Member Rights and Responsibilities

Magnolia members have the following rights:

  • To receive information about Magnolia, its benefits, its services, its network providers, and member rights and responsibilities.
  • 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 access all covered services, including certified nurse midwife services and pediatric or family nurse practitioner services.
  • To participate with your providers in making decisions regarding your healthcare, including the right to refuse treatment.
  • 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 receive healthcare services that are accessible, are comparable in amount, duration, and scope to those provided under Medicaid Fee-For-Service (FFS) 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 receive assistance from both Medicaid and Magnolia in understanding the requirements and benefits of Magnolia.
  • To receive family planning services from any participating Medicaid provider without prior authorization.
  • To a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • To receive information on the Grievance, Appeal and Medicaid’s State Fair Hearing procedures.
  • To voice grievances or file appeals about Magnolia decisions that affect your privacy, benefits, or the care provided.
  • To request and receive a copy of your medical record.
  • To make recommendations regarding Magnolia’s member rights and responsibilities policies.
  • To request that your medical record be corrected.
  • To expect your medical records and care be kept confidential as required by law.
  • To receive Magnolia’s policy on referrals for specialty care and other benefits not provided by the member’s PCP.
  • To privacy of healthcare needs and information as required by federal law (Standards for Privacy of Individually Identifiable Health Information).
  • To exercise these rights without adversely affecting the way Magnolia and its network providers treat you.
  • To allow or refuse your personal information be sent to another party for other uses unless the release of information is required by law.
  • To choose a PCP and to change to another PCP in Magnolia’s network.
  • To receive timely access to care, including referrals to specialists when medically necessary without barriers.
  • To file for a Medicaid State Fair Hearing
  • 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 make an advance directive, such as a living will.
  • To choose a person to represent you for the use of your information by Magnolia if you are unable to.
  • To get a second opinion from a qualified healthcare professional.
  • To receive oral interpretation services free of charge for all non-English languages.
  • To be notified that oral interpretation is available and how to access those services.
  • As a potential member, to receive information about the basic features of managed care; which populations may or may not enroll in the program and Magnolia’s responsibilities for coordination of care in a timely manner in order to make an informed choice.
  • To receive information on the following:
    • Benefits covered.
    • Procedures for obtaining benefits, including any authorization requirements.
    • Cost sharing requirements.
    • Service area.
    • Names, locations, telephone numbers and non-English language spoken by current Magnolia providers, including at a minimum, PCPs, specialists, and hospitals.
    • Any restrictions on your freedom of choice among network providers.
    • Providers who are not accepting new patients.
    • Benefits not offered by Magnolia, but available to you and how to obtain those benefits, including how transportation is provided.
  • To receive a complete description of disenrollment rights at least annually.
  • To receive notice of any significant changes in the Benefits Package at least 30 days before the intended effective date of the change.
  • To receive detailed information on emergency and after-hours coverage, to include, but not limited to:
    • What constitutes an emergency medical condition, emergency services, and post-stabilization services.
    • Those emergency services that do not require prior authorization.
    • The process and procedures for obtaining emergency services.
    • The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post-stabilization services covered under the contract.
    • Your right to use any hospital or other setting for emergency care.
    • Post-stabilization care services rules in accordance with Federal guidelines.

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.