Minnesota Health Care Programs

1.3.1.2 Authorized Representative

Minnesota Health Care Programs (MHCP) applicants and enrollees may designate an authorized representative at the time of application or at any other time. An authorized representative is a person or organization authorized by an applicant or enrollee to apply for a MHCP and to perform the duties required to establish and maintain eligibility.

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:

Contact the county, tribal or state servicing agency, including talking with the worker without additional consent
Contact the help desks, without additional consent
Have access to eligibility information in the applicant’s or enrollee’s case file
Complete and sign forms, such as applications and renewals, for the applicant or enrollee
Provide documentation
Appeal agency decisions
Receive forms and notices
Pay premiums
Act on behalf of the applicant or enrollee in all other matters with the county, tribal or state servicing agency
Maintain the confidentiality of any information regarding the applicant or enrollee provided by the county, tribal or state servicing agency

Who Can Be an Authorized Representative?

Authorized representatives must:

Be at least 18 years old,
Have access to required information and ability to verify eligibility requirements, and
Agree in writing to accept the responsibilities of an authorized representative.

Who Cannot Be an Authorized Representative?

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

County, tribal or state servicing agency employees who determine eligibility
Regional Treatment Center (RTC) reimbursement officers for MA enrollees
Certified assisters (navigators)

An incarcerated individual can have an authorized representative, but the authorized representative cannot enroll the inmate without his or her consent.

Designating an Authorized Representative

Any applicant or enrollee who is not incapacitated may designate an authorized representative. People who are incapacitated cannot designate an authorized representative. An incapacitated person is someone who a court has determined lacks understanding or capacity to make reasonable personal decisions and is not able to meet their own needs for medical care, nutrition, clothing, shelter, or safety. A court makes a finding of incapacitation when appointing a guardian. A person may also have executed a durable power of attorney that establishes an agent for handling personal affairs in the event of incapacity.

Designations by an applicant or enrollee must be in writing and must include the applicant or enrollee's signature unless the applicant or enrollee is unable to sign due to physical limitations. See 1.2.6 MHCP Signature for more information.

A designation may be made by submitting one of the following forms or a written statement containing signatures of both applicant or enrollee and the person specified to act on their behalf:

A completed Authorized Representative Designation attached to any MHCP application
A completed Giving Permission for Someone to Act on My Behalf (DHS-3437) or Minnesota Family Planning Program (MFPP) - Giving Permission for Someone to Act on My Behalf (DHS-3437A)
A written statement that clearly indicates the applicant or enrollee is giving permission to a specified person to act on their behalf in the health care application or eligibility process, including the name, address, and phone number of the person designated to act on their behalf.

In lieu of a form or written statement designating an authorized representative, documentation of legal authority to act on behalf of the applicant or enrollee serves as the designation. The following documents show legal authority to act on behalf of the applicant or enrollee:

A court or tribal court order establishing legal guardianship
A court or tribal court order establishing a conservatorship with the power to apply for assistance on behalf of the person subject to conservatorship.
A valid Power of Attorney
- A Power of Attorney is a legally binding document that authorizes a person or corporation to act on behalf of the named person, known as the principal, in financial matters.
- The Power of Attorney may or may not operate when the named person becomes incapacitated. If the agent can act in the event of incapacity of the principal, the Power of Attorney is considered a durable Power of Attorney.

The agency should contact its County Attorney if there is a question about the interpretation or validity of legal documentation.
Designations Involving Guardians and Conservators
If an applicant or enrollee has a court or tribal court-appointed guardian, the applicant or enrollee may not designate an authorized representative on their own behalf. The guardian is the authorized representative unless a court has also appointed a conservator. The guardian must provide a copy of the court order establishing the guardianship as evidence of authority to act on behalf of the protected person.
If an applicant or enrollee has both a guardian and a conservator with the power to apply for assistance on behalf of the person subject to conservatorship, the conservator is the authorized representative. The conservator must provide a copy of the order establishing the conservatorship as evidence of authority to act on behalf of the person subject to the conservatorship.
If an applicant or enrollee does not have a guardian but has a conservator, the applicant or enrollee may designate an authorized representative on their own behalf.
Organization Designated as Authorized Representative
An organization may be designated as an authorized representative. If an organization is named as authorized representative, an employee with authority to act on behalf of the organization must sign the authorized representative designation. The organization has the authority to exercise the rights of, and must carry out the responsibilities of the authorized representative.

Servicing Agency Designation of an Authorized Representative

The county, tribal or state servicing 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.

The agency must appoint a social service professional as the applicant or enrollee’s authorized representative if no qualified person is available to act as an authorized representative.

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

How Long Does the Designation Last?

The applicant or enrollee may change the authorized representative designation at any time. The designation remains in place until:

Revoked by the applicant or enrollee
Revoked by the authorized representative
The legal authority to act on the applicant or enrollee’s behalf changes
The authorized representative is disqualified
The applicant or enrollee dies

Disqualification of an Authorized Representative

Servicing agencies may disqualify authorized representatives who:

Knowingly provide false information
Are unable to provide required information
Refuse to provide required information

Only a court or tribal court can disqualify a guardian or conservator.

When a county, tribal or state servicing agency disqualifies an authorized representative, the applicant or enrollee can designate a new one.

If a servicing agency disqualifies an authorized representative, it must determine whether a vulnerable adult referral to social services is needed.

Authorized Representative Receipt of Forms and Notices

Unless the applicant or enrollee indicates otherwise, the authorized representative must be sent all of the forms and copies of eligibility and premium notices. See EPM 1.3.1.5 Notices for a list of required notices.

Authorization to Release Information

The General Consent/Authorization for Release of Information (DHS-3549) allows the county, tribal or state servicing 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.

Legal Citations

Code of Federal Regulations, title 42, section 435.923

Code of Federal Regulations, title 45, section 155.227

Minnesota Statutes, section 524.5-310

Minnesota Statutes, section 524.5-313

Minnesota Statutes, section 524.5-417

Minnesota Rules, part 9505.0085, subpart 2