County Spotlight: Changes to Mediaid billing set to save county $800,000 in jail costs

Published 1:30 am Wednesday, November 26, 2025

By Mark Ozias

This month I am excited to share an update on one of the ways that Clallam County is thinking creatively, improving service and saving local taxpayer dollars… in jail.

Every county is tasked with operating a jail facility, and numerous counties like ours also have a separate juvenile detention facility. Once an individual is incarcerated for any reason, that person’s health care becomes the responsibility of that county and it is local taxpayer dollars that support this expense through the General Fund.

This expense has been rising dramatically as the general health of our incarcerated population has been on the decline; currently more than 3 out of 4 adults in the Clallam County jail have either a mental health and/or a behavioral health diagnosis. Addressing these complex needs requires physicians, nurses, substance use disorder specialists and others and this work is complicated by lack of appropriate space in a facility that was designed with different needs in mind.

A substantial number of people who enter our facilities qualify for Medicaid; however, until recent changes in the law at both the federal and state level – changes that took years’ worth of advocacy from county commissioners across the state – Medicaid was cut off once someone entered a detention facility.

Now that the law has changed.

Clallam County is the first jail in the state that is working through the process of being able to bill for many of the services and medications those in our care require.

This effort has required both an investment in infrastructure – especially the technology systems necessary to accomplish medical billing – and re-thinking how we are organized internally. To this end, rather than having essentially parallel medical teams at each of our two facilities, we have created a single clinical services division staffed with a suite of medical professionals that are able to work in both facilities.

Other counties are looking to us to learn from our experiences.

Importantly, we are also working with community health care providers who are now able to come into our facilities, provide medical services, and bill Medicaid directly. This means that the expense for any medication or service provided doesn’t run through the county at all.

Between the Medicaid billing we expect to do directly, and the billing accomplished by our community partners, we anticipate a savings of more than $800,000 annually to local taxpayers.

What is most exciting about this effort, however, is what it means for those incarcerated individuals who are in our care. Until this change occurred, most of the time someone was released from jail they went right back out into the world with no connections and no support. Oftentimes people who had made significant personal progress in regaining their health while incarcerated struggled to maintain that trajectory upon release.

Now it will be much more likely that someone like this will have an established relationship with a medical provider that will continue post-release, bridging the gap between custody and community care. By formally integrating these “pre-release” supports, Clallam County aims to reduce recidivism, overdose risk and gaps in treatment continuity while promoting a smoother and more stable transition back into the community.

Even though we are just at the beginning of this effort we are already seeing success stories: a juvenile who first disclosed an eating disorder to her care team, after they worked hard to build trust; an adult, incarcerated seven times in the last four years, now participating in Drug Court while receiving medical and mental health care with the same community provider that saw him in our jail and who is now experiencing an extended period of sobriety; and another adult with multiple previous convictions, but no long-term treatment, who is now receiving mental health supports from community partners and who is well enough to petition for long-term supportive living out of county.

Both the Sheriff’s Department and Juvenile Services have worked very hard to make these new pathways possible, and I am proud of our county for once again taking the lead and developing a program that has the potential for such profound impact.