Persons Who May Represent a Client

Authorized Representatives

Who can be Appointed

Applicants who are competent to handle their affairs and understand their responsibilities may an individual to accompany, assist and represent them in various aspects of the MC process. This person is often referred to as an AR and may be:

A family member,
A friend,
A representative of an organization or law firm,
An organization (including any representative from the organization who has a signed agreement to adhere to AR rights and responsibilities may act on behalf of the applicant/client),
A legal aid staff member, or
Any other person the client chooses.

MC regulations do not prohibit a provider or provider's representative from serving as an AR for the applicant, although it may appear inappropriate for an employee of a provider (who has a financial stake in the eligibility of a client) to be an AR. EWs must make sure that clients understand that they have a free choice to appoint any person as the AR, and that designation of a provider representative as an AR is not mandatory to receive medical services.

Note: Competent is the ability to act on one's own behalf in business and in personal matters.

The Disability Determination Service Division (DDSD) accepts “Authorization for Release of information” (MC 220) forms signed by legal representatives only. A legal representative, per HIPAA, is a spouse, relative, legal guardian, conservator, executor, court appointed representative, or EW.

Client Responsibilities

The applicant/client may:

Authorize an AR with an electronic signature, telephonic signature, handwritten faxed or scanned document (SSApp, SAWS 2 Plus, MC 382).
Designate multiple ARs.
Appoint an individual or organization to serve as an AR.
Choose the role each AR services (i.e. application, redetermination, ongoing case maintenance.
Choose which notices, if any should be sent to the AR.

The AR designation is effective until the client or AR reports that the individual or organization is no longer an AR.

Applicants/clients who are incompetent/comatose/deceased, or otherwise unable to decide for him/herself, cannot appoint an AR. However, his/her representative who has signed the DHCS 7068 may sign an AR form to request an AR to assist in the MC application process or resolve issues.

Authorized Representative's Role

The AR may:

Accompany the applicant/client if a face-to-face interview is requested or required at application or redetermination.
Assist the client in understanding and answering questions during the interview.
Help the client obtain required verifications at application and redetermination.
Obtain information from an EW or DDSD regarding the status of an application.
Provide medical records and other information to an EW and DDSD for a disability evaluation.
Review the client's case record with or without the client being present.
Obtain copies of non-confidential documents from the case record if requested.
Accompany and assist the client in the appeal (fair hearing) process,
Fully act on behalf of the client, with the permission of the client,
Receive a copy of a specific Notice of Action (NOA) from the EW at the request of the client,
Sign the application and complete and submit the renewal form on behalf of the client, and
Inform the EW that he or she is no longer the AR for the client.

Authorized Representative Limitations

The AR may NOT:

Receive a NOA unless the client has requested that a specific NOA be sent to the AR or it is for an appeal (fair hearing).

Receive the client's Benefits Identification Card (BIC).

Receive a Letter of Authorization (MC 180) if the AR is an organization, law firm or group.

Assign another or new AR.

Note: The above limitations do not apply to incompetent clients in LTC facilities.

Representative Payees

A Representative Payee is a person who is appointed by the Social Security Administration to SSI clients who are not capable of handling their own affairs. (Representative Payees may also be appointed for individuals by other governmental agencies.) The Representative Payee receives and manages the benefits for the client.

ARs for MC clients are individuals appointed only to assist another person in the MC application, RD, and/or appeals process. The authority of a Representative Payee and an AR are different, the limitations of ARs to act on behalf of clients do not apply to Representative Payees.

Durable Powers of Attorney

Eligibility Workers may encounter individuals who have obtained Durable Powers of Attorney (DPA) which enable them to act as ARs for clients. These persons may present DPA documents to EWs and indicate their intent to act in place of the MC client.

This section provides information regarding an AR with Durable Powers of Attorney and the MC policies pertaining to them.

