Download - Trad Med Handbook
-
7/27/2019 Trad Med Handbook
1/20
Free Help Line
1-800-335-8957
Your Health
2012 EditionCare Guide
Vea al dorso
la version
en espaol.
-
7/27/2019 Trad Med Handbook
2/20
- Your address.
- Your expenses.
- People living in the home.
- Amount o money you get(income).
- Things you own (resourcesor assets).
- Insurance (including healthinsurance premiums).
- Land and buildings you own(property).
Ifyouneed
help
withthisgu
ide,
callthefree
MedicaidHelp
Line
at1-800-335-8957.
Remember
Pick one doctor or clinic or your health care.
Get prescriptions only rom your main doctor or
specialists that your doctor reers you to.
Try to use one drug store at one location to get al l o your medicine.
Do not get the same type o medicine rom dierent doctors.
Use the emergency room or an urgent care clinic only when you need
treatment right away.
Take your Medicaid ID to doctor visits and to the drug store.
Do not let anyone else use your Medicaid ID.
I you have a doctor visit and you cant make it, call the doctors ofce to
cancel. Then set up a new visit.
Tell us about changes to your case within 10 days o the change. When youhave a change, call 2-1-1 or 1-877-541-7905. Tell us about changes in things
such as:
-
7/27/2019 Trad Med Handbook
3/20
This guide tells you how to
use your Medicaid benefts.
Welcome.
This guide is
rom the Texas Healtand Human Services
Commission (HHSC).HHSC is the state agency
that runs Texas Medicaid. C1-800-335-8957 to ask or copy o this guide in audiolarge print, Braille, or othe
languages.
-
7/27/2019 Trad Med Handbook
4/20
Where to Get Help
Get Help on the Phone
Medicaid Help Line1-800-335-8957
Monday to Friday, 7 a.m. to 7 p.m.
Call this number to:
Find a Medicaid doctor.
Learn more about Medicaid services.
Texas Health Steps
1-877-847-8377
Monday to Friday, 8 a.m. to 8 p.m.
Call this number to nd a Texas Health Stepsdoctor, dentist, or other provider. Texas HealthSteps is or children, teens, and young adults age20 and younger.
Rides to the Doctor, Dentist, or Drug
Store
1-877-633-8747
Monday to Friday, 8 a.m. to 5 p.m.
Call this number i you need a ride or gas money
to get to visits with your Medicaid providers.
Relay Texas - For People with
a Hearing or Speech Disability
7-1-1 or 1-800-735-2989
Any time, day or night
Call any HHSC oce or program by using therelay service o your choice. The state o Texasofers Relay Texas at 7-1-1.
Alloft
he
phonen
umbers
inthis
bookar
e
freeto
call.
www.YourTexasBenefts.com
View your Medicaid services and healthhistory.
Check your benets case.
Finding Help in Texas2-1-1
Dialing 2-1-1 is a ree, easy way to nd outabout services you can get in your area orthrough state programs. Staf can talk to youMonday to Friday, 8 a.m. to 8 p.m. CentralTime.
Call 2-1-1 to:
Report changes to your case. (Youshould do this within 10 days o thechange.)
Check your Medicaid benets.
Check that we received items you sentus.
When you dial 2-1-1, pick a language andthen press 2. I you cant connect to 2-1-1,call 1-877-541-7905. You also can visit the2-1-1 Texas website at www.211texas.org tond services in your area.
Complaints about Medicaid Services1-877-787-8999
Monday to Friday, 8 a.m. to 5:30 p.m.
Call this number ater you call the oce orprogram you have a complaint about.
www.hhsc.state.tx.us
Learn about other benet programs.
Report Medicaid abuse or raud.
