1801.000.00 Authorized Representative(s) for MO HealthNet

1801.010.10 Appointing an Authorized Representative in a Household with Multiple Adults

IM-103 July 11, 2022

An authorized representative only represents the participant who signs, or whose legal guardian, conservator, or attorney in fact signs on their behalf, the Appointment of Authorized Representative (IM-6AR) form.

An authorized representative appointed by a parent or legal guardian would represent children under the age of 18 that are included in the case.

Only share information for other adults, age 18 or older, if the adults have the same authorized representative.

If another adult included in the case requests to appoint an authorized representative, the adult:

  • must complete an IM-6AR form;
  • may appoint the same authorized representative as the participant; or
  • may appoint a different authorized representative(s).

NOTE:  If appointing the same authorized representative, both adults’ names and signatures can be included on the same IM-6AR.

When multiple adults are receiving MO HealthNet (MHN) coverage and do not share an authorized representative, send separate notices to the appropriate authorized representative. The household will continue to receive a combined notice.

EXAMPLE:  Anita applies for MHN for herself and her husband, Bruce. Anita appoints ABC Behavior Health as an authorized representative but Bruce does not. ABC Behavior Health can only receive eligibility information and notices for Anita.