Your Rights

As a consumer of health services, you have some basic rights. These rights are yours regardless of your health plan or whether you receive health insurance services through the government (Medicaid). You must use your rights and put your needs first to get the services you need.

Medicaid Rights

You have the right to:

• Make your own decisions about your health care.
• Be treated fairly and with respect.
• Have your doctors explain your health care needs to you and talk to you about the different ways your health care problems can be treated.
• To work as part of a team with your provider in deciding what health care is best for you.
• To say yes or no to the care recommended by your provider.
• To be told why services or care were denied or not given.
• Know that your medical records and discussions with your provider will be kept private and confidential.
• Get copies of your medical records.
• Be able to get in and out of a health care provider's office, including barrier free access for persons with disabilities or other conditions limiting mobility, in accordance with the Americans with Disabilities Act.
• Have telephone access to a medical professional 24 hours a day, 7 days a week to get emergency or urgent care.
• Get medical care in a timely manner.
• Get emergency care from the emergency room nearest you.
• Be free from discrimination based on disability, race or national origin.
• Choose family planning services and have your choice kept confidential.
• Have interpreters, if needed, for appointments with your DHS worker, your doctor or when talking to your health plan. Interpreters include people who can speak in your native language, assist with a disability, or help you understand the information.
• Be given an explanation you can understand about your health plan rules, including the health care services you can get and how to get them.
• Make a complaint to your health plan or to the State Medicaid program about your health care, your provider, or your health plan.
• Get a timely answer to your complaint.
• Request a Medicaid Fair Hearing from the State about your complaint.
• Request a Medicaid Fair Hearing when you are denied eligibility or access to a Medicaid service.

STAR Medicaid Managed Care Rights

In addition to your Medicaid rights, you have more rights in STAR. Make sure you know your STAR rights.

These include the right to:

• Be informed of how to choose and change your health plan and your primary care provider (PCP).
• Choose any health plan you want that is available in your area.
• Choose your primary care provider (PCP) from the plan that you picked.
• Ask your health plan medical director to use a specialist as your primary care provider (PCP). This applies if you have a disability, or a chronic or life-threatening condition.
• Change your primary care provider (PCP) up to four times per year.
• Change your health plan when you need to (as often as every 30 days).
• Continue to see your doctor or specialists when you enroll in a health plan or when your doctor or specialists leave your health plan. This applies to you if you have a disability or chronic condition, are in the middle of treatment for a sudden, short-term condition; have a life-threatening illness; or are past the 24th week of pregnancy. The health plan must allow you to continue to see your doctor or specialist for at least 90 days. This also applies to new health plan members that go from regular Medicaid into managed care (STAR).
• Access any "value-added service" that the health plan offers.
• File a complaint and ask for a formal review of decisions made about your services.
• Request an expedited appeal when you need the HMO to make a decision quickly based on your health status and taking the time for a standard appeal could jeopardize your life or health.
• Have an expedited Medicaid Fair Hearing (appeal to the state) for an expedited appeal (with your health plan) when the issue is the denial of authorization for a service.
• Have a Medicaid Fair Hearing (appeal to the state) if you feel your managed care plan has not settled a complaint or provided care to your satisfaction.
• Sue your Healthcare Maintenance Organization (HMO) for medical malpractice if you believe you were harmed because medically necessary services were not given to you.

Home | Clients | Providers | Contact Us | Sign Up