Get Help on the Web
-
7/27/2019 Trad Med Handbook
5/20
Services or EveryoneW M cvr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
un yr tx Bnf M cr . . . . . . . . . . . . . . . . . . .3
Fnn M dr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
gn Mn n spp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4gn R dr, dn, r dr sr . . . . . . . . . . . . . .5
hp r Mn h, dr, r a Prbm . . . . . . . . . . . . . . .6
Rprn an . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
or h inrn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
M B-in Prrm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Services or ChildrenM n dn cr w tx h sp . . . . . . . . . . . . . . . .9
hp r crn w db r d n
grwn r lrnn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Services or WomenWmn h Prrm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Br n crv cnr Prrm . . . . . . . . . . . . . . . . . . . . . . . . .11
exr hp r Prnn Wmn . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
sp smkn hp r Prnn Wmn . . . . . . . . . . . . . . . . . . . . . 12
Services or People Age 65 and Older
and People with Disabilitiesln-trm srv . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Medicaid RulesM Prrm R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Rpr M W, ab, r Fr . . . . . . . . . . . . . . . . . . . . . .14
Your Rightsyr R W gn M . . . . . . . . . . . . . . . . . . . . . . . . . 15
yr R Prv . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
yr R yr h F . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15yr R b tr Fr . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
yr R Fr hrn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
yr R F cmpn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Content
s
-
7/27/2019 Trad Med Handbook
6/20
2 | Need a ride to the doctor, dentist, or drug store? Call 1-877-633-8747
Services or EveryoneWhat Medicaid CoversMedicaid pays or many health-care services. Here are some examples:
Doctor and clinic visits.
Hospital visits.
Emergency care.
Medicine.
Glasses.
Dentist visits.
Family planning.
Pregnancy and childbirth care.
Mental health care.
Care in a nursing home or other place o care.
Care in your home.
Speech therapy (helps you learn how to speak again or speak better).
Occupational therapy (helps you learn how to do everyday activities
like getting around your home, getting in a car, and getting dressed). Physical therapy (helps you learn how to move around better or
become stronger).
To nd out about other services, call the Medicaid Help Line at
1-800-335-8957.
-
7/27/2019 Trad Med Handbook
7/20
Medicaid Help Line 1-800-335-8957 | 3
Using the Your Texas BeneftsMedicaid Card
What is the Your Texas Benefts Medicaid card?
Its your Medicaid ID card. It's plastic and it has your Medicaid ID
number and other acts you need to get Medicaid services.
How oten will I get a new card?
You will get a new Your Texas Benets Medicaid card when you are
rst approved or Medicaid.
You will get a new card i yours is lost or stolen and you ask or a
new one.
You will get a new card i the type o Medicaid you get changes.
When do I use the Your Texas Benefts Medicaid card?
Carry the card with youjust like your drivers license or a credit card.
Take it with you every time you:
Visit your Medicaid doctor or dentist.
Get medicine at the drug store.
Go to the hospital.
They will use the acts on your card to make sure youre covered by
Medicaid.
YourTexasBenefts.comBy using this site, you can:
Check your Medicaid case.
View your Medicaid health history.
Update your address and phone number.
Get Texas Health Steps reminders.
Apply or other benets such as SNAP ood benets.
Get answers to common questions.
What i I lose my card?
I you lose your card or have problems using
it, call 1-855-827-3748. I you dont have your
card, you can still go to your doctor, dentist, or
drug store. They will need to make a call or go
online to see i you get Medicaid.
-
7/27/2019 Trad Med Handbook
8/20
4 | Need a ride to the doctor, dentist, or drug store? Call 1-877-633-8747
Finding a Medicaid Doctor
What i I dont have a doctor or my doctor doesnt take
Medicaid?
Call the Medicaid Help Line at 1-800-335-8957.
Go to www.hhsc.state.tx.us. Click on Questions about your benets.
Then click on Find a Doctor.
How will I know when to use the emergency room or an urgent
care clinic?
The rst time you visit your Medicaid doctor, ask what health problems
you should call him or her about. Also, ask i your doctors oce is open
in the evenings or on the weekends. This will help you avoid going to the
emergency room when its better to go to the doctors oce. Most health
problems do not need a trip to the emergency room.
