Medicaid Administrative Claiming: An Overview
The ultimate goal of MAC is to improve the health of citizens around the state.
MAC draws on federal matching funds to reimburse agencies for activities that connect individuals to medically necessary services funded by Medicaid. MAC is the cost-based reimbursement methodology the state uses to draw down the federal funds.
Need to Know
Public entities eligible to participate in MAC include:
- Independent school districts,
- Local health departments,
- Early Childhood Intervention (ECI) providers and
- Mental Health/Individuals with an Intellectual and Developmental Disability (MH/IDDs) authorities.
ECI and MH/IDD entities are required to participate in MAC. School districts and local health departments can choose whether to participate.
The Texas Health and Human Services Commission (HHSC) administers Texas Medicaid and MAC. The federal matching funds help to:
- Provide effective and timely access to care for people with Medicaid
- Facilitate appropriate use of Medicaid-funded services
- Promote activities that reduce the risk of poor health outcomes for the state's most vulnerable populations
The most vulnerable populations include students from low-income families, single parent households, children with special health needs and pregnant and parenting teenagers.
Children and youth age 20 and younger represent the largest segment of the state’s Medicaid population. The majority is school age, yet only about one-fourth of Texas school districts participate in the MAC program.
MAC reimbursements cover direct services as well as administrative activities. However, school districts and other public entities don’t have to provide direct Medicaid services to participate in MAC.
Reimbursable administrative activities under MAC include those related to transportation and translation, coordination, referral, monitoring, and outreach and informing. To be reimbursable, these activities must serve individuals who are enrolled in Texas Medicaid or eligible for Medicaid.