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Medicaid decisions should be available to the public

Both O.C.G.A. § 49-4-153(b)(1) and 42 C.F.R. § 431.244(g) require that all Medicaid agency decisions be accessible to the public, except that 42 CFR § 431.305(b) requires that the following information must be safeguarded:

(1) Names and addresses;
(2) Medical services provided;
(3) Social and economic conditions or circumstances;
(4) Agency evaluation of personal information;
(5) Medical data, including diagnosis and past history of disease or disability; and
(6) Any information received for verifying income eligibility and amount of medical assistance payments (see § 435.940ff). Income information received from SSA or the Internal Revenue Service must be safeguarded according to the requirements of the agency that furnished the data.
(7) Any information received in connection with the identification of legally liable third party resources under § 433.138 of this chapter.

Specfically, O.C.G.A. § 49-4-153(b)(1) provides: “Each agency shall maintain a properly indexed file of all decisions in contested cases, which file shall be open for public inspection except those expressly made confidential or privileged by statute.” 42 C.F.R. § 431.244(g) provices: “The public must have access to all agency hearing decisions, subject to the requirements of subpart F of this part for safeguarding of information.”

42 U.S.C. § 1396a(a)(7) provides: A State plan for medical assistance must—

(A) safeguards which restrict the use or disclosure of information concerning applicants and recipients to purposes directly connected with—

(i) the administration of the plan; and
(ii) the exchange of information necessary to certify or verify the certification of eligibility of children for free or reduced price breakfasts under the Child Nutrition Act of 1966 [42 U.S.C. 1771 et seq.] and free or reduced price lunches under the Richard B. Russell National School Lunch Act [42 U.S.C. 1751 et seq.], in accordance with section 9(b) of that Act [42 U.S.C. 1758(b)], using data standards and formats established by the State agency.

In practice, when an open records request was sent to the Georgia Office of State Administrative Hearings requesting copies of decisions, the request was denied on privacy and HIPAA grounds. Nonetheless, OSAH publishes selected decisions in its Administrative Law Report. Some Georgia decisions are on this website and can be found using the search tools.

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