Client rights

Medicaid participants 182-538-180 rights and protections

Individuals who apply and are eligible for Medicaid-funded health care services have Medicaid specific rights under WAC 246-341-0600.

• Individuals who apply and are eligible for Medicaid-funded health care services have Medicaid specific rights.
• Individuals with Medicaid-funded insurance have participant rights under WAC 246-341-0600.
• Participants may ask for help with completing and submitting forms to the agency.
• Participants may ask for help with giving and receiving the information that the agency needs in order to decide continuing eligibility.
• Participants may ask for help with requests continuing benefits.
• Participants may ask for help with the assistance of explaining the reduction in or ending of benefits.
• Participants may ask for assistance with requests for administrative hearings.
• On request, participants may ask for assistance in reviewing the agency's decision to terminate, suspend, or reduce benefits.
• Participants may receive the name, address, telephone number, and any languages offered other than English of providers in a managed care organization (MCO).
• Participants may receive information about the structure and operation of the MCO and how health care services are delivered.
• Participants may receive emergency care, urgent care, or crisis services.
• Participants may receive poststabilization services after receiving emergency care, urgent care, or crisis services that result in admittance to a hospital.
• Participants may receive age-appropriate and culturally appropriate services.
• Participants may ask to be provided with a qualified interpreter and translated material at no cost to the individual.
• Participants may request to receive information and help in the language or format of their choice.
• Participants may have an explanation of alternative treatment options and alternative treatment options.
• Participants may refuse any proposed treatment option.
• Participants have the right to receive care that does not discriminate.
• Participants have the right to receive care that is free of any sexual exploitation or harassment.
• Participants may create an advance directive that states the individual’s choices and preferences for health care services under 42 C.F.R. Sec. 489 Subpart I.
• Participants may choose their own contracted health care provider.
• Participants may request and receive a copy of their health care records.
• Participants may be informed if there is a cost for copies.
• Participants have the right to be free from retaliation.
• Participants my request to receive the policies and procedures of the MCO as they relate to health care rights.
• Participants have the right to receive services in an accessible location.
• Participants may receive medically necessary services in accordance with the early and periodic screening, diagnosis, and treatment (EPSDT) program under WAC 182-534-0100, if the individual is age twenty or younger.
• Participants have the right to be treated with dignity, privacy, and respect.
• Participants have the right to receive treatment options and alternatives in a manner that is appropriate to the individual’s condition.
• Participants have the right to be free from seclusion and restraint.
• Participants may receive a second opinion from a qualified health care professional within an MCO provider network at no cost or having one arranged outside the network at no cost, as provided in 42 C.F.R. Sec. 438.206(b)(3).
• Participants may receive medically necessary health care services outside of the MCO if those services cannot be provided adequately and timely within the MCO.
• Participants have the right to file a grievance with an MCO if the individual is not satisfied with a service provided.
• Participants may receive a notice of action in order to appeal any decision by the MCO.
• Participants may appeal an MCO decision that Denies or limits authorization of a requested service.
• Participants may appeal an MCO decision that reduces, suspends, or terminates a previously authorized service.
• Participants may appeal an MCO decision that denies payment for a service, in whole or in part.
• Participants have the right to file an appeal if the MCO fails to provide health care services in a timely manner as defined by the state or act within the time frames in 42 C.F.R. Sec. 438.408(b).
• Participants have the right to request an administrative hearing if an appeal is not resolved in a person's favor.