1801.000.00 Authorized Representative(s) for MO HealthNet

1801.010.20 Appointing Another Adult Member of the Household as an Authorized Representative

IM-103 July 11, 2022

When an adult (age 18 and older) is required to be included in a household, but is not the head of household (application signer), an Appointing an Authorized Representative (IM-6AR) form may be required to request benefits MO HealthNet (MHN) benefits for the adult member or to release information to the application signer.

EXAMPLE: Nancy applies for Angela. Angela is Nancy’s 22-year-old disabled child (whom she claims as a tax dependent). Nancy is able to sign the application for Angela, but an IM-6AR is required to allow Nancy to receive information regarding Angela’s pending MO HealthNet for the Aged, Blind, and Disabled (MHABD) application.

A valid IM-6AR is required:

  • To request benefits or receive information for another unrelated adult member who is mandatory in the household.

EXAMPLE: Carl and Joyce are not married, but they live together and have a child, Lyle. Carl applied for MHN benefits. Joyce must be included to determine Lyle’s benefits, but Carl cannot request benefits for Joyce without having a signed IM-6AR.

  • To request benefits or receive information for any related adult member who is not a spouse or tax dependent.

EXAMPLE: Tori is 27 years old and is living with her parents. Her parents do not claim her as a tax dependent. For her mom to request MHN benefits for Tori, an IM-6AR is required.

  • To receive information regarding an MHABD case for any other adult member, except a spouse.

EXAMPLE: William applied for MHN his children and his mom, Claire, who he claims as a tax dependent. Claire is 75 years old and an MHABD application was registered to explore eligibility. An IM-6AR is required to release information to William about Claire’s pending MHABD application.

NOTE: An authorized representative form may not be required to sign an application in some circumstances, such as for a minor or incapacitated participant, if certain circumstances are met. However, signing the application does NOT qualify the application signer as an authorized representative. See 1802.020.00 Signing the Application.