zz – Obsolete

IM-33 April 20, 2015

An authorized representative represents the applicant/participant who signs, or whose legal guardian/conservator or attorney in fact, signs on their behalf, the Appointment of Authorized Representative (IM6-AR) form. The authorized representative may only make application for the applicant who has appointed the individual to act as their authorized representative. If an applicant and the applicant’s spouse apply for MO HealthNet benefits and only the applicant appoints an authorized representative, do not share the spouse’s information with the applicant’s authorized representative.

The second parent or spouse is not required to appoint an authorized representative(s). However, if a second parent or a spouse requests to appoint an authorized representative, the second parent or spouse:

• must complete an Appointment of Authorized Representative (IM6-AR) form;
• may appoint the same authorized representative as the applicant/participant; or
• may appoint a different authorized representative(s). EXAMPLE: If Mrs. A appoints an authorized representative but her husband, Mr. A, does not, the authorized representative can only make application for Mrs. A, and only receive eligibility information and eligibility notices on Mrs. A.

  Mr. A. does not have to appoint an authorized representative. If Mr. A does not appoint an authorized representative, and he wants to apply for benefits, he will have to sign an application form. If Mr. A does not appoint an authorized representative and does not want to apply for benefits, the authorized representative must provide information about both Mr. and Mrs. A to complete the eligibility determination.

FAMIS forms and notices contain information on all members in the eligibility unit. When an eligibility unit contains a second parent or spouse who did not name an authorized representative, it is necessary to provide manual forms and notices, such as the Approval Notice form (IM-32), or Notice of Case Action form (IM-33) to the authorized representative for the applicant/participant. The manual forms and notices must only contain information about the applicant/participant who signed the IM6-AR.