Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part VIII - Applications for Medicaid › Section 12VAC30-110-1380 - Authorized representative for individual age 18 or older

Current through Register Vol. 40, No. 24, July 15, 2024
A. Patients in the Department of Mental
				  Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) facilities
				  may have applications submitted on their behalf by employees of the
				  DMHMRSAS.
B. The authorized
				  representative of an incapacitated individual shall be the individual's legally
				  appointed guardian or conservator.
C. A competent individual may sign an
				  application on his own behalf or may designate anyone to be his authorized
				  representative to file a Medicaid application on his behalf. If a competent
				  individual wants another person to file a Medicaid application for him, he must
				  designate the authorized representative in a written statement that is signed
				  by the individual applicant. The authorized representative statement is valid
				  for the life of the Medicaid application or until the applicant changes or
				  removes his authorized representative. If the application is approved, the
				  authorized representative statement is valid for any subsequent review and
				  redetermination until the applicant's Medicaid eligibility is cancelled. If the
				  applicant reapplies for Medicaid after Medicaid is cancelled, he must sign the
				  application or provide a new authorized representative statement.
D. When an individual has given
				  power-of-attorney to another person that includes the power to conduct the
				  applicant's business affairs, the attorney-in-fact is considered the
				  applicant's authorized representative.
E. For an individual who has not been
				  determined by a court to be legally incapacitated, but who is reported to be
				  mentally unable to sign his name or to make a mark, an application may be
				  signed under the following circumstances:
1.
				  When it is reported that an individual cannot sign the application and the
				  individual does not have an attorney-in-fact, an authorized representative or a
				  family substitute representative, the individual's inability to sign the
				  application must be verified by a written statement from the individual's
				  physician that the individual is mentally unable to sign and file a Medicaid
				  application because of the individual's diagnosis or condition.
2. If the individual does not have an
				  attorney-in-fact and has not signed a statement authorizing another person or
				  organization to apply for Medicaid on his behalf, the applicant's spouse will
				  be considered to be the individual's authorized representative. If the
				  individual is not married or is estranged from his spouse or his spouse is
				  unable to represent him, the individual's authorized representative shall be a
				  family substitute representative.
3. Treatment of an individual who is unable
				  to sign and who has no authorized representative or family substitute
				  representative:
a. When motion to appoint a
				  guardian or conservator has been filed with the court, but a final
				  determination has not been ordered. When an individual's physician has verified
				  that he is unable to sign the Medicaid application and the individual has no
				  legal representative, a determination of Medicaid eligibility shall not be
				  completed until a guardian or conservator has been appointed. Any application
				  filed on behalf of such individual shall be held in pending status until the
				  appointment of a legal guardian or conservator. The eligibility worker shall
				  mail the legal guardian or conservator a copy of the Medicaid application. The
				  legal guardian or conservator shall have 10 working days after appointment to
				  sign and return the Medicaid application and documentation of the guardian or
				  conservator's appointment. If the application has not been signed by the
				  deadline, eligibility for Medicaid shall be denied.
b. When motion to appoint a guardian or
				  conservator has not been filed with the court. When a motion to appoint a
				  guardian or conservator has not been filed with the court, the eligibility
				  worker shall refer the individual to the Adult Protective Services unit in the
				  local department of social services. The Medicaid application shall be held in
				  pending status until the adult protective services investigation is complete.
				  If the completed adult protective services investigation concludes that
				  guardianship proceedings will not be initiated, the application must be signed
				  by the applicant or the applicant must sign a statement designating an
				  authorized representative. If after 10 working days the application is not
				  signed, eligibility for Medicaid shall be denied.