Current through Register Vol. 41, No. 3, September 23, 2024
A. Patients in the Department of Mental
Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) facilities
may have applications submitted on their behalf by employees of the
DMHMRSAS.
B. The authorized
representative of an incapacitated individual shall be the individual's legally
appointed guardian or conservator.
C. A competent individual may sign an
application on his own behalf or may designate anyone to be his authorized
representative to file a Medicaid application on his behalf. If a competent
individual wants another person to file a Medicaid application for him, he must
designate the authorized representative in a written statement that is signed
by the individual applicant. The authorized representative statement is valid
for the life of the Medicaid application or until the applicant changes or
removes his authorized representative. If the application is approved, the
authorized representative statement is valid for any subsequent review and
redetermination until the applicant's Medicaid eligibility is cancelled. If the
applicant reapplies for Medicaid after Medicaid is cancelled, he must sign the
application or provide a new authorized representative statement.
D. When an individual has given
power-of-attorney to another person that includes the power to conduct the
applicant's business affairs, the attorney-in-fact is considered the
applicant's authorized representative.
E. For an individual who has not been
determined by a court to be legally incapacitated, but who is reported to be
mentally unable to sign his name or to make a mark, an application may be
signed under the following circumstances:
1.
When it is reported that an individual cannot sign the application and the
individual does not have an attorney-in-fact, an authorized representative or a
family substitute representative, the individual's inability to sign the
application must be verified by a written statement from the individual's
physician that the individual is mentally unable to sign and file a Medicaid
application because of the individual's diagnosis or condition.
2. If the individual does not have an
attorney-in-fact and has not signed a statement authorizing another person or
organization to apply for Medicaid on his behalf, the applicant's spouse will
be considered to be the individual's authorized representative. If the
individual is not married or is estranged from his spouse or his spouse is
unable to represent him, the individual's authorized representative shall be a
family substitute representative.
3. Treatment of an individual who is unable
to sign and who has no authorized representative or family substitute
representative:
a. When motion to appoint a
guardian or conservator has been filed with the court, but a final
determination has not been ordered. When an individual's physician has verified
that he is unable to sign the Medicaid application and the individual has no
legal representative, a determination of Medicaid eligibility shall not be
completed until a guardian or conservator has been appointed. Any application
filed on behalf of such individual shall be held in pending status until the
appointment of a legal guardian or conservator. The eligibility worker shall
mail the legal guardian or conservator a copy of the Medicaid application. The
legal guardian or conservator shall have 10 working days after appointment to
sign and return the Medicaid application and documentation of the guardian or
conservator's appointment. If the application has not been signed by the
deadline, eligibility for Medicaid shall be denied.
b. When motion to appoint a guardian or
conservator has not been filed with the court. When a motion to appoint a
guardian or conservator has not been filed with the court, the eligibility
worker shall refer the individual to the Adult Protective Services unit in the
local department of social services. The Medicaid application shall be held in
pending status until the adult protective services investigation is complete.
If the completed adult protective services investigation concludes that
guardianship proceedings will not be initiated, the application must be signed
by the applicant or the applicant must sign a statement designating an
authorized representative. If after 10 working days the application is not
signed, eligibility for Medicaid shall be denied.
§§ 32.1-324 and 32.1-325 of the Code of
Virginia; 42 CFR
435.906 and 435.907 .
