General eligibility requirements that apply to all Apple Health programs

Authorized representatives

Revised Date: 
December 1, 2014

Purpose: To explain what an authorized representative (AREP) is, how to designate someone an AREP, and what information the agency may disclose to AREPs.

WAC 182-503-0130 Authorized representative.

Effective August 17, 2015

  1. ​Designating an authorized representative (AREP).
    1. A person may designate an AREP to act on his or her behalf in eligibility-related interactions with the medicaid agency by completing the agency's Authorized Representative Designation Form (DSHS 14-532), or through any of the methods described in 42 C.F.R. 435.907(a) and 42 C.F.R. 435.923. The Authorized Representative Designation Form is available online at https://www.dshs.wa.gov/fsa/forms.
    2. A court-appointed legal guardian with authority to make financial decisions on a person's behalf is that person's AREP.
    3. An agreement creating power of attorney (POA) that grants decision-making authority regarding the person's financial interactions with the agency establishes the POA as the AREP.
    4. If a person is unable to designate an AREP due to a medical condition, an individual may designate himself or herself as the AREP by signing the agency's Authorized Representative Designation Form (DSHS 14-532).
  2. Serving as an AREP. To serve as an AREP, an individual or organization must:
    1. Have a good-faith belief that the information he or she provides to the agency is correct.
    2. Report any change in circumstance required under WAC 182-504-0105 unless doing so would exceed the scope of authorized representation or violate state or federal law.
    3. A provider, staff member, or volunteer of an organization must also comply with 42 C.F.R. 435.923(d-e).
  3. Terminating authorized representation.
    1. The person or the AREP may terminate the authorized representation at any time for any reason by notifying the agency verbally or in writing.
    2. Authorized representation terminates automatically when the person dies.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

What is an authorized representative (AREP)?

Defined in WAC 182-503-0130, an AREP is a person or organization who is authorized by an applicant or recipient to get only the information needed to determine the applicant's or recipient's eligibility for Apple Health programs and other information related to Apple Health coverage such as certification periods, renewals, etc. An AREP assists the applicant/recipient with the application, recertification, and general eligibility processes. Designating an AREP is never required.

An AREP can be any adult (including anyone who is not a member of the household/medical assistance unit) or organization (including any department, division, or other subset of an organization) who is both:

  • Sufficiently aware of the applicant's or recipient's household circumstances, and
  • Authorized by the applicant or recipient to act on behalf of him or her for eligibility purposes.

If an AREP is an organization, other individuals of that organization may also act as AREPs. If an AREP is a division or other part of a larger organization, only individuals in that division or part may act as AREPs.

Note: For example, King County Public Health is a large organization. If the Access and Outreach department of King County Public Health is designated an AREP, only those individuals in that department may act as AREPs. Individuals from other departments in King County Public Health are not AREPs.

An AREP is not authorized to receive health information about individuals unless they have power of attorney or have been named on the completed and signed DSHS 14-012(x) consent form.

An AREP can share any information relevant to eligibility; however, the department can only share information with the AREP that is necessary for the purposes of determining financial eligibility.

An AREP can receive letters, including the income computation sheet, renewal forms, and ProviderOne services cards if the individual has authorized the sharing of such correspondence.

The table below describes the forms used by HCA and DSHS for the following purposes: 1) designating an AREP, 2) authorizing consent to share information, and 3) releasing agency records.

  Authorized representative Consent to use and share confidential information Authorization to release agency records
HCA forms: 18-001
(14-430 for pregnant teens)
* See note below 80-020
DSHS forms: 14-532 or 18-005 14-012(x) 17-063
When to use? To authorize the agency to exchange with the AREP only the information needed to determine eligibility for Apple Health programs. HIPAA restrictions prevent us from discussing the person's individual health information with an AREP unless a current signed DSHS 14-012(x) consent form is in the record. To give consent for the agency to exchange more information with health care providers or other agencies (as identified on the form) than the basic eligibility information that can be shared with an AREP. DSHS Form 14-012(x) is HIPAA-compliant. To authorize the agency to release agency records and other information (as identified on the form) to the person or organization (as identified on the form). DSHS Form 17-063 and HCA Form 80-020 are HIPAA-compliant.
Who processes the request?

