Here’s a “plain English” breakdown of Washington State’s HCA / Medicaid Pre-Release Reentry Initiative (via the Health Care Authority and the Medicaid waiver) — how it’s designed, what it aims to do,
- Larry Ballesteros
- Oct 15
- 11 min read
What the Reentry Initiative is
This initiative is a new program under Washington’s Medicaid Transformation Project (MTP) waiver, implemented by the Health Care Authority (HCA). Washington State Health Care Authority+2Washington State Health Care Authority+2
In short: it allows incarcerated individuals who are (or would be) eligible for Medicaid (“Apple Health”) to receive certain health care and reentry support services before they are released — up to 90 days before release in participating facilities. Health and Reentry Project+3Washington State Health Care Authority+3Washington State Health Care Authority+3
Here are its main features:
Feature | What it means in practice |
Eligible population | Adults and youth in prisons, jails, and youth correctional facilities who are or would be eligible for Medicaid. Health and Reentry Project+3Washington State Health Care Authority+3Washington State Health Care Authority+3 |
Pre-release window (lookback period) | Up to 90 days before the person’s expected release date. Health and Reentry Project+3Washington State Health Care Authority+3Washington State Health Care Authority+3 |
Core required services | These “must be offered” in participating facilities: • Reentry targeted case management / care coordination Health and Reentry Project+3Washington State Health Care Authority+3Washington State Health Care Authority+3 • Medications for opioid and alcohol use disorders (MOUD / MAUD) as clinically appropriate, with counseling Health and Reentry Project+3Washington State Health Care Authority+3Medicaid+3 • 30-day supply of prescribed medications and durable medical equipment (medical supplies) at release Health and Reentry Project+3Washington State Health Care Authority+3Medicaid+3 |
Optional services | Facilities may also implement additional services, such as: • Lab / radiology • Community health workers / peer support • Physical and behavioral health clinical consults • Administering medications during the prerelease period • Other medical services deemed appropriate Health and Reentry Project+3Washington State Health Care Authority+3Washington State Health Care Authority+3 |
Phased rollout | The program is being rolled out in cohorts (groups of facilities) over time: – Cohort 1: July 1, 2025 – Cohort 2: January 1, 2026 – Cohort 3: July 1, 2026 Washington State Health Care Authority+1 |
Readiness requirements | Correctional facilities must attest to their readiness (staffing, ability to coordinate, processes) before providing services. Washington State Health Care Authority+1 |
Medicaid eligibility & coverage suspension | The plan assumes individuals’ Medicaid enrollment will be suspended (not terminated) during incarceration, so the transition back is smoother. Washington State Health Care Authority+2Medicaid+2 |
Goals / intended impacts | The program is designed to: • Reduce health risks, overdose, and mortality after release • Improve continuity of care (so medical treatments don’t get interrupted) • Reduce emergency department use and hospitalizations • Help with behavioral health & substance use disorder (SUD) • Aid reentry stability (so fewer people return to confinement) • Better coordination between correctional systems, Medicaid, and community health providers Washington State Health Care Authority+2Washington State Health Care Authority+2 |
Pros / Potential Benefits
Here are the advantages and the “why this is a good idea” arguments:
Continuity of medical care / prevents gaps
One big problem is that when someone is released, there’s a gap: their Medicaid (or health care) may have to be reapplied or reactivated, prescriptions might not be filled, etc. This initiative helps avoid that disruption by starting services before release. Washington State Health Care Authority+2Washington State Health Care Authority+2
Reduces health risks and overdose
The post-release period is a very high-risk time (especially for overdose, relapse, or untreated chronic or mental health conditions). Having medication continuity and health supports ready can save lives. Washington State Health Care Authority+1
Better reentry outcomes / lower recidivism
If people come out healthier, better supported, and with plans in place for continuing care, they may be more stable and less likely to relapse into criminal behavior. Washington State Health Care Authority
Cost savings / reduced emergency use
Preventing crises (emergencies, hospital admissions) is less expensive than reacting in crisis. Better preventative / transitional care may reduce public health and hospital costs. Health and Reentry Project+2Washington State Health Care Authority+2
More humane and equitable
Especially for people with mental health issues, substance use disorders, chronic diseases, etc., it gives a fair chance of treatment continuity rather than punishing them with disease neglect.
