17-01 Version of 25.5 Valid Signature
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State of Wisconsin
Department of Health Services

HISTORY

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

25.5 Valid Signature

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  1. 25.5.1 Witnessing the Signature
  2. 25.5.2 Telephone Signature Requirements
  3. 25.5.3 Valid Signature on the Federally-Facilitated Marketplace Application

 

The applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. or the applicant's caretaker relative must sign (using his or her own signature):

  1. The paper applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. form,

  2. The signature page of the application (telephone or face to face) or

  3. The ACCESS application form with an electronic signature.  

  4. The online or paper Application for Health Coverage & Help Paying Costs from the Federally-facilitated Marketplace.

 

Except when:

 

  1. A guardian signs for him or her.  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 his or her behalf.  File the copy of the document in the case record.

 

Your agency’s social services department determines the need for a guardian or conservatorA person, official, or institution designated to protect the interests of an incompetent person. A conservator has some, but not all, of the duties and powers of a legal guardian. (IMM, Ch. I, Part A, 19.0.0).  Determine the guardian type specified by the court.

 

Only the person designated as the guardian of the estate (IMM, Ch. I, Part A, 19.2.0), guardian of the person and the estate, or guardian in general may sign the application.  You may not require a conservator (IMM, Ch. I, Part A, 19.4.0) or guardian of the person (IMM, Ch. I, Part A, 19.1.0) to sign the application.
 

  1. An authorized representative signs for the applicant. The applicant may authorize someone to represent him or her (IMM, Ch. I, Part A, 18.3.0). An authorized representative must be an individual, not an organization.

 

If the applicant wishes to authorize someone to represent him or her when applying by mail, instruct him or her to complete the authorized representative section of the application form.

 

If the applicant needs to appoint an authorized representative when applying by telephone or in person, instruct the applicant to complete the Authorization of Representative form (F-10126).  

 

An authorized representative is responsible for submitting the signed application (completed insofar as able) and any required documents.

 

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.

 

When a Marketplace application is processed by the agency and an applicant has appointed an authorized representative in the application, the agency must honor this appointment of an authorized representative.

 

  1. The applicant’s durable power of attorney (§ 243.07, Wis. Stats.) signs the application.  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.

 

When a submitted application is signed by someone claiming to be the applicant’s durable power of attorney:

 

    1. Obtain a copy of the document the applicant used to designate the signer of the application as the durable power of attorney.

 

    1. Review the document for a reference that indicates the power of attorney authority continues notwithstanding any subsequent disability or incapacity of the applicant.

 

Do not consider the application properly signed unless both of these conditions are met.  File a copy of the document in the case record.  An individual's Durable Power of Attorney may appoint an authorized representative for purposes of making a BadgerCare Plus application, if authorized on the power of attorney form.  The Durable Power of Attorney form will specify what authority is granted.  

 

The appointment of a Durable Power of Attorney does not prevent an individual from filing his or her own application for BadgerCare Plus, nor does it prevent the individual from granting authority to someone else to apply for public assistance on his or her behalf.

 

  1. Someone acting responsibly for the individual signs the form on behalf of the individual, if the individual is incompetent or incapacitated.

 

Example 1:  Carl is in a coma in the hospital. Sherry, a nurse who works at the hospital, can apply for BadgerCare Plus on Carl’s behalf.

 

 

  1. A superintendent of a state mental health institution or center for the developmentally disabled signs on behalf of a patient.  

 

  1. A warden signs the application for an applicant that is an inmate of a state correctional institution that is out for more than 24 hours .
     

  2. The director of a county social or human services department delegates, in writing (retain a copy of this written authorization), to the superintendent of the county psychiatric institution the authority to sign and witness an application for residents of the institution.  

 

The social or human services director may end the delegation when there’s reason to believe that the delegated authority is not being carried out properly.

 

25.5.1 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 mail-in, online or telephone application.

  Note: This does not affect the State of Wisconsin’s ability to prosecute for fraud nor does it prevent the BadgerCare Plus program from recovering benefits provided incorrectly due to an applicant or member’s misstatement or omission of fact.  

25.5.2 Telephone Signature Requirements

Telephonic signatures are valid forms of signatures for BadgerCare Plus. To collect a valid telephonic signature:

  1. Create an audio recording of the following:
    • Key information provided by the household during the telephone interview
    • Signature statement that includes:
      • Rights and responsibilities
      • Attestation to the accuracy and completeness of information provided
      • Attestation to the identity of individual signing the application
      • Release of information
  1. Store the audio recording in the ECFElectronic Case File.
  1. 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 ten calendar days if any errors are noted.
  2. Store a copy of the written summary and cover letter in the ECF.

  Note: Applications that are submitted through ACCESS or transferred from the Marketplace are signed electronically, so an additional signature (telephone or physical) is not needed.

25.5.3 Valid Signature on the Federally-Facilitated Marketplace Application

Agencies should accept the signature on the FFM 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 BadgerCare Plus-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.

 

Example 2: Victoria and Timothy are married and filing taxes jointly. They are claiming Casey, their 24 year-old son, as a tax dependent. Victoria signs and submits an application to the FFM for health care for herself, Timothy, and Casey. The FFM assesses that they are potentially eligible for BadgerCare Plus and transfers the application to the agency.

 

Although Casey is included in the health care request, his BadgerCare Plus eligibility cannot be determined on his parents’ CARES case. The worker must set up a separate case for Casey. No additional signature or application is required for Casey’s health care request.

 

Example 3: Darrell is filing taxes and claiming Carmen, his 22 year-old niece, as a tax dependent. Darrell signs and submits an application to the FFM for health care for Carmen. The FFM assesses that she is potentially eligible for BadgerCare Plus and transfers the application to the agency.

 

The worker must set up a separate CARES case for Carmen. No additional signature or application is required for Carmen’s health care request.

 

Tax dependents living outside the home will not be included in the health care request for their tax filer’s household. A separate application is required to determine eligibility for the tax depending living outside the home.

     

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171