Effective Date: January 1, 2014

Contact DHHS Policy Specialist for Previous Policy

Confidential information may only be disclosed and used under limited circumstances. Do not disclose or use confidential information unless it is for one of the purposes described below.

Note: There are special STRIC rules for the disclosure and use of income match data. See sections 115 and 751-3 for specific information.

Administration of the Medicaid Program

Confidential information may be disclosed and used for purposes directly connected with the administration of the Medicaid program. However, only disclose and use the information to the extent necessary to assure valid administration of the program. Purposes directly connected with the administration of the Medicaid program include activities such as:

Establishing eligibility;

Confirming eligibility so the recipient may receive medical services;

Computing the amount of medical excess or nursing home payment;

Assisting with a civil or criminal investigation, or proceeding, that is directly connected with the administration of the Medicaid program.

If a court or law enforcement official asks for confidential information, for a matter not directly connected to the administration of the Medicaid program, the court or law enforcement official is not entitled to the information. If the individual persists in trying to obtain information, have a supervisor explain that Federal and State law prohibits the release of confidential information from a case file.

If a case file is subpoenaed by an outside source, call a Program Specialist immediately. The legal counsel for the Department will ask the court to disallow the information from the case record, citing the Federal Social Security Act and this manual.

Establishing Eligibility for Other Federal or State Programs

Confidential information may be released to governmental agencies, as long as the information is only used to verify and determine eligibility for the following programs: Insurance Affordability programs administered by the Federally Facilitated Marketplace (FFM) , FEP, food stamps, child support enforcement, unemployment compensation, SSA and SSI. Only release confidential information to the extent necessary to assist the agencies in the valid administration of the specific programs listed.

The Department may enter into written agreements with other agencies that permit the release of confidential information to the agencies. Currently the DHHS has agreements with the Department of Health and Human Services, the FFM, and the Department of Workforce Services. The agreement allows for the release of confidential information to the FFM, Department of Health and Human Services and the Department of Workforce Services when the information is to verify and determine eligibility for Medicaid and other assistance.

When governmental agencies request confidential information for purposes not directly related to the administration of one of the programs listed above, please contact a Program Specialist for clarification about whether confidential information may be released to them.

Public Request

The public may view policy manuals and receive non-identifying information about Medicaid recipients. The public is not entitled to information about particular applicants and recipients. This includes people who may demand to see confidential information as a taxpayer.

Do not publish applicant and recipient names.

Do not use applicant and recipient information to distribute commercial information, political information, holiday greetings, general public announcements, etc. The only exception to this is that eligibility workers may distribute material directly related to the health and welfare of applicants and recipients. For example, eligibility workers may distribute information about free medical examinations or services, free vaccinations, information that could protect the health of applicants or recipients, the availability of surplus food, etc.

Permission Granted By Applicants and Recipients

An individual can give written permission to release case record information. A valid permission form must include:

Individual’s name.

Individual’s Social Security number or Medicaid ID number. There is an exception to this requirement if the individual has not provided a Social Security Number, and is not required to do so (i.e., someone who is not applying for benefits for themselves).

Individual’s date of birth.

Name of the person or organization to whom the individual is authorizing the release of information.

The purpose of releasing the information.

The date the release ends. It starts the date it is signed by the individual.

A statement as to how the individual or authorized representative can revoke the authorization.

A statement that explains that there is no obligation to sign the release and that Medicaid eligibility will not be denied if it is not signed.

A statement indicating that the individual understands that once information is released, it may no longer be protected and may be re-disclosed.

The release must be signed and dated by whoever signed the application. If signed by someone other than the individual, describe their authority to sign.

Note : An applicant or recipient CANNOT authorize the release of Income Match Data from the case record. See section 115 for additional information about Income Match Data.

Link to e-Forms. Search for form 114.

Emergency Situations

When an agency, with comparable rules for safeguarding case records, requests information about an applicant or recipient due to an emergency, you may release the information and then get the applicant's or recipient's permission. The Regional Director or his designee decides what constitutes an emergency. Detail the nature of the emergency in eREP.

Note : Income Match Data CANNOT be released due to an emergency. See section 115 for additional information about Income Match Data.