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HCA outlines HR1 changes and 1115 waiver plan for jail reentry, citing outreach and implementation uncertainties
Summary
A Washington State Health Care Authority representative told Spokane County leaders the state will start new HR1-related eligibility work Jan. 1 and implement an 1115 waiver to allow Medicaid-funded services in jails ahead of release; officials flagged unresolved federal rules and upcoming deadlines.
Jason, a representative of the Washington State Health Care Authority, briefed Spokane County regional partners on HR1 implementation and a related 1115 waiver that will change how Medicaid covers services for people in carceral settings.
The HCA update focused on eligibility, enrollment and rural transformation efforts tied to HR1. Jason said the waiver permits Medicaid payment for certain services beginning up to 90 days before release and includes pharmacy coverage, medication for opioid use disorder and targeted case management. “One of the requirements is a 30-day supply upon release, not just a prescription, but in hand upon release from the carceral facility,” he said.
Jason explained jails, Department of Corrections facilities and juvenile institutions will each follow tailored protocols; DOC and some juvenile facilities will also go live on July 1. He said local jails may bill Medicaid either through internal licensed clinical staff or contracted providers and that capacity funding is available to help jails prepare to bill.
He flagged several implementation uncertainties. New federal CMS guidance references "functional eligibility" rather than diagnosis codes, and HCA is waiting for more detail on how to apply that standard. Jason also noted an October 1 coverage change that will affect certain noncitizen lawful residents and a coming requirement to move enrollment recertification to every six months.
Why it matters: these changes shift who pays for services, how jails and providers must prepare, and how behavioral health services are delivered at critical transitions out of custody. Local partners asked about operational details; HCA committed to sharing links and materials and to providing technical assistance.
What comes next: HCA will continue sharing guidance and data links with regional partners and work with individual jails and managed-care plans on the July 1 operational timeline and rollout of capacity funding.
