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Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability

2.3.1.3 Authorization to Obtain Information (Archive)

To be eligible people who have an asset test must complete a valid Authorization to Obtain Financial Information (DHS-7823) as a condition of eligibility for MA-ABD. The form must be signed and in the case file for the applicant or enrollee and any person whose assets deem to them before the county, tribal or state servicing agency requests their financial information through the Account Validation Service (AVS).

Before submitting a request through the AVS, the county, tribal or state servicing agency must verify a valid authorization is on file.

Each person may sign the same form or a separate form; however, no other authorization or release form may be used in place of the Authorization to Obtain Financial Information (DHS-7823) form.

The Authorization to Obtain Financial Information form(s) must be maintained in the enrollee's case file, even when it is no longer valid.

Authorization Requirements

The Authorization to Obtain Financial Information form must be signed by:

The person or their authorized representative
- If the person has a legal guardian, the guardian must sign for the person.
- If the person has passed away, the personal representative of the estate must sign for the person.
The person’s spouse, sponsor, sponsor’s spouse , or their legal representative, if their assets are used to determine the person’s eligibility. A sponsor is someone who signed an Affidavit of Support (USCIS I-864) as a condition of the person’s, or his or her spouse’s, entry to the country.

A separate authorization is needed for each spouse when both spouses are applying or eligible for MA-ABD and have an asset test.

Social Security Number (SSN)

A person’s SSN is required to submit a request through the AVS. The SSN must be provided on the current MHCP application or AVS authorization. An SSN known to the agency for any other reason cannot be used to submit the request to the AVS.

Applicants and enrollees who do not have an SSN or meet an exception for providing an SSN for purposes of MA eligibility are not required to provide their SSN for the purpose of submitting a request to the AVS.

Spouses and sponsors are not required to provide an SSN on the authorization form (DHS-7823). MA-ABD eligibility cannot be denied or terminated due to a spouse or sponsor not providing their SSN on the authorization.

Applicants and enrollees, their spouses and sponsors must verify proof of their assets, regardless of whether the AVS is used to access information about their financial accounts.

Duration of the Authorization

A signed authorization form remains in effect until one of the following occurs:

The MA application is withdrawn or denied.
The enrollee’s MA is closed. However, an enrollee’s authorization remains in effect if eligibility is reinstated due to agency error or delay in processing.
The enrollee’s MA basis of eligibility is no longer MA-ABD with an asset test.
The person or their authorized representative withdraws the authorization in writing.
The authorized representative who signed the AVS authorization on behalf of another person is no longer the authorized representative.
The person dies, even when it is signed by another person on their behalf.

New Authorization Required

A new authorization form is required before a request can be submitted through the AVS when:

A previously completed authorization is no longer in effect for any of the reasons listed under the Duration of the Authorization section above.
The agency cannot physically locate the required signed authorization.
An enrollee gets married or has a change in eligibility that causes the spouse’s assets to be considered in the eligibility determination when they previously were not considered.
- Only the spouse’s signature is required if the enrollee’s authorization form otherwise remains in effect.
- The spouse does not need to sign a new form if they already signed the authorization form which remains in effect.

The authorization is received and there is not an active MHCP program to make it valid or it was not received with or after an application for a MHCP.

Legal Citations

United States Code, title 42, section 1396w