Medicaid On Reentry: A Washington State Implementation

Highlighted Story

Editor's Note

For decades, one of the quiet drivers of cost and harm in both jails and health systems has been the silo between them. People cycle into jail with serious behavioral health needs, experience disruptions in care, and are then released back into the community without reliable continuity. Jails, whether we acknowledge it or not, are places where care is already being delivered — often under difficult conditions and without the tools or financing structures that support continuity beyond the jail walls. The result is predictable: instability, avoidable crises, and higher costs across systems.

Turning to this weeks highlighted story, Whatcom County, in Washington State, appears to understand this reality and that Medicaid is the key lever for aligning care across settings.

The county’s newly approved out-of-custody behavioral health treatment center is open to the public, not embedded in the jail, and designed to function as part of the broader community health system. That design matters. It unlocks Medicaid financing options and expands opportunities for people to begin, continue, or transition care regardless of whether they encounter services through the justice system or elsewhere. Having this facility in the community supports rapid connection back to community-based care following release.

The facility is also intentionally structured—including through two 16-bed units—to navigate long-standing Medicaid IMD constraints while still providing inpatient-level behavioral health and substance-use treatment to adults who need it. This kind of planning reflects an understanding that Medicaid financing isn’t an afterthought; it shapes what kinds of care settings are possible and sustainable.

Importantly, this approach aligns with Washington State’s 1115 waiver, which allows Medicaid-covered services to begin up to 90 days prior to release from incarceration. Facilities like this one make that policy actionable. Instead of release being a care cliff, it becomes a transition point, with assessment, stabilization, and care planning already underway and clear pathways into community-based treatment.

This is what it looks like when we plan for the world as it actually is: when we acknowledge that people receive care in many settings, including jails, and design Medicaid-supported systems that provide real choices and continuity once people return to the community. It maximizes all these new opportunities to support people wherever they encounter care.

If you’re working at the intersection of Medicaid, behavioral health, and justice—or trying to build continuity across these systems in your own state or county — this is the kind of model worth understanding and adapting. I’m always glad to talk through how Medicaid financing and system design can support this kind of alignment and you can reach me, Dan Mistak, at dmistak@cochs.org.

Medicaid On Reentry

The new behavioral health center Whatcom County (WA) is preparing to build will be available to the wider public. County council voted 6-1 to recommend the construction of a behavioral health center which will be accessible to those out of jail custody, including people not justice-involved. While the future jail will have behavioral crisis care for inmates, the behavioral health center acts as a more intensive inpatient treatment with 32 beds, divided equally between mental health treatment and substance-use disorder treatment. The out-of-custody model also creates more flexibility when it comes to public access and could be more affordable to operate due to Medicaid reimbursements.

Follow Ups

Previous Editor's Note Update

Editor's Comment: The first two Follow Ups extend themes from the November 4, 2025, Editor’s Note. In that issue, we examined Utah’s efforts to implement elements of the president’s executive order, Ending Crime and Disorder on America’s Streets, including plans to construct a facility to house homeless individuals through civil commitment. The Utah News Dispatch now reports that the National Homelessness Law Center is organizing opposition, viewing the Utah’s plan as a potential blueprint for similar facilities across the country.

The second article revisits another concern raised in that same Editor’s Note: the growing role of rural county jails as de facto mental health facilities for individuals awaiting placement in state hospitals. A tragic example occurred in Cooper County, Missouri, where a woman waiting for a state hospital bed died in jail after correctional officers reportedly dismissed her symptoms as malingering. Those officers now face manslaughter charges. The case also underscores a recurring COCHS theme: the inherent complexity of delivering medical care in correctional settings. When staff assume someone is “faking,” serious medical needs can go untreated—often with tragic consequences and significant legal exposure for the jurisdiction.