Stronger system coordination
It encourages correctional facilities, Medicaid (HCA), managed care organizations, and community providers to communicate and share information, which is often weak today. Health and Reentry Project+3Washington State Health Care Authority+3Washington State Health Care Authority+3
Cons / Challenges / Risks
Of course, it's not all smooth sailing — here are potential drawbacks or difficulties:
Implementation complexity
Coordinating health services inside correctional settings is logistically difficult (security protocols, staff, medical records, medications). Some facilities may lack infrastructure to support medical services, tracking, or coordination.
Short or unpredictable stays
In many jails or detention centers, people’s stay durations are short or release dates uncertain. Implementing a 90-day pre-release service for someone who doesn’t have that long in custody is challenging. Washington State Health Care Authority+1
Facility readiness / inconsistency
Some correctional facilities may not meet readiness criteria immediately (staffing, medical systems, coordination). This means unequal access across counties or institutions until more rollouts are complete.
Costs / funding burden
Providing medical services, staffing case managers, coordinating with community providers, medications, lab work, etc., all cost money. The state (and possibly local jurisdictions) must commit resources, and cost overruns or underfunding could throttle the program.
Eligibility limits / exclusions
While many services are mandated, some services are optional. Some incarcerated individuals might not qualify (e.g. non-Medicaid-eligible) or some facilities might opt out initially. This leaves gaps.
Data, privacy, and information sharing
Sharing health records between correctional health units and community providers, ensuring consent, privacy rules (HIPAA), etc., is tricky. Delays or miscommunications can disrupt care.
Measuring effectiveness / accountability
It will be difficult to isolate how much the program helps (versus other factors) — e.g. by how much did hospital use drop because of this program vs. other interventions. Ensuring real evaluation and oversight is key.
Here’s a realistic simulation of how Washington’s Medicaid Pre-Release / Health Reentry Initiative works in practice — showing what it changes for an individual compared to the old system.
🎭 Scenario: “Daniel’s Story”
Profile:
37-year-old male named Daniel.
Incarcerated in a state prison for 2 years for a non-violent drug-related offense.
Has a history of opioid use disorder (OUD) and depression.
He’s due for release in two months.
Previously enrolled in Apple Health (Medicaid) before incarceration.
🔹 Old System (Before the Reentry Initiative)
Step 1: Incarceration beginsDaniel’s Medicaid was automatically terminated when he entered prison (federal rules used to require this).
➤ Result: He lost all coverage while incarcerated.
Step 2: Limited in-facility treatmentThe prison medical team could provide basic health care, but Medicaid didn’t pay for it, and many community-type services (case management, medication-assisted treatment, counseling) weren’t available.
➤ Result: His depression went mostly untreated, and his medication for OUD (Suboxone) was stopped.
Step 3: Release dayDaniel was released with no medical coverage, no prescriptions, and no connection to a clinic.
➤ He left prison with a bus voucher and a few days’ worth of medication.➤ He didn’t have a doctor or therapist waiting for him.➤ Within a week, he relapsed and overdosed — a common pattern in post-release populations.
🔹 New System (With the Reentry Initiative, starting 2025)
Step 1: 90 days before releaseThe prison medical staff notifies HCA’s reentry coordinator that Daniel’s release is 60 days away.
➤ Daniel’s Medicaid suspension is lifted — his Apple Health coverage is reactivated.
Step 2: Reentry case management beginsHe’s assigned a Reentry Case Manager, who helps him:
Re-enroll in Medicaid officially (so his MCO coverage is live before he leaves)
Set up appointments with a community health center near his home
Create a treatment and medication plan for OUD and depression
Apply for transitional housing and a food card (EBT)
Step 3: Medication and continuity of careDaniel restarts Suboxone (MOUD) inside the facility.
➤ The care team ensures the same medication will be continued by a community provider upon release.➤ He’s given a 30-day prescription supply to bridge the gap between release and his first community appointment.
Step 4: Release dayWhen he walks out:
His Apple Health card is active.
He already has a next-day telehealth appointment with his new primary care provider.
His case manager checks in weekly for the first month.
He also receives peer support through a local reentry nonprofit funded by the Commerce Reentry Grant Program (these programs coordinate).
Step 5: 90 days after releaseDaniel has:
Stable housing
Weekly therapy
Ongoing MOUD treatment
No ER visits or arrests
A part-time job he got through a DOC-linked employment program
➤ Outcome: Instead of relapsing or overdosing, Daniel transitions successfully. His odds of staying out of prison improve dramatically.
