To collect or not to collect… Copays in Jail
Jonas, a detainee with diabetes, has limited funds on his jail account. He needs to pay a copay to see the jail doctor, but he won’t have enough money left on his books for commissary purchases afterwards. Instead of putting in a sick call request, Jonas decides to use his funds to purchase snacks. Eventually, his blood sugar becomes unbalanced, and Jonas is sent to the ER for a diabetic crisis—and the jail is on the hook for the emergency room bill.
Most states allow jails to collect a copay for health care services.¹ Copays can encourage appropriate use of medical services in the jail and sometimes help offset costs, but they cannot be a barrier to accessing care.
No copay equals more staffing
Copays are used in mainstream healthcare, as well as in jails, to prevent the over-use of health services.² Generally, copays are adjusted based on the resources needed for different services. In 2026, the average copay cost in the community is estimated at $26, while jail copays average $2 to $8.²,³ Some states prohibit copays in jails.
Jails that reduce or remove copays can see an uptick in sick call requests, including requests that are non-medical in nature.⁴ That volume shift calls for increased staffing to manage demand. Officers play a role by making sure detainees have daily access to request care and by routing concerns to health staff. Funding nursing triage positions and adjusting staffing levels can help jails meet the increased demand for timely access to care. No copay equals more staffing.
Copays cannot be a barrier to care
Patients must be seen by heath care staff regardless of their ability to pay.⁵ Copays cannot dictate whether a patient is seen by health staff. The National Commission on Correctional Health Care (NCCHC) has taken a position against excessive copays, stating that fees should not deter patients from seeking care for their health needs. Advocacy groups have also scrutinized systems where copays function as a financial barrier to care.
NCCHC standards call for copay exemptions to mental health, substance use, and sexual abuse care to ensure access to care. Some states offer copay waivers and grant funding to help detainees and jails cover the costs of health services. No matter the balance in a commissary account, each patient needs to have the ability access care. Copays cannot be a barrier to care.
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Lupez, E., Woolhandler, S. Himmelstein, D. (2024). Health, access to care, and financial barriers to care among people incarcerated in us prisons. JAMA Internal Medicine, 184(10), 1176–1184. http:// doi.org/10.1001/jamainternmed.2024.3567
Wagner, M. (2025). Steepest rise in employer health insurance costs projected for 2026. National Insurance Services. https://blog.nisbenefits.com/employer-health-insurance-costs-projected-2026
Ankney, D. (2025). Fines and fees destroy the impoverished and perpetuate mass incarceration. Prison Legal News. https://www.prisonlegalnews.org/news/2025/jan/15/fines-and-fees-destroy-impoverished-and-perpetuate-mass-incarceration
Schilling, B. (2011). Hitting the copay sweet spot. The Commonwealth Fund. https://www.commonwealthfund.org/publications/newsletter-article/hitting-copay-sweet-spot
Estelle v. Gamble, 429 U.S. 97 (1976).
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. When in doubt, send them out!®
