Researchers have found that higher copays for health care obstruct access to receiving care behind bars, even as prison populations in Mississippi and nationwide face increasing rates of physical and mental health conditions.

One in 10 people with at least one chronic condition in state and federal prisons had not been seen by a clinician since they were incarcerated.

Wanda Bertram, communication strategist for the Prison Policy Initiative, said the copays are often less than $7 but they represent massive barriers to health care.

"If you want to be seen, you have to pay, typically anywhere from $2 to $5, or in the case of Mississippi prisons, $6,," Bertram outlined. "and if you can't pay that, either you can't see the doctor or that becomes a debt that you have to the prison."

The research found medical copays in prisons significantly impede health care access for more than 500,000 people with chronic conditions, from heart or kidney disease, to asthma and hepatitis C.

People in Mississippi prisons are not compensated for the jobs they may have while they are incarcerated, so Bertram pointed out it is up to their families to cover any medical costs. She added some states have dropped their copays for people behind bars. Her group thinks Mississippi should do the same.

"We have been advocating for years for states to abolish these copays," Bertram explained. "And some states are doing this, Nevada, I believe, abolished prison copays, either this year or last year. California has also abolished copays. To force people to pay to see a doctor, you know, causes people to not see doctors when they actually need help."

Bertram added the research revealed alarming gaps in mental health care access for incarcerated individuals. More than one-third of those with diagnosed chronic mental illnesses have not seen any mental health clinicians since entering prison.


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A bill pending in the West Virginia Legislature would increase the length of penalties for "serious" felony convictions, but critics have said it would contribute to prison overpopulation.

The state Senate passed Senate Bill 136 by an overwhelming margin last week. The House of Delegates has yet to consider the measure.

Kenneth Matthews, West Virginia economic justice associate for the American Friends Service Committee, said extending the minimum time prisoners must serve before a parole hearing would pack the prisons with more people waiting for a conditional release.

"Increasing penalties for offenses will create an increase in the prison population that's already overpopulated and create an increase in the aging (prison) population in the state, which is also overpopulated," Matthews outlined.

West Virginia's overall jail population in 2024 was about 11,000, with an incarceration rate of 674 per 100,000 residents, considerably higher than the national average of 614.

According to the Prison Policy Initiative, the state's 10 regional jails were initially built to hold 2,883 people -- but they house more than 4,400 people on any given day. The bill's Republican backers, who have a legislative supermajority, said state law is not stern enough on serious offenders.

Matthews countered the numbers do not back up their position.

"West Virginia is already kind of tough on crime," Matthews pointed out. "We're not the lowest in terms of sentencing and penalties in the country or even in our area, and we're not like an outlier in terms of lower penalties for certain offenses."

He added proposed sentences of 40-60 years for murder before people are eligible for parole would significantly expand the number of older, less-dangerous members of the prison population.

"They have a geriatric wing there and they have actually instituted a job, called the orderly, where their whole job is to push individuals around on wheelchairs and take care of their needs throughout the facility," Matthews emphasized.


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Programs allowing incarcerated people to receive reductions in their sentences help lower chances of reoffending, according to a recent analysis.

North Carolina has earned time policies, enabling people to reduce their sentences by up to 30%.

Sarah Anderson, associate director of criminal justice and civil liberties at the conservative public policy think tank R Street Institute, said needs-based assessments when someone enters incarceration typically determine the programs to help a person improve themselves and succeed outside of incarceration.

"Whether it's a literacy program, other education programs, certain job programs," Anderson outlined. "Then for individuals with behavioral health or substance use issues, there's a lot of treatment opportunities."

People who complete evidence-based recidivism-reduction programs can see their time in prison decreased. At least 38 states have either earned time or good time programs, or both. Good time programs reduce sentences by incentivizing good behavior.

Anderson pointed out "truth-in-sentencing" laws became popular during the War on Drugs and required people to serve a certain percentage, usually 85%, of their sentence before becoming eligible for reductions. The approach waned in the 1990s but Anderson noted truth-in-sentencing laws saw a resurgence after the pandemic because of increases in crime, despite evidence such laws do not improve outcomes.

"These types of incentive programs actually work far better to prevent crime in the future than does just requiring somebody serve 85% of a sentence without any type of an incentive to even participate in a productive program while they're incarcerated," Anderson reported.

Anderson emphasized truth-in-sentencing laws also went away because the cost to imprison someone can strain state budgets. The cost to incarcerate someone in North Carolina last year, for instance, was on average more than $50,000 annually. Anderson argued the cost means we should ensure people do not go back to prison.

"It's sort of incumbent on us to make sure that if we're incarcerating people and they are in state custody that we're doing everything we can to make sure that the time that they're spending in there is the only time that they're going to be spending in there," Anderson contended.


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Medical neglect inside Ohio's jails is under scrutiny following the release of a new toolkit by The Marshall Project to aid in investigating in-custody deaths.

An investigation into the Cuyahoga County Jail uncovered serious lapses in emergency response. Families of those affected are demanding answers and accountability.

Tanya Anderson waited eight months to see surveillance footage of her nephew's death while he was incarcerated.

"What kind of people are they?" Anderson asked. "They're not doing anything but just walking around my nephew, Glenn Williams Jr.'s body, and not even trying to help him or revive him."

The state found the jail out of compliance with medical training requirements in this case, but no disciplinary action was taken against staff despite nine minutes passing before CPR was attempted.

Beyond Williams' case, concerns over medical neglect extend to other incidents.

Eric Jaeger, a paramedic, EMS educator and expert in emergency response argued the deaths and near-fatal incidents could have been prevented with proper training.

"You need to cycle back and reevaluate whether the folks who are responding to these emergencies ever received appropriate medical training," Jaeger emphasized.

Adam Chaloupka, attorney and union representative for the Ohio Patrolmen's Benevolent Association, which includes the county's corrections officers, said they have made attempts to master the training but it is unclear why.

"There is no discussion of jail policies on what you're supposed to do with this training," Chaloupka contended. "There's no discussion of how you're supposed to use it. They're just supposed to notify that people that there is potentially a medical emergency."

Cuyahoga County Jail officials maintain they are addressing compliance issues but critics argued without enforceable policies and accountability, inmates remain at risk. Families continue to push for reforms to prevent further tragedies.

This story is based on original reporting by Mark Puente and Brittany Hailer for The Marshall Project and Scott Noll for News 5 Cleveland. This story was produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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