State of Wisconsin
Department of Health Services

HISTORY

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

21-03 Version of 2.5 Valid Signature

2.5.1 Valid Signature Introduction

The applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility or his or her representative (see below) must sign one of the following:

2.5.1.1 Signatures From Representatives

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

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"Spousal Impoverishment Protection" refers to special financial provisions in Medicaid law regarding income and assets that affect certain married couples receiving or applying for nursing home or community waiver services. Medicaid applications, renewals, or changes in marital status that cause someone to be subject to spousal impoverishment rules, require the signatures of both the institutionalized person and the community spouseSomeone who is 1) Married to an institutionalized person and 2) Not living in a nursing home or other medical institution for 30 or more consecutive days. or of a person authorized to sign for them as described in Section 2.5.1.1 Signatures From Representatives.

If the benefits are denied or terminated because the community spouse refuses to sign, disclose the value of assets, or provide required information on income or resources, the applicant or member must be sent information on the Undue Hardship Waiver process. For more information on this policy, see Section 22.4 Undue Hardship and Process Help Section 11.7.

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:
    1. Key information provided by the household during the telephone interview
    2. 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
  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 FFMFederally-Facilitated Marketplace 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.

2.5.6 Electronic Signatures

In general, electronic signatures are valid signatures for documents requiring applicant or member signatures. Electronic signatures may appear typed or printed and may vary depending on the software used to collect the signature. Accept the electronic signature as a valid signature and process the document accordingly.

This page last updated in Release Number: 21-03
Release Date: 12/13/2021
Effective Date: 08/13/2021


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