I you need treatment right away and you cant visit with your doctor,
you can go to an urgent care clinic. These clinics usually have night and
weekend hours. You dont need to call the clinic beore going. You must go
to a clinic that takes Medicaid. To nd one near you, call 1-800-335-8957.
Getting Medicine and Supplies
How do I get my medicine?
Medicaid pays or most medicine that your doctor says you need. Yourdoctor will write a prescription so you can take it to the drug store.
Children age 20 and younger do not have a limit on medicines.
Most adults (age 21 and older) have a limit o 3 medicines each month.
Medicine that helps you quit smoking doesnt count toward the limit o
3 medicines.
How do I fnd a drug store that takes Medicaid? Visit www.hhsc.state.tx.us. Click on Questions about your benets?
Then click on Find a Drug Store.
Call 2-1-1 or the Medicaid Help Line at 1-800-335-8957.
What i my medicine needs pre-approval?
Some medicine needs to be pre-approved beore you can pick it up rom
the drug store. The drug store will need to get this pre-approval rom your
doctor. I they cant reach your doctor right away, they should give you a 3
day supply until your doctor approves the medicine.
Where do I get my
medicine?
Find a drug store thattakes Medicaid.
Use this same drugstore every time.
-
7/27/2019 Trad Med Handbook
9/20
Medicaid Help Line 1-800-335-8957 | 5
What i I need help getting medical supplies or equipment?
Call the Medicaid Help Line or2-1-1 to nd a drug store that can help
you get supplies or equipment. Supplies and equipment can include:
Spacers or inhalers to treat asthma.
Diabetic supplies.
Crutches.
Getting a Ride to the Doctor,Dentist, or Drug Store
What i I need a ride?
Children with Medicaid and their parent can get ree rides or gas
money to help get to and rom Medicaid-covered visits. Adults with
Medicaid can get ree rides, too. You can get gas money or rides to:
Pick up medicines covered by Medicaid at a drug store. Go to a Medicaid doctor or dentist.
How do I set up a ride?
Set up a ride or the day and time o your doctor visit. I you need
to go to a drug store, nd out when your medicine will be ready.
Call 1-877-633-8747 Monday to Friday, 8 a.m. to 5 p.m. Central
Time.
Call at least 2 weekdays (Monday to Friday) beore you need a
ride. I it will be a long ride, or the doctor is in another county, call
at least 5 weekdays ahead. I you need a ride sooner than that, call1-877-633-8747.
Have your Medicaid ID or Social Security number ready when you
call.
What kind o ride can I get?
You can get rides by bus, van, car, or plane.
I you have a car but no money or gas, Medicaid might be able to
send you gas money or your trip.
Someone you know (amily, neighbor, or riend) can give you a ride
and get paid back by the mile.
To learn more:
Call 1-877-633-8747.
Visit www.hhsc.state.tx.us. Click on Questions about your
benets? Then click on How to Get a Ride to the Doctor,
Dentist, or Drug Store.
Important
Theres a diferent number to
call or rides i you live in th
Dallas / Fort Worth or
Houston / Beaumont areas.
Dallas / Fort Worth Call
1-855-687-3255 to set up a
ride i you live one o these
counties: Collin, Dallas,
Denton, Ellis, Hood, Hunt,
Johnson, Kauman, Navarro,
Parker, Rockwall, Tarrant, or
Wise.
Houston / Beaumont Call
1-855-687-4786 to set up a
ride i you live in one o the
ollowing counties: Austin,
Brazoria, Chambers, FortBend, Galveston, Hardin,
Harris, Jasper, Jeferson, Libe
Matagorda, Montgomery,
Newton, Orange, Polk, San
Jacinto, Tyler, Walker, Waller,
Wharton.
-
7/27/2019 Trad Med Handbook
10/20
6 | Need a ride to the doctor, dentist, or drug store? Call 1-877-633-8747
Help or Mental Health,Drug, or Alcohol Problems
What kind o help can I get?
A visit to nd out what type o help you need.
Tests.
Counseling.
Medicine.
Hospital care.
Drug and alcohol treatment.
How do I get help or mental health, drug, or alcohol problems?
