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Abstract: This research investigation examines the widespread yet under-scrutinized practice of “pay-to-stay” fees—charges levied on incarcerated individuals, including both adults and youth, to cover the costs of their incarceration. Focusing on room and board and medical fees imposed at the state level, the study draws on an in-depth literature review, interviews with directly impacted individuals, and insights from fellow researchers. It finds that pay-to-stay fees impose severe financial burdens on incarcerated people and their families, restrict access to essential care, obstruct reentry efforts, and fail to serve as sound fiscal policy. Despite these harms, such fees remain authorized in nearly every U.S. state. Through a comprehensive analysis of state statutes and correctional policies, this investigation underscores the urgent need to abolish pay-to-stay practices and address the broader system of financial penalties that entrench poverty and perpetuate cycles of incarceration.