The simplest way to explain the Medicaid Administrative Match program is that the district receives financial reimbursement for the amount of time staff spends assisting our families in learning about, applying for, and utilizing Medicaid-related services. The process of determining that amount is complicated, involving multiple steps and data from a wide variety of sources. The remainder of this web page details how the reimbursement amount is determined and the factors involved.
All Eligible Staff members are included in the process of determining the total money the district can claim, not just Participating Staff.
Any Eligible Staff member who did not participate in the Time Study process is reimbursed using the same Average Time per Activity and Participation Factor calculated from the Random Staff member Time Sheets.
Each Designated Staff member is treated independently with an Average Time per Activity and Participation Factor established based on the Time Sheets submitted by that staff member for the quarter.
The reimbursement amount for each Eligible Staff member is determined separately based on the individual staff member's salary and benefits.
The Indirect Rate is established by OSPI and is based on information from the Federal Office of Management and Budget (OMB). The same Indirect Rate is applied to all staff members.
This rate represents the maximum amount of money an Eligible Staff member could be compensated through the MAM program for a single work day. This rate is determined by a two step process:
First, the sum of the staff member's salary and benefits eligible for MAM is multiplied by 1 + the Indirect Rate.
Second, that result is divided by the number of contracted days over which the staff members earns that salary and benefits.
A unique Daily Rate is determined for each Eligible Staff member.
Average Time per Activity:
Once all Time Study information is collected for a quarter, DSHS determines the average amount of time a staff member in North Kitsap School District spends on each of the reimbursable Medicaid-related activities (b code activities). These averages are determined by adding up the time spent reported on the activity for the quarter divided by the total amount of paid time reported.
One set of averages is determined using the aggregate of all Random Staff member information. These Average Times are applied to all non-Designated Staff members when determining the reimbursement amount for the staff member.
A separate set of averages is determined for each Designated Staff member based on the information from that staff member's Time Study forms. The specific Average Times for each Designated Staff member are applied when determining the reimbursement amount for that staff member.
Once the Average Time is determined, it is converted from being an amount of time to a fraction of the work day (so from 4 hours to 0.5 work days). This conversion is accomplished by dividing the Average Time by the average number of hours in the work day reported by all Participating Staff members (or each individual Designated Staff as appopriate).
Initial Reimbursable Amount:
The next calculation is done separately for each Eligible Staff member to determine how much the district should be reimbursed for that staff member. A separate reimburseable amount is calculated for each reimburseable activity (b code activity), and those amounts are totaled.
For each activity, the appropriate Average Time is multiplied by the staff member's Daily Rate to determine the amount of reimbursement for each day. This amount is then multiplied by the number of working days in the quarter to determine the Initial Reimbursable Amount for that activity.
This Initial Reimbursable Amount is not the actual reimbursement amount. Instead, it is modified according to each of the factors below. Once these factors are applied, the result is the actual amount the district can claim for reimbursement for that staff member and that particular activity. These amounts are then totaled for each staff member and across all staff members to determine the district reimbursement.
This factor is based on the average number of Time Sheets returned per quarter that included time for a given activity. If only 1 out 10 staff members included time for code 7b, the reimburseable amount generated by each Eligible staff for code 7b would be reduced to a 1/10th (or 10%) of the Initial Reimbursable Amount.
Medicaid Eligibilty Rate (MER)
DSHS establishes a rating factor that is the ratio of the number of students in the district who are enrolled in Medicaid divided by the total number of students in the district. This factor is applied to certain activities, such as Code 9 which includes referrals and follow up, but not others, such as Code 1 which includes outreach and sharing of information. This means that Participating Staff members do not have to know which students are enrolled in Medicaid when tracking activities on the Time Study Form. Participating Staff members may count any appropriate activities on a Time Study Form regardless of a student's Medicaid Status. Applying the MER factor for particular activities allows DSHS to determine how much of that time was Medicaid-related and how much was not so that only the Medicaid portions are reimbursed.
Federal Financial Participation (FFP)
This factor represents how much of the total reimbursement is available for funding through this program. Right now, this rate is 50%.
We are also able to claim time spent administering the program within the district. This time includes collecting, distributing, and validating data within the district and transferring that data to DSHS. The District Coordinator is able to claim time spent and so can each Building Coordinator (as long as the person claiming the time is not part of the Time Study Process). This time is reported to DSHS in total hours worked by each individual together with the hourly salary of that individual. These are multiplied to determine the initital reimbursement amount. That initial reimbursement amount is subject to the same Indirect Rate, MER, and FFP as applied when calculating Eligible Staff reimbursements.