Eliminating Financial Assessments for Health Care Services: Updated Position Statement

NCCHC is opposed to fees, copays, or any kind of disincentives – monetary or other – that limit access to health care. We encourage all correctional leadership to create an expectation of unobstructed access to health care for people who are incarcerated and advocate against mandates, policies, and cultural norms that create barriers to care and treatment.

NCCHC recently revised its position statement, formerly titled “Charging Inmates a Fee for Health Care Service,” which had been in place since 1996.  on this subject. NCCHC’s position is now unequivocal since recent studies have clearly demonstrated the harms of charging fees. Public health approaches are suggested for those systems where the position is not followed. However, the extensive changes were made as it is now clear that fees and other financial disincentives limit access to care and create an inequitable system that:

• Fosters myriad opportunities for greater risk of adverse health outcomes
• Limits access to community alternatives to incarceration for people with lower socioeconomic status, primarily Black, indigenous, and other people of color (BIPOC)
• Places additional financial burdens on health care systems serving communities to which people return after incarceration

There is unequivocal evidence that such financial assessments do harm. The American Medical Association, the American Public Health Association, and others are well-aligned with NCCHC’s updated position statement on the subject.

This position documents NCCHC’s support of unobstructed access to health care for people who are incarcerated and reminds the reader that access to health care among incarcerated people is a constitutional right under Estelle v. Gamble (1976).  

Despite the evidence of harm and call to eliminate financial assessments for health care services during incarceration, NCCHC recognizes that such practices continue. Thus, guidelines to help mitigate the harms imposed by financial assessment are strongly recommended including:

• Health professionals have no role associated with any fees.
• No charges should be assessed for specific essential services (receiving screening and assessments, chronic and acute care, infirmary or hospital care, pregnancy and postpartum care, mental health care, receiving screening and assessment, follow-up for chronic care or other staff-initiated care, acute care, infirmary care, hospitalization, pregnancy and postpartum care, mental health and substance use disorder treatment, laboratory and diagnostic services, medications, diagnosis and treatment of contagious disease, preventive health care and others).
• Administrative reviews should be conducted prior to initiating a financial assessment protocol and annually thereafter, including cost-benefit analyses, consideration of adverse outcomes when access to care is limited, and benchmarking of baseline utilization in order to assess the consequences of such protocols.
• Ongoing facility-specific utilization review should be conducted by diagnosis, disease prevalence, and other health problems to identify and quickly mitigate the consequences of hindering access to needed care.
• No one should be denied care because of a record of nonpayment or current inability to pay.
• The facility should have a grievance system that accurately tracks complaints about financial assessments.

NCCHC strongly encourages all jurisdictions to take the right next steps to eliminate financial assessments for health care services during incarceration.

Read the position statement in its entirety.

See all NCCHC position statements.

Alison O. Jordan, LCSW, MSW, CCHP, is an owner/member of ACOJA Consulting LLC, a New York City-certified M/WBE. She represents the American Public Health Association on the NCCHC Board of Representatives.