Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes
Chapter 3 - How to Apply
Rule 23-101-3.2 - Signature Requirements

A. An application form must be signed to be considered a valid application. The signature does not have to be an original signature since applications are allowed to be submitted via means other than on an original paper form; however, a valid signature by someone authorized to apply for Medicaid or CHIP is required.

B. If an applicant is unable to write his/her name, the form may be signed with an "X" mark; however, a witness signature is required. If an applicant is incompetent as adjudged by a court or incapacitated due to a physical or mental condition someone must be named to officially represent the applicant.

C. Unsigned applications or applications signed with an "X" mark that are not witnessed are not valid and are returned to the applicant with an explanation of the signature requirements.

D. Applications that are signed but are incomplete are accepted as valid applications. The Medicaid Specialist will work with the applicant to complete the information needed.

E. Applications signed by an individual other than a person who is authorized to apply, as specified in Miss. Admin. Code Part 101, Rule 3.4, are accepted as valid applications. The Medicaid Specialist must assist the applicant or head of household to obtain an acceptable signature on the submitted application form.