these prison nursery programs lacking in the Bureau of Justice Statistics report. For example, how many people participate in the programs each year and for how long? What programming is available to the participants while in the nursery program? How is eligibility determined for participating in these programs? Again, while data on the number of nurseries is helpful, it’s arguably more important to know how they are being used. So, to better understand how prison nursery programs actually work, we looked at the eligibility requirements and restrictions for prison nursery programs in 11 states and the federal Bureau of Prisons.

We found that in all but one of the prison nursery programs, participation requires release dates within 12 to 36 months of the expected delivery date.16 A number of factors can influence eligibility, including offense types, prison disciplinary history, medical or mental health status, prior Child Protective Services involvement, and prison security designation or classification. In Illinois, for example, any child that requires “more than normal well child health care” or any parent requiring “more than normal” prenatal or postnatal care can be excluded from the program. In California, Illinois, Indiana, Ohio, and West Virginia, the incarcerated mother must have sole legal custody of the child. To our knowledge, there are no data available about how often a child born to an incarcerated parent remains in their custody, but there is historical evidence to suggest that this is likely rare, or at the very least, complicated.

Eligibility requirements and considerations for prison nursery programs

For more details and sourcing, see the Appendix Table.
Jurisdiction Pregnant on prison admission Disciplinary record Current or prior offense Medical or mental health Legal custody of newborn
California
Federal
Illinois
Indiana
Missouri
Nebraska
New York
Ohio
South Dakota
Texas
Washington
West Virginia

Unfortunately, because the Bureau of Justice Statistics report does not include information on the sentence length, offense type, prior convictions, or classification status of pregnant people in prison, it is difficult to estimate how many pregnant people in prison would be eligible for these programs. These potentially beneficial programs are a vast improvement over the common practice of simply removing newborn children from their parent at birth.17 However, access to nurseries is still seriously limited, and ultimately, the best option would be to implement caregiver mitigation and diversion laws and prevent the incarceration of pregnant people.

Conclusion

This Bureau of Justice Statistics maternal healthcare report marks an important step toward filling the huge data gap regarding the incarceration of pregnant people in prisons. Given their particular healthcare needs and the challenges to a healthy pregnancy imposed by the prison environment, these data can help inform interventions that lead to better outcomes for incarcerated pregnant people. Although the data answer some of our initial questions about how many pregnant people enter prison and what jurisdictions have policies offering specific supports, significant questions remain. In addition to getting to the bottom of why the findings in the Pregnancy in Prison Statistics study differ so substantially from the Bureau of Justice Statistics survey, future researchers can make important contributions by answering questions such as:

  1. What are the trends in pregnancy in prison over time? Why are these estimates of the prevalence of pregnancy in prison lower than prior estimates?
  2. How many people actually receive the services that these jurisdictions report offering?
  3. What barriers do prison systems face in providing the most basic prenatal and postnatal care, like depression screenings?
  4. Why are so many pregnant people incarcerated (i.e, for what offenses) and for how long (i.e., sentence length)?
  5. What are the outcomes of the live births counted in this report (i.e., preterm, early term, C-sections, low birthweight)? What are the rates of neonatal death and maternal death among this population?

Data on maternal healthcare and pregnancy outcomes should continue to be collected and published on a regular basis by the Bureau of Justice Statistics. Doing so — especially in greater detail — would shed light on an important and understudied healthcare experience in prison.

Appendix table: Detailed eligibility requirements and considerations for participation in prison nursery programs

