Inmate Copayment Program

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

Program Statement 6032.01 at a glance

Field	Value
Program Statement	6032.01, Inmate Copayment Program
Subject	The $2.00 fee the Bureau of Prisons charges for inmate-requested health care visits, the services exempt from it, and what happens when someone has no money
Effective / current edition date	May 7, 2026 (PDF header: “Number 6032.01 / Date May 7, 2026”), approved by Director William K. Marshall III; office of primary responsibility DPI HSD
Change notice	None
Supersedes / rescinds	“Program Statement Rescinded: 6031.02 Inmate Copayment Program (8/15/2005).” Note the renumbering — the copayment policy moved from the 6031 series to its own number, 6032.01
Governing statute	Federal Prisoner Health Care Copayment Act of 2000, codified at 18 U.S.C. § 4048, “Fees for health care services for prisoners.” (The PS’s REFERENCES block also lists 18 U.S.C. § 4001; see the LAW-WATCH note)
Governing regulation (28 C.F.R.)	28 C.F.R. part 549, subpart F, “Fees for Health Care Services,” §§ 549.70–549.74 — five sections, current version effective December 29, 2016. Appeals run through 28 C.F.R. part 542
Related BP forms	None. The Program Statement names no BP form; charges are entered by the provider in the electronic health record
Official PDF	PS 6032.01, Inmate Copayment Program (May 7, 2026)

Checked against the BOP policy set · 2026-09-06.

The Bureau of Prisons charges $2.00 for each health care visit an incarcerated person requests, taken from their trust fund account, with eight enumerated categories of care exempt from the fee. The rule that matters most is the one the policy states twice: “Inmates will not be denied access to necessary health care because of an inmate’s inability to pay the copay fee.”

This page covers the fee and only the fee. If your question is about how care is actually delivered — sick call, intake screening, chronic care clinics, refusing treatment — that is Patient Care (PS 6031.06). If it is about which prison someone is designated to for their medical needs, that is medical designations and care levels (PS 6270.02). For the practical side of a live medical dispute, start at medical care in federal prison.

The rule itself: the $2.00 fee and the eight exempt services

PS 6032.01 is written in the Bureau’s two-typeface format — its own header line says “Federal Regulations from 28 CFR: this type. Implementing instructions: this type.” Regulation text is reproduced from 28 C.F.R. part 549 subpart F; everything else is the Bureau’s internal instruction to staff. That distinction is not cosmetic. The regulation binds the Bureau; the implementing instructions are policy. Both are reproduced below, labeled.

The fee — 28 C.F.R. § 549.70(b), verbatim

“(b) Generally, if you are an inmate as described in § 549.71, you must pay a fee for health care services of $2.00 per health care visit if you:

(1) Receive health care services in connection with a health care visit that you requested, (except for services described in § 549.72); or

(2) Are found responsible through the Disciplinary Hearing Process to have injured an inmate who, as a result of the injury, requires a health care visit.”

Source: PS 6032.01 at p. 2, reproducing 28 C.F.R. § 549.70(b).

So there are exactly two triggers: a visit you asked for, or a visit someone else needed because a disciplinary hearing officer found you responsible for injuring them.

The eight exempt services — 28 C.F.R. § 549.72, verbatim

“We will not charge a fee for:

(a) Health care services based on staff referrals; (b) Staff-approved follow-up treatment for a chronic condition; (c) Preventive health care services; (d) Emergency services; (e) Prenatal care; (f) Diagnosis or treatment of chronic infectious diseases; (g) Mental health care; or (h) Substance abuse treatment.”

Source: PS 6032.01 at p. 3, reproducing 28 C.F.R. § 549.72.

The Program Statement then gives the Bureau’s own examples of what falls inside categories (a), (b) and (c). Verbatim, these “include, but are not limited to”:

• blood pressure monitoring
• glucose monitoring
• insulin injections
• Chronic Care Clinics
• testing for tuberculosis
• vaccinations
• wound care
• patient education

Source: PS 6032.01 at p. 3.

The Bureau’s implementing instructions on when a fee applies

Three sentences in § 2 of the Program Statement are BOP instruction rather than regulation, and each one answers a question people actually ask:

Instruction, verbatim	What it means in practice
“The inmate presents with an acute exacerbation of a chronic condition, provided there is prior documentation indicating resolution of the acute episode between visits.”	A flare-up of a chronic condition can be charged as a new requested visit — but only where the record shows the previous acute episode had resolved. It is not a way to charge repeatedly for the same unresolved episode
“If an inmate is evaluated by more than one provider during a health care visit, the inmate will only be charged for one visit.”	Being seen by a nurse and then a physician assistant in the same encounter is one $2.00 charge, not two
“Inmates will not be charged a copay fee for a medical evaluation requested by non-clinical staff if the condition is not an emergency (e.g., injury assessment before placement in the Special Housing Unit (SHU), evaluation for hunger strike, restraint check).”	The pre-SHU injury screen, the hunger-strike evaluation and the restraint check are staff-driven, not inmate-requested, and carry no fee

Source: PS 6032.01 at p. 2.

