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Members

Member Rights & Responsibilities

Doctor and patient talking

Molina Healthcare staff and providers will comply with all requirements concerning your rights.

Molina Healthcare members have the right to:

  • Get information on the structure and operation of the health plan, its services, practitioners and providers and member rights and responsibilities
  • To receive notice of any significant changes in the Benefits Package at least thirty (30) days before the intended effective date of the change
  • Choose your Primary Care Provider
  • Know if a copayment or contribution is required
  • Know the names, education, and experience of your health care providers
  • Be treated with respect with recognition of your dignity and your right to privacy
  • Direct access to network women health specialists and pediatric providers for covered services necessary to provide routine and preventive health care services without a referral
  • Receive Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services
  • Take part in decision making with your doctor about your health care, including the right to refuse treatment and openly discuss appropriate or medically necessary treatment choices of your health problems, regardless of cost or coverage
  • Get a fair and timely reply to requests for service
  • Voice complaints or appeals about the organization and the care it provides
  • Know that your member information will be kept private. It is only used in reports to the state to show that Molina Healthcare is following state rules and laws
  • Ask how your doctor is paid
  • To be able to file an appeal, a grievance (complaint) or request a State Fair Hearing (after Molina has made a decision and you aren’t happy with that decision) 
  • To get help with filing an appeal, grievance (complaint) or request a State Fair Hearing (after Molina has made a decision and you aren’t happy with that decision)
  • To receive information and timeframes for filing an appeal, a grievance or a State Fair Hearing
  • To make recommendations regarding Molina Healthcare’s member rights and responsibility policy
  • To use any hospital or other setting for emergency care
  • To receive detailed information on emergency and after-hours coverage
  • To receive all information, including but not limited to, enrollment notices, informational materials, instructional materials, available treatment options, and alternatives in a manner and format that may be easily understood
  • Be free from any form of restraint or seclusion used as means of pressure, discipline, convenience or retaliation
  • Request and receive a copy of your medical records at no cost to you, and request that they be corrected
  • Be provided culturally and linguistically appropriate healthcare services (CLAS)
  • Be provided covered healthcare services
  • Be free to exercise your rights without negatively affecting the way Molina, our providers or the State treat you
  • Be free from other discrimination prohibited by State and Federal regulations
  • Request clinical practice guidelines upon request
  • Get a second medical opinion
  • Get help with any special language needs
  • To receive interpretation by phone services free of charge for all non-English languages, not just those identified as prevalent

Molina Healthcare members have the responsibility to:

  • Provide Molina Healthcare, its practitioners and providers with the necessary information needed to care for you
  • Know, understand, and follow the terms and conditions of the health plan
  • Follow plans and instructions for care that they have agreed to with their practitioners
  • Seek out information in order to make use of the services
  • Take part in decision-making about your healthcare. Understand your health problems and participate in developing mutually agreed-upon treatment goals
  • Report other insurance benefits, when you are eligible, to your Department of Health and Human Services Specialist and the Beneficiary Help Line at (800) 642-3195, TTY (866) 501-5656
  • Show your Molina Healthcare ID card, Medicaid mihealth card and valid ID to all providers before receiving services
  • Never let anyone use your Molina Healthcare ID card or Medicaid mihealth card
  • Choose a primary provider, schedule an appointment within 60 days of enrollment and build a relationship with the provider you have chosen
  • Make appointments for routine checkups and immunizations (shots)
  • Keep your scheduled appointments and be on time
  • Provide complete information about your past medical history
  • Provide complete information about current medical problems
  • Ask questions about your care
  • Follow your provider’s medical advice
  • Respect the rights of other patients and health care workers
  • Use emergency room services only when you believe an injury or illness could result in death or lasting injury
  • Notify your primary provider if emergency treatment was necessary and follow-up care is needed
  • Report changes that may affect your coverage to your Department of Health and Human Services specialist. This could be an address change, birth of a child, death, marriage or divorce, or change in income
  • Promptly apply for Medicare or other insurance when you are eligible
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This information is for Doctors and
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