Jurisdiction Release eligibility date Pregnant on prison admission Classification Disciplinary record Current offense and sentence Prior convictions Medical or mental health Prior Child Protective Services involvement Legal custody of newborn Source
California Wthin 6 years of birth18 Exclusion: found guilty of a serious rule violation Exclusion: sex offenses, violent offenses (some can be reviewed case-by-case), arson offenses, escape or aiding escape convictions, active detainer (unless for failure to appear or misdemeanor motor vehicle violations) Exclusion: previously removed from a community program resulting from violation of state laws, rules, or regulations in California Department of Corrections and Rehabilitation Exclusion: staff physician or psychiatrist assessment Exclusion: found “unfit parent in any court proceeding” Requirement: primary caretaker of the infant prior to incarceration (if born prior to incarceration) CA Penal Code §3417 (2024)
Federal19 Within 30 months of due date Requirement: must be pregnant when admitted Requirement: minimum security Exclusion: disciplinary violations of “an aggressive/assaultive nature” or for any “200 or higher series incident reports” in prior 6 months Exclusion: convictions for sex offenses, crimes against a child, domestic violence or other violent convictions Requirement: “be physically and mentally capable of caring for a child as determined by medical and mental health staff” Exclusion: current no-contact orders with minor children, contact-founded allegation or inconclusive referrals for neglect or abuse with Child Protective Services Female Offender Manual (2021)
Illinois Within 24 months of delivery Consideration: grade, security designation, and escape risk Consideration: disciplinary history Consideration: outstanding warrants or detainers, the nature and class of the offense, sentence, including factors such as the nature and class of the offense, length of sentence, and sentencing orders Consideration: history of violence, abuse, criminal neglect, sexual offenses, or crimes against children, affiliation with organized crime activities or narcotics trafficking Consideration: medical or dental health, psychological evaluation Consideration: Department of Children and Family Services involvement, including, but not limited to, “present or past investigations or cases regarding the offender and her children,” court order prohibiting contact with children Requirement: the baby “shall be in the custody of his or her mother” or “obtain consent from the father for the baby to participate in the Program” Illinois Department of Corrections press release (2010) & 20 IL Admin Code §475.20
Indiana Within 26 months of due date Requirement: must be pregnant when admitted Consideration: charged with a sex crime or any type of violence, abuse or endangerment of a child Requirement: sole, legal custody Department of Corrections Leath MCU Eligibility Criteria
Missouri Within 18 months of delivery Exclusion: dangerous felony, sexual offense, or offenses against the family convictions Missouri SB 834 (2022)
Nebraska Within 24 months of delivery Requirement: must be pregnant when admitted Exclusion: a long list of offenses including manslaughter and murder, as well as robbery and arson.20 Consideration: pending charges Consideration: mental health history Exclusion: history of child abuse as determined by state Department of Health and Human Services and file history Received via email communication with the Nebraska Department of Correctional Services.
New York Within 18 months of delivery21 NY Corr L § 611 (2024)
Ohio Sentence of 36 months or less Requirement: must be pregnant when admitted Exclusion: violent crime or any type of child abuse, or child endangerment conviction Requirement: sole, legal custody OH Admin Code § 5120-9 (2023)
South Dakota Within 30 months of delivery Exclusion: a long list of offenses including manslaughter, murder, rape, robbery, as well as arson, burglary, and violation of a drug-free zone.22 Consideration: pending charges, outstanding warrants. Exclusion: removal of a child by the state. Consideration: child abuse will be determined on crime, past history, inquiry to, and response received by Department of Social Services (DSS) Child Protection Services (CPS). Policy 300-25 (2024)
Texas Within 12 months of due date Requirement: minimum custody Exclusion: past or current conviction for any violent offense, arson or “an offense that would require registration as a sex offender” Department of Criminal Justice press release (2015)
Washington Within 30 months of birth Requirement: must be pregnant when admitted Requirement: minimum (MI)2 or MI1 custody level Exclusion: conviction for a crime against chidlren per RCW 28A.400.322, conviction for “a sex offense(s) and/or sexual motivation behavior” Requirement: vaccinations for annual influenza, MMR, Tdap Requirement: approved by Child Protective Services. Exclusion: current no contact order with minor children Policy 590.320 (2023)
West Virginia Within 18 months of delivery Requirement: must be pregnant when admitted Requirement: internal classification of the division Requirement: “be physically and mentally capable of caring for a child” Requirement: assessed by Child Protective Services (CPS) and cleared of any history of abuse and/or neglect Requirement: sole, legal custody Reporting from States of Incarceration & WV Code § 25-1B (2024)

Footnotes

  1. We acknowledge that people of many different gender identities can become pregnant. Unfortunately, the data published by the Bureau of Justice Statistics is not broken down by gender identity. Instead, it relies on administrative data, which is primarily reliant on the binary sex variables of male and female. The report presents data exclusively about women in the custody of state and federal correctional authorities and female admissions, ostensibly conflating “women” with administratively-identified “female” people.  ↩

  2. Not all women admitted to prison were given a pregnancy test: more than 7,500 women admitted to state prisons (13%) and about 470 women admitted to federal prisons (7%) were not tested.  ↩