🩺 System-Level Impact (What the Initiative Changes)
Area | Before | After the Reentry Initiative |
Medicaid status | Terminated | Suspended & reactivated pre-release |
Medication access | Usually disrupted | Continuous, 30-day supply guaranteed |
Behavioral health | Minimal / ad-hoc | Structured pre-release & post-release care |
Case management | None | Dedicated reentry case manager |
Community coordination | Very limited | Pre-scheduled handoff to clinics / support |
Outcome risk | High overdose, relapse, re-incarceration | Reduced risk, smoother transition |
🌿 Broader Social Outcome (Why this matters)
Post-release overdose deaths account for up to 10× the normal risk in the first two weeks after release.
Reconnecting people to Medicaid + behavioral health + medication continuity is proven to cut that risk sharply.
It also saves the state money: fewer ER visits, fewer hospitalizations, fewer people cycling back into jail.
🎭 Scenario 2: “Maria’s Story”
Profile:
Name: Maria
Age: 17
Facility: Echo Glen Children’s Center (a state juvenile rehabilitation facility)
Sentence: 18 months for property and drug-related offenses
Health issues: ADHD, anxiety, and a history of opioid misuse
Planned release: In 60 days
Prior status: Enrolled in Apple Health (Medicaid) before detention
🔹 Old System (Before the Reentry Initiative)
Step 1: During incarcerationMaria’s Medicaid coverage was terminated when she entered the juvenile facility.
➤ No Apple Health benefits while detained.
The on-site medical unit treated basic conditions but didn’t coordinate with outside providers or therapists.
➤ Her ADHD medication wasn’t always consistent, and she stopped therapy.
Step 2: Pre-release periodBefore release, there was little structured planning for medical or behavioral continuity.
➤ Her parole officer could refer her to community programs, but she’d have to wait for new coverage approval and find a clinic on her own.
Step 3: Release dayWhen she was released:
Medicaid wasn’t active yet.
She didn’t have ADHD medication or a refill.
Her anxiety returned quickly, and she missed parole appointments.
➤ Within a few weeks, she relapsed into drug use and re-entered the juvenile justice system.
🔹 New System (With the HCA Health Reentry Initiative)
Step 1: 60 days before releaseDCYF and HCA’s reentry program flag Maria’s case.
➤ Her Medicaid coverage is reactivated 60 days before her scheduled release.
Step 2: Reentry case management beginsA Health Reentry Case Manager meets with her weekly to build a personalized plan:
Schedules an appointment with a youth behavioral health clinic in her hometown.
Reinstates her ADHD medication with continuity planning.
Coordinates with her mother and a DCYF social worker for a stable home placement.
Helps her enroll in a job-readiness workshop funded through the Commerce Reentry Grant Program.
Step 3: Continuity of care & pre-release prepMaria participates in behavioral health counseling and begins virtual sessions with a therapist she’ll keep after release.
➤ She receives a 30-day supply of her medications and a written care plan.➤ Her mom and therapist both receive copies so everyone’s aligned on treatment.
Step 4: Release dayWhen Maria walks out:
Her Apple Health coverage is active.
She’s picked up by her mom and immediately connected to her local youth reentry navigator.
Her first post-release appointment is already on the calendar for the next day.
She has bus passes, ID documentation, and transitional youth housing as backup if family housing falls through.
Step 5: 3 months after release
Maria attends weekly therapy.
She completes her reentry job training.
She’s clean, enrolled in community college, and regularly checks in with her case manager.
➤ She’s stable, compliant, and no longer in the juvenile justice system.
🩺 System-Level Effects Illustrated
Area | Before | After Reentry Initiative |
Medicaid status | Terminated, long wait for reactivation | Reactivated pre-release |
Behavioral health | Interrupted therapy, relapse risk | Continuous therapy & case management |
Medication continuity | Inconsistent | 30-day bridge + ongoing prescription |
Family coordination | Minimal | Active family & DCYF involvement |
Post-release support | Ad hoc referrals | Scheduled appointments, transportation & navigator |
Outcome | Recidivism within weeks | Stable recovery, education, reduced risk |
🌿 Broader Social Impact (Why youth inclusion matters)
Youth in juvenile justice systems often have untreated mental health and substance issues — over 60% meet diagnostic criteria for behavioral disorders.
Ensuring coverage and treatment continuity before release prevents crisis cycles (self-harm, relapse, runaway, or re-offending).
The program strengthens family reunification, education, and workforce reintegration, key protective factors against recidivism.
