*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***

Chapter 07 - Applications

Effective:  June 1, 2012

07.15.10 - Authorized Representatives

Archived:  June 1, 2016 (Previous Versions)

Authorized Representatives

Applicants and enrollees may designate an authorized representative. This section provides information on who can be an authorized representative, what their role is and other requirements.

What Is an Authorized Representative?

Responsibilities of an Authorized Representative.

Who Can Be an Authorized Representative?

Who Cannot Be an Authorized Representative?

Designating an Authorized Representative.

How Long Does the Designation Last?

Disqualification of an Authorized Representative.

Authorized Representative Receipt of Forms and Notices.

Authorization to Release Information.

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What Is an Authorized Representative?

An authorized representative is a person or organization authorized by an applicant or enrollee to apply for any of the health care programs and to perform the duties required to establish and maintain eligibility.


ABC Assistors, an organization that assists people with applications for MA, helps Clara Jones complete her application. Ms. Jones signs the application and specifies that MedEligibles is her authorized representative. An employee from MedEligibles also signs the application.


Accept MedEligibles as Ms. Jones authorized representative until either Ms. Jones or MedEligibles revokes the designation.

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Responsibilities of an Authorized Representative

In most cases, authorized representatives have the same responsibilities and rights as applicants or enrollees.

Authorized representatives have the responsibility and right to:

l  Contact the agency, including talking with the worker without additional consent.

l  Have access to eligibility information in the applicant's or enrollee's case file.

l  Attend local agency interviews.

l  Complete forms.

l  Sign forms, such as renewals, for the applicant or enrollee.

l  Provide documentation.

l  Appeal agency decisions.

l  Receive forms and notices.

l  Pay premiums if the client wishes them to do so.

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Who Can Be an Authorized Representative?

Authorized representatives must:

l  Be at least 18 years old.

l  Have access to required information and ability to verify eligibility factors.

l  Agree in writing to accept the responsibilities of an authorized representative.

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Who Cannot Be an Authorized Representative?

The following people cannot be an authorized representative for a client on their caseload:

l  County and MCRE employees who determine eligibility.

l  Regional Treatment Center (RTC) reimbursement officers for MA clients.

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Designating an Authorized Representative

In most cases, the applicant or enrollee must designate the authorized representative. However, a guardian or conservator appointed by the court supersedes an authorized representative designated by the client.

l  The agency must appoint an authorized representative if the client is not able to do so and is not able to provide information necessary to determine eligibility. This could be a relative or friend who is able to provide the necessary information.

l  The agency must appoint a social service professional as the applicant’s or enrollee’s authorized representative if no qualified person is available to act as an authorized representative. Document in case notes the reason the agency appointed an authorized representative.

l  Potential authorized representatives for children in foster care or pre-adoptive placements include, but are not limited to, social workers or other representatives of the agency that has legal custody and control of the child.

Applicants and enrollees may designate an authorized representative by:

l  Filling in the authorized representative’s name, address, and phone number in the appropriate place on the application.

n  The authorized representative and the applicant must both sign the application unless the applicant is unable to sign. Explain in case notes why the client is unable to sign if the application is signed only by the authorized representative.

Note: See Application Signature for information on ApplyMN and authorized representative signature requirements.

n  The designation on the application authorizes the exchange of information. An additional consent is not required.

l  Providing a written request to designate an authorized representative.

The written request may include but is not limited to:

n  Providing the form Giving Permission for Someone to Act on My Behalf (DHS-3437).

n  Signing the pages of the application at a time other than application.

n  Signing externally created statements that designate an authorized representative.

Externally created statements must clearly indicate the client is giving permission for someone to act on the clients behalf and include the name, address and phone number of the authorized representative.

l  Providing a Power of Attorney.

A Power of Attorney is a legally binding document that authorizes a person or corporation to act on another person’s behalf in financial matters. The client granting the power of attorney is called the ”principal.” The person or corporation acting on the principal’s (client’s) behalf is called the Attorney-in-Fact. The powers granted to the Attorney-in-Fact can be limited to certain activities and to a specific time frame or they can be general and wide in scope.

n  The Power of Attorney must be dated, signed by the applicant or enrollee and include the name of the person or corporation who is being appointed to act on the applicant’s or enrollee’s behalf.

n  Accept a designation of Power of Attorney in place of an authorized representative designation if the Power of Attorney contains language that allows the Attorney-in-Fact to represent the applicant or enrollee in the health care application or eligibility process.

Note:  Also accept a designation of ”Durable Power of Attorney”. A Power of Attorney is durable if it contains language such as ”This power of attorney shall not be affected by the incapacity or incompetence of the principal” or similar words showing the intent of the principal to allow the authority to continue even if the principal becomes incapacitated.

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How Long Does the Designation Last?

l  Authorized Representative.

The authorized representative designation remains in place until revoked by the applicant or enrollee or the authorized representative.

l  Power of Attorney.

A nondurable power of attorney terminates upon the death, incapacity or incompetence of the principal, the expiration date specified in the power of attorney, or in the case of a power of attorney to the spouse of the principal, upon the commencement of proceedings for dissolution, separation or annulment of the principal’s marriage.

A durable power of attorney terminates on the expiration date specified or upon death of the principal.

l  Revocation of the Power of Attorney.

Revocation of a power of attorney must be in writing. The revocation must be signed by the principal or someone acting on behalf of the principal, such as a guardian or conservator, and acknowledged before a notary public.

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Disqualification of an Authorized Representative

County agencies or MCRE Operations may disqualify authorized representatives who do any of the following:

l  Knowingly provide false information.

l  Are unable to provide required information.

l  Refuse to provide required information.

Note:  A guardian or conservator can only be disqualified as an authorized representative by the court.

If you disqualify an authorized representative:

l  Allow the applicant or enrollee to designate a new one.

l  Determine whether or not a vulnerable adult referral to social services is needed.

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Authorized Representative Receipt of Forms and Notices

Unless the client indicates otherwise, the authorized representative will receive all forms and copies of eligibility and premium notices.

For MinnesotaCare, enter a ”Y” indicator on the RREP screen in MMIS, along with the authorized representative’s name and address, unless the client indicates they do not want the authorized representative to receive forms, eligibility notices and premium notices.

MAXIS automatically sends all notices of action to the authorized representative and the client. Enter a "Y" on STAT/AREP in the "Forms to AREP?" field, unless the client indicates they do not want the authorized representative to receive forms such as report forms and Explanations of Medical Benefits (EOMBs).

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Authorization to Release Information

The Permission to Share Information (DHS-5337) and General Consent/Authorization for Release of Information (DHS-3549) allow the agency to share information about the applicant or enrollee with the person or organization specified on the form. These forms do not appoint the person to be an authorized representative.

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