The 205AR form includes two sections: Authorized Representative & Alternate Reporter
Authorized Representative:
The person the applicant lists on the Authorized Representative section of the 205AR form gives a trusted person permission to:
- Talk about your application with us, and
- see your information, and
- act for you on matters related to your application, and
- includes getting information about your application and signing your application on your behalf.
This person is called an Authorized Representative.
The applicant, spouse or the applicant’s financial power of attorney or legal guardian must sign the Authorized Representative section of the 205AR form to designate someone as an authorized representative. If the Authorized Representative section is not signed by the appropriate person, the authorized person is not valid and DVHA LTC will not be able to discuss the applicant’s case with them.
If the authorized person is the applicant’s legally appointed representative such as a financial power of attorney or legal guardian, the 205AR form is not needed. However, the financial power of attorney or legal guardian document must be on file with Medicaid.
Alternate Reporter:
The person the applicant lists on the Alternate Reporter section of the 205AR form gives a trusted person permission to only get copies of notices about your application and about coverage for yourself and others on the application.
This person is called an Alternate Reporter.
An Alternate Reporter cannot act for you or report changes for you, but they can help you understand the notices or remind you if we ask you for information. The applicant, spouse or the applicant’s financial power of attorney or legal guardian must sign the Alternate Reporter section of the 205AR form to designate someone as an authorized representative. If the Alternate Reporter section is not signed by the appropriate person, the authorized person is not valid and DVHA LTC will not be able to give copies of notices about your application.
If the authorized person is the applicant’s legally appointed representative such as a financial power of attorney or legal guardian, the 205AR form is not needed. However, the financial power of attorney or legal guardian document must be on file with Medicaid.