25.5 Valid Signature

The applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. or the applicant's caretaker relative must sign (using his or her own signature):

The paper applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. form,
The signature page of the CAF (telephone or face to face) or
The ACCESS application form with an electronic signature.
The online or paper Application for Health Coverage & Help Paying Costs from the Federally-facilitated Marketplace.

Except when:

A guardian signs for him or her. When an application is submitted with a signature of someone claiming to be the applicant’s guardian, obtain a copy of the document that designates the signer of the application as the guardian. From the documents provided, ensure that the individual claiming to be the applicant’s guardian can file an application on his or her behalf. File the copy of the document in the case record.

Your agency’s social services department determines the need for a guardian or conservatorA person, official, or institution designated to protect the interests of an incompetent person. A conservator has some, but not all, of the duties and powers of a legal guardian. (IMM, Ch. I, Part A, 19.0.0). Determine the guardian type specified by the court.

Only the person designated as the guardian of the estate (IMM, Ch. I, Part A, 19.2.0), guardian of the person and the estate, or guardian in general may sign the application. You may not require a conservator (IMM, Ch. I, Part A, 19.4.0) or guardian of the person (IMM, Ch. I, Part A, 19.1.0) to sign the application.

An authorized representative signs for the applicant. The applicant may authorize someone to represent him or her (IMM, Ch. I, Part A, 18.3.0). An authorized representative must be an individual, not an organization.

If the applicant wishes to authorize someone to represent him or her when applying by mail, instruct him or her to complete the authorized representative section of the application form.

If the applicant needs to appoint an authorized representative when applying by telephone or in person, instruct the applicant to complete the Authorization of Representative form (F-10126).

An authorized representative is responsible for submitting the signed application (completed insofar as able) and any required documents.

When appointing an authorized representative, someone other than the authorized representative must witness the applicant’s signature. If the applicant signs with a mark, two witness signatures are required.

When a Marketplace application is processed by the agency and an applicant has appointed an authorized representative in the application, the agency must honor this appointment of an authorized representative.

The applicant’s durable power of attorney (§ 243.07, Wis. Stats.) signs the application. A durable power of attorney is a person to whom the applicant has given power of attorney authority and agrees that the authority will continue even if the applicant later becomes disabled or otherwise incapacitated.

When a submitted application is signed by someone claiming to be the applicant’s durable power of attorney:

1. Obtain a copy of the document the applicant used to designate the signer of the application as the durable power of attorney.

1. Review the document for a reference that indicates the power of attorney authority continues notwithstanding any subsequent disability or incapacity of the applicant.

Do not consider the application properly signed unless both of these conditions are met. File a copy of the document in the case record. An individual's Durable Power of Attorney may appoint an authorized representative for purposes of making a BadgerCare Plus application, if authorized on the power of attorney form. The Durable Power of Attorney form will specify what authority is granted.

The appointment of a Durable Power of Attorney does not prevent an individual from filing his or her own application for BadgerCare Plus, nor does it prevent the individual from granting authority to someone else to apply for public assistance on his or her behalf.

Someone acting responsibly for the individual signs the form on behalf of the individual, if the individual is incompetent or incapacitated.

Example: Carl is in a coma in the hospital. Sherry, a nurse who works at the hospital, can apply for BadgerCare Plus on Carl’s behalf.

A superintendent of a state mental health institution or center for the developmentally disabled signs on behalf of a patient.

A warden signs the application for an applicant that is an inmate of a state correctional institution that is out for more than 24 hours .
The director of a county social or human services department delegates, in writing (retain a copy of this written authorization), to the superintendent of the county psychiatric institution the authority to sign and witness an application for residents of the institution.

The social or human services director may end the delegation when there’s reason to believe that the delegated authority is not being carried out properly.

25.5.1 Witnessing the Signature

The signatures of two witnesses are required when the application is signed with a mark.

An agency staff person is not required to witness the signature of a mail-in, online or telephone application.

Note: This does not affect the State of Wisconsin’s ability to prosecute for fraud nor does it prevent the BadgerCare Plus program from recovering benefits provided incorrectly due to an applicant or member’s misstatement or omission of fact.

25.5.2 Telephone Signature Requirements

An audio recording of the following:

Key information provided by the household during the telephone interview;
Signature statement that includes:

1. Rights and responsibilities;
2. Attestation to the accuracy and completeness of information provided;
3. Attestation to the identity of individual signing the application;
4. Release of information.

Store the audio recording in the electronic case file (ECF).

Send a written summary of the information provided during the interview. Include a cover letter that outlines the applicant or member’s responsibility to review the information provided and notify the agency within ten calendar days if any errors are noted.
Store a copy of the written summary and cover letter in the electronic case file (ECF).

Note: Applications that are submitted through ACCESS or transferred from the Marketplace are signed electronically, so an additional signature (telephone or pen-and-paper) is not needed.

This page last updated in Release Number: 13-02

Release Date: 10/25/13

Effective Date: 10/01/13