Definition

A power of attorney, as defined in Senate Bill 1907, is a written instrument that is executed by a person having the capability to enter into a contract, and that grants authority to an attorney-in-fact.

A durable power of attorney contains a clause which states that it will not be affected by the incapacity of the principal, or it may state that the DPA will become effective at the time the principal becomes incapacitated (Civil Code Section 2400).

The principal is the person who appoints the attorney-in-fact.
The attorney-in-fact is the person who is authorized to act on behalf of the principal.

Types of Durable Powers of Attorney

There are two types of durable powers of attorney:

A Durable Power of Attorney for Property Management (DPAP) which authorizes an attorney-in-fact to handle an individual's financial affairs.
- Note: An MC 382 or other proof of legal authorization is still required for an individual who is a DPAP.
A Durable Power of Attorney for Health Care (DPAHC) which allows an attorney-in-fact to make health care decisions for a person who is unable to act on his or her behalf, i.e., comatose, incompetent, etc.
- Note: An MC 382 or other written authorization is not required for an individual who is a DPAHC.

For purposes of obtaining MC benefits, a Durable Power of Attorney for Property Management (DPAP) is required.

Conditions of Durable Powers of Attorney

Anyone with the ability to enter into a contract may appoint an attorney-in-fact.

A DPAP is valid only when executed by a COMPETENT adult.
Civil Code Section 1556 prohibits a DPA from being executed by a minor, a person of unsound mind, or a person deprived of civil rights (incarcerated or institutionalized).
The DPAP may become effective immediately upon its execution, or it may not become effective until the principal becomes incompetent.

State Policy

Any competent adult may appoint an AR, with or without a DPAP document, to assist him or her in the MC application or redetermination process. EWs must treat ARs with DPAP the same as an AR without DPAP.

A signed letter or MC 382 must be on file for a non-family member AR with or without DPAP.

The assistance of an AR with or without DPAP is limited to:

Completing the initial application for benefits,
Assisting the applicant in the interview, and
Helping the client obtain verifications.

Durable powers of attorney do not give a person any additional authority to act on behalf of a MC client. ARs with DPAP must be allowed to assist the client wherever necessary, but are not entitled to act in place of the client.

Specifically, an AR with a DPAP document may not:
Complete and sign a MC application for the client,
Complete the face-to-face interview (if requested or required) for the client, or
Accept responsibility for the MC client to report any changes that may affect eligibility.

Expiration of Authority

The time period in which the AR, with a DPAP document, may act on behalf of the competent applicant or client ends when the client or the AR themselves removes the AR at any time, either orally or in writing.

Public Guardian

The Public Guardian is a government representative who has court-appointed authority. Their ability to act on behalf of a client is not limited to those activities defined under [Refer to Chapter 5, "Authorized Representative's Role,” page-10]. A Public Guardian may complete and sign the MC application and receive the BIC card on behalf of someone who is a conservatee.

Appointment of an Authorized Representative

The following methods are the only acceptable and valid means for a MC applicant/recipient to appoint an individual or organization to act as an AR.

The “Appointment of Authorized Representative” form (MC 382)
The online/paper Single Streamline Application
Statewide Automated Welfare Systems (SAWS) 2 PLUS/online SAWS application portal

Note: Legal documentation of authority to act on behalf of the applicant/beneficiary under state law substitutes for a completed MC 382 form.

All of the three approved methods above may be received in person, by mail, telephone (with a telephonic signature), Internet or e-mail. Legal documentation may not be received via telephone as the actual document appointing authority must be received.

Time Frame of Authority

The authority of an appointed authorized representative does not expire until the applicant/recipient or the authorized representative themselves cancels or changes the AR.

Cancellation of an AR can be done by contacting the county electronically, by phone, in person or in writing. Upon cancellation by either the AR or the client the EW must update the AR information in the case and send the “Cancellation or Change to a Medi-Cal Authorized Representative Appointment” letter (MC 381) to both the client and the AR.