Who the fee applies to — § 549.71 and the Bureau’s overlay

The regulation itself is broad: the subpart “applies to: (a) Any individual incarcerated in an institution under the Bureau’s jurisdiction; or (b) Any other individual, as designated by the Director, who has been charged with or convicted of an offense against the United States” (28 C.F.R. § 549.71). That reaches pretrial detainees and holdovers in Bureau facilities, not only sentenced people.

PS 6032.01 § 3 then adds three implementing instructions about medical facilities and restrictive housing, reproduced verbatim:

• “Inmates designated to a Medical Referral Center (MRC), who are assigned medical or psychiatric out-patient status, will be charged a copay fee for inmate requested visits not directly related to their primary diagnoses.”
• “Inmates designated to the general population/work cadre of an MRC will be charged a copay fee except for services described in § 549.72 (see Section 4 of this program statement).”
• “Inmates housed in SHU will be charged copay fees for services described in § 549.72 (see Section 4 of this program statement).”

Source: PS 6032.01 at p. 2.

Read the third bullet against the second. The MRC bullet says a fee is charged except for the § 549.72 services. The SHU bullet, as printed in the Bureau’s own PDF, says a fee is charged for the § 549.72 services — that is, for staff referrals, chronic-care follow-up, preventive care, emergency services, prenatal care, chronic infectious disease treatment, mental health care and substance abuse treatment. That directly contradicts the regulation it cites. Section 549.72 states without qualification that the Bureau “will not charge a fee for” those eight categories, and 18 U.S.C. § 4048(b)(2) provides that the Director “may not assess or collect a fee under this section for preventative health care services, emergency services, prenatal care, diagnosis or treatment of chronic infectious diseases, mental health care, or substance abuse treatment.” Neither the statute nor the regulation carves out the Special Housing Unit. Where a Program Statement and a regulation conflict, the regulation controls — the Program Statement is the Bureau’s internal instruction for applying the rule, not the rule itself. We flag this at the foot of the page; it reads as a drafting error, and a charge assessed on that basis is the kind of thing the fee-appeal route in § 549.73 exists for.

No money, and no refusal of care

Two provisions do the work here. The regulation: “You will not be charged a health care service fee if you are considered indigent and unable to pay the health care service fee. The Warden may establish procedures to prevent abuse of this provision” (28 C.F.R. § 549.74, reproduced at PS 6032.01 at p. 4). Neither the regulation nor the Program Statement defines “indigent,” and neither sets a dollar threshold — that is left to local procedure.

The statute goes further, and it is the sentence to remember: 18 U.S.C. § 4048(f) provides that “[n]othing in this section may be construed to permit any refusal of treatment to a prisoner on the basis that— (1) the account of the prisoner is insolvent; or (2) the prisoner is otherwise unable to pay a fee assessed under this section.” The Program Statement says the same thing in its own words at § 1: “All inmates have access to Bureau health care services. The Bureau will charge a copayment (copay) fee for inmate requested visits to health care providers. Inmates will not be denied access to necessary health care because of an inmate’s inability to pay the copay fee.”

One more statutory provision the reader should know about, because it appears in neither the Program Statement nor the regulation: § 4048(l) requires comprehensive HIV/AIDS coverage and bars a fee for it. Verbatim: “The Bureau of Prisons shall provide comprehensive coverage for services relating to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to each Federal prisoner in the custody of the Bureau of Prisons when medically appropriate. The Bureau of Prisons may not assess or collect a fee under this section for providing such coverage.”

Where the money goes

Section 8 of the Program Statement quotes 18 U.S.C. § 4048(g): amounts collected from a prisoner subject to a restitution order under § 3663 or § 3663A “shall be paid to victims in accordance with the order of restitution.” For everyone else, “75 percent shall be deposited in the Crime Victims Fund … and 25 percent shall be available to the Attorney General for administrative expenses incurred in carrying out this section.” Section 4048(e) adds that “the consent of a prisoner shall not be required for the collection of a fee from the account of the prisoner.”

What the inmate copayment rule means for you

If you are the person inside: the fee is decided at the encounter

The charge is decided at the encounter, not by a billing office. PS 6032.01 § 7 says: “Based on the health care provider’s clinical evaluation and diagnosis of the inmate, Health Services staff will determine whether a copay fee will be charged,” and “[a]ll inmate health care visits will be entered into the electronic health record by the provider and a selection of a copay or no copay will be chosen.” That means the person who decides whether you are charged is the clinician who saw you, and the decision is a recorded field in your health record. Ask which selection was made and why.