The National Homelessness Law Center held a national organizing call to launch a campaign in response to what it described in a news release as “a surge in Trump-backed anti-homeless policies around the country.” Joined by civil rights, disability, and behavioral health advocates in Utah, the group urged people to oppose proposals they say would “criminalize” individuals experiencing homelessness. Utah is planning a 1,300-bed homeless services campus that some critics suggest could become a model replicated elsewhere. State officials estimate the project would cost more than $75 million to build and over $34 million annually to operate.

Robyn Pfeiffer and Rachel Atherton are charged with involuntary manslaughter for their alleged role in the death of Brooke Bailey in the Cooper County Jail in October 2023. Bailey was originally supposed to spend time at the Missouri Department of Mental Health, but was staying in the Cooper County Jail until a bed became available. Court documents say several jail workers told investigators with the Pettis County Sheriff's Office that Pfeiffer brushed off Bailey's complaints of feeling ill, saying the inmate was "playing games." Bailey was found dead on Oct. 27 in her cell with blood and vomit on the floor and on her clothing. In a recording played for the jury, Bailey can be heard telling her mother, "They won't check my blood sugar...I think they're laughing... I can't breathe...I love you, Mom."

Mississippi

Editor's Comment: In Mississippi, State Rep. Becky Currie, a Republican, continues her scrutiny of the Department of Corrections. She has identified seven opaque bank accounts tied to the system’s inmate welfare fund and has gained access to one containing approximately $32 million. At the same time, she is advancing healthcare reform. One proposed bill would allow officials to verify whether incarcerated individuals have actually been seen by medical providers.

Subscribers will recall that Currie’s involvement intensified after a visit to a state penitentiary, where she discovered that an incarcerated man with hepatitis C had gone untreated and was facing a life-threatening condition. She has since questioned the state’s healthcare vendor, VitalCore, asking: “Why are people getting sicker when we’re paying millions for medical care?” In a related development, the Department of Corrections has entered into an agreement with a law firm to monitor VitalCore’s performance.

As a point of interest, in the Correctional Healthcare Vendors section of this Weekly Update, Arkansas State Sen. Bryan King, also a Republican like Currie, is raising concerns about his state’s contract with its healthcare vendor, Wellpath. After Wellpath initially proposed a new $1.25 billion contract, the state sought another vendor in what appeared to be a cost-cutting effort. After a selection process for the new vendor, the state ultimately retained Wellpath—at a price tag $350 million higher than the original proposal. Senator King has characterized the arrangement as “fraud and corruption.”

Allegations of denied medical treatment, tens of millions of taxpayer dollars in opaque accounts, and rising costs tied to a prison farm program were the focus of bills approved by the House Corrections Committee. Chair Becky Currie, who has been pushing prison healthcare reform, is also scrutinizing the inmate welfare fund, which she says lacks accountability. She identified seven related bank accounts but gained access to only one, which held about $32 million—much of it difficult to trace. One bill would allow officials to verify whether incarcerated individuals were actually seen by medical staff. Disputes between prisoners and VitalCore are common, and because VitalCore, the company that controls medical records, is not required to release them when care is challenged, determining what treatment occurred can be difficult.

The Mississippi Department of Corrections quietly entered into an agreement with a powerful law firm last summer to monitor its private medical contractor after Mississippi Today reports of alleged denial of health care in state prisons. The move comes after the state Legislature instructed the department to deliver a report on the contractor’s performance and nearly a year after the agency entered into a medical services contract worth hundreds of millions of dollars it was responsible for overseeing. VitalCore holds a three-year contract worth over $357 million to provide medical services to people incarcerated in Mississippi prisons.

New York

Editor's Comment: In New York, it appears to be a moment of reckoning after the events of the past year. Former U.S. Attorney Preet Bharara has been appointed to lead an audit of the prison system, including an examination of the circumstances surrounding the murder of Robert Brooks. A second article tallies the financial cost of deploying the National Guard to prisons during last year’s wildcat strike.

