The purpose of the Medicaid Administrative Claiming (MAC) program is to provide State affiliated public agencies such as Local Health Districts (LHD's) in Texas the opportunity to submit reimbursement claims for 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.
LHD's can be reimbursed for certain medical and health-related activities such as outreach services delivered to clients within the community, regardless of whether the client is Medicaid eligible or not, and without any impact on other similar services the patient may receive elsewhere. Outreach services may be provided to a client and/or the client's family and may include activities such as coordinating, referring, or assisting the client/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 clients within the community. All MAC expenditures 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.
What is Medicaid Administrative Claiming for LHD's? (.pdf) (updated 08/17/2020)
Guides / Manuals / Tutorials
MAC Financial Participation Guide (.pdf) - (06/16/2022)
MAC Video Tutorial - (10/15/2015)
Time Study and MAC Guide (.pdf)
View a list of important notices regarding Medicaid Administrative Claiming for Local Health Districts.
The purpose of the Medicaid Administrative Claiming (MAC) program is to provide State affiliated public agencies in Texas the opportunity to submit reimbursement claims for administrative activities that support the Medicaid program. To participate in the MAC program, the LHD provider must be a public entity and enter into a MAC contract with the Texas Health & Human Services Commission (HHSC).
In addition to the contracting process, each LHD provider must also have an active Texas Provider Identifier (TPI) and/or National Provider Identifier (NPI), meet HHSC training requirements and participate in the Random Moment Time Study (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:
An LHD provider that is interested in participating for this upcoming Federal Fiscal Year (FFY) 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 LHD's.
The link below contains information regarding the LHD 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.
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).