State and federal prison co-pay policies and sourcing information

This table details medical co-pays for visits with health care providers charged to incarcerated people in state and federal prisons, along with sourcing information available as of April 13, 2017. It was originally published as an appendix to the April 19, 2017 blog post "The steep cost of medical co-pays in prison puts health at risk." We welcome additional or updated information.

Each state's policy is different, and county jail facilities may charge medical fees differently than state facilities. The services for which co-pays are charged, and the amounts charged for different services, are outlined in each state's policy. In this table, I have only included co-pays for non-emergency, patient-initiated visits with medical staff. In general, however, the following visits are exempt from co-pays and fees: treatment of chronic conditions, emergency care (as determined by medical staff), follow-up visits, referrals to specialists, work clearances, institution-initiated visits (intake physicals, screenings, etc.), and court-ordered services. Correctional facilities may not deny or delay treatment due to a patient's inability to pay co-pays or fees. See the table for each state's assessment of fees in cases of indigency or insufficient funds.
Medical Co-pay for Visits What if the patient can't afford to pay? Sources Links
Alabama $4 co-pay. For exceptions, see pages 5-6 of policy PDF. Patients who maintain a balance of less than $20 in their personal accounts for the prior 90 days are considered indigent and are not assessed a co-pay. For those who are not indigent but have inadequate funds, the unpaid balance remains payable until sufficient funds are received. DOC Admin. Reg. 703 http://www.doc.state.al.us/docs/AdminRegs/AR703.pdf
Alaska $5 co-pay. Treatment for chronic conditions is charged the $5 co-pay once per year. For exceptions, see page 4 of PDF. If a patient does not have sufficient funds, a debt is established. DOC Policy 807.07 www.correct.state.ak.us/pnp/pdf/807.07.pdf
Arizona Up to $5 health care fee. For exceptions, see pages 21-22 of PDF. If a patient does not have sufficient funds to pay the health care fee, a "hold" is placed on his or her account for future debiting when funds become available. DOC Dept. Order 1101 https://corrections.az.gov/sites/default/files/policies/1100/1101-effective_102216.pdf
Arkansas $3 co-pay. DOC Guide for Family and Friends. See page 18 of PDF. http://adc.arkansas.gov/images/uploads/Friends_and_Family_Guide.pdf
California $5 fee. For exceptions, see pages 196-197 of PDF. If the patient does not have sufficient funds at the time of the charge, and remains without sufficient funds for 30 days thereafter, he or she will not be charged for any remaining balance of the fee. Cal. Code Regs. tit. 15, § 2254.2. See page 196 of PDF. http://www.cdcr.ca.gov/Regulations/Adult_Operations/docs/Title15-2016.pdf
Colorado $3 co-pay ($1 for mental health care). For exceptions, see pages 3-4 of PDF. DOC Regulation 700-30 https://drive.google.com/file/d/0B4vYiI52TzO6TzQwaXRnWkozRFE/view
Connecticut $3 fee. For exceptions, see page 2 of PDF. If a patient does not have sufficient funds at the time of service, an obligation is established on his or her trust account. Subsequent funds are credited against the obligation until it is paid. DOC Administrative Directive 3.12 http://www.ct.gov/doc/LIB/doc/PDF/AD/ad0312.pdf
Delaware $4 co-pay. For exceptions, see page 1 of PDF. DOC Policy E-01.1 http://www.doc.delaware.gov/downloads/policies/policy_11-E-01-1.pdf
Federal $2 co-pay. For exceptions, see page 3 of PDF. A patient is considered indigent if he or she has not had a trust fund account balance of $6 for the past 30 days. The fee is not charged to indigent patients. For a patient who is not indigent but does not have sufficient funds, a debt is established and incoming funds are applied against this debt until it is paid. BOP Policy 6031.02 https://www.bop.gov/policy/progstat/6031_002.pdf
Florida $5 co-pay. For exceptions, see statute. If a patient does not have sufficient funds, 50% of each deposit into his or her account is withheld until the total amount owed has been paid. 2016 Fla. Stat. § 945.6037 http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0900-0999/0945/Sections/0945.6037.html
Georgia $5 fee. For exceptions, see page 16 of PDF. If a patient is unable to pay, the charge is recorded as an outstanding debt against his or her account. DOC Orientation Handbook for Offenders http://www.dcor.state.ga.us/sites/all/files/pdf/GDC_Inmate_Handbook.pdf
Hawaii $3 co-pay. For exceptions, see page 3 of PDF. If a patient has less than $10 in his or her account at the time the charge is posted, he or she is considered indigent and a debt is created until the account has over $10 and enough to pay the co-pay. If there is less than $10 but more than the total co-pay owed, the difference will be deducted from the account. DPS Corrections Administration Policy COR.10.1A.13 http://dps.hawaii.gov/wp-content/uploads/2012/10/COR.10.1A.13.pdf
Idaho $5 co-pay ($10 for people with work release jobs). For exceptions, see page 4 of PDF. DOC Procedure Control Number 411.06.03.001 https://www.idoc.idaho.gov/content/policy/851:DOC
Illinois $5 copay. For exceptions, see statute. A patient is considered indigent if he or she has less than $20 in an Inmate Trust Fund at the time of service and for 30 days prior to the time of service. Indigent patients are except from the co-pay. 730 Ill. Comp. Stat. 5/3-6-2 http://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=073000050K3-6-2
Indiana $5 copay. For exceptions, see pages 3-4 of PDF. Co-pays are paid from Inmate Trust Funds before commissary orders are processed. If there are insufficient funds to cover health co-pays, a hold is placed on the account for 30 days. A patient is not authorized to make any purchases or take money from his or her Inmate Trust Fund until outstanding health care co-pays are paid. If a patient does not receive sufficient funds to cover the co-pay within 30 days, any available funds up to the co-pay amount will be deducted and the hold will be removed at the end of the 30 day period. 210 Ind. Admin. Code Article 7 www.in.gov/legislative/iac/T02100/A00070.PDF
Iowa $3 co-pay. For exceptions, see page 4 of PDF. If a patient's account balance is not sufficient to cover the charges, his or her balance will be reduced to $0 and a lien will be placed against the account. The balance owed will be deducted from any deposit received. The debt will remain outstanding until paid, for as long as the sentence is in effect. DOC Policy HSP-505

