Medicaid Administrative Claiming

General Information

Medicaid Administrative Claiming (MAC), also known as Federal Financial Participation (FFP), is a way for states to receive federal funding for conducting administrative activities that support the Medicaid program. The role that the Aging Disability Resource Connection (ADRC)/No Wrong Door (NWD) System plays in helping older adults, people with disabilities, and caregivers understand and navigate the complex system of long-term services and supports includes many administrative activities that are eligible for MAC. ADRC activities that may be eligible for MAC include:

  • Outreach
  • Person-Centered Counseling
  • Facilitating Medicaid Eligibility
  • Training
  • Program Planning
  • Quality Improvement

Recognizing that MAC is one way to help sustain California’s ADRC/NWD System and enhance access to the Medi-Cal program, Senate Bill 453 (Hurtado, 2019) was passed in October 2019, directing the California Department of Health Care Services (DHCS) and the California Department of Aging (CDA) to work together to determine whether MAC can be used to support the ADRC/NWD System. Joint work efforts by DHCS and CDA to implement MAC are currently underway. The timeline below displays the projected timeline for MAC implementation.

This image represents a timeline which outlines the major tasks that need to be completed in order to meet the July 1, 2024 implementation date for Medicaid Administrative Claiming. In calendar year 2021, an ADRC Medicaid Administrative Claiming overview training took place in quarter 2, codes were developed in quarter 3, and a code clarity pilot took place in quarter 4. For calendar year 2022, the time study methodology was developed in quarters 1 and 2, the time study took place in quarter 3, and the time study analysis will be conducted in quarter 4. The claims submission process will also be developed in quarters 3 and 4. In calendar year 2023, monitoring processes will be developed in quarter 1, the November estimate will be completed in quarter 2, and the May revision estimate will be completed in quarter 4. Also, the DHCS statewide cost allocation plan will be updated in quarters 1 and 2, the local MOU between CDA and ADRC partners will be drafted in quarter 3, and the state MOU between CDA and DHCS will be drafted in quarter 4. The local guidance manual and federal submission packets will be developed simultaneously throughout calendar years 2021, 2022, and 2023. The federal packet to CMS will be submitted by December 31, 2023 to allow 6 months for review and approval prior to full implementation by July 1, 2024. During calendar year 2024, while awaiting review and approval by CMS, mock quarterly submissions will be conducted during quarters 1 and 2.
General Resources:

Time Study

Time studies are used to calculate the percentage of time ADRC staff spend performing Medicaid-related administrative activities that are reimbursable through MAC. Staff use the ADRC coding structure to document their daily activities for a set number of days each quarter.

Time Study Tools: