SACRAMENTO — California Governor Gavin Newsom today signed historic legislation to permanently bar county jails and state prisons from charging incarcerated Californians copays and other fees for medical and dental services. AB 45, state legislation introduced by Assemblymember Mark Stone (D-Monterey Bay), goes into effect January 1, 2020, making California the first state in the country to abolish the practice of charging copays in county jails. Nine other states have either eliminated or not instituted prison copays.
"Copays in custody are an obstacle to healthcare and create public health nightmares. We have been organizing across prison walls to improve access to healthcare and end copays for years. I am proud to be part of this historic effort and know our incarcerated members will be greatly relieved to have less barriers to healthcare," said Romarilyn Ralston, Policy Director with the California Coalition for Women Prisoners.
California, like most states, has charged incarcerated people a copay — five dollars in prison and three dollars in most jails — to access medical, mental, or dental care, in addition to fees for medical equipment such as glasses and dentures. Due to labor exploitation, people in prison earn pennies per hour, and a five-dollar copay for them is the equivalent of a more than six hundred-dollar copay for someone making minimum wage. Meanwhile, people in jail earn nothing for their labor. When factoring in costs for over-the-counter medicine, basic toiletries, and materials like phone cards, stamps, and paper for maintaining contact with loved ones, copays pose a serious barrier to healthcare access and deter many incarcerated Californians from seeking care until it is an emergency.
"What we saw with these copays was a two-tiered system — those incarcerated with family able to send money could see a doctor, while those with less means were effectively barred from accessing healthcare," said Derick Morgan, Policy Associate with the Ella Baker Center for Human Rights. "We thank Governor Newsom for signing AB 45 into law. For the thousands of families waiting for a loved one to come home after serving their sentence, this is a relief."
Lack of access to timely and adequate care puts incarcerated people at increased risk for worsening illnesses. Living in close quarters and crowded environments also puts incarcerated people at heightened risk of contagion. This jeopardizes incarcerated people as well as staff, volunteers, and family and friends who visit the facilities. In 2003, for example, the Centers for Disease Control and Prevention identified copays as one of the factors contributing to a MRSA outbreak among incarcerated people in California.
Citing public health concerns, the California Department of Corrections and Rehabilitation (CDCR) voluntarily decided to eliminate copays in state prisons earlier this year. AB 45 will make the CDCR’s decision state law.
"The governor’s decision to permanently remove copays from California jails and prisons brings us one step closer to fair and just access to healthcare for everyone, including those who are incarcerated," said Eric Henderson, Policy Director with Initiate Justice. "While a copay seems small, it is a significant barrier to accessing care. I applaud the CDCR for removing the copay from prisons and the governor for making this permanent and extending it to jails."
Lack of access to healthcare during incarceration also has racially and economically disparate impacts because Black Californians and low-income people are overrepresented in jails and prisons. In eliminating copays, AB 45 removes a barrier to care that has exacerbated existing health disparities.
AB 45 was sponsored by the Union of American Physicians and Dentists, Initiate Justice, Ella Baker Center for Human Rights, California Coalition for Women Prisoners, and the ACLU of California.