Public school districts
Apple Health (Medicaid) provides reimbursement for Medicaid-covered activities and services delivered in school settings via School-Based Health Care Services (SBHS) and Medicaid Administrative Claiming (MAC). Local Education Agencies (LEAs) are encouraged to participate in both programs to maximize reimbursement.
Ready to get started?
Some of Washington’s most vulnerable residents are children and families who experience difficulty accessing needed health care. Government agencies including LEAs provide many services on a daily basis to ensure their overall well-being.
The Health Care Authority (HCA) participates in a federal reimbursement program that allows HCA to contract with LEAs to reimburse a portion of their expenses for performing administrative activities that support the goals of the Medicaid State Plan. LEA 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 students and families to health care services.
Examples of activities include:
- A school nurse explains to a parent how Apple Health (Medicaid) could help their daughter get better access to a specialty doctor.
- A school principal attends a training hosted by a local medical provider on the process for referring Medicaid-eligible students for well-child exams.
- A school counselor provides training to staff about behavioral health activities.
Random Moment Time Study (RMTS)
The RMTS is a statistically valid way to measure the amount of time spent performing administrative activities eligible for reimbursement. LEA staff participating in the RMTS are assigned "moments" throughout the quarter that they must answer. A moment is a four-question 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 State Fiscal Year (FSY). The periods are:
- Q1: July 1 – September 30
- Q2: October 1 – December 31
- Q3: January 1 – March 31
- Q4: April 1 – June 30
ForHealth Consulting at UMass Chan Medical School (UMass) operates the web-based time study. UMass is available to provide system related technical assistance and training as needed. View the RMTS technical notes and system requirements.
System updates and manual revisions
The UMass system undergoes regular updates and maintenance. Please note manuals and resources will be revised as needed.
- 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 abuse 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 abuse 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.
Administrative services
- Office/clerical
- Principal/Vice Principal
- School administrator
- MAC coordinator or back up coordinator
Social and health services
- Board certified behavioral analyst
- Counselor
- Health room assistant
- Nurse
- Occupational or physical therapist
- Orientation and mobility specialist
- Psychologist
- Registered behavior technician
- Social worker
- Speech-language pathologist or audiologist
- What is a moment?
-
Participants will receive their moment notification email at the exact time the moment occurs. It takes approximately 1-2 minutes to complete the survey. Participants should click the link provided in the notification email that will take them to the RMTS system. They select from a list of predefined answers to the four questions below:
- What type of activity were you doing?
- What specifically were you doing?
- Why were you performing this activity?
- Who were you working with?
A brief narrative will follow the last question.
Claiming process
- When the fiscal quarter ends, the time study determines the percentage of staff time statewide spent performing reimbursable activities.
- Each district loads their quarterly eligible MAC expenses (participant salary and benefits) 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 a district’s Medicaid enrolled student population (MER).
- To account for quarterly indirect costs, the system adds the district’s indirect cost rate into the claim.
The Federal Financial Participation (FFP) for the MAC program is 50%.
- 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 - Example of MAC reimbursement
-
Districts that participate in MAC can receive potential revenue for their general funds. This table displays actual MAC reimbursements paid to school districts.
School Student population Participating staff Medicaid eligibility rate* Quarterly reimbursement School A 194 16 51.12% $2,130.51 School B 7,290 242 14.53% $13,551.36 School C 2,436 158 36.37% $17,398.02 School D 10,132 498 25.05% $45,792.39 *Medicaid eligibility rate: percent of student population eligible for Medicaid versus the entire student population.
Coordinator resources
Resources to help MAC coordinators manage the program, RMTS participants navigate the system, and interested districts answer questions about the program.
- Resources
Getting started
If you are interested in participating in MAC:
- Review a sample of the MAC contract.
- Fill out the Contractor Intake form.
- Email the completed form to: MAC at HCA.