  3. In fact, the 22 states included in the Pregnancy in Prison Statistics (PIPS) study had a lower average pregnancy rate (85.7 per 1,000 women aged 15-44) in 2016 than the total U.S. (89.6 per 1,000). We would therefore expect a higher reported pregnancy rate in the Bureau of Justice Statistics study that included states with higher pregnancy rates overall.  ↩

  4. At the time of this publication, the Bureau of Justice Statistics has not yet published race and ethnicity data for the 2023 prison population. For this comparison, we rely on the race and ethnicity of the sentenced prison population on December 31st, 2022, published in Table 10 of Prisoners in 2022.  ↩

  5. The pregnancy rate in the United States — calculated from the number of live births, pregnancy losses, and abortions — has been steadily declining since 2010. In 2016, the pregnancy rate was 89.6 per 1,000 women aged 15-44, and in 2020, this rate decreased by 8% to 83 per 1,000.  ↩

  6. Pregnancies resulting in live births were more common (91.5%) in prison in 2023 than in the total national population in 2020 (67%).  ↩

  7. Notably, abortions are more common outside prison (17% of pregnancies in 2020) than in prison (2% in 2023). Research shows that even in states where abortion is legal, many incarcerated people may be effectively blocked from obtaining the care they need, thanks to insurmountable barriers like self-payment requirements and physical distance from abortion caregivers.  ↩

  8. In 2023, the maternal mortality rate (calculated as the number of maternal deaths per 100,000 live births) in the United States was 17 per 100,000, more than double that of the United Kingdom (8 per 100,000) and higher than most other comparable developed nations.  ↩

  9. While maternal mortality rates are unacceptably high in the United States across the board, Black and American Indian and Alaska Native women are at increased risk for pregnancy-related death. Black women are three times more likely to die from pregnancy-related complications than white women. Women with lower socioeconomic status are more likely to face a number of serious pregnancy outcomes than those with the highest household incomes.  ↩

  10. In 2021, there were 49,038 women admitted to state and federal prison and 2,269 were admitted to those six states’ prison systems (Bureau of Justice Statistics, CSAT-Prisoners). More recent admissions data broken down by sex have not yet been published.  ↩

  11. Two thirds of women diagnosed with postpartum depression had depression prior to or during pregnancy. Other mental health conditions (prior to childbirth) including anxiety, PTSD, and bipolar disorder are also associated with postpartum depression. Rates of mental health conditions are extremely high among imprisoned women: 69% of women in state prison and 52% of women in federal prison have a history of a mental health problem, with 19% of women in state prisons and 17% in federal prisons reporting serious psychological distress in the past 30 days.  ↩

  12. Climbing onto a higher bunk is a risk factor for falling. Falls during pregnancy can result in fractures and sprains for the pregnant person, as well elevated risk for preterm labor, placental abruption (separation from the uterus), fetal distress, and fetal hypoxia.  ↩

  13. Prenatal vitamins are part of the basic standard of care for pregnant people: the use of prenatal vitamins can prevent 50-70% of neural tube defects, as well as other negative outcomes.  ↩

  14. Doulas are professionals who provide continuous support and comfort during pregnancy, delivery, and the postpartum period. Their presence is associated with positive delivery outcomes, including fewer cesarean sections and premature deliveries, as well as shorter labors. Doula support is also associated with reduced anxiety and stress and improved breastfeeding success.  ↩

  15. There are a number of potential serious complications associated with early weaning, including increased risks of breast cancer, ovarian cancer, diabetes, hypertension, and heart attacks. While people may choose not to breastfeed, the forced early weaning that inevitably occurs in prison is in-and-of-itself risky.  ↩

  16. The exception is California: “a probable release or parole date with a maximum time to be served of six years, calculated after deduction of any possible good time credit.”  ↩

  17. While we do not know the custody status of newborns born to incarcerated people, we do know that ultimately, incarcerated mothers are five times as likely to have their children placed in foster care and are more likely to have their parental rights terminated due to incarceration than fathers.  ↩

  18. People who were the primary caretaker of a child under six years of age prior to incarceration can also apply to the California Prisoner-Mother Program (CPMP).  ↩

  19. This is “an inter-governmental agreement with the Washington Department of Corrections (WADOC) to place qualified, interested pregnant inmates in the RPP at the Washington Correctional Center for Females in Gig Harbor.”  ↩

