22-03 Version of 2.5 Valid Signature

2.5.1 Valid Signature Introduction
1. 2.5.1.1 Signatures From Representatives
2.5.2 Witnessing the Signature
2.5.3 Spousal Impoverishment Medicaid Signatures
2.5.4 Telephone Signature Requirements
2.5.5 Valid Signature on the Federally-Facilitated Marketplace Application
2.5.6 Electronic Signatures

2.5.1 Valid Signature Introduction

The applicant, their representative (see below), or the applicant's caretaker relative must sign one of the following:

The paper application form
The signature page of the Application Summary (by telephone, electronically, or with a handwritten signature)
The ACCESS application with an electronic signature
The online or paper Application for Health Coverage & Help Paying Costs from the FFMFederally-Facilitated Marketplace

2.5.1.1 Signatures From Representatives

The following people can sign the application with their own name on behalf of the applicant:

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 their behalf.

When someone has been designated as one of the following, only the guardian, not the applicant, may sign the application or appoint an authorized representative:
- Guardian of the estate
- Guardian of the person and the estate
- Guardian in general
If the applicant only has a legal guardian of the person, the guardian can sign the application since they are acting responsibly for an incompetent or incapacitated person. However, a legal guardian of the person cannot appoint an authorized representative. The applicant must be the one to appoint an authorized representative if they choose to have one.

The applicant may appoint their guardian of the person to be their authorized representative. If the applicant has appointed their guardian of the person to be their authorized representative, the guardian may sign the application as the authorized representative.
Conservator (Wis. Stat. 54.76(2))
A conservator is a person who is appointed by a court at an individual’s request under Wis. Stat. 54.76(2) to manage the estate of the individual. When an application is submitted with a signature of someone claiming to be the applicant’s conservator, a copy of the document that designates the signer of the application as the conservator is required.

The conservator is not required to sign the application, though they are able to sign on behalf of the applicant. If an applicant has a conservator, the applicant can still sign the application on their own behalf.
Authorized Representative
The applicant may authorize someone to represent them. An authorized representative can be an individual or an organization (see Section 22.5 Representatives). If the applicant needs to appoint an authorized representative when applying by telephone or in person, the applicant must complete the Appoint, Change, or Remove an Authorized Representative form (F-10126). 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.

The authorized representative is not required to sign the application, though they are able to sign on behalf of the applicant. If an applicant has an authorized representative, the applicant can still sign the application on their own behalf.
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. Only a durable power of attorney for finances (may also be known as a durable power of attorney for finances and property) is considered to be the power of attorney for the purpose of providing a valid signature on the application. A power of attorney for health care is not considered the power of attorney for the purpose of providing a valid signature on the application.

When a submitted application is signed by someone claiming to be the applicant’s durable power of attorney for finances, the agency must do both of the following:
- Obtain a copy of the document the applicant used to designate the signer of the application as the durable power of attorney for finances.
- Review the document for a reference that indicates the durable power of attorney for finances authority continues notwithstanding any subsequent disability or incapacity of the applicant.
Do not consider the application properly signed unless both of the above conditions are met. An individual's durable power of attorney for finances may appoint an authorized representative for purposes of making a health care application, if authorized on the Durable Power of Attorney for Finances form.

The Durable Power of Attorney for Finances form will specify what authority is granted. The appointment of a durable power of attorney for finances does not prevent an individual from filing their own application, nor does it prevent the individual from granting authority to someone else to apply for public assistance on their behalf.

Someone acting responsibly for an incompetent or incapacitated person

Example 1:

Carl is in a coma in the hospital. Marco, a nurse who works at the hospital, can apply for health care on Carl’s behalf.

A superintendent of a state mental health institute or center for the developmentally disabled
A warden or warden's designee
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
The superintendent of a country psychiatric institution may sign an application for a resident of the institution provided that the county social or human services director has delegated to them (in writing) the authority to sign and witness applications for residents of the institution. Retain a copy of this written authorization. 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"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:

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
Store the audio recording in the ECF.
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.
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: 22-03
Release Date: 12/05/2022
Effective Date: 12/05/2022