Earlier this year, in what may be an Australian first, over-the-phone mental health appointments from prison were arranged and bulk-billed under Medicare. This was a concerted effort from me and a small team of legal and medical professionals.

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Medicare is defined as a “universal health scheme” available to all Australian citizens and some foreign nationals. Prisons, however, have never billed services to Medicare as they believe that legislation forbids them from doing so. In the absence of Medicare, state-run or state-funded private prison health services are often not equipped to provide the level of care required. Some services are not provided simply because no non-Medicare equivalent of them exists, while others are not funded appropriately to meet the needs of a vulnerable and growing prison population.

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However, inmates themselves don’t lose their Medicare coverage. If someone inside has ever had a Medicare card, there is still an active one in their name, even if they don’t have the physical green card in their property. Medicare cards automatically renew, and inmates have always been allowed to use Medicare services on day release.

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After much research, last year I co-wrote an article with Medicare expert Dr Margaret Faux and human rights lawyer Anthony Levin, which was published in the Journal of Law and Medicine. Due to the wording of the relevant legislation, and existing High Court precedent, the article argued that legislation does not actually prevent the billing of health services in prison to Medicare and that it is also not legal to deny billing to Medicare in prison when no equivalent services are provided by the prison.

People in prison have the right to book a private medical appointment with their own practitioners via video or phone. However, this option is rarely used, partially as appointments must be paid for by incarcerated people or their families. So far, this has occurred without Medicare rebates, as there was a commonly held belief that this was not allowed. The independent legal advice our team sought outlined that billing mental health telehealth services to Medicare is completely legal. Additionally, if a prison were to refuse to allow access to an external appointment on the grounds that it was being billed to Medicare, Dr Faux has suggested it would “likely be the trigger for a legal challenge”.

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There are unfortunately logistical issues with this option. Firstly, it is not always easy to arrange an external medical appointment over telehealth in custody. Our first attempt to schedule a requested appointment with a prisoner was delayed by the prison for months, while the second attempt at a different prison was approved in only a week. Obviously, some medical conditions also can’t be treated over telehealth, and not all medical professionals offer telehealth appointments. If you want a mental health care plan, the referral needs to come from your existing GP in the community, rather than a GP employed by the prison. Furthermore, most health professionals charge more than the rebates provided by Medicare, meaning people in custody or their families will have to pay the full fee upfront and claim back their Medicare rebate – online systems make this process easy, and the health professional will often do it for you.

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People in custody also have the right to apply to be taken to a medical practitioner in the community. However, they must pay for their own transport and escort by correctional officers. In NSW, the average cost of paying for transport to see a medical professional in the community, such as a psychologist, is $1,060 per trip. Paying the telehealth fee upfront and then claiming a Medicare rebate is considerably cheaper, and the fact that this option exists is something people in prison need to be aware of.