Medicaid Administrative Claiming (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:
- The time study results.
- The percent of individuals served who are Apple Health (Medicaid) eligible.
- Other calculations of the claiming process.
To find more information about or to contract for existing MAC programs, please see one of the programs below.
- Department of Corrections
- King County Superior Court juvenile probation services
- Local health jurisdiction
- Public school districts
- Washington State Federally Recognized Tribes
We may develop new MAC programs. If you are seeking information about MAC for governmental entities not listed above, contact our office.
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 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 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:
- 2 CFR Part 225: Cost Principles for State, local and Indian Tribal Governments (OMB Circular A-87)
- 1903 (w)(6)(A) of the Social Security Act.
Report suspected Medicaid fraud
Call 1-833-794-2345 or send us an email at HotTips@hca.wa.gov.