New research showed medical copays are preventing incarcerated people from receiving medical care.

West Virginia's $5 copay is much higher compared with those of many other states.

Wanda Bertram, communications strategist for the Prison Policy Initiative, said families do not always have the funds to cover repeated doctors visits. She contended copays are strategies states use to keep the number of sick calls down.

"That's not because people are making frivolous requests," Bertram asserted. "It's because prisons often don't have the resources and simply don't want to deal with what it would take to actually give incarcerated people the care they need."

Nearly one in five nationwide have not seen a doctor since entering state prison, according to the Prison Policy Initiative. Federal data show people who are incarcerated are more likely to have high blood pressure, asthma, cancer, arthritis and infectious diseases such as hepatitis C and HIV.

Bertram added pregnant people are no exception to the copay rule. She cited research done in 2016 showing the lack of access to prenatal care, noting while the study did not specifically look at the copay issue, it presents a serious obstacle.

"A shocking number of people were not receiving this really important care," Bertram reported. "Almost 10% hadn't received an obstetric examination. About a quarter hadn't seen any outside specialists."

According to research from Johns Hopkins University, fewer than 10 states have passed laws mandating prisons provide access to prenatal or postpartum health care for incarcerated people.


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In Indiana, the transition from prison back to society can be anything but smooth.

Many people released don't have a place to live and have difficulty with finding steady employment.

Indianapolis-based Give M3 Life began operating two male-only transitional housing facilities in 2022 to help keep people out of prison.

Executive Director Unique Webster explained that the facilities are calm and safe spaces that help people who are dealing with costly and stressful post-release mandates.

"All of these fees that you put on me - I have to pay for this GPS monitoring on a monthly basis. I have to go to these classes that I have to pay for. I have to come to court. I have to take these drug tests," said Webster. "I have to pay for those fees. And then I got legal fees, and I got child support fees. I have no job, so I can't pay these fees, and I'm stressed again."

Businesses are often reluctant to hire someone with a criminal record.

However, Webster said the majority of the men they work with have college degrees, marketable skills, and vocational training from before or during their incarceration.

She added that when they get out, they want to use those skills, but they're often not given the opportunity.

According to the Prison Policy Initiative, only 26% of people currently in prison have sought professional help to address mental health issues.

Webster said her organization's holistic approach to therapy helps people avoid distractions and find ways to decompress.

She said the stigma surrounding those who have been in prison can prevent them from getting the care and support they need.

"Many leaving the prison often have untreated or under treated physical and mental health issues," said Webster, "but face barriers assessing consistent care upon release."

The nature of someone's criminal offense can be a factor in substance abuse disorders and mental illness.

The Prison Policy Initiative identifies post-traumatic stress, manic depression, and bipolar disorder as the most common mental health diagnoses among the incarcerated.




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There are more than a dozen state and federal prisons in Central Appalachia, with some located in remote areas of West Virginia.

Connie Banta, board member of the Appalachian Prison Book Project, said the rural facilities face challenges in providing educational opportunities to incarcerated people. Her organization has donated more than 75,000 books to prison libraries in the region over the past two decades.

"Reading is one of the ways that people keep themselves healthy, both physically and mentally," Banta explained. "We feel like it's a basic human right that people have access to information and literature."

According to a report from the group PEN America, prison libraries are less funded than public school and community libraries and lack the resources needed to purchase books. Those available tend to be mostly westerns and romance novels.

The number of people held behind bars in West Virginia has jumped by more than 400% since 1970, according to the Vera Institute of Justice.

Banta emphasized reading can help people move forward in their own personal journey as they reenter society.

"We get many letters from people talking about how much it means to them that people who could be doing all kinds of other things take the time to mail them books," Banta reported.

"This Book Is Free and Yours to Keep: Notes from the Appalachian Prison Book Project" was recently selected by the Appalachian Studies Association for the 2024 Weatherford Award in Nonfiction.


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A Minnesota proposal is in the works that supporters say would end forced labor in correctional facilities.

They note the 13th Amendment was adopted nearly 160 years ago, but believe a form of slavery is still present in America's prisons. Advocacy groups point to wording in the Minnesota Constitution that there should be no slavery in the state, with exceptions for punishment for a crime. They say incarcerated people are exploited by having to work for 50 cents an hour, providing them little money to pay victims back, support their families or have resources to rebuild their lives post-release.

Aaron Ernst, who served time in Minnesota, said this overshadows other reforms.

"The rehabilitation part is kind of there," he said, "and then the reconnection to the community is just nonexistent."

While incarcerated, Ernst said he was outsourced for municipal work but would have had a hard time landing that same job after his release. The End Slavery in Minnesota Coalition is working with lawmakers on a bill for next year's session to classify these individuals as legal workers with specific rights. There are similar efforts elsewhere, but advocates say Colorado's reforms haven't ended the practice there.

By not providing a minimum wage, said David Boehnke, the coalition's lead organizer, they estimate the current pay structure in prisons steals $100 million each year from the poorest Minnesotans.

"If we want a safety system and not a slavery system, this is how we get it - we give people basic rights and basic wages," he said. "That lifts up their whole communities, and that allows people to repair harm they've caused in a meaningful way."

Groups pushing for change add that the longstanding effects of slavery are still found in incarceration numbers. Nearly 40% of people held in Minnesota prisons are Black - despite representing less than 8% of the state's overall population.

In a statement, the Department of Corrections said it's committed to providing work experiences for incarcerated individuals that improve fundamental skills and can lead into opportunities for more technical training. It said that can help create a successful re-entry.


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