Michigan prisoners pay a $5 copay for most medical visits, a fee advocates say deters inmates from seeking adequate care
As Michigan prison population ages, inmates’ health care needs are projected to increase
Senate legislation, budget proposal aim to eliminate the co-pays, but could face hurdles in divided legislature
Michigan prisoners are avoiding preventive care because of mandatory co-pays for basic trips to the doctor, according to critics backing new bipartisan legislation to eliminate the fees, a move they say could improve health outcomes and save taxpayers money down the line.
A typical non-emergency medical appointment currently costs Michigan prisoners $5 per visit. An inmate can earn as little as 74 cents per day, depending on their work assignment and educational attainment.
Given the choice between a doctor’s visit or spending their money on other basic needs, inmate advocates say many will choose the latter, which could ultimately mean a greater expense for taxpayers who may have to foot the bill for emergency procedures down the line.
“It’s a very restrictive barrier to basic health care,” said Ken Nixon, director of community outreach and partnerships at the nonprofit advocacy group Safe & Just Michigan. “Someone may be having what starts out as a minor issue, but because they’ve avoided treatment for so long, it morphs into something larger.”
Taxpayers shoulder the bulk of health care costs for the 32,700 inmates currently housed in Michigan prisons. The current state budget included $374 million for prisoner health care costs, or 17.4% of the $2.1 billion Department of Corrections budget.
In 2024, inmates paid $202,580 in health care co-pays, required whenever an inmate initiates a medical, dental or optometric appointment. Exceptions include routine assessments, screenings, communicable disease testing or emergency services.
Michigan is one of 16 states where the co-pay for health care costs more than the average weekly wage for inmates, according to an analysis of state and federal prison systems conducted by the nonprofit advocacy group Prison Policy Initiative.
As Michigan’s existing prison population gets older, reform advocates warn that the costs of untreated chronic illnesses will only increase over time if they aren’t addressed at the front end.
Bipartisan legislation introduced in the Democratic-majority state Senate this spring would do away with the co-pays entirely in Michigan, leaving exceptions for an inmate to pay for the full costs of any self-inflicted injuries. One Republican, Sen. John Damoose of Harbor Springs, joined seven Democrats as a co-sponsor on the bill.
Separately, a budget plan for next fiscal year approved by the Democratic-led Senate includes $500,000 for the Department of Corrections to “make every effort to lower co-payment amounts paid by prisoners for medical services and other medical needs.”
Gov. Gretchen Whitmer’s budget plan did not include changes to the co-pay structure, but advocates believe the Michigan Department of Corrections will ultimately back the change.
Jenni Riehle, a spokesperson for the corrections department, said potential changes could be a factor in ongoing budget negotiations.
“MDOC looks forward to finalizing a budget with both the House and Senate that supports our staff and provides quality care to those who are incarcerated, while ensuring continued value for taxpayers,” she told Bridge.
States have traditionally used co-pays as a method to “reduce costs associated with unnecessary medical visits by deterring prisoners from over utilizing health care services,” according to a 2023 report by the Citizens Research Council of Michigan.
But state Sen. Rosemary Bayer, a West Bloomfield Democrat co-sponsoring the legislation, said removing barriers to preventive health care could help avoid emergency visits or long-term chronic care in the future, especially for prisoners who are “fundamentally, hugely disadvantaged” in their ability to pay up front.
Removing the co-pay could be the difference between the state covering costs for a quick dental appointment or a major emergency tooth extraction and followup repair work, Bayer said.
“They’re not getting the health care they need,” Bayer said. “If you don’t have health care, then you don’t get things fixed before they’re an emergency. Once it’s an emergency, it’s really, really expensive.”
The legislation hasn’t yet come up for a hearing, and a deadlock between the Senate and Republican-led House over budget negotiations could complicate any proposed reforms.
Lawmakers blew past a July 1 deadline to pass the budget, which needs to be done by Oct. 1 to avoid a state government shutdown.
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