See also: DOC Health Services Offender Co-Pay Notice
https://doc.iowa.gov/sites/default/files/hsp-505_health_clinic.pdf

https://doc.iowa.gov/sites/default/files/hsf-505a_offender_co-pay_notice.pdf
Kansas $2 fee. For exceptions, see Admin. Reg. on page 597 of PDF. If a patient has insufficient funds to cover the fee, the fee will be transferred as soon as funds become available. Kan. Admin. Regs. § 44-5-115c (2016). See page 597 of PDF. http://www.sos.ks.gov/pubs/kar/2016/044_44-Department%20of%20Corrections,%202016%20KAR%20Supp.pdf
Kentucky $3 co-pay. For exceptions, see page 5 of PDF. A patient who maintains a balance in his or her inmate account of $5 or less for 30 days prior to requesting indigency status is considered indigent. Indigent patients are not charged co-pays. DOC Policy 13.2

For definition of indigency, see DOC Policy 15.7
http://corrections.ky.gov/communityinfo/Policies%20and%20Procedures/Documents/CH13/CPP%2013-2%20Health%20Maint%20Srvcs%20-%20Eff%208-5-16.pdf

http://corrections.ky.gov/communityinfo/Policies%20and%20Procedures/Documents/CH15/CPP%2015.7%20eff%201-6-17.pdf
Louisiana $3 co-pay. I could not find a state-wide policy, but according to an In These Times article, when a patient can't afford a co-pay, a debt is created that can follow him or her even after release from prison. DOC guide, "Time in Prison: The Adult Institutions." See page 5 of PDF.

See also: Katie Rose Quandt and James Ridgeway, "At Angola Prison, Getting Sick Can Be a Death Sentence," In These Times, December 20, 2016.
http://web.archive.org/web/20070205093744/http://www.corrections.state.la.us/Whats%20NEw/PDFs/TimeInPrison.pdf

http://inthesetimes.com/features/angola-prison-healthcare-abuse-investigation.html
Maine $5 fee. For exceptions, see statute paragraph A. A patient is not charged if they have less than $15 in a facility account and have not received additional money from any source for 6 months following the medical service. Maine Rev. Stat. tit. 34-A § 3031 (2).

