13 Eecve March 1, 2020
Your Medicaid Rights and Responsibilies
Discriminaon Prohibited
Medicaid benets will be extended in full
compliance with the 1964 Civil Rights Act, which
prohibits discriminatory administraon of benets
from federally funded programs because of sex,
race, color, religion, naonal origin, ancestry, age,
polical aliaon or physical/developmental/
mental challenges.
Medicaid does not discriminate on the basis of
disability in admission to or access to its programs
or in its operaons, services or acvies. If you have
quesons or complaints or if you want to talk about
whether you have a disability according to the
Americans with Disabilies Act (ADA), you may
contact the State ADA Coordinator at: WV
Department of Administraon, Building 1, Room
E-119, 1900 Kanawha Blvd., East, Charleston, WV
25305, or call (304) 558-4331, extension 57004.
Condenality
Any informaon obtained from you or concerning
you, including your Social Security Number (SSN),
shall be kept condenal. No informaon regarding
applicants or members shall be disclosed, without
consent, for any purpose other than those directly
concerned with administrave requirements. A copy
of the Medicaid Noce of Privacy Pracces is
provided at the end of this booklet.
Right to Appeal
You have the right to appeal if you are not sased
with the decision regarding your applicaon and/or
it is not handled within a reasonable period of me;
if you were not allowed to le an applicaon; or if
you think you were treated unfairly in any way.
Requests for appeals should be directed to your
local DHHR oce.
If you have received noce of a reducon,
suspension or terminaon of a Medicaid covered
service, you have a right to appeal that denial or
terminaon through the fair hearing process. The
noce that you receive will include an explanaon
of your appeal rights and a form that you may use to
request a fair hearing. You may represent yourself
or use legal counsel, a relave, friend or other
spokesperson.
If you appeal prior to the date of terminaon of a
covered service, you may connue the service unl
a decision is made regarding your appeal. However,
if the state’s acon is upheld, the agency may start
recovery acons to recoup the cost of the services
furnished.
Services
You have the right to choose and/or make decisions
about health care for you and your children. You
may receive medical assistance for your child(ren),
including Early Periodic Screening, Diagnosis and
Treatment (EPSDT).
Upon request, you may receive informaon
regarding:
• Family planning services; and
• Domesc violence services.
You may be qualied to apply for low-priced
telephone services called Tel-Assistance/Lifeline
that the telephone company in your area oers.
With your permission, DHHR may release
informaon to the telephone company concerning
your eligibility for this service. If your eligibility for
Medicaid is stopped, DHHR will nofy the telephone
company.
Right to Informaon
You have the right to see your medical records and
ask quesons about health care.
You have the right to be treated fairly and with
respect.
You have the right to know the laws and rules of the
Medicaid Program and to ask quesons about your
plan.
Changes Aecng Eligibility
You must nofy DHHR of the following within 10
days if:
• Your address, name, or telephone number
changes;
• Anyone in your household obtains/loses
employment or there are changes in your
household income;