Nebraska Authorized Representative for Medicaid and Medicare Savings

An adult child calls Nebraska DHHS to check on a parent's Medicare Savings Program application and gets told nothing. No case status, no next steps, no document requests. DHHS cannot share any information because the child isn't an authorized representative. Without formal designation, HIPAA and state privacy rules block the conversation entirely — even if the child filled out the application.

How to Establish Authorization

Nebraska DHHS accepts these methods:

Form MLTC-35 (Designation of Authorized Representative): This standalone form names someone to act on behalf of the applicant for Medicaid and MSP purposes. The applicant signs it, and you attach it to the application or submit it separately. Once on file, the authorized representative can receive correspondence, submit documents, speak with caseworkers, and manage the case through iServe.

With the paper application: Form MLTC-64 is the application for Nebraska Medicaid for Aged and Disabled; it does not include the authorized-representative designation. Submit the separate Form MLTC-35 with the application.

In iServe, you can also designate a representative during the online application process. The system walks through the authorization within the Medical Assistance intake flow.

What an Authorized Representative Can Do

Once DHHS has the designation on file, you can:

• Receive all DHHS correspondence (approval letters, denial notices, renewal packets, verification requests)
• Call (855) 632-7633 and discuss the case by name
• Upload documents through iServe on behalf of the applicant
• Respond to action alerts and verification deadlines
• File fair hearing requests if the application is denied

What It Does Not Cover

A DHHS authorized representative designation is specific to Nebraska Medicaid and MSP. It does not give you authority to deal with:

• Social Security Administration: SSA requires its own Form SSA-1696 (Appointment of Representative) or a formal Representative Payee arrangement
• Medicare / CMS: CMS requires Form CMS-10106 (Authorization to Disclose Personal Health Information)

If your parent needs you to handle their SSA business (which comes up when tracking the Part B premium buy-in after MSP approval), you'll need separate SSA authorization. If they need conditional Part A enrollment at SSA, the parent typically has to be present at the field office.

Power of Attorney vs. DHHS Authorization

A general financial or medical Power of Attorney can be submitted to DHHS for review, but it does not automatically register with DHHS or replace Form MLTC-35 unless DHHS confirms it authorizes the representative to discuss the case. Submit Form MLTC-35 to authorize case communications; DHHS legal staff can review the POA for sufficiency.

A POA also doesn't replace the SSA or CMS authorizations mentioned above. Each agency has its own process.

For Out-of-State Adult Children

If you live outside Nebraska and are managing a parent's MSP application remotely, get the MLTC-35 signed and submitted with the very first application packet. Every verification request, every caseworker call, and every renewal form will go through you once it's on file. Without it, DHHS sends everything to the parent — who may not understand the notice or respond in time.

The Nebraska Medicare Savings Programs & Extra Help Guide includes the complete authorization setup workflow, including how the DHHS, SSA, and CMS forms interact when you're managing a parent's case across multiple agencies.

See more Nebraska guides →