  20. The full list of current or past offenses that result in exclusion from the program is as follows: “1st and 2nd degree murder, manslaughter, 1st degree sexual assault, 1st degree assault, robbery, all other sexual assault offenses, stalking involving a minor, kidnapping/false imprisonment involving a minor, arson, child abuse (as determined by DHHS and file history), incest, other serious crimes against children, any other serious offenses that could place the child in jeopardy” (including attempts, conspiracy or solicitation to commit these offenses).  ↩

  21. People who are nursing a child under one year old at time of prison admission can also apply to the program.  ↩

  22. The full list of current or past offenses that result in exclusion from the program is as follows: “manslaughter 1st and 2nd, murder 1st and 2nd, rape all, robbery (all), arson (all), burglary 1st, commission of a felony while armed with firearm (all), possession of a weapon by offender, criminal pedophilia, possession of weapon in jail, aggravated assault – baby (includes subsequent offense), aggravated assault against law enforcement, child abuse (all), sexual contact (all), vehicular homicide, vehicular battery, removal of a child from state, stalking (includes 1st felony offense, subsequent offense and child 12 or younger), discharging a firearm at an occupied structure or motor vehicle (with bodily injury), photographing child in obscene act, possession of a firearm by a felon, sliming (felony), indecent exposure (all), simple assault (all), possession of child pornography, incest (all), discharging a firearm from a moving vehicle, sexual exploitation of a child (includes subsequent offense), threatening to commit a sexual offense, solicitation of a minor (includes subsequent offense), riot (all), enticing away a child, violation of drug free zone (reviewed on a case-by-case basis), distribution of drugs/controlled substance/flunitrazepam to a minor, permitted physical or sexual abuse of a child” (including attempts, conspiracy, solicitation to commit, or accessory to these offenses).  ↩


Today, we released a new tracking tool that shows the full scale of the crisis unfolding in communities and behind bars, and a new resource page for folks looking to learn more about the repression and detention of undocumented immigrants.

by Mike Wessler, April 30, 2025

With the first 100 days of President Trump’s second term complete, today, we released a new tracker on our website that highlights the ways the administration is making the criminal legal system larger, harsher, and less effective. The new tool, which will be updated regularly, highlights the ways that the administration is eviscerating the rule of law, undermining solutions that reduce incarceration and improve community safety, encouraging the use of extreme sentences and harsh law enforcement tactics, making prisons and jails worse, and reducing transparency in the carceral system.

Actions from the administration have come so fast that it has been nearly impossible to keep track of them all. This new tool connects the dots on these actions to show that they’re not individual policy choices but instead part of a larger strategy that doubles down on the failed policies that created the nation’s mass incarceration crisis in the first place.

The tracker also explains that, while the federal government directly controls only a relatively small slice of the American carceral system, the administration is using its bully pulpit and control over federal spending to coerce state and local governments into expanding their criminal legal systems and making them even more brutal.

Additionally, today we released a new resource page on our website that focuses on the intersection of criminal and immigration law, often referred to as “crimmigration.” While we include immigration detention in our broad view of mass incarceration, it is not our primary area of expertise. For those looking to learn more about the crimmigration crisis, we have compiled resources from experts and organizations directly focused on immigration on this new page.

The new federal policy tracker is available at: https://www.prisonpolicy.org/federaltracker.html

The new crimmigration resource page is available at: https://www.prisonpolicy.org/blog/2025/04/30/crimmigration_resource_roundup/

This new tracker and resource page are just the first steps in our organization’s commitment to create tools, data, and resources for advocates, lawmakers, and journalists as they work to push back on this new crisis in America’s criminal legal system.


A list of valuable online resources from organizations and agencies focused on immigration detention.

by Prison Policy Initiative, April 30, 2025

The current presidential administration is hellbent on making life difficult, if not impossible, for immigrants in the United States. Following through on campaign promises of mass deportation, Donald Trump has directed Immigration and Customs Enforcement (ICE) agents to raid neighborhoods and workplaces or otherwise expedite the removal of hundreds of thousands of people2 who are in the country under various programs. This is an escalation of the troubling, decades-long merger of criminal and immigration law, sometimes referred to as “crimmigration.“ The government’s treatment of immigrants as criminals — from policing and criminally prosecuting them to incarcerating them in oppressive detention centers — raises profound concerns about due process, constitutionality, and the humane treatment of people.