Medicaid continuity for youth also ensures they can transition smoothly into adult coverage at 18 without gaps.
💡 Summary Takeaway
The Health Reentry Initiative transforms how Washington handles incarceration and health care — especially for high-risk youth like Maria.It replaces reactive systems with proactive coordination, ensuring that release day is not a cliff but a bridge — connecting individuals to stable, continuous care.
Scenario 3: “Robert’s Story”
Profile:
Name: Robert
Age: 56
Facility: Monroe Correctional Complex (state prison)
Sentence: 6 years for a property-related offense
Health issues: Type 2 diabetes, hypertension, and schizophrenia
Release date: In 75 days
Prior insurance: Apple Health (Medicaid) before incarceration
🔹 Old System (Before the Initiative)
Step 1: Incarceration beginsRobert’s Medicaid coverage was terminated when he entered prison.
➤ He was no longer eligible for Apple Health, and prison medical care operated separately.
Step 2: In-facility treatmentHe got basic medical attention but it was often inconsistent:
His insulin supply sometimes varied with staffing.
His psychiatric medication was switched for a cheaper alternative.
There was no long-term continuity planning for after release.
Step 3: Release dayWhen he walked out:
His Medicaid was not yet reinstated.
He had no insulin, no refills, no doctor, and no psychiatric follow-up.
He tried to schedule care but faced a 3–4 week delay for coverage reactivation.
➤ Within a week, he ended up in an ER for a diabetic episode and later relapsed into homelessness.
🔹 New System (With the HCA Health Reentry Initiative)
Step 1: 75 days before releaseThe Department of Corrections notifies HCA’s Reentry Health Team.
➤ His Medicaid suspension is lifted and coverage reactivated in the system.➤ He’s assigned a Reentry Health Case Manager (RHCM) trained for chronic-care coordination.
Step 2: Pre-release coordination (60–30 days)The RHCM builds a medical transition plan with Robert and his current prison medical team:
Confirms his insulin dosage and supplies.
Schedules a post-release appointment with a primary-care physician and psychiatrist at a community clinic already contracted with Apple Health.
Works with a community housing nonprofit funded by the Commerce Reentry Grant Program to secure temporary housing near the clinic.
Registers him for a pharmacy program that ensures insulin affordability.
Step 3: Final 30 days before release
Robert begins virtual appointments with his new community psychiatrist (telehealth pilot within the facility).
He receives a 30-day supply of insulin, blood-pressure medication, and antipsychotics in labeled blister packs.
His case manager enrolls him in a peer-support network for people with chronic illness reentering society.
Step 4: Release day
Robert leaves prison with his Apple Health card active.
His RHCM meets him outside the gate with a care packet (medications, appointment list, ID copies, bus card).
He moves directly into transitional housing coordinated by Commerce-funded partners.
Within 48 hours, he visits his new doctor and refills prescriptions without interruption.
Step 5: 3 months later
Blood sugar and blood pressure are stable.
He’s compliant with psychiatric treatment and therapy.
No hospitalizations, no police contact.
He begins part-time janitorial work through a DOC-linked employment pathway.
➤ Outcome: Stable health, consistent housing, reduced recidivism risk.
🩺 System-Level Comparison
Area | Before | After Initiative |
Medicaid coverage | Terminated; long re-enrollment delays | Suspended & reactivated 90 days pre-release |
Medication continuity | Often disrupted; no supply at release | 30-day supply + scheduled pharmacy refill |
Chronic-care management | None after release | Coordinated with community clinic |
Mental-health support | Disconnected | Ongoing telehealth + psychiatrist |
Housing & social services | Ad hoc, inconsistent | Linked through Commerce Reentry Grants |
Outcomes | ER visits, relapse risk | Stable, no rehospitalization, employed |
🌿 Broader Social & Fiscal Impact
People with chronic illnesses are among the costliest re-entrants; unmanaged conditions drive ER visits and reincarceration.
Providing continuity of care saves the state money: treating diabetes in-clinic costs a fraction of emergency hospitalization.
The program strengthens coordination between HCA, DOC, and community clinics, breaking the old siloed model.
For people with serious mental illness, continuity also means better medication adherence, fewer psychiatric crises, and safer community integration.
💡 Summary
The HCA / Medicaid Reentry Initiative converts release day from a point of medical vulnerability into a continuum of coordinated care.For someone like Robert, it’s the difference between relapse and recovery — between cycling through hospitals and living stably with dignity.
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