Medicaid Administrative Claiming FAQs for District Attorneys
What is the Medicaid Administrative Claiming Program (MAC)?
The Medicaid Administrative Claiming Program (MAC) reimburses county agencies and public entities for linking, educating, and planning activities related to health care services specifically covered by Medicaid. It does not reimburse for direct services.
Can district attorneys participate in MAC?
Yes. Even district attorneys in states that have not expanded Medicaid can participate in MAC.
Why would a district attorney participate in MAC?
Many of a district attorney’s activities are reimbursable through MAC. By participating in MAC, district attorneys can save money and help connect people with health insurance and services.
What are some activities that district attorneys perform or could perform that are reimbursable through MAC?
A number of activities that district attorneys perform may be reimbursed under MAC, including the following:
Medicaid outreach: Educating and informing people about Medicaid and how and where they can enroll are reimbursable. In addition, time spent linking someone with a health care service (e.g., mental health, substance abuse treatment, etc.) is eligible for reimbursement.
Referral, coordination, and monitoring: Following up to determine whether a person sought health care treatment for which he or she was referred is reimbursable. In addition, time spent discussing the health care status and needs of an individual with clinicians, therapists, case managers, and others is reimbursable.
Medicaid eligibility intake: Helping someone gather documentation needed to complete a Medicaid application is reimbursable, as is time spent filling out the application. In addition, time spent responding to questions from local and state agencies (including courts) regarding an application is reimbursable.
Arranging transportation to a health care service: Coordinating a person’s transportation to a doctor’s office or other health care provider is reimbursable. In addition, the actual cost of providing that transportation is reimbursable.
How can a district attorney’s office begin claiming MAC?
The process for claiming MAC varies from state to state. The first step is to contact your state Medicaid agency and ask about the process for qualifying as a claiming unit.
How do you actually file a MAC claim?
To file a MAC claim, you must track and record your work time in 15-minute increments according to activity codes, some of which are reimbursable and some of which are not. You may do this on paper or electronically. Alternatively, if you are only performing one reimbursable activity, you can claim via a direct charge. Here, you only track and record time that falls under a reimbursable activity code. For example, if you spent three hours of a 40-hour week discussing how and where at-risk individuals can receive mental health services through Medicaid, you would be responsible only for tracking those three hours of reimbursable time—not the other 37 hours of non-reimbursable time.
Can services be claimed for community-based providers, such as victim’s assistance programs?
Yes, community-based providers are eligible for participation in MAC, as long as a portion of their funding comes from a local or state source. Typically, the provider would have a contract with a county agency or a local public entity for eligible services.
Is MAC a treatment service program?
No, MAC was not created with direct service providers (doctors, nurses, psychologists, etc.) specifically in mind. Instead, it is intended for a much broader audience. Managers, clerical staff, analysts, case managers, and even lawyers are all eligible to participate in MAC. There is absolutely no job title or educational level requirement for participation in MAC.
Is a medical record created when participating in MAC?
No. Unlike other health care billing programs, MAC does not follow the services provided to an individual client. Instead, it is the claiming entity’s time that is of most importance. This is why tracking your time accurately is vital to participation in MAC.
Information provided by COCHS