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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 July 2025 Subchapter Subject Page ending with Page M0120 MEDICAL ASSISTANCE APPLICATION M0120.200 5

NO: Does the applicant have at least one of the following who is age 18 or older: • spouse,

• child,

• parent,

• sibling,

• grandchild, niece or nephew, or

• aunt or uncle?

YES: The authorized representative is the individual identified above who is willing and able to act on the applicant's behalf.

NO: Verify the inability of the applicant to sign the application because of a diagnosis or condition through a written statement from the applicant’s doctor. Refer to APS. Pend the application. At the conclusion of the APS investigation, if APS concludes that guardianship proceedings will not be initiated, the applicant must sign or make a mark on the application or designate an authorized representative in writing. If the signed application form is not received by the specified date, deny MA.

C. Applicants Under Age 18

1. Child Applicant

A child under age 18 years is not legally able to sign his own MA application unless he is legally emancipated from his parents. If the child is not legally emancipated, one of the following individuals who is age 18 or older must sign the application: • his parent (custodial or non-custodial) • legal guardian, • authorized representative (including Department of Juvenile Justice staff for individuals under 18), or • an adult related by blood or marriage with whom the child lives (documentation of the relationship is not required).