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Know Your Rights

Tuesday, September 30, 2014
Freedom of Choice: Most Medicaid recipients may choose the doctor or clinic they wish to use. The doctor or clinic must be willing to accept Medicaid's Payment.
Other Health Insurance (Third Party Liability / TPL): You must report to the Department of Health Care Finance (DHCF) any health insurance you may have. If you have health insurance and Medicaid, you must give your insurance information to your doctor when you get services. Medical payments from any source (insurance, liability coverage, Worker's Comp, employer liability, CHAMPUS, lawsuits, accidents or other) that you get for services covered by Medicaid must be reported to Medicaid. In order to be eligible for Medicaid, you must assign your rights to medical payments from any source to DHCF. 
Things You Must Do to Get Health Care Services: Always remember to take your Medicaid ID card every time you go to get health services. Remember that not all doctors, dentists and other providers accept Medicaid. You should always ask the provider if he accepts DC Medicaid before you get services.
Civil Rights: Participating providers of services in the Medicaid program must comply with the requirements of Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. Under the terms of those laws, a participating provider or vendor of services under any program using federal funds is prohibited from making a distinction in the provision of services to recipients on the grounds of race, age, gender, color, national origin or disability. This includes distinction made on the basis of race or disability with respect to (a) waiting room, (b) hours for appointments or (c) order of seeing patients.  
Fair Hearings: The Social Security Administration (SSA) holds fair hearings for Medicaid eligibility decisions that are part of a Supplemental Security Income (SSI) decision for low income, aged and blind and disabled individuals. You may call the SSA at 1-800-772-1213.  
Fair Hearings:  The Department of Human Service (DHS) - holds fair hearing for Medicaid applicants who thinks DHS has made a mistake in their eligibility decisions.  You may call DHS at (202) 698-4650.
Fraud: Please contact the Department of Health Care Finance at 1-877-632-2873 if your health care provider is: 
performing a service that you think you may not need; 
billing for services you did not get;  or 
asking you to pay for a service you think Medicaid covers.