Note: If an AR is appointed and the case is denied or discontinued, the AR appointment remains valid for 90 days after the denial or discontinuance for the purposes of acting on behalf of the client on issues related to the applicants eligibility.

Forms and Notices

Appointment of Authorized Representative (MC 382)

The purpose of the MC 382 is to provide a competent Medi-Cal applicant/recipient with a written method to designate an AR, specify the scope of the AR’s role and authorize an AR to receive some or all copies of notices and correspondences. The MC 382 may be used to appoint either an individual or an organization as an AR.

Important: The MC 382 has been created to replace the MC 306. Use of the MC 306 must be discontinued immediately.

Signature Requirements

The MC 382 must be signed by the applicant/recipient in order for the appointment of the AR to be valid. The appointed AR may also sign the MC 382, however, the ARs signature is not required.

Appointment Requests Without the MC 382

If the appointment of an AR is completed via any other method (i.e. phone or request sent in on unauthorized form) the EW must complete the MC 382 on behalf of the client, and scan it into IDM. In order to complete the MC 382 the EW must contact the client and obtain the following information:

AR name
AR contact information
Authority given to the AR
Confirm if the AR should receive some or all copies of notices and correspondence

Once the information is obtained and the form completed the EW must document how the required information was received. If the required information is received over the phone the EW must read Section D “Acknowledgment and Signatures” of the MC 382 to the applicant/recipient. A telephonic signature must be obtained and copies of the completed form must be sent to both the applicant/recipient and the AR.

Note: If you are unable to reach the client to obtain the required information the MC 382 must be mailed out and the AR not added to the case until it has been returned.

Single Streamline Application and Statewide Automated Welfare System (SAWS 2PLUS)

Until the paper and online applications are updated to allow the applicant/recipient to choose the scope of the AR’s duties and the notices to be copied to the AR, when an applicant/recipient appoints an AR via an application, the AR is considered to have full authority. Full authority does not however include authorization to receive copies of notices or other correspondence. In order for an AR to receive correspondence the applicant/recipient must make a request directly to the county.

If an AR is appointed via the SSAPP or SAWS 2PLUS the EW is required to complete an MC 382 on behalf of the client informing them of the authority given to the AR. Copies of the MC 382 must be mailed to both the client and AR. The copies are not required to be returned and a signature is not required as it has already been obtained on the original request (SSAPP or SAWS 2PLUS).

Notice of Appointment of Authorized Representative (MC 380)

The purpose of the MC 380 is for counties to notify the applicant/recipient and the new AR of the AR appointment and the scope of that appointment. This notice also informs the applicant/recipient that they may modify, cancel and/or limit the scope of duties of the appointed AR at any time. It also provides the newly appointed AR their rights and responsibilities and notifies them of their ability to opt out as an AR at any time.

The MC 380 must be sent to both the applicant/recipient and the AR at the initial appointment.

Authorized Representative Standard Agreement for Organizations Form (MC 383)

The purpose of the MC 383 is for an individual acting on behalf of an organization that was named as an AR to sign an agreement under penalty of perjury to adhere to federal and state regulations. This form is not to be used to appoint an AR and should not be provided to applicants/recipients. The MC 383 must be provided to an individual who is designated to represent a larger organization.

Cancellation or Change to a Medi-Cal Authorized Representative Appointment Letter (MC 381)

The purpose of the MC 381 is to be used to inform both the applicant/recipient and the AR of the cancellation or change in duties of the AR appointment. Only the applicant/recipient can modify the AR duties at any time by contacting the county. This request may be made in person, over the phone, electronically or in writing. After receiving a request the EW must update the case and mail the MC 381 to both the client and AR within 10 days of the request.

