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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |203

Effective Month: December 2016 101.03.04 REPRESENTATIVES AUTHORIZED TO ACT FOR AN APPLICANT There are three (3) types of representatives allowed to act in behalf of an applicant or recipient in filing an application for health coverage through DOM: 1. Authorized Representative An authorized representative is a person or employee of an organization who is acting responsibly for the applicant with his knowledge and written consent. 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. ABD applications require the use of a separate authorization form (DOM-302A) in order for an applicant or recipient to appoint an authorized representative. The authorized representative 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. The authorized representative must be authorized in writing by the applicant to act on his behalf. The application is filed in the name of the applicant. The authorized representative 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. The appointment of an authorized representative does not prevent the Division of Medicaid from communicating directly with the applicant or recipient as deemed appropriate. NOTE: In instances where the applicant or recipient designates an authorized representative but places a limit on the receipt of notices by the representative, maintain the authorized representative information in the case record rather than entering the representative information in the system. If representative information is entered into the system, the representative will receive all letters and notices issued by the system. 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 a case representative, completion of the “Authorization for the Use/Disclosure of Protected Health Information” form may be more appropriate to allow access to information while the applicant or recipient represents themselves. Contact with the applicant or recipient is needed to make this determination, which must be documented in the case record.