Designate an Agent

Appoint your certified agent to help you navigate Medicaid programs.

  • What is Agent Designation?
  • Steps to Designate
  • Remove Designation

What is Agent Designation?

If you have been referred to Medicaid, you can appoint your Your Health Idaho-certified Agent or broker as an authorized representative with the Idaho Department of Health and Welfare (DHW) to assist you with their programs.

Steps to Designate Your Agent

1

Step 1 — Complete the Form

Fill out DHW’s Authorized Representative form using one of the options below:

Access Form Online
Download and Print

Please note: The form must include unique signatures from both you and your Agent. Your Agent cannot sign on your behalf.

2

Step 2 — Email the Completed Form

Once the form is completed, email it to YHIAuthorizedRep@dhw.idaho.gov.

In your email, please note that this is a designation for an application from Your Health Idaho.

Need to Remove an Agent?

To remove an agent or broker as an authorized DHW representative, you must contact DHW directly. DHW contact information can be found on their website.