Local health jurisdictions

Some of Washington’s most vulnerable residents are children and families who experience difficulty accessing needed health care. Government agencies including LHJs provide many services on a daily basis to ensure their overall well-being.

LHJ staff participate in a Random Moment Time Study (RMTS) to determine what percentage of their time is spent performing reimbursable activities such as outreach, application assistance, and referring individuals and families to health care services.

• View an info sheet for LHJ MAC.
• View a list of participating LHJs.

Examples of activities include:

• Assisting individuals in applying for or renewing Apple Health (Medicaid).
• Explaining Apple Health and covered services.
• Assisting individuals in accessing Apple Health covered services.

Random Moment Time Study (RMTS) and claiming

The RMTS is a statistically valid way to measure the amount of time spent performing administrative activities eligible for reimbursement. To achieve statistical validity, participating LHJs are grouped into consortium-based time studies.

• View the LHJ MAC RMTS consortium list (effective January 2026)

LHJ staff participating in the RMTS are assigned "moments" throughout the quarter that they must answer. A moment is a survey followed by a brief narrative description summarizing the activity performed on a given day at a specific one-minute interval of time.

The time study follows the calendar year. The periods are:

• Q1: January 1-March 31
• Q2: April-June 30
• Q3: July 1-September 30
• Q4: October 1-December 31

Program support

RMTS support: The Washington State Association of Local Public Health Officials (WSALPHO) manages the web-based RMTS system and provides technical assistance. Access the URMTS web-based system to view the RMTS system guide.

Program assistance: The Health Care Authority (HCA) manages the LHJ MAC Claiming Program and provides program oversight and assistance.

MAC activities

Outreach

Activities that inform eligible or potentially eligible individuals about Medicaid and how to access the program. Such activities include bringing potential eligible individuals into the Medicaid System for the purpose of the eligibility process.

Application assistance

Assisting individuals and families with the Medicaid eligibility process.

Arranging for transportation to Medicaid services

Assisting individuals and families in obtaining transportation to services covered by Medicaid. This does not include providing the actual transportation service or the direct costs of the transportation such as bus fare, taxi fare, etc., but rather the administrative activities involved in arranging transportation.

Arranging or coordinating translation or interpretation related to Medicaid services

Arranging or coordinating translation or interpretation for Medicaid-related activities if it is not included and paid for as part of a medical assistance service.

Program planning, policy development, interagency coordination related to Medicaid services

Activities in direct support of the Medicaid agency and the Medicaid state plan associated with the development of strategies to improve the coordination and delivery of:

• Medical
• Dental
• Mental health
• Substance use disorder treatment
• Family planning services to individuals and families
• Collaborative activities with other agencies and/or providers

This refers to activities such as planning and developing procedures to track requests for services.

Medicaid-related training

Coordinating, conducting, or participating in training events regarding Medicaid related services. How to assist individuals and families in accessing Medicaid services and how to effectively refer them for services.

Referral, coordination, and monitoring of Medicaid services

Referring, coordinating, and monitoring the delivery of Medicaid covered services such as:

• Medical
• Dental
• Mental health
• Substance use disorder treatment
• Family planning services

Eligible job descriptions

Only staff who are reasonably expected to perform Medicaid activities should be added into the RMTS. The following are currently approved job descriptions.

• Public health nurses
• Health educators/care coordinators
• Dieticians or nutritionists
• Physical therapists or occupational therapists
• Program assistants or office Managers
• Family support workers

Claiming process

• When the calendar quarter ends, the time study determines the percentage of staff time spent performing reimbursable activities.
• Each LHJ loads their quarterly eligible MAC expenses (participant salary and benefits) and eligible local match funding in the RMTS system.
• The time study results reduce expenses to only reimbursable activity expenses.
• The system reduces reimbursable activity expenses to account for only an LHJ’s Medicaid eligibility rate (MER), which measures the percentage of Medicaid-eligible individuals within a county.
• To account for quarterly indirect costs, the LHJ certifies their approved indirect cost rate into the claim.

The Federal Financial Participation (FFP) rate for the MAC program is 50% and increases to 75% for eligible Skilled Professional Medical Personnel (SPMP) activity.

Example of claim calculation

Quarterly expenses	$1,000,000 = $1,000,000
Medicaid related staff time	10% x $1,000,000 = $100,000
MER	30% x $100,000 = $30,000
Indirect cost rate	10% x $30,000 = $3,000
Total computable	$30,000 + $3,000 = $33,000
FFP	50% x $33,000 = $16,500
Quarterly claim	$16,500
Potential annual reimbursement	4 x $16,500 = $66,00

Coordinator resources

Resources to help MAC coordinators manage the program, RMTS participants navigate the system, and interested districts answer questions about the program.

Resources

• LHJ MAC Claiming Manual
• Annual Medicaid Eligibility Rate (MER) proposal form
• Certificate of indirect costs
• Certified Public Expenditures (CPE) local match certification form
• ProviderOne client eligibility (RAC) list
• New job classification assessment tool
• 2023 school-based guide to Medicaid services and administrative claiming
• LHJ MAC cost allocation plan
• Code of Federal Regulations: 2 CFR Part 200
• Sample LHJ MAC contract