Ask your doctor to help you nd a provider who ts your needs. A provider can
be a doctor, therapist, hospital, community mental health center, or drug abuse
treatment acility.
Reporting Accidents
What i I have an accident?
I Medicaid paid or medical care that you got or an accident or injury,
you must call 1-800-846-7307 and give:
Your name.
Medicaid ID number.
Date o the accident or injury.
Also, give the name, address, and phone number o your lawyer or insurance
company i:
You have a lawyer working or you.
There is an insurance company involved.
You led a claim or this accident or injury.
You also must tell Medicaid staf about any lawsuits you or your amily le or
being injured. Include the name and address o your lawyer or the insurance
company working on your lawsuit.
It is important to ollow all o these rules to keep your Medicaid benets.
You also can mail your inormation to: TMHP/TORT
PO Box 202948
Austin, TX 78720-2948
ImportantI you live in Collin,
Dallas, Ellis, Hunt,
Kauman, Navarro, or
Rockwall County, and
need help with mental
health problems, call:
NorthStar at
1-888-800-6799
Or
The North Texas
Behavioral Health
Authority at
1-877-653-6363.
-
7/27/2019 Trad Med Handbook
11/20
Medicaid Help Line 1-800-335-8957 | 7
Other Health Insurance
I I have other insurance, can I still get Medicaid services?
You can still see a Medicaid doctor i you have other insurance and
Medicaid. I a doctor takes you as a Medicaid patient, the doctor must le
claims with your other insurance.
You must tell Medicaid staf about any other health insurance you have.
This includes insurance or medicine. Call 1-800-846-7307 i:
You lose your other insurance.
You get new insurance.
You have questions about other insurance.
Will Medicaid help me pay or other insurance?
The Medicaid Health Insurance Premium Payment (HIPP) program can
pay or other health insurance i:
Someone in your amily gets Medicaid. It could be you, your spouse, or
your child, and
Someone in your amily can get health insurance at work.
People in the HIPP program can:
Get coverage rom another health insurance plan.
Get coverage or amily memberseven those who dont get Medicaid.
Go to any doctor who takes the other insurance.
To learn more: Call 1-800-440-0493.
Visit www.GetHIPPTexas.org.
How do I keep getting Medicaid?
Most people must sign up every 6 months to keep getting Medicaid. We will send you a
orm in the mail to renew Medicaid benets. Fill out the orm and mail it back. I you have
questions, call 2-1-1 or your HHSC benets oce.
-
7/27/2019 Trad Med Handbook
12/20
8
Medicaid Buy-In Programs
What are the Medicaid Buy-In programs?
Medicaid Buy-In programs ofer health-care services to people who make
too much money to be approved or other types o Medicaid. Buy-inprograms allow some people to get Medicaid by paying a monthly ee.
Services can include community-based services and supports.
To be in the Medicaid Buy-In program or people with disabilities who
work, a person must:
- Have a physical, intellectual, developmental, or mental disability.
- Work.
- Live in Texas.
- Not live in a state institution or nursing home all the time.
To learn more, visit www.hhsc.state.tx.us. Click on How to get help.Then click on People 65 and Older and People with Disabilities.
To be in the Medicaid Buy-In or Children program, a child must:
- Be age 18 or younger.
- Not be married.
- Meet the same rules or a disability that are used to get
Supplemental Security Income (SSI). The child doesnt have to get
SSI.
- Live in Texas.
To learn more
Go to www.hhsc.state.tx.us. Click
on How to get help. Then clickon Children.
-
7/27/2019 Trad Med Handbook
13/20
Medicaid Help Line 1-800-335-8957 | 9
Services or ChildrenMedical and Dental Carewith Texas Health StepsTexas Health Steps is the Medicaid health program or people age 20
and younger. Texas Health Steps services include:
Medical checkups and treatment.
Dental checkups and treatment starting at 6 months old.
A case manager to help you nd and get other services.
Texas Health Steps will help you:
Find a doctor, dentist, or case manager.
Set up doctor and dentist checkups.
