DHCS is providing counties with new documentation around designating an authorized representative for Medi-Cal.
- Appointment of Authorized Representative Form (MC 382): provides an applicant/beneficiary with a way to appoint an AR, limit the AR’s scope, and authorize an individual or organization as AR.
- Notice of Authorized Representative Appointment (MC 380): notifies the beneficiary and AR of appointment and scope of appointment.
- Authorized Representative Standard Agreement for Organizations (MC 383): allows an individual acting on behalf of an AR organization to sign agreements.
- Cancellation or Change to a Medi-Cal Authorized Representative Appointment Letter (MC 381): informs the applicant/beneficiary of cancellation or change in scope of AR appointment.
The current MC 306 Appointment of Representative form will no longer be acceptable after June 4, 2019. DHCS’s guidance includes examples about AR appointment and cancellation.
DHCS ACWDL 18-26 (December 4, 2018)