See also: DOC Maine Correctional Center Male Prisoner Handbook. See page 23 of PDF.
http://legislature.maine.gov/statutes/34-A/title34-Asec3031.html

https://www1.maine.gov/corrections/adultfacilities/2016%20Handbook%20MALE%20revisions%20completed.pdf
Maryland $2 copay. According to the Department policy, Maryland state law permits correctional agencies to assess a maximum of $4 as a medical co-pay, but the Department currently assesses $2. For exceptions, see pages 2-3 of PDF. DPSCS Executive Directive OPS.130.0001 http://itcd.dpscs.state.md.us/PIA/ShowFile.aspx?fileID=490
Massachusetts $3 co-pay. For exceptions, see pages 6-7 of PDF. Co-pays are deducted from available earned funds or from savings funds if no earned funds are available. If a patient has no available earned funds, he or she is not charged a co-pay unless he or she voluntarily agrees to pay the co-pay from unearned funds by using a charge slip. 103 DOC 763 http://www.mass.gov/eopss/docs/doc/policies/763.pdf
Michigan $5 co-pay. For exceptions, see pages 1-2 of PDF. If a patient does not have sufficient funds to pay the fee, the fee is considered an institutional debt and at that time, all available funds will be collected to go toward payment of the debt. When future funds are received in the account, 50% will be put toward the debt until the debt is paid. DOC Policy Directive 03.04.101.

For information on institutional debt, see DOC Policy Directive 04.02.105. See page 6 of PDF.
https://www.michigan.gov/documents/corrections/03_04_101_268638_7.pdf

https://www.michigan.gov/documents/corrections/04_02_105_305884_7.pdf
Minnesota $5 co-pay. For exceptions, see Directive Procedure B. The co-pay charge is logged into the patient's account with a negative balance until funds become available to cover partial or total cost of care. DOC Directive 500.100 http://www.doc.state.mn.us/DocPolicy2/html/DPW_Display_TOC.asp?Opt=500.100.htm
Mississippi $6 co-pay. For exceptions, see "Do I (inmate) have to pay a co-pay every time?" on Medical Concerns FAQ page. If a patient does not have sufficient funds, the balance will be paid upon receipt of future funds into his or her account. DOC Medical Concerns FAQ web page http://www.mdoc.ms.gov/Inmate-Info/Pages/Medical-Concerns-FAQ.aspx $6 is "global charge" so no additional charges after one copay per visit
Missouri No co-pay or fee. As of April 2017, the Missouri state legislature is considering HB 268, which would establish a 50 cent co-pay for correctional medical services. DOC Guide for Family and Friends. See pages 20 and 39 of PDF.

For information on pending legislation, see HB 268.
http://doc.mo.gov/Documents/FFWeb.pdf

http://www.house.mo.gov/Bill.aspx?bill=HB268&year=2017&code=R
Montana No co-pay or fee. By statute, incarcerated people are obligated to pay for "reasonable costs" of medical care. However, a 2016 Legislative Audit found that the department is not yet charging for medical treatment. DOC 2019 Budget Analysis Summary. See page 4 of PDF (D-137 of document).

For the relevant statute, see Mont. Code Ann. § 53-1-107(6) (2015).
http://leg.mt.gov/content/Publications/fiscal/Budget-Books/2019/Budget-Analysis/section_d/6401-00summary.pdf

http://leg.mt.gov/bills/mca/53/1/53-1-107.htm
Nebraska No co-pay or fee. NCS Health Services Inmate Health Plan (2016). See page 13 of PDF. http://www.corrections.nebraska.gov/pdf/Inmate%20Health%20Plan%20-%20July%201,%202016.pdf
Nevada $8 co-pay. For exceptions, see page 12 of Initial Orientation Handout PDF and page 73 of Audit Report PDF. I could not find a policy addressing insufficient funds or indigency, but the Audit Report found that "Inmates were not charged for visits due to insufficient funds to make co-payments in 40 (18%) of the visits reviewed." DOC Initial Orientation Handout (2010). See page 12 of PDF.

See also: DOC Inmate Programs, Grievances, and Access to Health Care Audit Report (2008). See page 72 of PDF.
https://www.law.umich.edu/special/policyclearinghouse/Documents/Nevada%20Initial%20Orientation%20Handout.pdf

http://www.leg.state.nv.us/Division/Audit/Full/documents/CorrectionsCorrectionalProgramsLA08-19FULL.pdf
New Hampshire $3 co-pay. For exceptions, see pages 2-3 of PDF. A patient with a negative account balance will be charged. When he or she receive funds, the negative balance will be paid off before any other charges can be incurred. DOC Policy and Procedure Directive 6.16 http://www.nh.gov/nhdoc/policies/documents/6-16.pdf
New Jersey $5 co-pay. For exceptions, see Admin. Code and page 55 of Inmate Handbook. N.J. Admin. Code § 10A:16-1.5 (2017). Free access available via Lexis Nexis.

