Skagit County to join Medicaid jail-reentry waiver, seeks up to $2.25 million to set up billing and reentry services

Skagit County commissioners heard on Jan. 21 from George Kosovich of the Skagit County Public Health Department about the county’s decision to join the second cohort of a state Medicaid waiver intended to preserve health coverage for people who are incarcerated pretrial.

Kosovich told the board the waiver would let the county bill Medicaid for people who are slated to be released within 90 days and that the Health Care Authority has offered up to $2,250,000 to help establish billing systems and other capacity-building work. “It’s $2,250,000 up to $2,250,000 of funding to help us establish the processes to bill Medicaid,” Kosovich said.

The waiver aims to avoid a break in continuity of care that occurs today when Medicaid coverage is suspended upon incarceration, a change that county staff and commissioners said shifts the immediate cost of care to local taxpayers and complicates reentry. “When somebody’s incarcerated at the Skagit County Justice Center, Medicaid suspends their coverage and what that means is that the county … pay[s] for the cost of medical care,” Kosovich said.

County staff said the program could fund IT for billing, medication‑dispensing logistics, and other infrastructure. Kosovich described remaining uncertainties: cohort 1 jails have not yet started billing, so the county does not yet know likely reimbursement levels; some logistical questions remain about how to provide medication and bridge services at release. He said the county will submit a capacity‑building application in spring to request technical assistance from the Health Care Authority.

Kosovich also said the county has obtained an additional Health Care Authority grant to fund interim “bridge” services for people experiencing substance use disorders while the waiver implementation proceeds. Staff will bring a professional services agreement related to that work back to the commissioners for approval.

County leaders said joining the second cohort gives Skagit County time to learn from earlier participants. Kosovich said cohort 1 included about 40 jails and that roughly a dozen jurisdictions are joining Skagit County in cohort 2. The Health Care Authority has allowed flexibility in the implementation timeline; the current target go‑live date is Jan. 1, 2026.

The item was included on the commissioners’ consent agenda and approved as part of the consent motion. Commissioner Browning moved to approve the consent agenda items 1 through 29; the motion was seconded by the presiding commissioner and passed by recorded voice vote 2 to 0.

Next steps identified in the meeting record include the county’s spring capacity‑building application to the Health Care Authority and continued participation in Health Care Authority webinars and peer‑learning sessions.