In the U.S., individuals who qualify as being in absolute poverty also qualify for Medicaid benefits, which is underneath the U.S. Department of Health and Human Services (HHS). Each of the 50 states administers their own program by combining federal and state funds. The mandatory services required by the Center for Medicaid and CHIP Services include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy. State governments can cover optional benefits and set the percentage of the federal poverty line below which residents will qualify for Medicaid benefits. Therefore, the poorest Americans receive healthcare services through Medicaid and the Children’s Health Insurance Program (CHIP). There is one unusual circumstance in which the poorest of Americans are offered healthcare but cannot afford it, even though it may only cost $2 to $8 per appointment. This situation occurs within prisons. Forty-two state prisons allow for copays for prisoner-initiated visits for medical care, although healthcare cannot be denied if the prisoner is indigent. In West Virginia, prisoners make 4 cents per hour; therefore a $5.00 copay would require nearly a month’s salary. The rationale for copays is that it reduces prisoners feigning illness and requesting medical care for frivolous reasons. This policy is potentially costly if inmates put off routine care because they want to spend their limited earnings at the commissary. Their health may decline, and had they had preventive care, it may have saved the prison system resources in the long run. This is an example of how the poorest of the poor may still suffer even though they have access to healthcare services.