Medicaid Administrative Claiming (MAC)
What is Medicaid Administrative Claiming?
The purpose of the Medicaid Administrative Claiming program is to
provide Texas School Districts the opportunity to submit reimbursement claims
for administrative activity that supports the Medicaid program. In order for
the cost to be allowable and reimbursable under Medicaid, the activities must
be found to be necessary for the proper and efficient administration under the
Texas Medicaid State Plan, and must adhere to applicable requirements as
defined in State and Federal Law.
School districts can be reimbursed for certain medical and
health-related activities such as outreach services delivered to students
within the district, regardless of whether the student is Medicaid eligible or
not, and without any impact on other similar services the student may receive
outside the district. Outreach services may be provided to a student or their
family and may include activities such as coordinating, referring, or assisting
the student/family in accessing needed medical/health or mental care services.
Revenue generated from MAC claims is dedicated to the provision of
health services and may be used to enhance, improve and/or expand the level and
quality of health/medical services provided to all students within the
More information regarding the Medicaid
Administrative Claiming (MAC) can be found at theTexas Health and Human Services Commission website.
A variety of personnel in local districts currently provide many
health-related activities on behalf of their students. These include medical
services such as physical therapy, occupational therapy, mental health
services, and transportation services. Most schools conduct health screenings
for all their students in such areas as vision and hearing. Many school
districts employ school nurses to assist with the administration of medications
and to assist students who become ill or injured. Some schools operate
school-based clinics that provide direct medical services. More and more
schools are engaged in Medicaid outreach activities to inform students and
their families about the availability of Medicaid and the State Children’s
Health Insurance Program (CHIP) and to assist them in applying for these
programs. District personnel may be asked to provide families with
health-related information about their child’s growth and development or what
to expect in caring for a student with disabilities or students with
Case Management Activities
Student Assistance Program’s may provide comprehensive case
management programs for high-risk students. Special education programs perform
routine case management and case coordination functions for special education
students and coordinate the delivery of related services. Administrators often
coordinate and/or become involved in community groups or councils and work to
identify gaps or improve the delivery of health-related services to their
Front line staff, often perform a range of case management and
case coordination functions to insure that students with health-related needs
access care in a timely and appropriate manner. School staff in the
elementary schools may identify health concerns and provide outreach and
information to the family as well as referring them to Medicaid or other
federal and state programs to help ensure the child obtains health care. As
part of the ongoing case management function performed in the schools, staff
may assist families in arranging transportation to take a child to a medical
appointment. Staff who maintain the school’s health clinic/office may discover
that families of sick children do not have health insurance. Referrals are made
to Medicaid when it is suspected that a family may be eligible for services.
Other staff, especially those in special education, may facilitate Supplemental
Security Income (SSI) applications for special needs students.
Identification of Health Related Services
Speech, occupational and physical therapists may provide
information to parents and other staff about specific health conditions or
services to help such conditions. School staff may provide information to
students and their parents about the risk of drug and alcohol usage and the
signs of abuse or dependency.
School nurses, along with special education personnel, and even
office staff are often the first to identify suspected health problems in children
and to refer them for diagnosis, treatment of follow-up health, mental health,
or substance abuse services. When ongoing health services are necessary and
need to be provided in the school setting, school staff is in a position to
assist children in appropriately following their health care plans. School
nurses may monitor and provide training to aides who perform health procedures.
School psychologists or counselors commonly do
crisis intervention in schools. They may perform case management activities
with families to ensure the child’s access to mental health or substance abuse
treatment services. School staff may be required to assist an injured child in
getting immediate medical attention.
How does the district obtain reimbursement?
Prior to submission and reimbursement of any claims made,
participating Districts/Programs seeking to submit MAC claims for reimbursement
must first enter into a contractual agreement with HHSC and participate in the
Random Moment Time Study (RMTS).
To determine allowable Medicaid administrative
costs within a local education agency, a quarterly RMTS will be conducted. The
RMTS process starts with school districts identifying staff that perform
Medicaid allowable activity. Participating staff are then added to a participant
list. The participant list is used to randomly select staff to participate in a
RMTS. The RMTS measures the amount of time spent on eligible and reimbursable
activity for MAC and direct medical services. Once the time study is completed
and the results are compiled, they are used to calculate the MAC quarterly
How is the reimbursement determined?
School districts identify staff that perform Medicaid allowable administrative activities for some part of their work day. These staff will then be eligible to participate in the state wide RMTS and the results will be used in the calculation of the MAC Claim.
A claim will be constructed based on the following formula:
- The percent of allowable time based on the state wide RMTS results.
- The percent of children in the district who are Medicaid eligible.
- The indirect cost rate received from the Texas Education Agency.
- The quarterly costs of staff in the district who are listed on the participant list.
For additional information regarding the Medicaid Administrative Claiming (MAC) Project, please send your inquiry to MAC@hhsc.state.tx.us .
For information regarding the Random Moment Time Study (RMTS), please send your inquiry to TimeStudy@hhsc.state.tx.us . Additional information regarding RMTS can be found at the Texas HHSC website.
Division of Federal and State Education Policy
Telephone: 512.463.9414 | Fax: 512.463.9560
Page last modified on 3/26/2013 11:49:13 AM.