General eligibility requirements that apply to all Apple Health programs

Confidentiality information

Revised Date: 
July 25, 2014

Purpose: To describe HCA's rules regarding confidential information and whom HCA discloses confidential information to.

Clarifying Information

  1. The following information is considered confidential:
    1. Information contained in case records:
      1. Names, birth dates, marital status, employment status, personal history;
      2. Location, current address and telephone number;
      3. Types of services being received, amounts of benefits and fair hearing activity;
      4. Social Security numbers; and
      5. Medical or psychiatric information.
    2. Information about third parties:
      1. Information about the identity of individuals who have filed complaints; and
      2. The identity of individuals who have provided information under condition of remaining anonymous.
    3. Information available from other agencies:
      1. Employment or benefit information from the Employment Security Department;
      2. Information from the Social Security Administration; and
      3. Birth information from Vital Statistics.
  2. Confidential information except chemical dependency treatment information may be provided to a person who works directly with:
    1. Federal- or state-funded public assistance programs including the federal food stamp program when used for the administration of the programs;
    2. The child support program under Title IV-D of the Social Security Act when used for the administration of the child support program; or
    3. Local, state or federal law enforcement agencies. Information will be released to a local, state, or federal law enforcement agency only when the request:
      1. Identifies the person making the request including their authority to do so;
      2. Identifies the individual;
      3. Provides the Social Security Number of the individual;
      4. States the request is an official duty or that finding and apprehending the individual is an official duty;
      5. Describes the violation being investigated; and
      6. Limits the requested information to the address of the individual.
  3. Release information to the U.S. Consulate (U.S. Department of State) only when the individual has provided a written release for the information requested.
  4. At the individual's request information provided by the individual or previously given to an individual may be disclosed to the individual or their representative.
  5. Information provided by third parties may be disclosed to the individual or the individual's representative when:
    1. A fair hearing has been requested on an issue related to the information; or
    2. The Public Disclosure Coordinator determines that:
      1. The release is necessary; and
      2. The information was provided with the understanding that it might be released.
  6. Information relating to the identity of third parties who have filed complaints regarding individuals (or other) and/or who have provided information on condition of anonymity must not be released unless required by a court order.
  7. Information may be released to individuals or agencies with valid releases of information signed and dated by the individual. A release of information is valid if it is:
    1. Signed by the individual, presented within any time frames mentioned on the release;
    2. Presented by the individual to whom the release is made out; and
    3. A request for information that can be legitimately released.
  8. Information other than chemical dependency treatment information may be disclosed to any administrative division of HCA when the purpose of the request for information is to administer the programs of HCA.
  9. Routine transfers of information are subject to the same criteria.
  10. Information may be disclosed to outside agencies only for purposes directly connected with the administration of HCA programs. Outside agencies who receive confidential information are bound by the same rules as HCA.
  11. The following information may be disclosed to medical providers:
    1. Proof that the individual is eligible for medical assistance;
    2. Dates of eligibility;
    3. The PIC code with the tie breaker;
    4. The program for which the individual is eligible; and
    5. Medicare eligibility status.
  12. The following information may not be disclosed to medical providers:
    1. Individual names and addresses;
    2. Medical services provided;
    3. Social and economic conditions or circumstances;
    4. Agency evaluation of personal information; and
    5. Medical data.
  13. Confidential information cannot be provided for:
    1. Commercial or political purposes
    2. Personal purposes by any employees of the department.

Worker Responsibilities

  1. Disclosure to third parties: HCA must disclose to anyone making inquiry whether or not a named individual is currently receiving Apple Health coverage. HCA's response is limited to a "yes" or "no" answer. Further information is prohibited without a release from the individual.
  2. Disclosure to courts of law: Information can only be disclosed with a court order.
  3. Disclosure to government officials: Treat requests from government officials like any other third-party request. Refer the request to the HCA Public Disclosure Coordinator.
  4. Special situations:
    1. Translators and contractors must be informed of the rules regarding confidentiality and are bound by those rules to the same degree as a department employee.
    2. See Civil Rights and Complaints for rules and procedures related to the rights and responsibilities of an individual receiving public assistance.
    3. See Equal Access for rules and procedures for equal access services.

Clarifying Information

Disclosing Information to Parents with Visitation Rights or Legal Custody

Disclosure of the address of a child covered by Apple Health to a parent who is not in the child's household is governed by RCW 74.04.06026.23.120 and 74.12.