Manhattan’s former top prosecutor Preet Bharara, known for his anti-corruption crusades and probe into failures at the Rikers Island jail complex, is helping to lead New York's $9.3 million, two-year audit into its prison system and the "root causes behind the Robert Brooks incident" . The investigation by public corruption experts is to result in a report on the state Department of Corrections and Community Supervision’s "patterns and practices related to the use of force, our internal systems and processes to determine if there are any systemic issues within DOCCS," according to a copy of the contract for the work.

New York’s total bill to post the National Guard in prisons — a response to last year’s corrections officers strike — is set to swell past $1 billion, officials said.Gov. Kathy Hochul’s proposed budget includes another $535 million to keep troops in the state prison system. The proposed expenditure shows the prisons’ ongoing staffing issues,, which were exacerbated by a three-week wildcat strike that began last February.

Opioid Epidemic

The White House officially launched the Great American Recovery Initiative on January 29, 2026, through an executive order to create a coordinated, federal-wide strategy against the nation’s addiction crisis. Co-chaired by the Department of Health and Human Services, the initiative aims to improve, integrate, and fund federal efforts regarding prevention, treatment, and recovery services. The program prioritizes treating addiction as a disease, enhancing community-level support, and fostering a culture of recovery to assist millions of affected Americans.

Opioid overdose deaths in the US rose through the 2000s and skyrocketed with the introduction of fentanyl starting in 2013. The crisis continued to worsen during the COVID-19 pandemic. But drug overdose deaths across the country are now on a 2-year decline. A study published in JAMA Network Open last June found that starting in August 2023, the US drug overdose death rate declined for 15 consecutive months.

ICE

When Sens. Alex Padilla and Adam Schiff visited the California City immigration detention center last week, they were appalled. “We saw firsthand today at California’s largest detention center the inhumane conditions that detained individuals are facing, violating basic standards for access to health care, food, water, and legal counsel,” reported Padilla. This week, the Department of Homeland Security fired back. “Any claims there are inhumane conditions at ICE detention centers are FALSE,” Tricia McLaughlin, assistant DHS secretary, told the Sacramento Bee in an email. Padilla responded "This is yet another example of an administration that is asking us to reject what we are seeing with our own eyes".

With Congress set to consider legislation to further increase Immigration and Customs Enforcement (ICE) funding and detention beds this week, U.S. Senator Alex Padilla (D-Calif.), Ranking Member of the Senate Judiciary Immigration Subcommittee, and Cory Booker (D-N.J.) announced the Dignity for Detained Immigrants Act to end the use of private, for-profit detention facilities, prohibit the practice of detaining families, and ensure due process for detained individuals. It would also end mandatory detention and increase federal oversight, accountability, and transparency of the immigration detention system.

A coalition of legal and immigrant rights organizations has filed a federal lawsuit alleging unconstitutional and abusive conditions at the Adelanto ICE Processing Center, a private immigration detention facility. The center reportedly houses nearly 2,000 immigrants and is operated under contract by the GEO Group, a private prison company. The lawsuit outlines widespread neglect and mistreatment inside the facility, including denial of medical and mental health care, lack of access to the outdoors, inadequate food and water, and unsanitary conditions.

The Kansas owners of a southwest Oklahoma City warehouse targeted for immigrant detention are pulling out of a deal to sell the property to the Department of Homeland Security. Oklahoma City Mayor David Holt said he spoke with the owners of the warehouse at 2800 S Council Road and they told him they are no longer engaged with the Department of Homeland Security to sell or lease the property for use by Immigration and Customs Enforcement (ICE).

AB 1633, authored by Assemblymember Matt Haney would impose a 50% tax on corporate profits derived from immigration detention operations. Revenue generated by the tax would be redirected to immigration-related services, including legal representation for detainees. The bill targets major for-profit detention operators: CoreCivic, GEO Group and Management and Training Corporation. Haney acknowledged California cannot prevent the federal government from entering into detention contracts but argued the state has the authority to tax companies operating within its borders.

