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Advocate/Representative Authorization

In certain cases, there will be the need for you as a Medicaid member to have an authorized advocate or representative communicate with your DFR caseworker or Medicaid staff. In order for your advocate to be able to discuss your case or history with your caseworker, you will need to have an Advocate/Representative Authorization form on file with the State.

If you want someone to act on your behalf in applying for benefits and/or act for you on an ongoing basis with your caseworker and the Division of Family Resources (DFR), you must complete an Authorized Representative for Health Coverage Form.

If you want your caseworker to be able to share your personal information, which may include health information, to persons or organi­zations outside of the Division of Family Resources (DFR), you must complete the Authorization for Disclosure of Personal and Health Information Form.

If you want someone to represent you concerning services received under Medicaid, including the sharing of your protected health care information, you must complete the IHCP Personal Representative Authorization Form.