SC Form 1282 is the South Carolina Department of Health and Human Services form you use to name an authorized representative for your Medicaid case, giving that person or organization permission to sign applications, submit renewals, receive agency notices, and represent you in appeals. You can download it as a free PDF from the SCDHHS member forms page in English, Spanish, or Arabic.1South Carolina Department of Health and Human Services. Forms Its full title is “Authorization for Release of Information and Appointment of Authorized Representative for Medicaid Applications/Reviews and Appeals.”
What Your Representative Can Do Once Named
Federal Medicaid rules recognize four categories of authority under a written designation like Form 1282. Your representative may sign an application for you, complete and submit a renewal, receive copies of all SCDHHS notices and communications, and act for you in every other matter with the agency.2eCFR. 42 CFR 435.923 – Authorized Representatives That last category is broad. It covers responding to document requests, speaking with caseworkers, and standing in for you in an appeal if your eligibility is denied or your benefits are reduced.
The designation has no built-in expiration. It stays in effect until you change it or tell SCDHHS your representative is no longer authorized.2eCFR. 42 CFR 435.923 – Authorized Representatives Keep that in mind before signing: whoever you name keeps access to your Medicaid information until you actively revoke it.
Who You Can Name
You can name an individual or an organization. Individuals are usually a family member, close friend, or someone else you trust with sensitive health and financial information. Organizations that fill this role include legal aid groups, social service agencies, and community organizations that help people navigate Medicaid.
If a court has appointed a legal guardian or conservator for you, or you have executed a power of attorney, that existing legal authority already counts as a valid written designation under federal rules.2eCFR. 42 CFR 435.923 – Authorized Representatives Submit Form 1282 anyway to put SCDHHS on notice, with the underlying legal document reinforcing the representative’s standing.
Filling Out Form 1282
The form is a short PDF. As you work through it, you will provide:
- Your full legal name, Social Security number, and Medicaid case number if you already have one. These identifiers link the authorization to the right file in the Healthy Connections system.
- The full name, mailing address, and phone number of the person or organization you are naming. If it’s an organization, include the specific contact person there.
- Signatures from both you and your chosen representative, each dated.
A missing signature from either party is the most common reason the form gets sent back. Incomplete contact information for the representative also causes delays, because SCDHHS has no way to reach them for verification. Check every field before you submit.
How to Submit It
SCDHHS accepts Form 1282 through three channels:
- Mail. SCDHHS, P.O. Box 100101, Columbia, SC 29202. Keep a photocopy or scan before mailing.3South Carolina Department of Health and Human Services. Where To Go For Help
- Fax. (888) 820-1204. This is the usual route for legal aid offices and other organizations that submit these regularly.4South Carolina Department of Health and Human Services. Annual Reviews
- Online upload. Use the SCDHHS Document Upload Tool at tools.apply.scdhhs.gov. Files must be PDF, JPEG, PNG, GIF, BMP, or TIFF, and under 5 MB each. You will need to provide your name, date of birth, and Medicaid ID or Social Security number so the upload attaches to your case.5Healthy Connections. Document Upload Tool
Fax and online upload move fastest because there’s no postal transit. Whichever route you pick, confirm both signatures are on the form before it goes out. An unsigned form has to be resubmitted from scratch.
Confirming the Designation Is Active
After submitting, check your case through the SCDHHS Review Status tool at tools.apply.scdhhs.gov/quick-tools/reviewstatus. You’ll need your first and last name, date of birth, and either your Medicaid ID or Social Security number.6Healthy Connections. Review Status Tool Only the primary contact on the case can use the tool, so if your representative wants a status check, you may need to do it yourself or call the Healthy Connections member line at (888) 549-0820.
Once the authorization is processed, your representative starts receiving copies of official notices and can contact caseworkers directly. If a renewal deadline or documentation request arrives while the form is still in processing, respond to it yourself rather than assuming your representative has been notified.
Changing or Revoking Your Representative
You can modify or revoke the designation at any time. Federal regulations guarantee this right, with no waiting period and no reason required.2eCFR. 42 CFR 435.923 – Authorized Representatives To change representatives, submit a new Form 1282 naming the new person. To end the designation without naming anyone else, send SCDHHS written notice that you are revoking it. Either can go through mail, fax, or online upload.
The old authorization stays active until SCDHHS processes your revocation, so submit the change as soon as you decide to make one. That prevents a former representative from continuing to receive your personal health and financial information after your circumstances have changed.