Member Rights and Responsibilities

Magnolia members have the following rights:

  • To receive information on available treatment options and alternatives, presented in a manner appropriate to the member's ability to understand.
  • To participate in decisions regarding his/her healthcare, including the right to refuse treatment.
  • To seek second opinions.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in the federal regulations on the use of restraints and seclusion.
  • To express a concern or appeal about Magnolia or the care it provides and receive a response in a reasonable period of time.
  • To be able to request and receive a copy of his/her medical records (one copy free of charge) and request that they be amended or corrected.
  • To request and obtain information on any limits of your freedom of choice among network providers.
  • To receive healthcare services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid fee-for-service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness or medical condition.
  • To exercise his/her rights freely with no fear of adverse treatment by Magnolia or Magnolia's providers.
  • To receive materials - including enrollment notices, information materials, instructional materials, and available treatment options and alternatives - in a manner and format that may be easily understood.
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent.
  • To be notified that interpretation services are available and how to access those services.
  • To receive information about the structure and operation of Magnolia.
  • Be free to exercise these rights without retaliation.
  • To be treated with respect and with due consideration for your dignity and the right to privacy and non-discrimination as required by law.
  • To privacy of healthcare needs and information as required by federal law (Standards for Privacy of Individually Identifiable Health Information).
  • Be furnished health care services in accordance with 42 C.F.R. 438.206 through 438.210
  • Receive information in a manner and format that may be easily understood in accordance with 42 CFR 438.10
  • To voice complaints/ grievances or file appeals about the Magnolia's decisions that affect the member's privacy, medical care provided, services received and/or benefits.
  • To receive information about Magnolia, its benefits, its services, its network providers, and member rights and responsibilities.
  • To receive information on the Grievance, Appeal and Medicaid's State Fair Hearing procedures.

Magnolia members have the following responsibilities:

  • To inform Magnolia of the loss or theft of their ID card.
  • To present your ID card when using healthcare services.
  • To be familiar with Magnolia procedures to the best of your ability.
  • To call or contact Magnolia to obtain information and have questions clarified.
  • To provide information (to the extent possible) that Magnolia and its providers need in order to provide care.
  • To follow the prescribed treatment (plans and instructions) for care that has been agreed upon with your providers.
  • To inform your provider on reasons you cannot follow the prescribed treatment of care recommended by your provider.
  • To understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  • To keep your medical appointments and follow-up appointments.
  • To access preventive care services.
  • To follow the policies and procedures of Magnolia and Medicaid.
  • To be honest with providers and treat them with respect and kindness.
  • To get regular medical care from your PCP before seeing a specialist.
  • To follow the steps of the appeal process.
  • To notify Magnolia, Medicaid, and your providers of any changes that may affect your membership, your healthcare needs, or your access to benefits. Some examples may include:
    • If you have a baby.
    • If your address changes.
    • If your telephone number changes.
    • If you or one of your children are covered by another plan.
    • If you have a special medical concern.
    • If your family size changes.
  • To keep all your scheduled appointments.
  • To be on time for your scheduled appointments.
  • To cancel your scheduled appointments at least twenty-four (24) hours in advance if you cannot keep an appointment.
  • To access care by following Magnolia rules; failure to do so may cause you may be responsible for the charges.