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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 January 2020 Subchapter Subject Page ending with Page M0110.000 GENERAL INFORMATION M0110.110 4

1. Authorized Represent- atives Individuals not determined to be incapacitated by a court can designate whomever they choose to be their authorized representatives, including a provider or a provider’s contractor (such as an application assistance company). The designation must be in writing, with the applicant or recipient specifying the information to be released to the authorized representative.

It is not sufficient to indicate that any information in the case record may be released; the designation must state the specific information to be released (i.e. notices, the ability to make application or provide information necessary to determine eligibility, and what, if any, other information can be released to the authorized representative). The authorized representative designation is valid until:

• the application is denied; • medical assistance coverage is canceled; or • the individual changes his authorized representative. The authorized representative can file an appeal on behalf of an individual whose application was denied or canceled. The DMAS Appeals Division will determine whether or not the authorized representative can represent the individual during the appeal.

2. Application Assisters Application assisters are authorized under the Affordable Care Act (ACA) to provide assistance with completing the MA application and renewal, and with explaining and helping the individual to meet documentation requirements. They must be authorized by the individual to provide assistance with completing the application and/or renewal. There are two categories of application assisters:

a. Certified Application Counselors (CAC) CAC are individuals authorized to assist individuals with obtaining health insurance coverage, including Medical Assistance. CAC are generally under the supervision of a non-profit organization and do not receive a fee for providing application counseling.

b. Navigators Navigators receive federal funding to assist individuals with obtaining health insurance coverage, including Medical Assistance.

Application assisters cannot sign forms, receive notices or other communications or otherwise act on behalf of the individual and do not have the same CommonHelp system privileges as authorized representatives.