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
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.