Member rights and responsibilities

If you get Medicaid from any of the counties in the Cardinal Innovations Healthcare region, you are a member of the NC MH/DD/SAS Health Plan. As a member of the NC MH/ DD/SAS Health Plan, you have rights and responsibilities for your care.

Your Rights
Every member has the right to:

  • Receive information about Cardinal Innovations Healthcare’s structure and operations, its services, its providers and practitioners, and have member rights and responsibilities presented in a manner you can understand
  • Be treated with respect and with recognition for your dignity and privacy
  • Receive information on available treatment options and alternatives in a manner you can understand
  • Receive information about changes in benefits, services or providers; Cardinal Innovations will notify members in writing of any significant changes to programs or services
  • Receive information in culturally and linguistically appropriate formats
  • Make suggestions about Cardinal Innovations’ member rights and responsibilities policy
  •  Make suggestions to us about our policies and services by calling the 24-hour, toll-free Crisis and Referral Line at 1-800-939-5911 (for deaf or hard of hearing, dial 711 for NC Relay) and requesting to speak to a Member Engagement Specialist. You also may call our toll-free Anonymous Concern Line at 1-888-213-9687. If you would prefer to email your suggestions, they can be sent to the Member Engagement department at or to our Quality Management Department at If you prefer to contact someone other than Cardinal Innovations, you may contact the NC Department of Health and Human Services (NC DHHS) Customer Service Center at 1-800-662-7030
  • Participate with providers and practitioners in making decisions about healthcare, including the right to refuse treatment
  • Prepare Advance Directives. These are instructions for your care if, in the future, you are unable to make decisions about your care
  • Have an open discussion with service providers or practitioners on appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage. You may need to decide among relevant treatment options, risks, benefits and consequences, including your right to refuse treatment and to express your preferences about future treatment decisions regardless of benefit coverage limitations
  • Voice complaints about us or the care we provide. You may voice your concerns or file a grievance by calling 1-888-213-9687 (at this number, you may leave a message to have someone return your call or you may leave an anonymous message, if you prefer)
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
  • Receive a second opinion from a qualified behavioral health professional within the Cardinal Innovations network, or one that is out of network at no cost to the member
  • Request and file an appeal for changes in your Medicaid behavioral healthcare services
  • Request a reconsideration if your service has been denied, reduced, suspended or terminated. You (or your provider with your permission) can request Reconsideration within 60 days of such notice. This is the first step in the Appeal Process. For more information call your assigned Care Coordinator or contact the Appeals Coordinators at 1-704-939-7700
  • Have a state-level Fair Hearing
  • Request and receive a copy of your medical records and to request that the medical records be amended
  • Disagree with what is written in your medical records. If you disagree, you have the right to write a statement to be placed in your file. However, the original notes will also stay in the record until the time for retention ends according to the MH/DD/SAS retention schedule (11 years for adults; 12 years after a minor reaches the age of 18; 15 years for DUI records)
  • Take part in creating a written, person-centered treatment plan that builds on your needs, strengths and preferences. A treatment plan must be put into action within 30 days after services start
  • Participate in the creation of an Individual Support Plan (ISP) to request services specific to people with IDD or a Person-Centered Plan for other services
  • Help create and update your treatment plan or ISP and consent to treatment goals in that plan
  • Express freedom of speech and freedom of religious expression
  • Receive equal employment and educational opportunities
  • Receive treatment in the most natural, age-appropriate and least restrictive environment possible
  • Ask questions when you do not understand your care or what you are expected to do
  • If you live in an Adult Care Home, you have the right to report any suspected violation of your rights to the appropriate regulatory authority, which is North Carolina Division of Health Service Regulation. You may contact them by phone at 1-800-624-3004 or 1-919-855-4500

Rights of Minors
Under NC state law, minors have the right to treatment for the following conditions without the consent of a parent or guardian:
  • Venereal diseases
  • Pregnancy
  • Use of controlled substances or alcohol
  • Emotional disturbances
Exercising Your Rights
You are free to exercise all of these rights. Exercising these rights will not negatively affect your access to services or the way that Cardinal Innovations or our network providers treat you.

Your Responsibilities
In addition to your rights as a member of the NC MH/DD/SAS Health Plan, you can reach the best outcomes for yourself by taking on the following responsibilities:
  • Supplying information (to the extent possible) that Cardinal Innovations and our providers need to provide care for you
  • Following the plans and instructions for care that you have agreed to with your providers
  • Understanding your health problems and taking part, to the degree possible, in creating treatment goals
  • Telling the doctor or nurse about any changes in your health and asking questions when you do not understand your care or what you are expected to do
  • Inviting people who will be helpful and supportive to you to be included in creating your treatment plan 
  • Respecting the rights and property of other members and of provider staff
  • Respecting other members' needs for privacy
  • Working on the goals of your person-centered plan
  • Keeping all the scheduled appointments that you can
  • Canceling an appointment at least 24 hours in advance, if you cannot keep it
  • Paying for services, if payment is included in your established agreement
  • Informing staff of any medical condition that is contagious
  • Taking medications as they are prescribed for you
  • Telling your doctor if you are having unpleasant side effects from your medications, or if your medications are not helping you feel better
  • Telling your provider if you do not agree with their suggestions
  • Telling your provider when or if you want to end treatment
  • Carrying your Medicaid or other insurance card with you at all times
  • Cooperating with those trying to care for you
  • Being considerate of other members and family members
  • Seeking additional support services in your community
  • Reading, or having read to you, written notices from Cardinal Innovations about changes in benefits, services or providers
  • Requesting a discharge plan when you leave a provider; being sure you understand it and being committed to following it
  • Contacting our toll-free Anonymous Concern Line at 1-888-213-9687 if you feel that your rights have been violated. You may also email our Quality Management Department at or our Member Engagement Department at If you prefer to con someone other than Cardinal Innovations, you may contact the NC DHHS Customer Service Center at 1-800-662-7030

Updated 10/26/2018 to reflect changes made in the 2018 Member handbook.
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