About 48,000 immigrants1 are languishing in immigration detention centers, local jails, private prisons, and other facilities like hospitals and hotels. Tens of thousands more are in federal prisons and local jails, primarily for simply entering the country; thousands more are children, in shelters, awaiting permanent placement. Add to this the hundreds of people from Venezuela that the U.S. has now disappeared to a mega prison in El Salvador, arguing it has no duty to provide them due process, and no power or responsibility over what happens to them next.

These numbers provide only a glimpse at the complex web of immigration detention, but they’re important given the many false narratives and misinformation filling the airwaves. It’s more important than ever to know where timely, reliable data exist about immigration detention and advocacy efforts to end the unjust confinement and removal of people and families who enter the U.S.

While we include immigration detention in our broad view of mass incarceration, it is not our primary area of expertise. For those looking to learn more about the crimmigration crisis, we’ve compiled several resources from experts and organizations directly focused on immigration. These lists are far from exhaustive and resources listed in no particular order; if there are others you think we should know about, please get in touch via our contact form.

Information and statistics about immigrant detention and removal

  • The Transactional Records Access Clearinghouse (TRAC) is an essential resource for immigration data and summary reports about trends in immigration detention. (It also offers data and analysis on other federal agencies and issues.)
  • Freedom For Immigrants, an organization working to abolish immigration incarceration, maintains a detailed interactive map on immigration detention, with data points like ICE field offices, companies that contract with ICE, and deaths in ICE detention.
  • The federal agency itself, Immigration and Customs Enforcement (ICE), maintains the following data, though it should be approached with a measure of “data skepticism”:
    • ICE’s Detention Statistics dataset is updated twice per month and contains detailed data about people in custody, where they’re confined, the number of people on electronic monitoring or other surveillance technologies,3
      and other metrics like length of stay and segregation. (Scroll down to the bottom of the linked page to find the download links for the most recent data and previous year-end reports.)
    • ICE’s Enforcement and Removal Operations (ERO) statistics dashboards present the agency’s arrest, detention, removal, and expulsion data in a more interactive format, and include information about country of citizenship, how many people had a criminal conviction or pending charges, and changes over time.
    • ICE publishes lists of both active and pending 287(g) partnerships — those state and local law enforcement agencies who voluntarily report the immigration status of people in their custody to ICE, and carry out other immigration functions on ICE’s behalf.

Immigration advocacy efforts (national-level)

  • The National Immigrant Justice Center, which has been providing legal services, research, and advocacy for over 40 years, has a lot of information on its website for those interested in how immigration intersects with mass incarceration, legal representation, the LGBTQ+ community, and other topics.
  • Similarly, the Immigrant Legal Resource Center, which engages in policy advocacy as well as training and support for legal advocates, has compiled a number of policy maps, explainers, toolkits, model policies, and other timely resources for advocates on its Immigration Enforcement webpage.
  • Detention Watch Network has comprehensive overviews of immigration detention issues, from family detention to ineffective oversight and the laws, quotas, and financial incentives that keep immigration detention centers filled.
  • United We Dream has an extensive library of resources ranging from guides and fact sheets to webinars and livestreams.
  • The Black Alliance for Just Immigration has compiled all immigration-related executive actions from the Trump administration, with clear explanations of what they entail and how they may impact Black immigrant communities.
  • The Pioneer Valley Workers Center, an organization of low-wage immigrant workers in western Massachusetts, has advice for those looking to set up a “rapid-response network” of volunteers and services that can provide immediate assistance during immigration crackdowns and workplace raids. Though originally published in 2018, this resource remains relevant today.

