Corrections director recommends Cowlitz County withdraw from Medicaid program for inmates

Marin Fox, director of corrections, told the board the county should not move forward immediately with the Medicaid Transformation Act (MTA) program that would extend Medicaid for inmates for the initial 90 days of incarceration.

Fox said the state, through the Health Care Authority, offered up to $2.25 million in infrastructure funding to help counties stand up the program, but county projections show net costs for the county. "We were looking at about we'd be up about $126,000 in 2026, but by 2030 the county would be expending 1.44 million in the red," Fox said, summarizing financial estimates prepared with county staff.

Fox said many counties that have gone live report weak reimbursement results and that only a small portion of the county’s outside medical costs would be billable through the Medicico contract. Staff recommended withdrawing and returning the infrastructure funds because ongoing Medicaid reimbursements are unlikely to offset the administrative and liability costs.

Fox also warned of a two‑part risk: if the county declines now, a future state or federal requirement could force participation and make current startup funds unavailable; conversely, starting the program now requires near‑term spending on staff, offices and software. The board expressed reluctance to start spending immediately and accepted staff’s recommendation to remain on the sidelines for now, with a commitment to come back if circumstances change.