101.03.05 WHO CAN FILE THE APPLICATION

An application can be filed by one of the following individuals, as applicable to the case: • Adult applicants; • Certain minor applicants, including; o A pregnant minor of any age requesting coverage solely due to pregnancy; or o A married minor living with a spouse; or o A minor living independently; or o A minor living with his/her parents and applying only for the minor’s own children. • The parent who has primary physical custody of a minor child; • Either parent of a minor child when physical custody is equally divided between legal parents; • The caretaker relative with whom a dependent child is living who has primary responsibility for the child’s care. o A caretaker relative is a relative by blood, adoption or marriage with whom the child is living who assumes primary responsibility for the child’s care. o A dependent child is under the age of 18 and deprived of parental support by reason of death, absence from the home or physical or mental incapacity. • An authorized representative designated in writing by the applicant on the MAGI application or on DOM-302A, Authorized Representative Form, for ABD; • A self-designated representative who signs the appropriate DOM-302B, Self-Designated Representative Form, allowing self-designation. • A legal representative with the authority to make healthcare decisions for the applicant who has completed Form 302C, Legal Representative Form. An application signed by anyone other than a person described above will be accepted, but a signature of a person authorized to apply must be obtained during the application process.