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Medi-Cal Administrative Activities

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					                                                                                 Appendix J


                 Medi-Cal Administrative Activities (MAA) Overview

At the very outset, it should be noted that TCM case managers are prohibited from
providing MAA with the exception that they can provide Outreach A services “provided
there is an accurate accounting and reporting of time spent on each” (CDHS MAA
Manual page 37 – the prohibitions on providing other MAA services begin on page 39).

Brief Program Overview
Medi-Cal Administrative Activities for which Probation Departments might claim
include outreach activities intended to
    - Bring potential eligible persons into the Medi-Cal system to determine their
       eligibility
    - Encouraging Medi-Cal eligible persons to obtain Medi-Cal Services
    - Refer persons, including those eligible for Medi-Cal to services covered by Medi-
       Cal
    - Assist persons to apply for Medi-Cal through provision of information,
       application forms, assistance in completing forms, etc.
    - Arrange for non-emergency, non-medical transportation for purposes related to
       applying for Medi-Cal eligibility or services. This often takes the form of
       providing vouchers for public transportation. (Non-emergency, non-medical
       refers to the type of vehicle used. Emergency medical means ambulance.)

Federal Participation in Costs
The extent to which there is federal reimbursement for the costs of MAA depends on the
nature of the activities
    - Outreach A activities (bringing potentially eligible persons into the Medi-Cal
        system to determine their eligibility and encouraging Medi-Cal eligible persons to
        obtain Medi-Cal services) are reimbursed at 50% of cost.
    - Outreach B activities (referring persons from the general population, regardless of
        their Medi-Cal eligibility status, to medical services and encouraging them to
        obtain needed health-related service) are reimbursed at 50% of cost discounted by
        the Medi-Cal eligibility rate. The Medi-Cal eligibility rate is established either by
        determining how many of those served are enrolled in Medi-Cal (generally
        through computer matching) or by using the county-wide Medi-Cal eligibility rate
        published by the CDHS.
    - Facilitating Medi-Cal application (explaining Medi-Cal eligibility rules, helping
        applicants fill out application forms, etc.) is reimbursed at 50%.
    - Providing non-emergency, non-medical transportation is reimbursed at 50%.

Time Study
One month each year is selected by CDHS for the time study which forms the basis for
MAA claiming. The month varies each year. The time study is similar in process to the
TCM time survey.

TCM vs. MAA
                                                                                 Appendix J


TCM is case-specific. Services are provided to identified individuals and a detailed
record of services provided is required. MAA is activity-specific. Most activities are
aimed at groups rather than individuals (an exception is helping individuals apply for
Medi-Cal). No records of activities with specific individuals are required.

MAA is a much simpler program. Other than the annual time study, there are no
administrative requirements placed on line staff. A manager must be given the job of
ensuring that required administrative and financial records are maintained. Claiming
information is provided to the county MAA/TCM Coordinator. Job descriptions or duty
definitions must contain language showing that staff is expected to provide MAA type
services (CDHS MAA Manual page M.5-2-8). Only a careful analysis of MAA activities
currently being conducted or planned for the future will reveal the likely revenue to be
derived from MAA claiming.

The following is hypothetical example of how a department might claim for MAA.
Departments can substitute data more likely to be characteristic of their practices to
obtain better estimates of potential revenue.

Outreach A Activities
A brochure describing Medi-Cal, application procedures, and written encouragement to
apply is supplied as part of the packet of information given to new adult probationers.
The assigned deputy probation officer spends 3 minutes discussing the brochure with the
probationer. On average one new probationer is seen each day by a typical deputy
probation officer. (15 minutes per week x 50% = 7.5 minutes per week)

Outreach B2 Activities
As deputy probation officers become aware of a probationer’s need for medical or
general health maintenance assistance, the probationer is referred to service providers and
encouraged to obtain needed services. This process takes 5 minutes. A typical deputy
probation officer makes one such referral each work day. (25 minutes per week x 50% =
12.5 minutes per week x 18% (statewide Medi-Cal rate) = 2.25 minutes per week)

Facilitating Medi-Cal Application
During either of the above two activities, the probationer lets the deputy probation officer
know (s)he is concerned about all the paperwork associated with applying for Medi-Cal.
The deputy probation officer spends 15 minutes going over an actual Medi-Cal
application form and helping the probationer fill in the required information. This
process occurs, on average 2 times a week. (30 minutes per week x 50% = 15 minutes
per week)

Arranging for or Providing Transportation
Following the filling out of the application form described above, the probationer says
(s)he has no way of getting to the welfare department office to turn in the application.
The deputy probation officer provides a bus voucher. This process takes 1 minute and
the bus voucher costs the probation department $2. (2 minutes per week x 50% = 1
minute per week)
                                                                                   Appendix J



Federal MAA Revenue as a Percentage of Total Cost
The total time spent by this hypothetical deputy, reduced by the federal participation rate
and the Medi-Cal eligibility rate (required for Outreach B2) results in 25.75 minutes per
week being paid for by federal revenue. In this hypothetical example, federal MAA
revenue would pay for about 1% of the deputy’s salary/benefits/and overhead. It should
be noted that the 18% Medi-Cal eligibility rate used was a state-wide average. Individual
county rates vary from about 7% to 28%. Counties with eligibility rates higher than the
state average would recover a larger percentage of actual cost. Counties with eligibility
rates lower than the state average would recover a smaller percentage of actual cost.

It should also be stressed that the above calculation methodology is provided only as an
approach to estimating potential revenue. The actual numbers used in the calculations
will probably vary considerably depending on the nature of the MAA program in place or
envisioned.

Medi-Cal Eligibility Criteria
While Medi-Cal eligibility is influenced by many factors, generally, “to be eligible for
Medi-Cal, a person must be “linked” to one of the two major public assistance cash grant
programs, either California Work Opportunity and Responsibility to Kids (CalWORKs)
or Supplemental Security Income (SSI). To be “linked” to CalWORKs, the family must
include at least one child who is deprived of parental support or care, generally due to the
absence, unemployment, or disability of one parent. Linkage to SSI is based on age (65
years of age or older), blindness, or disability. Virtually all eligibility categories, whether
mandatory or optional, include only individuals who have linkage to one of these two
programs.” (See the section on eligibility in the MAA Manual starting on page M.2-1-2)

The CDHS MAA Manual can be found at http://www.dhs.ca.gov/MAA.

				
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