Learn about services or your child.
Get a ree ride or gas money to get to checkups or the drug store.
Medical and dental checkups will:
Help nd problems beore they get worse and are harder to treat.
Make sure your child is growing like other children their age.Children need these checkups even when they are healthy.
How is your baby?
Children grow and learn
more in their rst 3 years
than any other time in their
lives. Is your baby having
diculty learning to sit up,
walk, or talk? I yes, talk to
your childs doctor or:
Call 1-800-628-5115.
Visit www.dars.state.tx.us
Click on EarlyChildhood Intervention
Services.
-
7/27/2019 Trad Med Handbook
14/20
10 | Need a ride to the doctor, dentist, or drug store? Call 1-877-633-8747
When is the right time or a Texas Health Steps checkup?
Texas Health Steps will send you a letter when your child is due or a
medical or dental checkup. Even i your child is not due or a checkup,
Medicaid will pay or health services i your child is sick or in pain.
Medicaid also will pay to treat other health problems ound during a Texas
Health Steps checkup.
To learn more: Call 1-877-847-8377 or2-1-1.
Visit www.dshs.state.tx.us/thsteps.
Help or Children with Disabilitiesor Delays in Growing or LearningChildren age 2 and younger who have disabilities or delays in growing
or learning can get special help. You can get a checkup to see i
your childs growth and learning are on target. We can visit your
childs home or child care center. To learn more, watch the videos at
www.dars.state.tx.us/ecis/videos.
To learn more: Call 1-800-628-5115.
Visit www.dars.state.tx.us. Click on
Early Childhood Intervention Services.
Extra Help or Children withSpecial Health NeedsAsk to get a case manager to help you i:
Your child has a health issue, disease, or disability (such as asthma,
diabetes, or mental health problems).
Your child is at risk or certain health problems (due to things such as
your amilys health history or growing or eating issues).
A case manager can help you:
Work with doctors and get medical services.
Deal with amily, school, housing, and other concerns.
Get medical equipment and supplies.
Work with other agencies.
To learn more: Call 1-877-847-8377.
Visit www.dshs.state.tx.us.
You can use this checklist
to make sure your child gets
checkups at certain ages:
3-5 days old
2 weeks old
2 months old
4 months old
6 months old
9 months old
12 months old
15 months old
18 months old
2 years old
2 1/2 years old
Children 3 years and older
need Texas Health Steps
checkups once a year.
-
7/27/2019 Trad Med Handbook
15/20
Medicaid Help Line 1-800-335-8957 | 11
Services or WomenWomens Health ProgramThis program is or women who are age 18 to 44 and not pregnant. Women
in this program can get limited Medicaid services or health issues such as:
A history o pregnancies with problems.
Diabetes.
High blood pressure.
Heart disease beore pregnancy.
Vaginal bleeding.
Drug abuse or mental health issues.
A amily planning exam every year, which might include:
- Pap smear.
-Screening or breast and cervical cancers, diabetes, sexually transmitteddiseases, and high blood pressure.
- Family planning counseling and education, including natural amily
planning and abstinence.
- Birth control (except emergency birth control).
To learn more: Call 1-866-993-9972.
Visit www.hhsc.state.tx.us. Click on How to get help.
Then click on Women. Scroll down to Womens
Health Program.
Breast and Cervical Cancer ProgramMedicaid covers medical care or women age 18 to 64 who have:
Breast cancer.
Cervical cancer.
Some breast or cervical pre-cancer conditions.
Women in this program get ull Medicaid services while getting treatment.
To learn more: Call 2-1-1.
Visit www.hhsc.state.tx.us. Click on How to Get
Help. Then click on Women. Scroll down toMedicaid or Breast and Cervical Cancer.
-
7/27/2019 Trad Med Handbook
16/20
12 | Need a ride to the doctor, dentist, or drug store? Call 1-877-633-8747
Extra Help or Pregnant WomenMedicaid ofers help with getting medical services and other needs or
women with high-risk pregnancies. The people who give this help are
called case managers.
