Connecticut Medicaid Authorized Representative: How to File for Your Parent Using Form W-3013N

Your parent needs HUSKY C Medicaid or CHCPE home care services, but they can't manage the application themselves. You have a durable power of attorney, and you assumed that covers everything. Then the Department of Social Services tells you they need a separate authorization form — their own Form W-3013N — before they'll discuss the application with you or treat you as its authorized representative.

This is one of the most frustrating layers of Connecticut's eldercare bureaucracy: DSS requires its own agency-specific authorized representative designation on top of whatever legal documents you already have. Understanding why, and completing the form correctly, is the difference between a Medicaid application that moves forward and one that stalls.

What Form W-3013N Does

The Designation of Authorized Representative (Form W-3013N) gives a named individual the legal authority to act on behalf of the applicant specifically for Department of Social Services purposes. That includes:

• Submitting HUSKY C or CHCPE applications on the applicant's behalf
• Providing financial documentation — bank statements, asset verifications, income records — that DSS requires to determine eligibility
• Receiving correspondence and notices from DSS, including eligibility determinations, renewal notices, and fair hearing decisions
• Signing DSS forms and declarations that the applicant cannot complete themselves
• Communicating directly with DSS caseworkers about the application status

The form is valid only for DSS interactions. It doesn't give you authority over bank accounts, medical decisions, or anything else outside the DSS application process. And it doesn't replace the durable power of attorney — you still need the POA for financial management, and the Health Care Representative appointment for medical decisions.

Why DSS Requires Its Own Form

DSS operates under state and federal privacy regulations that require specific written consent before releasing an applicant's information to third parties. A general power of attorney may grant broad financial management authority, but DSS interprets its privacy obligations strictly: they want a document that explicitly names them as the agency and explicitly authorizes the representative to interact with their specific programs.

This isn't unique to Connecticut — most state Medicaid agencies require their own representative form. But the requirement catches families off guard because they've already invested time and money in a comprehensive POA.

How to Complete the Form

Form W-3013N is available on the Connecticut DSS website. The form itself is straightforward, but the details matter:

Who signs it: If your parent is competent, they sign the form designating you as their representative. If your parent has lost capacity, the form can be signed by the person holding an active power of attorney or a court-appointed conservator — but DSS will require a copy of the POA or the conservatorship decree along with the form.

What to include: Name of the authorized representative, relationship to the applicant, contact information, and the scope of authorization. Mark it for all DSS programs unless you have a specific reason to limit it.

Submit it with the application: Don't file the W-3013N separately and then wait for confirmation before submitting the Medicaid application. Include the designation form as part of the initial application package to avoid processing delays.

Timing the Application

For families navigating the HUSKY C or CHCPE application process, the authorized representative designation is one of the first steps — not something to address after the application is filed. DSS may not discuss an application or release information to a family member who has not been formally designated.

If your parent is hospitalized and you're racing to get CHCPE home care services authorized before discharge, having the W-3013N filed from day one prevents the most common delay: DSS receiving your parent's application but refusing to discuss it with you because you haven't been formally designated.

The Bigger Picture: Stacking Legal Authority

The DSS authorized representative form is one of several legal instruments Connecticut families need for comprehensive eldercare management. Each covers a specific domain:

• Durable Power of Attorney — banks, property, taxes, general financial management
• Health Care Representative — medical decisions when the parent is incapacitated
• HIPAA Authorization — access to medical records
• DSS Authorized Representative (W-3013N) — Medicaid and CHCPE applications
• Representative Payee (SSA) — Social Security benefit management

Missing any one of these creates a gap. The DSS form is the one most families forget because they assume the POA covers government agencies. It doesn't — not for DSS.

The Connecticut Power of Attorney & Guardianship Kit includes the complete set of legal authority documents Connecticut families need, including detailed guidance on the DSS authorized representative process alongside the financial POA, health care documents, and benefit application forms.

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