The New Hampshire Petition for Special Medicaid Representative is a form that can be filed with the New Hampshire Department of Health and Human Services (HHS), Division of Family Assistance to appoint a representative to assist in the management of an applicant's Medicaid benefits. This form is used to appoint an individual or an organization to act as an applicant's representative on their behalf in matters related to their Medicaid coverage, including the filing of claims, application for services, and appeals of decisions made by HHS. There are three types of New Hampshire Petition for Special Medicaid Representative: Individual Representative, Organization Representative, and Designated Representative. An Individual Representative is an individual appointed by the applicant to act on their behalf. An Organization Representative is an organization appointed by the applicant to represent them in matters related to their Medicaid coverage. A Designated Representative is an individual or organization appointed by the applicant to manage their Medicaid benefits and act as their representative in all matters related to their Medicaid coverage.