Ask or a case manager or help i you are pregnant and have health issuessuch as:
A history o pregnancies with problems.
Diabetes.
High blood pressure.
Heart disease beore pregnancy.
Vaginal bleeding.
Drug abuse or mental health issues.
To learn more: Call 1-877-847-8377.
Visit www.dshs.state.tx.us/caseman.
Stop Smoking Help orPregnant WomenStarting January 1, 2012, pregnant women age
10 to 55 can get help rom their doctor to stop
smoking. Women can get up to 8 counseling
sessions per pregnancy. The sessions can take place
during the pregnancy and 6 weeks ater the birth o
the baby. To learn more, ask your doctor.
-
7/27/2019 Trad Med Handbook
17/20
Medicaid Help Line 1-800-335-8957 | 13
Services or PeopleAge 65 and Older andPeople with DisabilitiesLong-Term ServicesI you have a long-lasting illness or disability, you might be able to get help
with daily health-care and living needs. This help can be at home or in an
adult day care center, nursing home, or assisted living acility.
A case manager can help you get the services you need. Long-term
services include:
- Help dressing, bathing, and using the bathroom.
- Help xing meals, grocery shopping, and using money.
- Help with light housework.
- Nursing care in the home.
- Hospice services (care or people in severe pain due to diseases such
as cancer).- Care in a nursing home or other place o care.
To learn more:
Call 2-1-1 or Consumer Rights and Services at 1-800-458-9858.
Visit www.dads.state.tx.us. Click on Help or Texans.
-
7/27/2019 Trad Med Handbook
18/20
14 | Need a ride to the doctor, dentist, or drug store? Call 1-877-633-8747
Medicaid RulesMedicaid Program RulesI you get Medicaid, you must ollow these rules:
Pick one doctor or clinic to see when you need care.
Be sure your main doctor and any specialists you see are the only doctors that give you prescriptions. Pick one drug store to use all the time.
Do not get the same type o medicine rom diferent doctors.
Do not use the emergency room i you dont have an emergency.
I you dont ollow these rules, you might be put in the Medicaid Limited Program. This program might
limit which doctor and drug store you can use. You also might be put in this program i you commit raud
or abuse services.
We will let you know i you are going to be put in the Limited Program. People in this program stil l get
Medicaid benets. To learn more, call 1-800-436-6184. Pick option 8.
Report Medicaid Waste, Abuse, or FraudLet us know i you think a doctor, pharmacist at a drug store, other health-care provider, or a person getting
Medicaid is doing something wrong. Doing something wrong could be waste, abuse, or raud, which is
against the law. For example, tell us i you think someone is:
Getting paid or Medicaid services that werent given or necessary.
Getting Medicaid services that are not approved.
Not telling the truth about a medical condition to get medical treatment.
Letting someone else use a Medicaid ID.
Using someone elses Medicaid ID. Not telling the truth about the amount o money or resources he or she has.
To report waste, abuse, or raud, you can do one o the ollowing:
Call 1-800-436-6184.
Visit oig.hhsc.state.tx.us. Click on Click Here to Report Waste, Abuse, and Fraud. Fill out the
online orm.
Mail a letter to report a doctor, pharmacist, or other provider to:
Ofce o Inspector General
Medicaid Provider Integrity / Mail Code 1361
PO Box 85200 Austin, TX 78708-9920
Mail a letter to report a person who gets Medicaid to:
Ofce o Inspector General
General Investigations / Mail Code 1368
PO Box 13247 Austin, TX 78711
-
7/27/2019 Trad Med Handbook
19/20
Medicaid Help Line 1-800-335-8957 | 15
Your RightsYour Rights While Getting Medicaid
You have the right to:
Be treated airly and with respect by doctors and medical staf.
Be treated airly, regardless o race, color, national origin, sex, age, disability, religion, or political belies.
Pick your doctor as long as he or she is accepting people with Medicaid.
Have a reasonable amount o time to pick your doctor.
Change to another doctor in a air and easy manner.
