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• Federally Facilitated Marketplace (Note: When a Marketplace application is processed by the agency and an applicant has appointed an authorized representative in the application, the agency must honor this appointment of an authorized representative.) • Paper form (signed in writing or electronically): Appoint, Change, or Remove an Authorized Representative (F-10126) If an applicant or member is represented by a guardian of the person and the estate, guardian of the estate, or conservator, the guardian or conservator must appoint the authorized representative. A guardian of the person can appoint the authorized representative only if the court document appointing the legal guardian of the person includes language granting the guardian the authority to enroll the person in BadgerCare Plus, Medicaid, or public assistance programs. If the applicant or member only has a guardian of the person who does not have the authority to enroll the person in Medicaid or public assistance programs, the applicant or member must appoint the guardian of the person as an authorized representative if the applicant or member would like the guardian of the person to act on their behalf. If the applicant or member has a power of attorney, the applicant or member can still appoint an authorized representative. A valid authorized representative appointment requires all contact information of the authorized representative and the signatures of the applicant or member, the authorized representative, and a witness. If the applicant or member is signing with an “X,” a valid appointment requires two witness signatures. If any of the required signatures are missing, the following three conditions apply: • The authorized representative appointment is not valid. • This authorized representative cannot take action on behalf of the applicant or member. • The agency cannot disclose information about the case to the invalid authorized representative. There can be only one authorized representative at a time on a case. There is no time limit on how long a person or organization can act as authorized representative. The appointment of the authorized representative is valid until the applicant or member notifies the agency of a change or removal in writing. Once appointed, the authorized representative has ability to act for all open programs on the case. Organizations acting as authorized representatives must provide the name and contact information of a person from the organization. Once the organization has been appointed as the authorized representative, anyone from the organization will be able to take action on behalf of the applicant or member (not just the person who signed the form on behalf of the organization). If an organization is only changing the contact person for the organization, the member is not required to complete a new Appoint, Change or Remove Authorized Representative form if the organization is going to remain as the authorized representative. The authorized representative should be familiar with the applicant or member’s household situation and is expected to fulfill their responsibilities to the same extent as the individual being represented. An authorized representative is limited to doing any or all of the following on behalf of the applicant or member: • Apply for or renew benefits • Report changes in the applicant or member’s circumstances or demographic information • Receive copies of the applicant or member’s notices and other communications from the agency • Work with the IM agency on any benefit related matters • File grievances or appeals regarding the applicant or member’s eligibility