See also: New Jersey Inmate Handbook. See page 55 of PDF.
http://www.lexisnexis.com/hottopics/njcode

https://www.law.umich.edu/special/policyclearinghouse/Documents/New%20Jersey%20Inmate%20Handbook.pdf
New Mexico No co-pay or fee is mentioned in DOC policies. The DOC Guide for Families and Friends states that "All residents have access to medical and mental health care," with no mention of co-pays or fees. However, several articles mention county jails charging co-pays of $3 to $10. DOC Policy CD-170000 (Medical Services Administration) does not mention co-pays or fees.

See also: DOC Guide for Families and Friends. See page 10 of PDF.

For information about co-pays charged in county jails, see Marisa Demarco, "Many N.M. Jails Charge Inmates Copays," KUNM, October 15, 2015.

For another source on jail co-pays, see Michelle Andrews, "Prisons and Jails Forcing Inmates To Cover Some Medical Care Costs," Kaiser Health News, September 29, 2015.
http://cd.nm.gov/policies/docs/CD-170000.pdf

http://cd.nm.gov/ocs/docs/Offender_Family_Guidebook.pdf

http://kunm.org/post/many-nm-jails-charge-inmates-copays

http://khn.org/news/prisons-and-jails-forcing-inmates-to-cover-some-medical-care-costs/
New York No co-pay or fee. New York State Assembly staff
North Carolina $5 co-pay. For exceptions, see page 4 of PDF. Co-pays are deducted from trust fund accounts, regardless of indigent status. However, co-pay fees deducted will not take the account balance below $2. If there is not enough money to pay the co-pay, the charge remains as a lien on the account. When deposits are made, up to 50% of a deposit will be taken to pay the co-pay balance. Co-pay charges remain liens against the account until release or parole. DOC Policy AD III-1 http://www.doc.state.nc.us/div/Prisons/HealthServices/AD_Administration/AD_III_ManagedCare/adIII1.pdf
North Dakota $3 co-pay. For exceptions, see page 53 of PDF. DOC Inmate Handbook (2015). See page 53 of PDF. https://www.nd.gov/docr/adult/docs/INMATE_HANDBOOK.pdf
Ohio $2 co-pay. For exceptions, see pages 2-3 of PDF. A patient is considered indigent if he or she has earned or received less than $12 and his or her balance has not exceeded $12 at any time in the 30 days preceding the co-pay request. Indigent patients are not charged co-pays. DRC Policy 68-MED-15 www.drc.ohio.gov/Portals/0/Policies/DRC Policies/68-MED-15.pdf
Oklahoma $4 co-pay. For exceptions, see pages 5-6 of PDF. DOC Operating Procedure OP-140117. See page 5 of PDF. https://www.ok.gov/doc/documents/op140117.pdf
Oregon No co-pay or fee. According to the DOC Issue Brief, Or. Admin. Rule 291-124-0085 allows, but does not mandate, the DOC to collect a co-pay. The DOC currently charges co-pays only for eyeglass exam visits, elective procedures, items that become the patient's property (e.g., glasses, dentures, prosthetics), and non-essential self-care items (e.g. medicated shampoos and supplements). See Or. Admin. Rule 291-124-0085 for those charges. Or. Admin. R. 291-124 "Health Services (Inmate)".

For the reasoning behind the Department's decision not to charge co-pays for most services, see DOC Issue Brief "Inmate Copays for Healthcare" (2012).
http://arcweb.sos.state.or.us/pages/rules/oars_200/oar_291/291_124.html

https://www.prisonpolicy.org/scans/Ore-IB-120-Co-Pay%20HS%20Issue%20Brief.pdf
Pennsylvania $5 co-pay. For exceptions, see pages 6-8 of PDF. If a patient does not have sufficient funds to pay the co-pay fee, his or her account will be debited and the fee recouped from future deposits by collecting up to 50% of the account balance, unless the balance is less than $10. The Department may seek the amount owed for medical fees from a patient after he or she is released through a civil action. DOC Policy DC-ADM 820. See page 6 of PDF.

For information about the collection of co-pay debts, see DOC Policy DC-ADM 005. See page 17 of PDF.
http://www.cor.pa.gov/About%20Us/Documents/DOC%20Policies/820%20Co-Payment%20for%20Medical%20Services.pdf

