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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 July 2020 Subchapter Subject Page ending with Page M0120 MEDICAL ASSISTANCE APPLICATION M0120.200 2a

1. Authorized Representative An authorized representative is a person age 18 years or older who is authorized to conduct business for an individual. A competent individual age 18 years or older must designate the authorized representative in a written statement (which defines the representative’s responsibilities). The individual may change or his authorized representative at any time by submitting a new authorized representative statement.

The authorized representative statement is valid while the application is being processed and for as long as the individual is covered, as well as during an appeal related to the denial, reduction of or cancellation of the individual’s coverage. An individual who reapplies after a period of non-coverage must sign another authorized representative statement to designate an authorized representative.

The authorized representative of an incompetent or incapacitated individual is the individual’s spouse, parent, attorney-in-fact (person who has the individual’s power-of-attorney), legally appointed guardian, legally appointed conservator (committee), or family substitute representative.

2. Family Substitute Representative When it is reported that an applicant cannot sign the application and the applicant does not have a guardian, conservator, attorney in fact or designated authorized representative, one of the individuals listed below who is age 18 years or older and is willing to take responsibility for the applicant’s MA business will be the applicant’s “family substitute” representative. The family substitute representative will be, in this preferred order, the applicant’s: • spouse,

• child,

• parent,

• sibling,

• grandchild,

• grandparent,

• niece or nephew, or

• aunt or uncle.