Medicaid Administrative Claiming (MAC)

What is MAC?

MAC is a program available for governmental entities that interact with individuals who are, or may be, eligible for Washington Apple Health (Medicaid). Partial reimbursement is available for the time that governmental entities spend helping individuals:

  • Apply for Apple Health (Medicaid), including renewals.
  • Explaining the Apple Health (Medicaid) program.
  • Helping individuals access Apple Health (Medicaid) services.

How can I participate?

To participate in the program, you must:

  • Be a governmental entity.
  • Be contracted with the Health Care Authority.
  • Participate in a time study designed to identify the percent of time you spend performing the Medicaid administrative activities listed above.

What and how much is reimbursed?

We will partially reimburse the staff salary and benefits that you expend while performing these activities. Only the portion of these costs that is confirmed as Medicaid is allowable for federal reimbursement.

The reimbursement is based on several key factors including:

  • The time study results (percent of time documented as Medicaid).
  • The percent of individuals served who are Medicaid eligible.
  • The Federal Financial Participation rate.

We reimburse contractors with federal funds, using the Federal Financial Participation rate. The final reimbursement will be 50 percent (or 75 percent) of the expenses after they are reduced by:

  1. The time study results.
  2. The percent of individuals served who are Apple Health (Medicaid) eligible.
  3. Other calculations of the claiming process.

Current MAC programs

To find more information about or to contract for existing MAC programs, please see one of the programs below.

We may develop new MAC programs. If you are seeking information about MAC for governmental entities not listed above, contact our office.

Important information

The Centers for Medicare and Medicaid Services is the federal agency with national oversight of the Medicaid program, including Medicaid Administrative Claiming.

Cost Allocation Plan

In order for the us to operate a MAC program, a Cost Allocation Plan must be developed and approved by the Centers for Medicare and Medicaid Services. The Cost Allocation Plan describes how the we will administer the program and ensure the federal funds are monitored and distributed appropriately.

Medicaid School-Based Administrative Claiming Guide

The Centers for Medicare and Medicaid Services published the 2003 Medicaid School-Based Administrative Claiming Guide. All Medicaid Administrative Claiming programs and Cost Allocation Plans must be designed based on this guide, in addition to other federal regulations including, but not limited to:

Report suspected Medicaid fraud

Call 1-800-562-6906 or send us an email at HotTips@hca.wa.gov.

Contact

Medicaid administrative claiming
Jennifer Inman, Section supervisor
Email: jennifer.inman@hca.wa.gov
Phone: 360-725-1738
Mailing address:
PO Box 45530
Olympia, WA 98504-5530

Ask MAC!
Email: mac@hca.wa.gov