Reentry from a carceral setting

Why is this initiative important?

Through this initiative, we aim to:

• Prepare people for a successful transition and reentry into their community and help them live their healthiest life.
• Improve health outcomes and reduce recidivism (reoffense), emergency department visits, overdoses, and death.
• Support substance use disorder and recovery and target infectious diseases like Hepatitis C before a person’s release.
• Stabilize and treat other conditions before a person’s release, so they can reenter their community as healthy as possible.

What services will the initiative provide?

This initiative will support and fund the delivery of targeted prerelease services to Apple Health-eligible adults and youth in state prisons, jails, and youth carceral facilities. HCA will require facilities to support the first three targeted prerelease services below. The remaining four services are optional, and facilities may implement them individually.

• Case management
• Medications for alcohol and opioid use disorder
• 30-day supply of medications and medical supplies at release
• Medications during the prerelease period
• Lab and radiology
• Services by community health workers with lived experience
• Physical and behavioral clinical consultations

View our overview.

How will the initiative provide services to incarcerated individuals?

Care coordination staff play a significant role in supporting those leaving a carceral setting. Care coordination staff will:

• Assess a person’s health care needs.
• Develop reentry care plans.
• Ensure medications for opioid use disorder and alcohol use disorder are provided by facility staff.
• Facilitate referrals and transportation to treatment following reentry.
• Arrange for medications and durable medical equipment upon release.
• Connect individuals to health-related social needs services, such as food, transportation, and housing.

In addition, the reentry program puts many other factors into play:

• Passed legislation allows Washington State to change the Medicaid suspension rules upon and after a person’s incarceration.
• Multiple partners are part of this work, including the Health Care Authority, Department of Corrections, local jails, Tribal jails, youth correctional facilities and other similar institutions, managed care organizations, workgroups, among others.
• Different systems, data, and technology are working together for better coordinated care.
  • For example, a person can get a prescription filled the same day they are released, so they don’t have to wait to get necessary medication. This same-day access is critical for an individual with substance use disorder, serious mental illness, or other behavioral health need.

What activities will a participating facility perform?

Facilities that choose to participate in the initiative are responsible for:

• Meeting cohort milestones (described below).
• Ensuring that a client receives targeted prerelease services.
• Adopting an electronic health record (EHR) that supports communication with community providers and Medicaid billing.

Additional information

Background on reentry legislation and MTP

• Senate Bill (SB) 6430 passed in 2016, which allowed HCA to suspend—and not terminate—Medicaid coverage for incarcerated individuals.
• In 2021, House Bill 1348 passed, which delays the suspension of an incarcerated person’s Medicaid coverage. SB 5304 also passed in 2021, which allowed HCA to seek federal funding to:
  • Provide prerelease services to a person leaving a carceral setting.
  • Maximize care coordination, so a person can transition into their community successfully and be connected to the care and services they need.
• MTP is Washington State's Section 1115 Medicaid demonstration waiver, which is an agreement between the Health Care Authority (HCA) and Centers for Medicare & Medicaid Services (CMS).
  • In June 2023, CMS approved MTP to continue for an additional five years. The MTP renewal—called MTP 2.0—began July 1, 2023, and ends June 30, 2028.
  • MTP (the waiver) is what allows our state to have the reentry program and provide certain Medicaid services up to 90 days before a person’s release.

Impacts before reentry legislation

Before 2017, people had to reapply for Apple Health (Medicaid) coverage after release (because their coverage was terminated and not suspended). That process took a while to show a person as eligible for Medicaid coverage, so—during their most vulnerable and at-risk time—released individuals could not:

• Receive necessary medications, equipment, or treatments.
• Access medical or health-related social needs services, such as:
  • Scheduling an appointment with a health care provider or counselor.
  • Securing housing, food, or transportation.

This delay created significant dangers for people with substance use disorder, serious mental illness, or other behavioral health need.

HCA’s reentry workgroup

In 2021, HCA formed the Reentry Advisory Workgroup, which plays a crucial role in our state’s reentry work. This workgroup—and the four subcommittees they oversee—are working on:

• Improving communication with managed care organizations (MCOs) for when an enrollee is incarcerated.
• Exploring a real-time data-sharing solution to provide booking and release notifications.
• Transmitting health records (which is especially important for jails), using HCA’s Clinical Data Repository.

In past work, the Reentry Advisory Workgroup added jail locations to a file that informs MCOs of an enrollee’s incarceration location. In partnership with MCOs, they also identified a solution that provides pharmacies same-day access upon an individual’s release.

• This way, a pharmacy can fill a person’s prescription the same day as their release, which is essential for medications and treatments for SUD and other behavioral health conditions.

Read the 2023 Re-Entry Community Services Workgroup legislative report.

Resources

• Invitation to participate - letter from Dr. Charissa Fotinos (April 2024)
• Reentry Initiative overview (April 2024)
• Intent to Participate form - for carceral facilities, including state prisons, city or county jails, Tribal jails, and youth correctional facilities (April 2024)
• FAQ and key points on the Reentry Initiative(December 2023)