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Spokane County reports progress and hurdles implementing Medicaid '11:15' prerelease services
Summary
Officials said Spokane County went live with Medicaid waiver '11:15' on July 1 but faces staffing gaps, managed‑care contract complexities and potential reimbursement lag; staff said pharmacy and medication billing may be an early source of recoveries but legal/contract amendments remain.
County staff and contracted providers briefed the board on the '11:15' Medicaid waiver pilot, which provides up to 90 days of prerelease case management and substance‑use disorder treatment for eligible incarcerated individuals.
"It's Medicaid waiver 11:15 where incarcerated individuals that are eligible for Medicaid will get 90 days of prerelease services," Eric Green, the county project manager, told commissioners, summarizing program scope and the phased cohort approach the state has used.
Staff said Spokane County joined cohort 1 early in 2025 but later shifted to cohort 2 and then cohort 3 as state readiness and contract transitions took place. A contract with a medical provider (identified in the packet as MediCo/Medico) began Feb. 1 and county staff reported a program go‑live on July 1 with Medico billing on the county's behalf.
Ongoing challenges noted to the board included: (1) managed‑care organization (MCO) contracts — three county‑level MCO contracts that now need amendments to distinguish detention‑services billing from juvenile court contracts; (2) staffing and recruitment for clinical, enrollment and billing roles (staff reported five initial core positions, with three filled); and (3) enrollment system work (Provider 1) to determine eligibility and enable billing.
Staff said pharmacy prescriptions and ER visits have been early categories where billing and recuperation are expected; presentation materials suggested monthly pharmacy costs on the order of tens of thousands of dollars and the potential for significant recoupment as billing systems mature, but staff cautioned reimbursement could be delayed.
What’s next: staff will continue MCO amendment work and recruitment; county and vendor teams will complete Provider 1 enrollment to estimate eligible populations and expected billing recoveries, and staff will return with further implementation details.
