2.5 Valid Signature

2.5.1 Valid Signature Introduction

2.5.2 Witnessing the Signature

2.5.3 Spousal Impoverishment MA Signatures

2.5.1 Valid Signature Introduction

The applicant or his or her representative (see below) must sign:

The paper application form,
The signature page of the Application Summary,
The ACCESS or FFM application form with an electronic signature, or
Telephonically.

Signatures from Representatives

Except when:

Guardian: 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. Only the person designated as the guardian of the estate, guardian of the person and the estate, or guardian in general may sign the application. When someone has been designated as the guardian of the estate, guardian of the person and the estate, or guardian in general, only the guardian, not the applicant, may sign the application, or appoint another representative.

Authorized Representative : The applicant may authorize someone to represent him or her. 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 a completed signed application 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.

Durable power of attorney (§ 243.07, Wis. Stats.): 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:

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

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. An individual's Durable Power of Attorney may appoint an authorized representative for purposes of making a Medicaid 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 Medicaid 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 an incompetent or incapacitated individual pending a guardianship determination.

Example 1: Carl is in a coma in the hospital. A guardianship proceeding has been started. Sherry, a nurse who works at the hospital, can apply for Medicaid on Carl’s behalf.

A superintendent of a state mental health institute or center for the developmentally disabled.

A warden or warden's designee for an inmate of a state correctional institution who is a hospital inpatient for more than 24 hours.

The superintendent of the county psychiatric institution, who has been designated by the county social or human services director, 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.

2.5.2 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 Medicaid program from recovering benefits provided incorrectly due to an applicant or member’s misstatement or omission of fact.

2.5.3 Spousal Impoverishment Medicaid Signatures

All spousal impoverishment Medicaid applications and reviews require the signatures of both the institutionalized person and the community spouse , or of a person authorized to sign for them.

If the institutionalized person's signature is missing, deny the application.

Beginning with applications dated November 11, 2013, if the community spouse refuses to sign the application, refuses to disclose the value of assets, or refuses to provide required information on income or resources, deny the application unless the agency determines that denial of eligibility would result in undue hardship for the person (see Section 17.17 Undue Hardship).

If the community spouse refuses to sign the application or provide required information, enter an “N-No” in the Health Care Signature field on the General Case Information page.

When policy requires a witness to the institutionalized person's signature, the community spouse's signature must also be witnessed.

For ongoing cases where eligibility was determined without using spousal impoverishment rules, apply the spousal impoverishment rules at the next renewal. This includes completing an asset assessment using the couples assets on the first day of the month of the review month and determining eligibility for the next certification period by comparing the current combined assets of the couple to the total of the Community Spouse Asset Share plus the $2,000 asset limit for the institutionalized spouse.

This page last updated in Release Number: 15-01

Release Date: 06/10/2015

Effective Date: 06/10/2015