Researchers say higher healthcare copays are blocking access to care for people behind bars, as prison populations in Georgia and nationwide struggle with rising rates of physical and mental health issues. One study estimates one in 10 people with chronic conditions in state and federal prisons have not seen a clinician since their incarceration.

Wanda Bertram, communication strategist with the Prison Policy Initiative noted that while copays are often less than $7, they present a significant barrier for incarcerated individuals, many of whom have little to no income.

"If you want to be seen, you have to pay, typically anywhere from $2 to $5 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," Bertram said.

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

People in Georgia aren't guaranteed compensation for the jobs they may have while they're incarcerated, so Bertram says it's up to their families to cover any medical costs. She added that some states have dropped their copays for people behind bars. Her group thinks others should do the same.

"We have been advocating for years for states to abolish these copays. 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 continued.

Bertram added the research also reveals alarming gaps in mental healthcare access for incarcerated individuals. Over one-third of those with diagnosed chronic mental illnesses have not seen any mental health clinicians since entering prison.


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Changes in federal law will permit West Virginia and other states to use Medicaid dollars to pay for health care services for incarcerated youths beginning Jan. 1.

In addition to helping kids get physical and dental health care, the new rules should give them needed resources to address mental and behavioral health challenges stemming from childhood trauma.

Elizabeth Crouch, associate professor of health services policy and management at the University of South Carolina, said mitigating adverse childhood experiences is a growing part of efforts to keep rural children out of the juvenile justice system and detention.

"A fifth of rural children are diagnosed with developmental behavioral mental health disorders," Crouch pointed out. "Rural children are more likely to be diagnosed with developmental behavioral disorders, such as ADHD, than their urban counterparts."

About 45% of West Virginia children experience adverse childhood experiences, a rate five points higher than the national average. The Medicaid coverage for youth in detention includes physical, dental and behavioral health screenings and case management services.

States are also taking into account neurocognitive research showing teen brains do not fully develop until the mid-20s. Crouch noted arrests of young people have dropped by more than 80% since the mid-1990s, as a greater understanding of childhood trauma has increased the number of alternatives to detention. Still, she acknowledged the challenges for rural kids are formidable.

"What we have found is that rural children have been disproportionately living in homes affected by current substance use or mental illness," Crouch explained. "Rural children have experienced much higher rates of opioid use."

Despite declining arrests and detention rates, young people of color are still far more likely than white youth to be held in juvenile facilities, according to The Sentencing Project.

The New York Police Department's new commissioner must address the agency's dwindling public trust as her tenure begins.

Jessica Tisch became the agency's top official after former commissioner Edward Caban resigned amid federal investigations. Past surveys show high trust in the department but a new survey of heavily policed neighborhoods paints a different picture.

Brett Stoudt, associate director of the Public Science Project, said it found people in such neighborhoods want crime handled differently.

"A significant number of these residents do not desire more investments in policing but instead desire approaches to public safety that invest in a broad set of supports and services, and institutions," Stoudt explained. "The kind that more fundamentally address the root causes of violence."

Other findings show people are fearful of their neighborhood's expanded police presence. Along with this, some said they have experienced physical or sexual violence from police officers. Stoudt noted this kind of policing mostly affects minorities in the city. The New York Civil Liberties Union finds Black people are 20% of the city's population, but were 60% of people police stopped in 2023.

Recommendations to fix the issues include increasing transparency for the department, firing officers who abuse their position for power and stopping the spread of misinformation from the agency.

Ileana Méndez-Peñate, program director for the group Communities United for Police Reform, said other recommendations aim to reduce the department's omnipresent role in some areas.

"The other policy recommendation related to that is the real need to invest in the fundamental needs of New Yorkers," Méndez-Peñate emphasized. "I talked about housing and education but also youth programs and services and quality city infrastructure through security. These are some of the top concerns."

There could be challenges to enacting the survey's solutions. One is the charter revisions passed on Election Day, since one of them gives the department more power. She added another challenge is financing, since the millions of dollars the city spends on the police department do not address the root causes of certain issues.


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By Christopher Blackwell and Loretta Pierre for The Appeal.
Broadcast version by Danielle Smith for Mississippi News Connection reporting for The Appeal-Public News Service Collaboration

About a year ago, a close friend, Garrett Felber, told me about a project close to his heart—the campaign to Free the Mississippi Five (MS5). 

The MS5 are the last remaining women in Mississippi sentenced to life with the possibility of parole after ten years before the state virtually abolished parole in 1995. Although they are, ostensibly, parole-eligible, the state has routinely denied their release without reasonable justification. They each have been imprisoned for more than 30 years.

