State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

2.5 Valid Signature

2.5.1 Valid Signature Introduction

The applicant or his or her representative (see below) must sign one of the following:

 

• The paper application form

• The signature page of the Application Summary, either over the telephone or face to face

• The ACCESS application with an electronic signature

• The online or paper Application for Health Coverage & Help Paying Costs from the FFM

2.5.1.1 Signatures From Representatives

An applicant's representative can be one of the following:

 

• 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 person 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 can be an individual or an organization. See Section 22.5 Representatives for more information.

 

If the applicant needs to appoint an authorized representative when applying by telephone or in person, instruct the applicant to complete the Appoint, Change, or Remove an Authorized Representative form (Person F-10126A or Organization F-10126B).

 

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 (Wis. Stat. ch. 244): 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. 1. Obtain a copy of the document the applicant used to designate the signer of the application as the durable power of attorney.
   2. 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 Durable 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 applicant from filing his or her own Medicaid application nor does it prevent the applicant from granting authority to someone else to apply for public assistance on his or her behalf.

 

• Someone acting responsibly for an incompetent or incapacitated person.

  

Example 1: Carl is in a coma in the hospital. 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 a 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 is 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 paper, online, or telephonic 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's 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, disclose the value of assets, or 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 22.4 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.

2.5.4 Telephone Signature Requirements

Telephonic signatures are valid forms of signatures for Medicaid. To collect a valid telephonic signature:

 

1. Create an audio recording of the following:

 

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

Rights and responsibilities

Attestation to the accuracy and completeness of information provided

Attestation to the identity of individual signing the application

Release of information

 

2. Store the audio recording in the ECF.

3. Send the applicant or member 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 10 calendar days if any errors are noted.

 

4. Store a copy of the written summary and cover letter in the ECF.

 

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

2.5.5 Valid Signature on the Federally-Facilitated Marketplace Application

Agencies should accept the signature on the FFM application for all individuals on that application and create companion cases for adult children without obtaining a separate signature or application. Workers should reference the original FFM ACCESS application in case comments on the companion case. This policy is for FFM applications only. Current policies for non-FFM applications requiring an adult child to apply separately are still valid.

 

Because the Medicaid-specific rights and responsibilities information is not provided when a person applies for health care through the FFM, a summary must be sent to the applicant once the application is processed. No additional signature is required.

 

Note: Referrals from the FFM may include households with individuals whose eligibility may not be able to be determined on one case.

 

 

 

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The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030