http://www.cor.pa.gov/About%20Us/Documents/DOC%20Policies/005%20Collection%20of%20Inmate%20Debts.pdf
Rhode Island $3 co-pay. For exceptions, see pages 2-3 of PDF. If a patient does not have sufficient funds to pay the co-pay amount, all but $10 will be withdrawn from his or her account, and the balance owed will be charged as a debt to the account. Half of all subsequent deposits are used to pay the debt until the it is paid in full. Any remaining debt at the time of release is considered a legal debt and is subject to civil remedy by the state. If an individual returns to DOC custody before repayment of the debt, his or her account will reflect the unpaid debt from prior incarceration(s.) DOC Policy 2.28-3 DOC http://www.doc.ri.gov/documents/administration/policy/2.28-3%20DOC.pdf
South Carolina $5 co-pay ($12 for people with work release jobs). For exceptions, see pages 2-3 of PDF. Co-pays are charged to patients regardless of indigent status. DOC Policy HS-18.17. See page 3 of PDF. http://www.doc.sc.gov/pubweb/policy/HS-18-17.htm1491948031259.pdf
South Dakota $2 co-pay ($10 to see a physician for people with work release jobs). For exceptions, see page 2 of PDF. If a patient does not have sufficient funds to pay the co-pay amount, a debt will be applied to his or her account. DOC Policy 1.4.E.10 http://doc.sd.gov/documents/about/policies/Inmate%20Medical%20Co-Pay.pdf
Tennessee $3 co-pay. For exceptions, see pages 2-4 of PDF. DOC Policy 113.15 https://www.tn.gov/assets/entities/correction/attachments/113-15.pdf
Texas $100 flat yearly fee, assessed when an incarcerated person initiates a request for health care services. Once assessed, the fee covers all subsequent visits for 12 months. For exceptions, see the Annual Health Care Services Fee Pamphlet. If a patient does not have sufficient funds to cover the fee, 50% of each deposit to his or her inmate trust fund is applied toward the balance until the total amount is paid. If he or she has less than $5 in his or her account, nothing will be collected at that time, but 50% of future deposits will be applied to the debt. If multiple annual fees are assessed but remain unpaid, they are cumulative (i.e. each year a service is requested, another $100 fee is charged to the account). The Department does not bill patients for unpaid balances after release, but if an individual returns to DCJ custody, any previous debt is reapplied to his or her account. Tex. Gov't. Code Ann. § 501.063.

See also: DCJ Annual Health Care Services Fee Pamphlet.
http://www.statutes.legis.state.tx.us/Docs/GV/htm/GV.501.htm

http://tdcj.state.tx.us/divisions/cmhc/docs/TDCJ_Annual_Health_Care_Services_Fee_Pamphlet.pdf
Utah $5 co-pay. DOC web page "Inmate Health Care" https://corrections.utah.gov/index.php?option=com_content&view=article&id=1054&Itemid=182
Vermont No co-pay or fee. Vermont Prisoners' Rights Office
Virginia $5 co-pay. For exceptions, see page 4 of PDF. Co-pays are collected from the patient's spend account, but the charge will never reduce the account balance below $5. Any amount still owed is collected when the account balance next exceeds $5. DOC Operating Procedure 720.4.

For information about indigency, see DOC Operating Procedure 802.2. See page 7 of PDF.
https://vadoc.virginia.gov/about/procedures/documents/700/720-4.pdf

https://vadoc.virginia.gov/about/procedures/documents/800/802-2.pdf
Washington $4 co-pay. For exceptions, see pages 2-3 of PDF. Co-pays are collected from the patient's trust accounts, but will not draw the balance below $10. The remaining balance will be collected from subsequent deposits. DOC Policy 600.025.

For information on indigency, see Policy 200.000 Attachment 3.

For more on indigency, see Wash. Rev. Code § 72.09.015
http://www.doc.wa.gov/information/policies/default.aspx?show=600

http://www.doc.wa.gov/information/policies/default.aspx?show=200

http://app.leg.wa.gov/rcw/default.aspx?cite=72.09.015
West Virginia $5 co-pay for doctor's visit, $3 co-pay for nurse visit. W. Va. Code caps co-pays at $5 for any billable service and explains exceptions. Lakin Correctional Center Inmate Handbook (2014). See page 45 of PDF. The Handbook references a state-wide DOC Policy Directive 424.01 "Inmate Medical Co-Payments," but that policy is not available on the DOC website.

See also: W. Va. Code § 25-1-8.
https://www.law.umich.edu/special/policyclearinghouse/Documents/West%20Virginia%20LCC%20Inmate%20Handbook.pdf

http://www.legis.state.wv.us/WVCODE/ChapterEntire.cfm?chap=25&art=1§ion=8#01
Wisconsin $7.50 co-pay. For exceptions, see Wis. Admin. Code. If a patient does not have sufficient funds to pay the co-pay amount, a debt will be applied to his or her general or trust account. Wis. Admin. Code DOC § 316.04 https://docs.legis.wisconsin.gov/code/admin_code/doc/316
Wyoming No co-pay or fee. DOC staff

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