Get another doctors opinion about your treatment.
Get help in talking with your doctor i you speak a diferent language or use sign language.
Get emergency care rom the emergency room closest to you.
Get a letter that tells you why you cant get a Medicaid service you asked or.
Use the Medicaid complaint and appeal process.
Get a ast response to your complaint.
Get a Medicaid Fair Hearing i you couldnt get a Medicaid service.
Your Right to PrivacyEvery time you get a health-care service, your doctor writes down what happened and puts it in your le. This le is
kept private. Your doctor can only give out your le i you agree.
Your Right to Your Health FilesYour Right to Share Your Health RecordsMedicaid doctors and other approved providers can use a secure online network to share your Medicaid health
records. When doctors can see your Medicaid health records online, they can help you aster. Sharing your records
online is more secure than mailing or axing your records.
You have the right to let us know i you dont want us to share your Medicaid health records. I you dont want your
Medicaid doctors to see your health records on our secure online network, call 1-877-518-0899. You also can visit
www.tmhp.com. Then click on Clients / English.
Your Right to Get a Copy o Your Case Files and Health RecordsYou have the right to get copies o your case les and health records. You might have to pay or the copies. You also
can ask or changes to your les or records i you know something is wrong.
You can ask or copies o your health records. I you change your doctor, you can ask that your records be sent to you
new doctor. I your doctor, or other Medicaid provider, doesnt give you or your new doctor a copy o your health
records within 3 work days, you can call 2-1-1 or1-800-335-8957.
Your Right to be Treated FairlyContact the HHSC Civil Rights Oce right away i anything like the ollowing happens to you when using Medicaid:
Someone treated you unairly because o race, color, national origin, sex, age, disability, religion, or political
belies.
You could not get services because o race, color, national origin, sex, age, disability, religion, political belies
or language needs.
-
7/27/2019 Trad Med Handbook
20/20
You were the victim o unwanted sexual advances.
Someone threatened you with words or actions.
You can contact the HHSC Civil Rights Oce by:
Mail or
in Person Civil Rights Ofce
Health and Human Services Commission
701 West 51st St., MC W206 Austin, TX 78751
Phone 1-888-388-6332. People in the Austin area can call 1-512-438-4313
Fax 1-512-438-5885 or 1-512-438-4754 (not toll-ree outside the Austin
area)
E-mail [email protected]
To learn more, visit www.hhs.state.tx.us. Click on Civil Rights.
Your Right to a Fair HearingA air hearing is a chance or you to tell us the reasons you think you should have a Medicaid service you asked or bu
did not get. You can ask or a hearing within 90 days o the date o the letter that said you could not get the service.You can ask or a air hearing by calling 1-800-727-5436. Pick option 5. I you would like to make your request in
writing, send it to the ollowing address:
Texas Medicaid & Healthcare Partnership (TMHP)
Attention: Medical Aairs Support, MC A13
PO Box 204270 Austin, TX 78720-4270
Ater we get your phone call or letter, a hearing ocer will send you a letter. The letter will tell you the date and time
o the hearing. It also will tell you what you need to know to get ready or the hearing. The hearing can take place by
phone or in person.
During the HearingYou can explain why you asked or the service that you didnt get. You can speak or yoursel. Or you can ask
someone else to speak or you. This could be a riend, amily member, or lawyer. The hearing ocer will listen
to what you have to say. The hearing ocer also will listen to the reasons why you were told you couldnt get the
service. You can ask questions about these reasons. The hearing ocer might ask you some questions. A nal decision
will be made within 90 days rom the date you asked or the hearing.
Your Right to File a ComplaintI you have a complaint about Medicaid services, call the department, oce, or program you have a complaint about.
I you dont get the help you need there, contact the HHSC Oce o the Ombudsman by:
Mail HHSC Ofce o the Ombudsman
PO Box 13247, Mail Code H-700
Austin, TX 78711
Phone
Fax
1-877-787-8999
1-888-780-8099
E-mail http://txheart.dhs.state.tx.us/heartwebextr/hhscOmd