Analysis and commentary

  • César Cuauhtémoc García Hernández is a writer, law professor, and fierce advocate for a just and functional system of immigration laws. In addition to authoring three books about crimmigration, he maintains a newsletter, Immigration Law Unhinged, which has been tracking the Trump administration’s actions.
  • Syracuse Professor Austin Kocher also writes a helpful data-focused newsletter with insights about immigration data and policy, as well as tips for data literacy for people working with official immigration data published by ICE.
  • John Washington is a journalist and author of The Case for Open Borders, which exposes the dangers and lost creative potential of closed national borders, and makes the case for drastically rethinking how we approach borders.
  • A recent Truthout article details the embrace of increased immigration detention by jails and private prisons across the country.
  • In These Times, a monthly news magazine focused on politics and the economy, has published an opinion piece on the current blitz on immigrants and others who merely express ideas counter to the current administration.
  • Silky Shah is a longtime immigrant justice organizer and currently the Executive Director of Detention Watch Network. Her writing can be found in several media outlets, but her book Unbuild Walls is a thorough primer on the intertwined systems of immigration and incarceration.
  • Debunking misinformation is just as helpful as putting out accurate information. The American Immigration Council has done just that, with a fact sheet amassing dozens of studies all showing plainly that there is no connection between immigration and crime.
  • The Economic Policy Institute, a nonprofit, nonpartisan think tank, put out this helpful explainer on why immigration is beneficial to the U.S. economy, busting myths about how immigration impacts jobs, taxes, housing costs, and more.
  • Migrant Insider provides regular coverage and analysis of immigration news with a special focus on happenings ‘inside the Beltway’ — i.e., in Congress, the executive branch, and more.
  • Jess Pishko’s Posse Comitatus newsletter is an indispensable resource on sheriffs, who play a unique and important role in immigration enforcement. One recent article examines Florida as “ground zero” for Trump’s mass deportation agenda.

Resources for immigrants, journalists, attorneys, and educators

For immigrants, “Know your rights” resources are all over the internet. These are some we found to be the most valuable:

  • United We Dream published a Preparedness Packet of essential documents and key legal information to keep in a safe place, in case of immigration emergencies.
  • Muslims for Just Futures has a free double-sided poster print-out with guidance on how to handle an unexpected visit from immigration law enforcement.
  • Freedom for ImmigrantsResources page contains contact information and answers to common questions about immigrant detention and legal assistance.
  • The National Immigration Law Center has a library of FAQs, fact sheets, and one-pagers about immigration enforcement and the rapidly changing policies and executive orders impacting immigrant communities.

Journalists, attorneys, and educators may find these additional resources helpful:

  • Freedom for Immigrants has specific resources for journalists covering these issues.
  • The Immigrant Legal Resource Center is a treasure trove of resources for attorneys and legal advocates, offering legal trainings, practice manuals, technical assistance, and other educational materials, including timely, responsive guidance about new policies and practices. In addition to serving legal advocates, they publish resources for directly-impacted people and community advocates.
  • The National Immigration Project trains thousands of attorneys each year to ensure high-quality legal representation for immigration. Their library of resources for attorneys includes practice advisories, quick guides, and summaries of relevant case law.
  • For educators, we suggest checking out this robust toolkit from the Children Thrive Action Network, which features a wide range of resources for helping children and families facing deportation, preparing communities to respond to workplace raids, and educating the public and lawmakers about the impact of immigration enforcement on children.
  • The Zinn Education Project offers educators several role play lessons to help students think critically about immigration, particularly in historical context.
  • The National Education Association, the nation’s largest teachers’ union, “strongly encourages schools and school districts to adopt a Safe Zones policy that outlines what educators, and staff should do if ICE attempts to engage in immigration enforcement at school.” It offers a toolkit for creating these protections.

Footnotes

  1. The administration’s goal is reportedly to deport “one million” people. This would require the administration’s blowing past its own definition of “illegal” immigration. We already see this through its targeting and removal of permanent U.S. residents whom it deems a risk, regardless of how little evidence it may have or due process it may provide. In particular, the administration claims to be targeting migrants with “violent” criminal records and those it alleges are affiliated with certain gangs. Meanwhile, many counties are collaborating with these efforts through 287(g) agreements that essentially turn local law enforcement into de facto federal immigration agents and local jails into ICE detention facilities.  ↩

  2. This number was already growing, but has exploded in the last two months since we reported it in this year’s Mass Incarceration: The Whole Pie report.
     ↩

  3. In the last ten years, ICE has expanded its use of electronic monitoring and other “alternatives to detention” rapidly, from 23,000 people under active surveillance in 2014 to more than 185,500 people in February of 2025. Instead of providing a humane alternative to confinement, these “ICE digital prisons” simply expand the agency’s carceral reach.
     ↩


President Trump’s recent comments about sending Americans to a Salvadoran prison mark a new, dark turn in the fight to end mass incarceration.

by Prison Policy Initiative, April 17, 2025

Standing in the Oval Office on Monday, just before members of the media were ushered into the room, President Trump said to President Bukele of El Salvador, “Home-growns are next. The home-growns. You gotta build about five more places. It’s not big enough.”

Those “home-growns” he’s talking about, they’re United States citizens. They’re you and me.

