General Information
The school-based Medicaid Administrative Claiming (MAC) program provides Texas school districts, including public charter schools, the opportunity to obtain reimbursement for certain costs related to health administrative activities that support the Medicaid program. 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 district. All MAC expenditures which are subject to reimbursement are Title XIX funds. The MAC reimbursements payments received from Medicaid Administrative Claims CFDA #93.778 are subject to the Single Audit Act. Therefore, the funds should be included on the SEFA (Statement of Expenditures of Federal Awards) on each entity's audited financial statements. If the MAC award is identified as a major federal program, the entity's external auditor should perform work deemed necessary to reduce risk and report the funds appropriately in accordance with the Annual Single Audit. The auditor should research all other requirements to ensure that MAC funds are appropriately audited and reported.
Additional Information
What is Medicaid Administrative Claiming for ISD's? (.pdf) (updated 08/17/2020)
Reimbursement Opportunity through MAC (.pdf) (08/17/2020)
Examples of MAC Activities (.pdf) (10/29/2012)
Related Information
Fairbanks, LLC-State of Texas Automated Information Reporting System (STAIRS)
Department of State Health Services (DSHS) School Health Program
Medicaid Administrative Claiming (MAC)
School Health and Related Services (SHARS)
Texas Education Agency (TEA) website
Guides / Manuals / Tutorials
MAC Financial Participation Guide (.pdf)
MAC Video Tutorial - (10/15/2015)
MAC Managing Contacts in STAIRS Guide (.pdf)
Timestudy Implementation Guide (.pdf) (04/25/2007)
Notices
View a list of important notices regarding Medicaid Administrative Claiming for Independent School Districts.
Participation Documents
Contracting Information
To participate in the MAC program, districts must first enter into a MAC contract with the Texas Health & Human Services Commission (HHSC). All participation documents must be approved, and a MAC contract must be executed prior to the close of the Random Moment Time Study (RMTS) participant list for the quarter in which the district wishes to claim. The effective date (execution date) of the MAC contract is the date signed by the designated HHSC contact.
In addition to the contracting process, each district must also have an active Texas Provider Identifier (TPI) and/or National Provider Identifier (NPI), meet HHSC training requirements and participate in the RMTS, which includes the certification of the participant list and participation in the time study. To enroll as a Medicaid provider, please complete the Texas Medicaid fee-for-service provider enrollment form on the Texas Medicaid and Healthcare Partnership (TMHP) website:
Visit the TMHP provider enrollment site.
Districts that are interested in participating should consider beginning the process as soon as possible, as it may take many months to complete all paperwork and training requirements..
Listing and links to all forms required for participation in the MAC program by ISD's.
Training
The link below contains information regarding the ISD training information. It is IMPORTANT to carefully read all the information provided so as to fully understand who must attend "initial" training and who is eligible to take "refresher" training.
Learn more about training opportunities
Methodology / Rules:
The MAC program rules are located at Title 1 of the Texas Administrative Code, Part 15 Chapter 355, Subchapter J, Division 5, Rule 355.8095.
Preparers of MAC Financial Claims must apply the cost principles outlined in:
- 2 CFR Part 200; and
- Texas Administrative Code (TAC) rules located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, Subchapter J,
- Rule 355.102 of this chapter (relating to General Principles of Allowable and Unallowable Costs),
- Rule 355.103 of this chapter (relating to Specifications for Allowable and Unallowable Costs),
- Rule 355.104 of this chapter (relating to Revenues); and
- Rule 355.105 of this chapter (relating to General Reporting and Documentation Requirements, Methods, and Procedures).