Representatives Authorized to Act for an Applicant

Representatives Authorized to Act for an Applicant A. An authorized representative is defined as a person or employee of an organization who is acting responsibly for the applicant with his knowledge and written consent. 1. The MAGI-related application form allows the head of household to designate an authorized representative with no separate written authorization required except in cases where the head of household has a legal representative who is required to act on his/her behalf. 2. ABD applications require the use of a separate authorization form in order for an applicant or recipient to appoint an authorized representative. 3. The authorized representative: a) Has knowledge of the applicant’s circumstances and is usually a relative or close friend, but may be a designee of an organization if the applicant or recipient permits. b) Must be authorized in writing by the applicant to act on his/her behalf and files the application in the name of the applicant. c) Can provide eligibility information and sign the application form and receive all eligibility notices; however, the applicant or recipient has the right to limit the authority of their authorized representative. 4. The appointment of an authorized representative does not prevent the Division of Medicaid from communicating directly with the applicant or beneficiary as deemed appropriate. 5. When an organization or other individual assisted with the completion of an application and their primary need is access to case record information rather than function as an authorized representative, the “Authorization for the Use and Disclosure of Protected Health Information” form must be completed. B. A self-designated representative is defined as a person acting responsibly for an applicant or beneficiary because the physical or mental condition of the applicant/ beneficiary is such that he/she cannot authorize anyone to act for him/her nor can he/she act for himself/herself. 1. Family members or non-relatives with knowledge of the applicant’s or beneficiary’s circumstances are allowed to self-designate in writing with the use of the form designed for this purpose. 2. A representative of an organization or a provider cannot self-designate to represent an applicant or beneficiary, except in cases where the self-designating individual is an owner, operator or employee of a state-owned long-term care facility. 3. All other individuals representing an organization or provider must be legally appointed to represent an individual for health care decisions, in which case the individual becomes the legal representative of the applicant or beneficiary. 4. A self-designated representative must file an application or review form in the name of the applicant/beneficiary with the self-designated representative providing required information to determine or re-determine eligibility and sign all eligibility-related forms that are required. The self-designated representative will receive all eligibility notices and letters. C. A legal representative is defined as someone legally appointed to act on behalf of an applicant or beneficiary. 1. The legal representative must complete the Legal Representative Form and provide documentation of their legal authorization to act for the applicant or beneficiary, including, but not limited to, one (1) of the following: a) Power of Attorney document, b) Legal guardianship decree, c) Conservatorship decree, d) Custody decree, or e) Other type of court order. 2. All such documents must specify that the legally appointed individual has the right to make health care decisions for the applicant or beneficiary. 3. If an applicant or beneficiary is deceased, proof that the individual is the executor or administrator of the applicant’s or beneficiary’s estate is required if eligibility is needed in the month of death and/or retroactive period. 4. The legally appointed representative must act on behalf of the applicant or beneficiary in all matters with the Division of Medicaid without limitation.