The government running the facility pays for medical care during incarceration. If you’re in a state prison, the state covers it. In a federal prison, the federal Bureau of Prisons pays. In a county jail, the county or city is responsible. This obligation comes from the U.S. Constitution: the Supreme Court ruled in 1976 that the government must provide medical care to people it punishes by incarceration, and that “deliberate indifference to serious medical needs” violates the Eighth Amendment’s ban on cruel and unusual punishment. In practical terms, this means incarcerated people are one of the only populations in the country with a constitutional right to health care.
How Facilities Pay for Care
Most state prison systems fund health care through their general operating budgets, which come from state tax revenue. Spending varies enormously. In fiscal year 2015, Louisiana spent $2,173 per incarcerated person on health care while California spent $19,796, nearly ten times as much. These differences reflect varying wage costs, staffing levels, and how much care states actually deliver.
Many facilities contract with private companies rather than employing medical staff directly. A handful of corporations dominate this market: Wellpath Holdings, Corizon Health, NaphCare, PrimeCare Medical, and Armor Correctional Health Services. Wellpath and Corizon, the two largest, are owned by private equity firms. These companies typically operate under fixed-price contracts, meaning they receive a set amount per incarcerated person regardless of how much care that person needs. The financial incentive, critics note, runs in the wrong direction: the less care the company provides, the more profit it keeps.
When someone needs care beyond what the prison can offer, such as surgery, cancer treatment, or emergency hospitalization, the facility arranges transport to an outside hospital. The correctional system is still responsible for the bill. States negotiate reimbursement rates with hospitals, often pegged to Medicare rates or a percentage above them, though the specifics vary widely.
The Medicaid Inmate Exclusion
Federal law generally prohibits Medicaid from paying for health care provided to incarcerated people. This is known as the “inmate exclusion policy,” and it has been in place since Medicaid was created in 1965. Even if someone was enrolled in Medicaid before being locked up, coverage is suspended (not terminated) for the duration of their incarceration.
There is one longstanding exception. Medicaid can cover inpatient hospital stays lasting 24 hours or more, as long as the care is delivered at a community hospital open to the general public, not a facility restricted to incarcerated patients. The hospital must be a certified Medicaid provider, and the services must be covered under the state’s Medicaid plan. Some states actively use this exception to shift costly hospitalizations from their corrections budget to Medicaid. Others don’t bother with the administrative process.
This exclusion creates a significant cost burden for state and local governments. It also means that routine care like chronic disease management, mental health treatment, and prescriptions must come entirely from corrections budgets.
New Medicaid Waivers for Reentry
A major policy shift is underway. The federal government has approved special Medicaid waivers (called Section 1115 demonstrations) that allow states to use Medicaid funds for services provided to incarcerated people shortly before their release. The goal is to improve continuity of care during the transition back to the community, a period when overdose deaths and emergency visits spike.
As of now, 18 states have approved waivers: Arizona, California, Colorado, Hawaii, Illinois, Kentucky, Maryland, Massachusetts, Montana, New Hampshire, New Mexico, North Carolina, Oregon, Pennsylvania, Utah, Vermont, Washington, and West Virginia. These waivers don’t cover care throughout a person’s entire sentence. They’re limited to a pre-release window and typically focus on behavioral health, substance use treatment, and care coordination. Virginia, among other states, has also begun coordinating Medicaid enrollment for eligible inmates so that coverage can activate immediately upon release.
What Incarcerated People Pay Out of Pocket
Even though the government is constitutionally required to provide care, 40 states charge incarcerated people a copay to see a doctor. The typical fee is $5 per visit. That might sound trivial, but prison wages range from a few cents to about a dollar per hour in most states. Researchers have noted that a $5 copay for someone earning prison wages is the functional equivalent of $200 to $500 for someone on the outside. Four medical visits would cost $20 total, a meaningful sum when your monthly income might be $15.
These copays don’t come close to covering actual care costs. They exist primarily to discourage what corrections officials call “frivolous” sick calls. Most states exempt emergency care, chronic disease management, and mental health treatment from copay requirements. But the fees can deter people from seeking care for symptoms that turn out to be serious, and several states have eliminated copays in recent years for that reason.
Federal Benefits During Incarceration
Veterans who are incarcerated generally cannot access VA health care while behind bars, because the correctional facility is responsible for providing medical treatment. The VA does operate a Veteran Justice Outreach initiative focused on connecting justice-involved veterans with mental health and substance use services, but this is primarily designed to facilitate access upon release or as an alternative to incarceration. VA pension payments are terminated on the 61st day of imprisonment following a felony or misdemeanor conviction.
Social Security disability and retirement benefits are similarly suspended during incarceration. Medicare coverage can technically remain active, but since the correctional facility is responsible for care, Medicare generally does not pay for services delivered to someone who is incarcerated. The practical effect is that no federal benefit program routinely covers day-to-day medical care behind bars.
Federal Grants for Specific Conditions
Some targeted federal programs can supplement correctional health care in limited circumstances. The Ryan White HIV/AIDS Program, administered by HRSA, allows its funding to be used for HIV-related medical services and support for incarcerated people, but only on a transitional basis in federal and state prisons, and on a short-term or transitional basis in local jails and for people under community supervision like parole. Critically, Ryan White funds cannot duplicate services that the correctional system already provides or is expected to provide. The program functions as a payer of last resort, filling gaps rather than replacing the facility’s obligation.
The State Criminal Alien Assistance Program, run by the U.S. Department of Justice, reimburses states for some costs of incarcerating undocumented immigrants, including medical expenses. Virginia, for example, receives about $2.3 million annually from this program. These grants offset a fraction of total costs but don’t change the fundamental responsibility: the facility footing the bill.