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Kittitas County Public Health Public Health <br />Contract/Agreement Review Form <br />Today's Date: <br />11 /25/2025 <br />Legal Request #: <br />12072 <br />Fund/Department: <br />116- Pubic Heatlh <br />Agenda Date: <br />rnntrart/AorPPmPnt Information <br />Contract/Agreement Agency: Washington State Health Care Authority <br />Contract/Agreement Title: Interagency Agreement for Medicaid Administrative Claiming <br />Begin Date: 01 /01 /2026 <br />End Date: 12/31 /2029 <br />Total $ Amount: No max amount <br />Contract/Agreement #: K863O <br />Contract/Agreement Summary: <br />The purpose of this Contract is to support Medicaid related outreach and linkage activities <br />performed by Local Health Jurisdictions (LHJ) to Washington State residents who live within its <br />jurisdiction. These activities assist residents who have no or inadequate medical coverage, and <br />includes explaining the benefits of the Medicaid program, assisting them in the Medicaid <br />application and renewal processes, and linking them to Medicaid covered services. This <br />Agreement provides a process for partially reimbursing the Contractor for allowable and <br />reasonable expenses associated with the time its staff spend performing Medicaid Administrative <br />Claiming (MAC) activities. <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />re of Pksecutor's Off' VEDate <br />E�EID <br />Gam. -- C.fitM <br />Sienat a of Auditor's <br />Rirrivat Infnrmatinn <br />ZME <br />Date <br />_4 <br />Revenue Code(s): <br />116 - 612.95.333.93.778 <br />Expense Code(s): <br />116 - 612.95.51001 <br />0 <br />Agency is not suspended/disbarred <br />Not Checked (reason) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub -Contract Approved Date: <br />ADMIN I Version: 0 1 Supersedes: 0 1 Date Adopted: 12/01/2024 Modified By: Katie Odiaga I Approval By: Chelsey Loeffers <br />