The five have each taken responsibility for the harm they caused and spent decades pursuing growth and repair. Felber sent me interviews he conducted with each person about their lives and the repeated, arbitrary denials by the Mississippi Parole Board. One of the group, Loretta Pierre, has been denied parole 14 times, more than any other woman in the state’s history. 

The more I learned, the more I wanted to help. So I am sharing the words of Loretta Pierre, who tells us her story and introduces us to the other four women with whom she has spent nearly four decades in prison. —Chris Blackwell 

My name is Loretta Pierre. In 1985, when I was 20 years old and five months pregnant, I shot a woman during an argument. I immediately called 911 for help. But tragically, she did not survive. 

When the police arrived, I was arrested for aggravated assault and eventually charged with murder. Once my court proceedings began, I had five mistrials before I was convicted at my sixth trial. In 1989, I was sentenced to life with the possibility of parole after ten years. 

I have now been in prison for 36 years and denied parole 14 times. I hold the record in the state of Mississippi for the number of times a woman has been denied. 

Before my conviction, I had never spent a single day in jail. The son I was pregnant with then is now 38 years old, and he has three daughters of his own. I have never met them. My Mama, my strongest supporter, died in September 2017, brokenhearted that I was never released in her lifetime. My sister, who was 10 years old when I was arrested, is now 49. And my brother, who was 24, is now 63. My siblings still support me, but with each parole denial, our hope of reuniting becomes more elusive. Nevertheless, we communicate daily and refuse to let this unreasonable punishment break us. 

I have completed more than 50 classes, courses, and programs in prison. Yet, when I last met with the parole board in January 2022, my file was completely empty and looked as if I had wasted decades doing nothing. There was no record of the job I held for more than 23 years; none of the letters of support that professors, friends, and family had sent in; or the document promising me a job when I came home. What was available for the board was my disciplinary record—the rule violations levied against me for filing grievances against the Mississippi Department of Corrections (MDOC) during my captivity. 

It has been a never-ending cycle that I’ve had to endure, day after day, year after year. I was not sentenced to life without parole or death by incarceration. Nor were the four other women from MS5 I want to introduce you to.

Evelyn Smith, 82, aka Mama E, has been incarcerated for 32 years for murder. She is an amazing cook, always makes extra for her friends, and has a remedy for anyone who is sick. Mama E’s last parole hearing in January 2022 lasted three minutes. They told her to come back in five years. I delivered the board’s decision to her in the privacy of her room. We shared our pain together, aware that she may not have another five years left to live but her faith in God is strong and she still holds hope she will one day be released.

Lisa Crevitt, 59, was just 20 years old when she succumbed to drug-induced psychotic delusions and dropped her child from a bridge. She has held the same job during her nearly 40 years in prison and has never received a single rule violation report. Lisa’s ex-husband and the deceased child’s father is now a judge in Warren County, Mississippi. Many believe that his political influence has kept Lisa imprisoned. Her first parole date was in 1995. The board has denied her nine times. 

Anita Krecic, 65, has been incarcerated since 1987, after her then-boyfriend shot and killed a Mississippi Highway Patrolman. Anita’s co-defendant, who shot the trooper, was executed in 2002. While incarcerated, she has consistently worked a job, earned over 100 college credits, and maintained an exemplary behavior record. She displays strong values, morals, and ethics in her daily life and is currently enrolled in seminary school. But in the lead-up to each of her parole hearings, signs opposing her release are typically posted throughout the county where she was convicted. In 2022, she was denied by the board and told to return in 2030. 

Linda Ross, 62, has been incarcerated since 1989 for killing a man who attacked her. She has maintained a job throughout her incarceration and is currently pursuing a bachelor’s degree. She is very generous and loves to cook for friends. Linda loves to share stories with those incarcerated with her. 

Each time we are denied parole, the board cites the “serious nature” of our crimes. None of us can change what we did—only who we have become since. I have completed every program MDOC has made available to me. That this doesn’t seem to matter makes me think that those with authority see no value in the department’s rehabilitation courses. These programs feel like a sham, nothing more than a way for crooked authorities to generate funding while putting on a show for the public. 

Change will not happen unless the public pressures those who oppress us without oversight. Without transparency and accountability, we five—and many like us across the country—will be forced to die behind these towering walls—not to provide safety for our communities, but for retribution and punishment. 

For this to change, we need your help! Our website includes our clemency petitions, ways to support us, and addresses to contact us—please share on social media so others can learn about our plight. Relationships and correspondence can be life-saving forms of support. For too long the parole board in Mississippi has been able to act as judge, jury, and executioner. We must build our collective strength to combat this repressive system. It is far past time for us to get a chance to return to our communities. 


Christopher Blackwell and Loretta Pierre wrote this article for The Appeal.


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