Confidentiality 510-05-10-15

(Revised 6/1/22 ML #3675)

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All applications, information and records concerning any applicant or recipient of Medicaid shall be confidential and shall not be disclosed or used for any purpose not directly connected with the administration of the Medicaid or Healthy Steps programs. Application, information and records may not be released to elected officials or to any other person not directly connected with the administration of the Medicaid or Healthy Steps programs. Refer to Service Chapter 448-01-25 for additional guidelines.

Federal law and regulations:

Federal law and regulations require that the State Plan have protections in place to ensure that the use or disclosure of information concerning applicants and recipients be limited to purposes directly connected with the administration of the plan. Those purposes include establishing eligibility, determining the amount of medical assistance, providing services, and conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the plan. (42 U.S.C. § 1396a(a)(7); 42 C.F.R. § 431.300-306).

NOTE: Information from certain sources may not be released, even with a signed release form. For details see 448-01-25-10-05 “Confidential Information that Must Not be Released”.

Sharing basic information regarding eligibility with HCBS Case Managers:

Case Managers going out for an initial assessment can be informed if an individual is eligible for Medicaid, the type of coverage (full Medicaid or Medicare Savings Programs), and whether the recipient has a client share.

A county or other waivered service provider is a prospective provider so they can find out if an individual is eligible in order to determine if they can provide Medicaid waivered services, or if they need to pursue other program such as SPED.

An assessment for services under HCBS does not allow for providing eligibility income and asset information or disclosing eligibility to Spousal Impoverishment benefits. A release signed by the recipient, or a verbal release, if documented, is needed if specific information from the eligibility file must be obtained.

Specific information that may be released is a yes/no if the client is eligible on a specific date, any client share amount and the recipient’s billing address; which are specific data that can be released to any provider of Medicaid Services. This is like any other potential provider calling the Verify system.

Sharing asset, income, household composition, etc. information with social work staff:

Information cannot be released unless the applicant or recipient has authorized the release of information (form or verbally).

Sharing information with Social Workers for investigations of abuse, neglect, or protective services:

Information requests by social workers are not made for the purpose of administration of Medicaid, but are with regard to abuse investigations. The family may not be receptive, but that is not a valid reason to release the information. A signed release is necessary to share specific information about the child/family.

‘Protective Service Alerts’ from the North Dakota Department of Human Services, Children and Family Services (CFS) Division and other States are often sent to all county staff. These alerts request information regarding the family’s whereabouts. These alerts, do not fall under ‘administration of the Medicaid program’ so specific information cannot be released. However, it is allowable to disclose the county and state in which the individual is residing and the county social service office that may be contacted for child protective service information, to the requestor as well as to their own county child protective service unit.

Any additional information, including ‘How eligibility staff knows this information’ or ‘The family has applied or is receiving services’ may not be disclosed.

Sharing information with Child Support and other specific assistance programs:

Can share information with Child Support as federal regulations specifically require.

Can share information between Healthy Steps and Medicaid per federal requirements to coordinate benefits between the two programs.

Can share information between Medicaid and SSA for Title II and Title XVI benefits as federal regulations specifically require.

Can share information between TANF, and SNAP per federal regulations to coordinate benefits between the programs.

Sharing information with Foster Care social workers when an application is received and the child is already on Medicaid:

The county has care, custody, and control, so is acting on behalf of the child. Also, the child is going from one Medicaid case to another for the purpose of establishing eligibility.

Copies of identifying information such as a birth certificate may be made for the Foster Care file so that both files contain the proper documentation.

Only pertinent information needed to determine the child’s eligibility should be provided. A social worker needs the parent’s income information to determine if the child is IV-E eligible. If that has been established, the social worker should NOT be requesting the information, nor should the eligibility worker be releasing it without a signed release of information.

Sharing information with Law Enforcement:

Medicaid cannot provide information about a specific applicant or recipient to law enforcement unless it has to do with administration of Medicaid.

Release of information on application:

These statements allow county and state staff to obtain information from other sources, but do not give permission to release information to others.