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8.1.9.2 Client Responsibilities
Medicaid managed care health plans and primary care providers should help clients understand their responsibilities. These include the responsibility to:
• Learn and understand each right they have under Medicaid. That includes the responsibility to:
•Learn and understand their rights under the Medicaid program.
•Ask questions if they do not understand their rights.
•Learn what choice of health plan is available in their area.
•Abide by the health plan and Medicaid managed care policies and procedures. That includes the responsibility to:
•Learn and follow their health plan rules and Medicaid rules.
•Choose their health plan and a primary care provider.
•Make any changes in their health plan and primary care provider in the ways established by Medicaid managed care and by the health plan.
•Keep their scheduled appointments.
•Cancel appointments in advance when they cannot keep them.
•Always contact their primary care provider first for nonemergency medical needs.
•Be sure they have approval from their primary care provider before going to a specialist (except for self-referred services).
•Understand when they should and should not go to the ER.
•Share information relating to their health status with their primary care provider and become fully informed about service and treatment options. That includes the responsibility to:
•Tell their primary care provider about their health.
•Talk to their providers about their health-care needs and ask questions about the different ways their health-care problems can be treated.
•Help their providers get their medical records.
•Actively participate in decisions relating to service and treatment options, make personal choices, and take action to maintain their health. That includes the responsibility to:
•Work as a team with their providers in deciding what health care is best for them.
•Understand how the things they do can affect their health.
•Do the best they can to stay healthy.
•Treat providers and staff with respect.
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