Your Health Information

 The Medicaid program must obey laws on how we use and share your information, such as your name, address, personal facts, the medical care you had and your medical records.  Any information shared must be for a reason related to the administration of the Medicaid program. Such reasons include:
  • To approve eligibility for medical and dental benefits
  • To establish ways to pay for health care
  • To approve, provide, and pay for Medicaid health care
  • To investigate or prosecute Medicaid cases (like fraud)


  1. For treatment: Medicaid may need to approve care before you see a doctor, dentist, clinic or other health care provider.  We will share information with necessary providers to make sure you get the care you need.  For instance, we may use your health records to identify if you need special information about a health problem like diabetes. 
  2. For Payment: When Medicaid pays your health care bills, we share information with your health care provider and others who bill us for your health care.  We may send some bills to other health plans or groups who pay bills.  For instance, if you are taken to an emergency room they may call to see if you are covered. 
  3. For health care operations: We may use your health records to check the quality of the health care you get.  We may also use them in audits, fraud and abuse programs, planning, and managing the Medicaid program.  For instance, your prescriptions are reviewed to be sure the medicines can be used together without harm to you. 
  4. For health notices: We may use your health records to provide you with additional information.  This may include sending appointment reminders to your address, giving you information about treatment options, alternative settings for care, or other health-related services. 
  5. For legal reasons: We may give your information to a court, investigator, or lawyer in cases about Medicaid.  This may be about fraud or abuse, to get back money from others that should pay your Medicaid bills, or other issues related to the Medicaid program.  If a court orders us to give out your information, we will do so. 
  6. To report abuse: We may disclose your health information when the information relates to a victim of abuse, neglect, or domestic violence.  We will make this report only in accordance with laws that require or allow such reporting, or with your permission. 
  7. Public Health Activities: We will disclose your health information when required to do so for public health purposes.  This includes reporting certain diseases, births, deaths, and reactions to certain medications.  It may also include notifying people who have been exposed to a disease. 
  8. Research: We may disclose your health information in connection with medical research projects.  Federal rules govern any disclosure of your health information for research purposes without your permission. 
  9. For appeals: You or your health care provider may appeal Medicaid decisions made about your health care services.  Your health information may be used to decide these appeals. 
  10. For Eligibility: We may share your information with federal, state, and local agencies when you apply for Medicaid to verify eligibility, and for other purposes related to the administration of the Medicaid program.
 I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700 | Contact Us | Site Map
To view Nondiscrimination Policies and Plans, please click here.