If the individual designates an AREP in Healthplanfinder (which the individual can do at anytime), Healthplanfinder accepts the request when submitted. Outside of Healthplanfinder, the AREP designation is received and entered into ACES or Healthplanfinder as follows:

  • HBE staff process HCA Form 18-001 (Medicaid paper application).
  • HCA medical assistance specialist (MAS) staff process HCA Form 18-001 and DSHS Form 14-532 sent to HCA.
  • DSHS financial service specialist (FSS) staff process all HCA Form 18-005 (Classic Medicaid paper application) and DSHS Form 14-532 sent to DSHS.
DSHS receives DSHS Form 14-012(x) and uploads it into the Electronic Case Record (ECR). Only the Public Disclosure Unit at HCA or DSHS can approve or deny requests to release agency records, whether on HCA Form 80-020 or DSHS Form 17-063 or by other correspondence.
How long is the designation effective?

An AREP designation on HCA Form 18-001 or HCA Form 18-005 is effective for the duration of the certification period (usually 1 year).

An AREP designation on DSHS Form 14-532 is effective for either 90 days or the duration of the certification period (usually 1 year), whichever is selected by the applicant/recipient.

The AREP information must be reviewed at recertification.

The consent on DSHS Form 14-012(x) is effective for the period of time specified on the form. The authorization to release records on HCA Form 80-020 or DSHS Form 17-063 is effective for the period of time specified on the form.

* Note: The consent to Use and Share Confidential information form is not required for HCA to obtain information from a provider.

Note: Every signed consent form is unique so it is critical that the authorized information, designated parties, and effective dates be carefully reviewed before releasing information.

Power of Attorney/Legal Guardianship

DSHS Form 14-532 and DSHS Form 14-012(x) are not required when the AREP has Power of Attorney or Legal Guardianship. Power of Attorney/Legal Guardianship must be verified. For medical assistance programs, legal guardianship is designated by coding the AREP screen Rep Type field in ACES with CG or GN and power of attorney is designated by coding the AREP screen Rep Type field in ACES with AD or NA.

Institutionalized Children and Designating Facilities as AREPs

When a child age 18 or younger is institutionalized and the facility is applying on their behalf, the DSHS 14-532 AREP form or the designation of the facility as an AREP on the application or eligibility review is not required when the individual is:

  • In a court ordered, out-of-home placement under chapter 13.34 RCW; or
  • Involuntarily committed to an inpatient treatment program by a court order under chapter 71.34 RCW.

Worker Responsibilities

For information regarding AREP Screens for Long-Term Care cases.

  1. Depending on what an Apple Health recipient chooses, an AREP may:
    1. Receive letters/notices/forms/ProviderOne cards; or
    2. Have permission only to discuss the case; or
    3. Both.
  2. For Classic Medicaid:
    1. The worker records on the AREP screen in ACES the representative's name and address and the REP Type code, which determines what forms, letters, etc. they receive.
    2. At each review, check that the AREP information coded in ACES is consistent with what the individual indicated on the review form. AREP designation is not valid after the certification period and should not be extended without confirming with the individual that the AREP information is still valid. Document extensions or changes to the designated AREP in remarks behind the AREP screen in ACES.
    3. If the individual is completing their review over the phone and they are designating a new AREP, the individual should complete a DSHS 14-532 AREP form. The worker should not add the new AREP until they receive the completed DSHS 14-532 AREP form or written confirmation from the individual. Completing the DSHS 14-532 AREP form is not required if the individual is confirming or making changes to their current AREP.
  3. For MAGI-based Medicaid, the applicant or worker clicks the box in Washington Healthplanfinder to choose whether the AREP will receive letters/notices/form/ProviderOne cards. This information is then transferred to ACES.
  4. Initial designation of an AREP by an individual should be made on the application, review or DSHS 14-532 AREP form. Changes to an AREP can be made verbally but must be well documented in the remarks behind the AREP screen in ACES.