Medicaid is a health insurance program for low-income individuals. It was designed to be accessible to healthcare consumers at or below the federal poverty level. In California, the Medicaid program is referred to as Medi-Cal.
MAA stands for Medi-Cal Administrative Activities and MAC stands for Medicaid Administrative Claiming. MAC and MAA are one in the same. In California, the MAC program is referred to as MAA. However, most other participating states refer to their administrative claiming program as MAC.
MAA/MAC is a Medicaid reimbursement program. MAA/MAC provides reimbursement to county agencies and public entities for performing administrative activities that directly support efforts to identify, link, educate and enroll potentially eligible individuals into Medicaid/Medi-Cal. MAA/MAC does not provide reimbursement for direct services.
Participating California county agencies and their contracted CBOs draw down approximately $60 million annually through the MAA/MAC program. This number is expected to rise with the large increase in Medi-Cal eligible patients, a large number of which are justice-involved individuals.
No. MAA/MAC was not created with only direct service providers (doctors, nurses, psychologists, etc.) in mind, but for a much broader audience. Managers, clerical staff, analysts, case managers and yes, even lawyers are all eligible to participate in MAA/MAC. There is absolutely no job title or educational requirement for participation in MAA/MAC.
No. Unlike other healthcare billing programs, MAA/MAC does not follow the services provided to the individual client. Instead, it is the participant’s time that is ultimately of most importance. This is why tracking your time accurately is vital when participating in MAA/MAC.
County Social Service departments are ultimately responsible for determining Medi-Cal eligibility. However, other county agencies and Community Based Organizations (CBOs) can help facilitate the process by engaging potentially eligible individuals in pulling together necessary information and assisting with the completion of the Medi-Cal application. Keep in mind that Covered California, California’s healthcare exchange, has a separate application, but is also used for screening Medi-Cal eligibility.
Community based providers are eligible for participation in MAA/MAC so long as a portion of their funding originates from a local or state source. This typically takes the form of a contract between the community based provider and a county agency, or a local public entity for eligible services.
Yes. In California, approximately 48 of the 58 counties participate in MAA, and within them are a number of agencies, including but not limited to: Public Health, Mental Health, Public Guardian, Probation and Sheriff’s Offices. In addition, other organizations also participate, such as First 5s, CBOs, and a couple of public hospitals.
TCM is Targeted Case Management, a federal reimbursement program. TCM provides reimbursement for case management services rendered to Medicaid/Medi-Cal beneficiaries. Medicaid covers allowable costs for case management services in most of the 50 states.
Encounters are a mechanism for claiming TCM services provided to a client, typically during a face-to-face meeting. In California, an encounter rate is based on an interim rate determined by using a unit’s previous year’s allowable costs, and dividing that number by the projected number of the current year’s encounters.
TCM requires case planning documentation, but MAA/MAC does not. MAA/MAC does not track encounters. In TCM, case managers must track their time on their time surveys, including time spent conducting an encounter (face-to-face). Time spent performing an encounter should appear in the time survey as well as in the client’s case plan. Information in the time survey regarding an encounter must correspond with information recorded in the client’s case plan.
In California, new county departments/agencies typically start participating in MAA/MAC at the beginning of a quarter.
If your department or agency wishes to explore participating in MAA/MAC or TCM, please contact Ramsell Public Health & Safety. We have the tools and expertise to facilitate MAA/MAC or TCM program implementation and administration.
Contact a Ramsell Public Health & Safety team member at 1-888-900-6635 to discuss next steps today!