Revision 15-2; Effective June 1, 2015


Applicants/recipients requesting assistance on the basis of disability must complete a medical information release form.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that sets additional standards to protect the confidentiality of individually identifiable health information. Individually identifiable health information is information that identifies or could be used to identify an individual and that relates to the:

  • past, present or future physical or mental health or condition of the individual;
  • provision of health care to the individual; or
  • past, present or future payment for the provision of health care to the individual.


C-4100 Privacy Notice

Revision 15-2; Effective June 1, 2015


The MEPD eligibility specialist must send each applicant/recipient a copy of the HIPAA — Notice of Privacy Practices or HIPAA — Notice of Privacy Practices (Spanish) upon certification. The privacy notice tells the applicant/recipient about:

  • his or her privacy rights,
  • the duties of HHSC to protect health information, and
  • how HHSC may use or disclose health information without a person's authorization. (Examples of use or disclosure include: health care operations [for example, Medicaid], public health purposes, reporting victims of abuse, law enforcement purposes, sharing with HHSC contractors and coordinating government programs that provide benefits.)


C-4200 Applicant/Recipient Authorization

Revision 11-4; Effective December 1, 2011


The applicant/recipient may authorize the release of his or her health information from HHSC records by using a valid authorization form. Form H1003, Appointment of an Authorized Representative, includes all the authorization elements required by HIPAA privacy regulations. See Section C-3000, When and What Information May Be Disclosed, for the elements necessary for a valid authorization.


C-4300 Minimum Necessary

Revision 09-4; Effective December 1, 2009


Reasonable efforts must be made to limit the use, request or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of individual medical information from HHSC records must be limited to the minimum necessary to accomplish the requested disclosure. For example, if an applicant/recipient authorizes release of income verification, including disability income, do not release related case medical information unless specifically authorized by the applicant/recipient.