Most states say they charge the fees to discourage prisoners from abusing the medical system and overtaxing their staffs; about three-quarters of states in the U.S. charge some co-payment for medical services.
Connecticut’s DOC waived its $3 medical copays in March 2020, as the virus spread throughout the state.
“We didn’t want the lack of funds to be a reason offenders were denied medical treatment, especially during the pandemic,” said Andrius Banevicius, of the state’s DOC. “We wanted as many offenders as possible to have access to medical care.”
Since prisoners in most states earn from $0.14 to $0.63 cents per hour, a few dollars in copay charges can amount to the equivalent of hundreds of dollars for free citizens, and a single visit can cost several days wages or more.
Other states have taken a different approach. In Arkansas, the state waived copays for a month and then reinstated them, saying they were buried with non-pandemic-related medical requests. Prisoners who show COVID symptoms are now exempt from the fees, and indigent patients can get treatment regardless of their ability to pay.
Arkansas prisoners have sued over prison conditions including medical copays, arguing that financial barriers to medical care risk prisoner lives. After the state’s copay policy was put into effect, one prisoner says it noticeably affected medical care.
Kaleem Nazeem spent over 20 years behind bars in Arkansas. He says after the policy change, prisoners were required to endure multiple medical visits before being designated as ill enough to see a doctor, and they were charged co-pays each time.
“When guys have ailments that aren’t life-threatening from a self-diagnostic perspective, they don’t want to go to the infirmary, because they don’t want a lien on their account or to waste $3 to be told they need ibuprofen,” Nazeem said.
Connecticut and 10 other states have waived medical co-pays due to the pandemic, but many others have suspended the fees only for those with COVID symptoms. Some DOCs made the changes on their own, while others were forced by the courts to remove the medical fees.
Nevada charges prisoners $8 per sick call, to defray the costs of prisoner medical care, according to a spokesman. Scott Kelley said that prison officials won’t charge prisoners “when there is clear evidence the medical service is directly COVID-19 related.”
Waiving co-pays only for symptomatic patients is also problematic, given CDC estimates that 40 percent or more of those infected with the virus are asymptomatic. Some prisons, like Marion Correctional Institution in Ohio, reported that as many as 95 percent of prisoners infected showed no symptoms.
A recent study by medical experts found that medical co-pays can become a barrier to proper treatment and can aggravate disease outbreaks. A June 2020 study in the American Journal of Preventive Medicine, “COVID-19 and the Correctional Environment: The American Prison as a Focal Point for Public Health,” found that high fees can “prevent the timely identification, isolation, treatment, and referral” of COVID-19 cases. The study recommended eliminating medical fees during the pandemic.
The National Institute of Health recommendations for prisons also advocates that states “[e]liminate medical copays for prisoners,” and to “[u]rge symptom reporting from prisoners and staff.” The NIH report reminds corrections officials that the well-being of prisoners “is inexorably linked to the health of the country as a whole.”
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