Appointment of Representative Form and Notice Distribution

Forms/Notices sent to Applicant/Recipients

Forms/Notices sent to the AR

Initial AR Appointment (individual)

Appointment Notice (MC 380)
Copy of Appointment form (MC 382)

Initial AR Appointment (individual)

Appointment Notice (MC 380)
Copy of Appointment form (MC 382)
Rights and Responsibilities (MC 219)

Initial AR Appointment (Organization)

Appointment Notice (MC 380)
Copy of Appointment Form (MC 382)

Initial AR Appointment (Organization)

Appointment Notice (MC 380)
Copy of Appointment form (MC 382)
Rights and Responsibilities (MC 219)

Modification of AR Appointment

Cancellation or Change Letter (MC 381)

Modification of AR Appointment

Cancellation or Change Letter (MC 381)

Cancellation of AR Appointment

Cancellation or Change Letter MC 381

Cancellation of AR Appointment

Cancellation or Change Letter (MC 381)

EW Action

When an EW receives a request to add an Authorized Representative (AR) via the approved methods the Medi-Cal section of the Authorized Representative window in CalSAWS must be updated to reflect the new information. The EW entries must mirror the authority granted on the MC 382.

If the Client...	And...	Then...
Appoints an AR via the SSAPP or SAWS 2PLUS	N/A	Check the box to indicate Limited Authority and select all types of authorization allowed. A new line with the same AR information will need to be added in order to grant all types of authority. (Full authority may not be selected as Client Correspondence cannot be approved without the client’s request)
Does not limit authority in Section C of the MC 382	Checks the box indicating the AR can receive all Medi-Cal notices and mail	Check the box to indicate Full Authority (this will automatically check the Client Correspondence box as well)
Limits or does not limit authority in Section C of the MC 382	Checks the box indicating the AR cannot receive all Medi-Cal notices and mail	Check the box to indicate Limited Authority and select all approved types of authorization. A new line with the same AR information will need to be added in order to grant each approved types of authority. Note: Full Authority may not be selected as Client Correspondence cannot be approved without the client’s request)
Limits or does not limit authority in Section C of the MC 382	Checks the box indicating they only want certain types of notices issued to the AR	Check the box to indicate Limited Authority and select all approved types of authorization. A new line with the same AR information will need to be added in order to grant all approved types of authority. The client will have to request if/when they want a specific NOA or form issued to their AR. Note: Full Authority may not be selected as Client Correspondence cannot be approved without the client’s request)

Note: Per DHCS the only method for the AR to receive the 1095B is to request via the process outlined in the UGSS manuel. Though this button auto checks when full authority is granted, there is currently no functionality behind it. EW staff must complete the normal 1095-B process if a request is made to issue one to the client’s AR.

Once updates have been made, the Notice of Appointment of Authorized Representative” (MC 380) along with a copy of the Appointment of Representative (MC 382) must be mailed to both the applicant/recipient and the AR within 10 days of obtaining all required information.

The EW must also send the MC 219 “Rights and Responsibilities” and document in the journal all actions taken.

Appointment of an Organization as an AR

In order to appoint an organization as an AR, the applicant/recipient must complete the request via an approved methods (listed in 5.5.5) and the AR must provide the “Authorized Representative Standard Agreement for Organizations” form (MC 383). The same MC 383 may be signed by multiple individuals from that organization that are appointed as an AR.

If the MC 383 is not received, the EW may contact the organization to have the form completed telephonically (telephonic signature is required).

Upon receipt of the form the designated individual named on the MC 383 is authorized to act as the clients AR.

Note: When an organization is appointed and copies of correspondence are authorized to be sent to the AR, they should be sent to the organization and not to the individual acting on behalf of the organization.

Multiple Authorized Representatives

The client may have any number of individuals acting as his/her AR. However, each person must be appointed on a separate MC 382 (or other authorized method of appointing authorization).

Mental Health Sub Payee Cases

These cases are processed in the same manner as Public Guardian cases with one exception. Instead of a “Letter of Conservatorship”, a letter from the Mental Health Agency is required, stating that they are accepting responsibility as the AR for the client.