South Bay Rep. Ro Khanna is ramping up congressional Democrats’ push for accountability at the California City immigration detention facility after making an oversight visit that he described as “alarming.” Khanna is echoing the widespread condemnation of the administration’s violent immigration enforcement escalation, which has swelled after the shooting of Alex Pretti. Khanna said the behavior of immigration agents in Minneapolis and inside ICE detention centers — where a record 70,000 people are now detained — is two facets of the same problem. n the letter to Kristi Noem and Todd Lyons, sent Jan. 22, Khanna demanded a list of records from DHS about operations of the California City facility, which is owned and run by the private prison company CoreCivic.

Rev. ellie hutchison writes: Where i am geographically located, the state’s first private prison built in the 1990s was closed due to horrid conditions that impacted the rights of the humans incarcerated there, as well as being a tax burden on the hard-working people who live in the state. In early 2025, this closed prison was sold to a private prison company, Utah-based Management and Training Corporation, without local officials or community members being informed. This company has explicitly stated they are reopening it to house a minimum of 500 humans who have been detained by ICE/DHS and/or BP. While many officials in charge of opening or building these types of facilities talk about job growth. How does job growth relate to your understanding of Jesus’ teachings or the Spirit’s guidance in our understanding of Christianity?

Wall Street investors have seen the value of their holdings in stocks of private prison operators plummet as President Donald Trump’s mass deportation push fails to hit hoped-for highs, according to Bloomberg. Shares of the two largest private prison operators in the country, Geo Group Inc. and CoreCivic Inc., have crashed a year after skyrocketing in anticipation of Trump’s huge deportation drive.

The Albanese Government is under renewed pressure after investigative reporting revealed it has awarded more than A$3 billion in on- and offshore immigration-detention contracts to Management and Training Corporation (MTC) Australia—the local arm of a US prison operator heavily criticized for its role in the Trump administration’s Immigration and Customs Enforcement (ICE) crackdown.

State Roundup

California

In July 2013, tens of thousands of California prisoners refused to eat. They were participating in a state-wide hunger strike, protesting policies that kept people locked in solitary confinement indefinitely. Hundreds of people in Pelican Bay State Prison, the state’s supermax facility, had been in isolation for over a decade. After 60 days of refusing food, and along with a concurrent lawsuit, the hunger strikers ultimately won major policy changes from the California corrections department. Among them was an agreement to move most people in long-term solitary back into the general population, giving many a renewed chance at parole.

Connecticut

Failures people spoke about during a public hearing about the “Conditions of Confinement” report. The report from the Office of the Correction Ombuds said the Connecticut prison system is operating “in a state of institutional failure” after looking at 13 facilities last year. The report found issues with mold-contaminated ventilation, rodent infestations, sewage backups. It also found the Department of Correction heavily relied on lockdowns all across the state, not because of emergencies but due to staffing shortages.

Nebraska

Mateja Weindorff was 18 years old when her father died while incarcerated at the Work Ethic Camp, a state-run minimum-security prison. Robert Weindorff had died of cardiac arrest brought on by untreated diabetes. He was 47 years old. In the three years since her father’s death, Mateja’s grief has driven her to action. When the Office of the Inspector General for the Nebraska Correctional System struggled to obtain Robert’s medical records from the prison, she hired a lawyer and obtained them herself. She then began the process of convincing legislators to introduce Legislative Bill 902, or the Weindorff Medical Act, has four main components. It would require the prison’s medical director to develop “standardized medical care protocols” for the treatment of chronic and acute medical conditions, to include routine screening and early detection procedures for inmates. It would also require that each facility establish a maximum timeframe – not longer than 48 hours – for medical staff to complete an initial assessment into an inmate’s health complaint.

New Hampshire

The state says a man who alleges that he was abused while held at Mount Prospect Academy lost his right to seek justice because of the statute of limitations, but the New Hampshire Supreme Court is being asked to allow the lawsuit to go forward. The case of John Doe 533, who claims he was subjected to physical abuse, illegal and painful restraints, and solitary confinement as a 13-year-old, was dismissed when the Superior Court ruled the statute of limitations for his complaint expired by the time he filed his lawsuit. But his attorney, David Vicinanzo, argued before the court on Tuesday that John Doe is essentially being punished for not knowing the law when he was an abused 13-year-old.

