For years, King County jails did not bill insurance before a new initiative changed that, and people walking out the door of the Seattle or Kent facilities often left with nothing: no appointment, no medication refill, no plan. Now Medicaid dollars are funding a different approach, paying for case management, treatment scheduling, and a 30-day supply of medication and medical supplies the moment someone is released.
Casandra Adams knows that gap firsthand. Adams, who has been in recovery for almost four years, recalled leaving jail without money or anywhere to go about 90% of the time, she told KUOW. She now works as a peer advisor for King County's jail reentry initiative, using that experience to help design better options for people leaving custody. “The most important thing to give someone leaving jail is the name and number of someone to call,” Adams said, according to the station's report. Her own recovery supports included drug court, sober housing, methadone, support groups, and reconnecting with family, she said.
Adams, Megan Murphy, and Denotra McBride discussed the changes underway. Murphy manages the county's jail reentry initiative and said the Medicaid waiver now enables jail health staff to plan transitions before someone is released, rather than scrambling afterward. Release planning is required for all eligible people, with what Murphy described as a warm handoff to an appropriate provider, per the same account.
Treatment Options Expand Behind Bars
McBride, director of King County Jail Health Services, said the department is ramping up available opioid use disorder treatments as part of the shift. Seattle and Kent jails will allow people to start methadone treatment within the next year and will expand access to long-acting injectable buprenorphine for medically eligible people, the station reported. That injectable formulation provides relief from withdrawal symptoms and cravings for 28 days, giving people a longer runway before they need to find follow-up care in the community. McBride said the treatment expansion should be fully scaled by January 2027.
The timeline matters because jail stays in King County are often brief. About half of the people held in the Seattle and Kent jails spend three days or less in custody, leaving staff a narrow window to enroll someone in Medicaid, plan their discharge, and administer long-acting medication before they walk out. The vast majority of the 1,400 people held in those jails could qualify for the new assistance, according to the KUOW report.
A Decades-Old Funding Barrier
The reason jails historically did not bill insurance traces back to 1965. The federal rule barring Medicaid funding for health care provided to incarcerated people originates from the Social Security Act Amendments of that year, known as the Medicaid Inmate Exclusion Policy, according to the Center for Health Law and Policy Innovation. For decades, that exclusion barred federal Medicaid payments for covered services provided to incarcerated people; states generally could suspend or terminate coverage under prior rules.
Washington has chipped away at that barrier in stages. State lawmakers enacted changes in 2016 preventing people from having to reapply for Medicaid after incarceration, and the Centers for Medicare & Medicaid Services approved the state's five-year Section 1115 demonstration renewal, the Medicaid Transformation Project 2.0, on June 30, 2023, authorizing federal reimbursement for pre-release services through June 2028, according to the Washington State Health Care Authority. More recently, provisions in the federal Consolidated Appropriations Act of 2024 barred states from terminating Medicaid eligibility for incarcerated adults altogether, requiring programs to suspend rather than cancel coverage so it can be reactivated immediately upon release, per the National Health Law Program.
The Health Care Authority administers Washington's Medicaid program and began phasing in its Medicaid Reentry Initiative for eligible youth and adults across participating facilities starting in 2025. The authority is implementing the program in three cohorts, with facilities launching on July 1, November 1, and in later planned waves. More than 40 facilities statewide now participate, and Washington was awarded nearly $44 million in federal funds for capacity building and IT infrastructure during the initiative's first year. As of August 2026, participating facilities had received $3 million in reimbursement for pre-release services. Washington's model earned national attention in November 2025, when the National Association of Medicaid Directors gave the state its annual Spotlight Award for implementing pre-release Medicaid services in county jails and youth detention facilities, according to NAMD.
Why the Timing Matters
The stakes behind the policy shift are grim. A study published in Drug and Alcohol Dependence examined mortality after release from prison in Washington state.
County overdose numbers have shifted this year. Confirmed fatal drug overdoses in King County fell to 446 through July 2026, down from more than 900 recorded over the same seven-month stretch in 2025, according to data from the King County Prosecuting Attorney's Office cited by KIRO 7. A 2022 study found that pre-release planning coverage led more people with substance use disorder to access outpatient care after leaving custody, per KUOW's reporting.
Seattle Builds a Handoff for People Leaving Jail
Seattle officials are developing a separate protocol for supporting people as they leave the downtown jail. Under the plan, corrections officers will be able to summon CARE — Community Assisted Response and Engagement — crisis response teams to connect with people at the moment of release. Amy Barden, the CARE chief, said priority assistance will go to people released after hours or those who appear particularly vulnerable. CARE teams have already provided rides and adequate clothing to people leaving jail, the station reported.
King County's jail reentry initiative relies on peer advisors like Adams to help design these options from lived experience. Public Health – Seattle & King County had previously provided release planning for a small subset of people, funding it for about 15% of the most acutely ill and vulnerable individuals, James Apa, a Public Health spokesperson, told KUOW. County officials say they will continue release planning regardless of any future federal changes to Medicaid eligibility.
A Broader County Push and an Uncertain Federal Clock
The jail health changes fit into a wider county strategy. King County Executive Girmay Zahilay issued an executive order on March 31, 2026, launching the Breaking the Cycle Initiative, which set a goal of creating 500 new shelter and affordable housing units in 500 days while integrating county health, housing and criminal legal systems, according to the King County Executive Office.
King County juvenile detention youth are included in a separate pilot that preserves full Medicaid benefits throughout their stay, and the county's juvenile detention facility is eligible to receive up to $2 million in Medicaid funding for that youth pilot, which allows continuous medical, behavioral health, dental and care-coordination services without a break in coverage. Nationally, 22 states have qualified for a waiver allowing Medicaid reimbursement for certain transition-related expenses, KUOW reported.
But the federal reentry funding underpinning all of it remains a pilot program set to expire in less than two years. Jail Health Services staff are hopeful Washington will get an extension of that pilot. Release planning, officials say, is intended to reduce recidivism, emergency hospital visits and other downstream costs — the kind of outcome Murphy and McBride are racing to lock in before the clock runs out.
