A-170, Authorized Representatives

Revision 21-4; Effective October 1, 2021

All Programs

An applicant, person receiving benefits, head of household (HOH), or someone with legal authority to act on their behalf (e.g., legal guardian or power of attorney) may designate a person or organization as an AR.

An AR must be verified using a(n):

  • applicant's or recipient's signature on one of the following HHSC applications for benefits containing the AR designation:
    • Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
    • Form H1010-R, Your Texas Works Benefits: Renewal Form;
    • Form H1034, Medicaid for Breast and Cervical Cancer;
    • Form H1200, Application for Assistance — Your Texas Benefits;
    • Form H1200-MBI, Application for Benefits — Medicaid Buy-In;
    • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children;
    • Form H1205, Texas Streamlined Application;
    • Form H1206, Health Care Benefits Renewal;
    • Form H1840, SNAP Food Benefits Renewal Form;
    • Form H1841, SNAP-CAP Application;
    • Form H1842, SNAP-CAP Renewal Application;
    • Form H2340, Medicaid for Breast and Cervical Cancer Renewal; or
    • Form H2340-OS, Medicaid for Breast and Cervical Cancer.
  • applicant's signature on a Marketplace application for health care benefits that is transferred to HHSC and contains the AR designation;
  • legal document that the AR has authority to act on behalf of the applicant or recipient under state law (e.g., legal guardianship or power of attorney);
  • letter designating AR authority and containing the applicant's or recipient's signature, in addition to the name, address, and signature of the AR;
  • completed Form H1003, Appointment of an Authorized Representative; 
  • applicant's or recipient's electronic signature designating the AR on an application, renewal, or reported change submitted through YourTexasBenefits.com.

If a person or organization submits an application on behalf of an applicant, indicates they wish to be the AR and the application is not signed by the applicant, send correspondence to both the unverified AR and the HOH on the case to request the verification.

  • Send the following to the HOH for the case:
    • Form H1020, Request for Information or Action, listing the missing information needed before eligibility can be determined; and
    • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.
  • Send the following to the unverified AR:
    • Form H1004, Cover Letter: Authorized Representative Not Verified, explaining what is needed to verify the AR; and
    • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.

For the AR to be verified, either the AR or the HOH must return the completed Form H1003 within 10 days (or 30 days from the file date). All missing information listed on the Form H1020 must also be returned timely. If the AR verification is not received by the due date, do not designate an AR.

The AR designation is effective from the date the AR is verified until:

  • the applicant or recipient notifies HHSC that the AR is no longer authorized to act on their behalf;
  • the AR notifies HHSC that they no longer wish to act as AR for the applicant or recipient;
     
  • there is a change in the legal authority (i.e., legal guardianship or power of attorney) on which the AR’s designation is based; or
  • the applicant or recipient designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization that the client most recently designated as the AR will replace the existing AR on the case.

Requests to end the designation of an AR must include the signature of the applicant, the recipient or the AR as appropriate. During the redetermination process, the AR cannot end their AR designation, if the AR is the person completing and signing the redetermination. 

Note: An AR is not automatically a personal representative.

An AR is designated at the case level to have access to all benefit information for that case. A verified AR may:

  • sign an application on behalf of an applicant;
  • complete and submit a renewal form;
  • receive copies of notices or renewal forms in the preferred language selected on the application, and other communications from HHSC;
  • designate a health plan; and
  • act on behalf of the applicant or the recipient in all other matters with HHSC.

The applicant, recipient, or AR may also request that the AR receive the recipient’s Medicaid or CHIP ID card and enrollment-related agency correspondence.

Note: The AR will not receive Healthy Texas Women (HTW) correspondence. 

Mailing Address for AR

During the interview, obtain the AR’s complete mailing address if not included on the application form. Record the AR’s address on the TIERS Data Collection page, Household - Authorized Representative. If the applicant cannot provide a complete mailing address for the AR during the interview or an interview is not required for the program type, do not pend the case. Record the household’s mailing address as the AR’s address in TIERS.

When an applicant or recipient and their designated AR have the same mailing address, correspondence will only be sent to the AR.

When an applicant or recipient has a legal guardian, correspondence will only be sent to the guardian, even if the applicant or recipient and the guardian have different mailing addresses.

Applicants, recipients, or ARs who have chosen to receive eligibility correspondence electronically, will continue to receive them electronically.

Medical Programs

An AR can be verified using an applicant’s or recipient’s telephonic signature submitted by calling 2-1-1.
 

SNAP

People disqualified for SNAP benefits because of an administrative disqualification hearing or a nonmember living with the household may serve as an AR only if:

  • no other responsible household member is reasonably able to be the HOH or AR; or
  • that person is the only adult living in the household.

HHSC employees involved in certification or issuance of SNAP benefits and retailers authorized to accept SNAP benefits may serve as an AR only if the unit supervisor gives written approval.

Related Policy

Electronic Correspondence, A-119.1
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000
Personal Representatives, B-1212
Establishing Identity for Contact Outside the Interview Process, B-1213
Telephone Contact, B-1213.1
Confidentiality, W-2400 

 

A—171 Protective Payee

Revision 15-4; Effective October 1, 2015

TANF

A grandparent (including great- or great-great- grandparent) may represent the household in the application and review process upon the grandparent's request and when the advisor determines that the incompetent or incapacitated individual is not using TANF for the child's benefit. In these situations, the individual's signature and designation of the grandparent as AR in writing is not required on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. If the grandparent is designated AR, the grandparent is also designated protective payee.

Related Policy

Receipt of Application, A-121
Receipt of Application from Residential Child Care Facility , A-121.1
Verification Requirements, A-180
Documentation Requirements, A-190
Children Residing in General Residential Operations Facilities, A-923

 

A—172 AR Applying for Household

Revision 15-4; Effective October 1, 2015

All Programs

The AR must be informed about the household circumstances. The individual is liable for any overissuance resulting from inaccurate information that the AR gives, except in situations when drug/alcohol treatment centers or group living facilities act as AR for a SNAP household.

The AR must be an adult.

 

A—173 AR for Residents of Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities

Revision 22-1; Effective January 1, 2022

SNAP

For residents of D&A facilities, a facility employee must serve as the AR to apply for the household and to use the benefits.

Residents of GLA facilities may apply:

  • for themselves;
  • through an AR of their choosing; or
  • through an AR employed by the facility.

For D&A and GLA facilities, the AR designated to use SNAP benefits may be a different person from the AR who applies for the household.

Related Policy

Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440
D&A or GLA Facility Responsibilities as Authorized Representatives, B-445
Authorized Representatives, B-453

 

A—174 Abuse by AR

Revision 15-4; Effective October 1, 2015

SNAP

An advisor who suspects an AR of acting against the household's interests must report the circumstances to the advisor's program manager.