North Carolina

Anna Stein, the First Lady of North Carolina says her decision to focus on reentry and rehabilitation — along with ending stigma around substance use and mental health disorders — was shaped by her work from 2011 to 2024 as an attorney and policy adviser at the N.C. Department of Health and Human Services. She specialized in policy related to legal substances such as tobacco and alcohol, as well as illicit substances. During that work, Stein learned that people leaving incarceration are 40 times more likely than someone in the general population to die of an opioid overdose in the first two weeks after their release. She set an early goal of visiting all 55 of North Carolina’s state prisons.

Wisconsin

Gov. Tony Evers is asking a federal judge to lift restrictions on the state's corrections department that were put in place nearly a decade ago. after inmates at the state's youth prison were subjected to excessive use of solitary confinement, pepper spray and shackles. U.S. District Judge James Peterson in 2017 put Wisconsin corrections officials under a consent decree that outlines how prison guards must handle inmates at the Lincoln Hills School for Boys and Copper Lake School for Girls in Irma. In the motion, the governor noted pepper spray and mechanical restraints have not been used at the prison since 2021.

Rikers Island

New York City's notorious Rikers Island jail complex has officially been placed under federal oversight, with Nicholas Deml appointed as independent administrator, relieving the city and Mayor Zohran Mamdani of local control. The federal takeover comes after U.S. District Judge Laura Taylor Swain found the city in civil contempt for failing to implement core safety reforms. Despite a decade of monitoring, violence, staff misconduct, and systemic failures have remained dangerously high at the facility.

Nick Deml, former commissioner of the Vermont Department of Corrections, will lead the Rikers Island jail complex in New York City. Federal district judge Laura Taylor Swain picked Deml for the role. Deml stepped down from his Vermont post in August after almost four years on the job. He previously worked for the CIA and said he would begin consulting on prison-related issues following his departure. Under Deml’s leadership, Vermont’s Corrections Department focused on addressing substance use disorder among people in prison. A spate of deaths in 2022 and 2023 at the Southern State Correctional Facility in Springfield also colored Deml’s tenure.

Correctional Health Care Vendors

Wellpath

State Sen. Bryan King, R-Green Forest, is calling for an investigation into what he describes as “fraud and corruption” involving millions of dollars tied to a medical services contract for Arkansas Department of Corrections inmates. In April 2023, then–Secretary of Corrections Joe Profiri asked the Board of Corrections to cancel a proposed 10-year, $1.25 billion contract with Wellpath in an effort to reduce costs. The board instead approved a one-year extension of Wellpath’s existing agreement while soliciting new bids. After reviewing those proposals, Wellpath was again selected as the highest-rated bidder with the lowest price, resulting in a new 10-year contract totaling more than $1.6 billion. This amount was $350 million more from Wellpath’s initial proposal. King is now questioning why delays in the contracting process led to higher overall costs and has placed responsibility on Profiri—now an aide to Gov. Sarah Huckabee Sanders—as well as the governor and certain legislators.

The Board of Supervisors is weighing an expansion of healthcare services at the Loudoun County Adult Detention Center as its contract with Wellpath approaches expiration in 2027. The agreement was originally awarded in 2017 to Correct Care Solutions, which was later acquired by Wellpath. As officials prepare a new request for proposals, concerns have resurfaced about Wellpath, which has faced numerous wrongful death and medical negligence lawsuits. Sheriff’s Office Lt. Col. Bob Mosier acknowledged those concerns. Currently, healthcare services are divided between Wellpath and the county’s Department of Mental Health, with some medical staff shared across multiple facilities. County supervisors are now considering whether to bring more services in-house rather than continue contracting them out.