Washington State Federally Recognized Tribes

Some of Washington’s most vulnerable residents are Tribal members who experience difficulty accessing needed health care. Government entities including federally recognized Tribes provide many services to Tribal communities daily to ensure their overall well-being.

The Health Care Authority (HCA) participates in a federal reimbursement program that allows HCA to enter into agreements with federally recognized Tribes to reimburse a portion of their expenses for performing administrative activities that support the goals of the Medicaid State Plan. Tribal 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 Tribal members and families to health care services.

• View the info sheet for Tribal Medicaid Administrative Claiming (MAC).

Examples of activities include:

• A community health representative explains to a family how Apple Health (Medicaid) could help their daughter get better access to a specialty doctor.
• A Tribal assister (who is not supported by funding from the Health Benefit Exchange) helps a Tribal member and her family apply for Apple Health.
• A contract health worker refers a Tribal member to a specialty health care provider.

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. Tribal 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 (SFY). 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.

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 interpreter or translation services that assists individuals and families to access and understand necessary care or treatment covered by Medicaid.

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

View the Tribal MAC activity codes.

Eligible job descriptions

Only staff who are reasonably expected to perform Medicaid activities should be added into the RMTS. The following are some examples of eligible job descriptions:

• Billing and benefits specialists
• Case managers/Caseworkers/Clinic coordinators
• Mental health/Chemical dependency professionals
• Family support specialists
• Program managers/Coordinators
• Community health representatives (CHR)
• Recovery specialists
• Health directors

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?
• Who were you working or interacting with?
• Why were you performing this activity?

A brief narrative will follow the last question.

View the RMTS participant quick reference guide.

Claiming process

• When the fiscal quarter ends, the time study determines the percentage of staff time statewide spent performing reimbursable activities.
• Each Tribal Government 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 only for Medicaid enrolled clients served by participating tribal staff (MER).
• To account for quarterly indirect costs, the system adds the Tribal Government’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 = $66,000

Example of MAC reimbursement

Tribal Governments that participate in MAC can receive potential revenue for their general funds. This table displays actual MAC reimbursements paid to Tribal Governments.

*Medicaid eligibility rate: percent of clients eligible for Medicaid served by Tribal staff versus the total number of clients served by Tribal staff.

Tribe	Clients served by Tribe	Participating staff	Medicaid eligibility rate*	Quarterly reimbursement
Tribe A	1172	10	47.95%	$12,011.57
Tribe B	63	22	41.3%	$22,059.44
Tribe C	753	37	37.8%	$30,774.14
Tribe D	1265	138	57.87%	$190,972.59

Coordinator resources

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

Resources

• Coordinator calendar 2027
• Coordinator calendar 2027 - list format
• Coordinator designee form
• Quarter readiness checklist
• MAC overview and participation requirements - video for Tribes interested in joining the MAC program
• Tribal MAC webinar - video for new staff

Getting started

If you are interested in participating in MAC:

1. Review a sample of the MAC contract.
2. Fill out the Contractor Intake form.
3. Email the completed form to: MAC at HCA.