Those “five more places” he asked the Salvadoran dictator to build, they’re “prisons”1 like the one where the Trump Administration has already sent hundreds of immigrants, many of whom were snatched off the streets and shipped off without due process. This includes Kilmar Armando Abrego Garcia, whom the Trump administration has refused to bring back to the United States, defying a unanimous order from the Supreme Court.

The actions of the Trump administration against immigrants in this country, many of whom were here legally, are an unconstitutional human rights violation. At Prison Policy Initiative, we know that we are not experts in the immigration system in the United States, and as such, have so far deferred to the amazing organizations, experts, and advocates leading the fight against these policies. Trump’s words make clear that a different approach is needed from us.

Our mission at Prison Policy Initiative is to provide facts, research, and data about the ways mass incarceration harms residents of the U.S. — and not just those behind bars.

After these comments, we’ve been asked by countless people to weigh in on the steadily increasing signs that Trump is working to deport and incarcerate U.S. citizens to El Salvador. However, the truth is that there are no facts or data to provide context for this situation.

American presidents have done some really heinous things, and while these injustices provide clues about what we can expect next, they are not exact parallels to the threat that every resident of the U.S. currently faces.

American and Salvadoran prisons have more in common than you think. They’re large, brutal, costly, and don’t make communities safer. They destroy the lives of the people ensnared in them and the lives of their families. Both countries incarcerate similar numbers of people per-capita and both of their prisons serve as a death sentence for many inside. It is important to note, though, that the American system has at least the guise of due process and legal standards for facilities — such as prison conditions, oversight, and transparency — while this Salvadoran facility does not. Sending U.S. residents to far-flung prisons without due process would be a dramatic escalation of our country’s already misguided policies.

Those three words — “home-growns are next’ — should send a chill down the spine of every person in the country.

We don’t know exactly what Trump and his subordinates are planning. He’s made clear that Attorney General Pam Bondi is exploring the legality of incarcerating American citizens in another country. All credible legal experts agree that doing so would be unconstitutional.

But as we’ve already seen, the Trump administration doesn’t see the Constitution as an impediment to its actions. So there is little doubt that once the administration recognizes it can’t find a legal rationale for deporting U.S. citizens, it will surely make one up out of thin air.

In his remarks, he indicated that he was talking about deporting “violent people.” Perhaps this is an attempt to assure people that his unconstitutional plan to deport American citizens won’t go too far. But the truth is, many so-called “violent” crimes don’t actually involve physical harm. In some states, even drug offenses are deemed a violent crime.

The simple fact is that law enforcement can spin nearly any criminal accusation to be a “violent” offense in the U.S. criminal legal system. There is little doubt that if given the chance, the administration would warp the definition of “violent crime” beyond its already sagging bounds.

Of course, some apologists will attempt to assure the American people that as long as they don’t commit a crime, they have nothing to be afraid of. But does anyone really doubt that Trump is planning to use the full force of law enforcement to go after those who displease or oppose him? For months, he has said he wants do just that. This would make it so any act he doesn’t like would put you at risk of deportation to a Salvadoran prison, without due process and the opportunity to defend yourself in a court of law.

You would think that a president convicted of multiple felony offenses, which he insists are politically motivated, would be more attuned to the risks of such political prosecutions. But you’d be wrong.

Those three chilling words — “home-growns are next” — signal a dark pivot for our country and a dramatic expansion of the already devastating criminal legal system.

For an organization that prides itself on its ability to use visualizations and clear language to make sense of the goings-on in the criminal legal system, we are, for perhaps the first time ever, left at a loss for what to say.

But just because we’re at a loss today, doesn’t mean we’re sitting on the sidelines. Over the coming weeks, months, and maybe even years, as this crisis unfolds, we’ll be here:

  • When we can provide data and analysis, we’ll share them with you.
  • When we can elevate the voices and actions of experts and organizations in areas that are outside of our expertise, we’ll point you to them.
  • And when there are opportunities to take action, we’ll tell you about them and be by your side.

We don’t know what comes next, but we’re in this fight with you.

Footnotes

  1. We use the term “prison” in this blog post for simplicity, but it is not an exact fit for these facilities. The U.S. Holocaust Museum’s explanation suggests that these facilities may be better described as concentration camps: “What distinguishes a concentration camp from a prison (in the modern sense) is that it functions outside of a judicial system. The prisoners are not indicted or convicted of any crime by judicial process.”  ↩




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