Learn the eight exempt categories, because most of what people are charged for wrongly falls inside them. Chronic Care Clinic appointments are exempt. So are staff referrals — if a nurse tells you to come back, that return visit is a staff referral, not a visit you requested. Vaccinations, tuberculosis testing, blood pressure and glucose monitoring, insulin injections, wound care and patient education are named by the Bureau itself as examples of exempt services. Mental health care and substance abuse treatment carry no fee at all.

If you believe you were charged for an exempt service, the route is the one the regulation names: 28 C.F.R. § 549.73 — “You may seek review of issues related to health service fees through the Bureau’s Administrative Remedy Program (see 28 CFR part 542).” Start with a BP-A0148 cop-out to Health Services identifying the date, the encounter and the category you say it falls in. Keep the copy.

If you are a family member: why the pattern matters

Two dollars is not the point; the pattern is. A person who is charged for every visit — or who believes they will be — stops going to sick call, and a delayed complaint is how a manageable condition becomes a serious one. If your loved one is describing repeated $2.00 charges for chronic-care appointments, insulin, blood pressure checks or wound care, those are on the Bureau’s own list of exempt services.

You can help with the record, not the filing. The trust fund statement shows what was deducted and when. Money you send is subject to the same account, so a $2.00 charge is visible. Note the dates alongside what your loved one tells you the visit was for, and you will have the two halves of a fee dispute: what was charged, and what the encounter actually was.

Understand the limits of what a family member can do here. Under 28 C.F.R. § 542.10, “[a]n inmate may not submit a Request or Appeal on behalf of another inmate,” and the administrative remedy system runs on the incarcerated person’s own signature. There is no family-side co-pay appeal. What there is, is a paper trail you can help keep.

If you are counsel: medical copayments

The co-pay is small and the doctrine around it is thin, but it is occasionally load-bearing in a larger medical file, in three ways.

First, as evidence of access. The provider’s copay/no-copay selection in the electronic health record is a per-encounter, dated field that characterizes each visit as inmate-requested or staff-referred. In a file where the dispute is whether a person sought care and was turned away, that field is a contemporaneous record of every encounter that was billed as a request.

Second, as a hierarchy problem worth stating precisely. The fee rests on a statute that sets a floor and no ceiling — 18 U.S.C. § 4048(d): “Any fee assessed and collected under this section shall be in an amount of not less than $1.” The $2.00 figure is set by regulation, at 28 C.F.R. § 549.70(b), not by Congress. And the exemption list in § 549.72 is broader than the statutory exclusion in § 4048(b)(2), because the statute handles staff referrals and chronic-care follow-up definitionally instead: § 4048(a)(4)(B) provides that a “health care visit” “does not include a visit initiated by a prisoner— (i) pursuant to a staff referral; or (ii) to obtain staff-approved follow-up treatment for a chronic condition.” Two routes, same result.

Third, as exhaustion. Section 549.73 channels fee disputes into the Administrative Remedy Program, and the ordinary deadlines apply — a BP-9 within 20 calendar days of the event, a BP-10 within 20 days of the Warden’s signed response, and a BP-11 within 30 days of the Regional Director’s (28 C.F.R. § 542.15). Where a response does not arrive within the allotted time, § 542.18 permits the inmate to “consider the absence of a response to be a denial at that level.”

A closing point of framing: a Program Statement is agency policy, not law. The binding sources here are § 4048 and 28 C.F.R. part 549 subpart F. Where PS 6032.01 says something the regulation does not — the SHU bullet discussed above is the live example — the regulation controls.

What changed with Program Statement 6032.01

PS 6032.01 states its own changes on page 1, and both of them are worth understanding.

“Program Statement Rescinded: 6031.02 Inmate Copayment Program (8/15/2005) Changes:

• The program statement number has been changed.
• Updated language and clarification of applicable Code of Federal Regulations in regard to the Federal Prisoner Health Care Copayment Act of 2000.”

Source: PS 6032.01 at p. 1.

The renumbering is the practical headline. For nearly 21 years — from August 15, 2005 to May 7, 2026 — the co-pay policy was PS 6031.02, sitting in the same 6031 series as Patient Care. It is now PS 6032.01, with its own number. Every citation to “PS 6031.02” in a filing, a form letter, a consultant’s guide or a third-party explainer now points at a rescinded document. If you are reading anything about the BOP co-pay written before mid-2026, check the number.

The substance of the fee did not move. The $2.00 amount comes from 28 C.F.R. § 549.70(b), whose current version has been effective since December 29, 2016, and the exemption list at § 549.72 dates from the same rulemaking. The statute has not been amended in a way that changes the fee. What the 2026 reissue did was tighten the alignment between the Program Statement’s text and the regulation’s text — which is why the document is now formatted with regulation text and implementing instructions in different typefaces, and why the section headings mirror §§ 549.70 through 549.74 one for one.

