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County reentry team says 1115 waiver has boosted Medicaid billing and continuity of care for people leaving jail
Summary
Clinic staff told the Clallam County Behavioral Health Advisory Board that a Medicaid 1115 waiver allowed pre‑release enrollment and billing for services, producing about $320,000 in billings and improved medication continuity; presenters cautioned the figures are preliminary and federal policy uncertainty remains.
Madison Gallantine, clinic director for the county’s clinical services reentry team, told the advisory board that a Medicaid 1115 waiver has allowed her team to enroll people who are incarcerated up to 90 days before release and connect them with case management, behavioral‑health and substance‑use disorder treatment.
Gallantine said the waiver shifted some cost burden from local taxpayers to Medicaid, enabled billing for services previously unpaid and allowed the team to provide a 30‑day supply of medications at release to reduce lapses in treatment. “The 1115 waiver has allowed us to enroll people who are incarcerated and within 90 days of release and, essentially, bill Medicaid,” Gallantine said.
The presenter reported the program has generated roughly $320,000 in billing reimbursements through March, while stressing that figure reflects what the clinic has billed to date and is not a final audited revenue number. She described declines in medication costs in program periods the team tracked — calling out a large drop in inpatient medication reimbursements when the waiver was first used — but said those comparisons are imperfect because jail charting and charge capture remain difficult. “Our nursing staff is really stretched thin,” Gallantine said, explaining why some charges and diagnostic coding may be missing from current tallies.
Gallantine also presented enrollment and referral metrics: in the period presented the team recorded about 379 new adult arrests, 150 enrollments in the reentry program with 34 opt‑outs, and juvenile figures of 68 arrests with 42 enrolled and 9 opt‑outs. She said 167 of the new adult arrests were released within 24 hours, a group the program has difficulty reaching before release.
Board members pressed on staffing and billing capacity. Gallantine said the team could benefit from an additional full‑time nurse and a biller, and noted that Medicaid billing in a jail setting requires specialized coding work. “We could use probably a biller, and another full‑time nurse will be great,” she said.
Participants also discussed program longevity. Gallantine said the county is entering the program’s second year and expected the waiver to remain in effect for at least four more years under the current agreement, but other participants warned federal policy can change. Wendy Sisk, CEO of Peninsula Behavioral Health, flagged federal and state uncertainty while encouraging contingency planning at the local level.
The board acknowledged the reentry program’s potential to reduce recidivism and medication gaps, but members and presenters agreed the financial and operational figures remain a work in progress. The board received the presentation and offered praise for the team’s work; staff said they will continue refining data and suggested the program will return with further updates once tracking improves.
The advisory board did not take formal policy action during the presentation; the item was presented for information and discussion.