Two gaps survived the tightening. The Program Statement’s REFERENCES block lists “Federal Prisoner Health Care Copayment Act of 2000, 18 U.S.C. § 4001” alongside “Fees for Health Care Services for Prisoners, 18 U.S.C § 4048.” Verified against the current U.S. Code, 18 U.S.C. § 4001 is “Limitation on detention; control of prisons” — the provision stating that “[n]o citizen shall be imprisoned or otherwise detained by the United States except pursuant to an Act of Congress” and vesting control of federal prisons in the Attorney General. It does not create the co-pay. The operative statute is § 4048. And the reference block gives the regulation range as “28 CFR § 549.70–549.74,” which is correct — subpart F contains five sections and there is no § 549.75.

The other gap is § 4048(l). The statute’s express bar on charging a fee for HIV/AIDS coverage appears nowhere in PS 6032.01 and nowhere in 28 C.F.R. § 549.72. It is arguably subsumed by the “diagnosis or treatment of chronic infectious diseases” exemption, but Congress stated it separately, and a policy that reproduces the regulation’s list without it is reproducing an incomplete picture of the statute.

Where people get stuck over chronic care charges

Charged for a chronic care appointment

This is the most common complaint and the clearest error. “Chronic Care Clinics” appears by name on the Bureau’s own list of examples of services that carry no fee, and § 549.72(b) exempts “[s]taff-approved follow-up treatment for a chronic condition.” The statute reaches the same result from the other direction: under § 4048(a)(4)(B), a visit “to obtain staff-approved follow-up treatment for a chronic condition” is not a “health care visit” at all.

The route: a BP-A0148 Inmate Request to Staff to Health Services identifying the encounter date and asking that the copay selection be corrected, then — if that fails — the Administrative Remedy Program, which § 549.73 designates as the review mechanism for “issues related to health service fees.” The BP-9 clock is 20 calendar days from the event.

“You requested it” versus “staff referred you”

Most fee disputes are really this dispute. A staff referral is exempt; a self-initiated visit is not. The trouble is that a single episode of care often contains both — you go to sick call (requested, chargeable), the nurse tells you to come back Thursday (referral, exempt), and the Thursday visit gets billed anyway. Because the copay/no-copay selection is made by the provider in the electronic health record at the encounter, the fix is to identify the specific encounter and the specific reason it was a return visit, in writing. General complaints about “being charged too much” do not give anyone a decision to make.

Indigence that nobody has defined

Section 549.74 exempts an inmate who is “considered indigent and unable to pay,” but neither the regulation nor the Program Statement says what indigent means or who determines it, and § 549.74 expressly leaves the Warden room to “establish procedures to prevent abuse of this provision.” In practice that determination is made locally, which means the first question in a dispute is what the local procedure is. That is a legitimate subject of a cop-out to the Trust Fund Supervisor or the Health Services Administrator: what is the institution’s indigence standard, was it applied, and on what date. See Trust Fund / Commissary (PS 4500.13) for how the underlying account works.

The fee is not the reason care was denied

Sometimes the co-pay is a symptom rather than the problem. If someone is not being seen at all, the fee provisions will not fix it, and the governing rules are elsewhere: sick call, triage, and the third-encounter physician referral in Patient Care (PS 6031.06). If the barrier is that the institution cannot provide the needed care, that is a designation question under PS 6270.02. And if the claim is that inadequate care caused injury, the administrative remedy process is not the vehicle — the Federal Tort Claims Act route is separate and carries its own deadlines. Getting the vehicle right the first time matters more than getting the letter written quickly.

Related BOP policy on medical copayments

Page	What it covers
Medical care in federal prison	The practical overview and what can be done about a live medical dispute
Patient Care (PS 6031.06)	Sick call, intake screening, chronic care clinics, treatment refusal
Medical designations and care levels (PS 6270.02)	Care Levels 1–4 and transfer to a medical facility
Trust Fund / Commissary (PS 4500.13)	The account the $2.00 is deducted from, and how deposits work
Inmate Financial Responsibility Program (PS 5380.08)	The other standing claim on a trust fund account
Over-the-counter medications (PS 6541.03)	Commissary medications, which are purchased rather than charged as a visit
Administrative Remedy Program (PS 1330.18)	The route § 549.73 designates for fee disputes, with the BP-9/10/11 deadlines
Inmate Request to Staff (PS 5511.08)	The BP-A0148 cop-out that starts an informal resolution
Management of Aging Offenders (PS 5241.01)	Age thresholds and accommodations, for readers whose medical issue is age-related
Federal Tort Claims Act (PS 1320.07)	The separate route for a negligence claim

Frequently Asked Questions About the Inmate Copayment Program

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026