Michigan Corrected Mediciaid Final Departmental Review For Crawley Lawsuit

DEPARTMENTAL CLEARANCE/FINAL DEPARTMENTAL REVIEW Author: DCH/Heffron
Michigan Department of Human Services

Date: 5/24/2010 Project Number: BPB 2010-00B Project Title: Bridges Program Policy for Medicaid
EMAIL TO: from Crawley Lawsuit
Ismael Ahmed, Director Cash Assistance Payments FOA (Jane Goetschy)
Interagency & Community Service(Jocelyn Vanda) Children’s Services (Kathryne O’Grady)
State Legislation (Dawn Pline) Juvenile Justice (John Evans)
Community Action (Stacie Gibson) Child Welfare Bureau (Suzanne Stiles Burke)
Communications (Edward Woods III) Child Welfare Improvement (Terri Gilbert)
Customer Service (Karen Golejewski) Child Welfare Training Inst. (Carol Siemon)
Relative Licensing (Nancy Rostoni) Chief Administrative Officer (Susan Kangas)
Chief Deputy Director (Stanley Stewart) Administrative Services (Dan Werk)
Legal Affairs (Luttrell Levingston) Contracts & Rate Setting (Helen Weber)
Child Support (Marilyn Stephen) Accounting (Russ Hecko)
Inspector General (Alan Kimichik) Budget (Jane Schultz)
Equal Opportunity (James Newsom) Financial/Quality/Tech Services(Barbara Anders)
Family Advocate (Stacie Bladen) Office of Program Policy (Kim Keilen)
Early Ed/Care, Fed Liaison (L.Brewer-Walraven) Adult Services (Cynthia Farrell)
FAP Payment Accuracy (Sandy Mose) Quality Assurance (Julie Horn Alexander)
Internal Audit (Rod Markowski) Technology & Info Mgm't (J. Kurnick-Ziegler)
Human Resources (Susan King) Interstate(Ted Forrest)
Field Operations (Terry Salacina) Chief Information Officer (Jim Hogan)
Child Welfare Outstate FOA (Steve Yager) Wayne County Director (Dwayne Haywood)
DCH Program Policy (Edmund Kemp) Training Division (Dawn Callahan)
DCH MA Director (Stephen Fritton)
FROM:
Office Name Purpose
Office of Communications, Grand Tower Suite 1510, Clearance Required
PO Box 30037, Lansing, MI 48909 Information Only – Sent to all offices checked above.
Contact Person: Phone Number Due Date
Judith Galant 517-241-7084
Contact Email: Fax Number June 25, 2010
galantJ@michigan.gov 517-373-8471
THIS SECTION COMPLETED BY RECEIVER

INSTRUCTIONS
Please review the attached manual material.
Combine all comments from your administration and forward one consolidated recommendation by the due date.
If you wish to discuss the material, please contact the above named “contact person.”
Clearance
No Comments Discussion Required Prior to Making Changes
Approved See Comments Below This Office Must Review After Changes
Disapproved See Comments in Text Review Not Necessary After Changes
Signature Date Bureau/Office Name Phone Number
Comments
Department of Human Services (DHS) will not discriminate against any individual or group
AUTHORITY: P.A. 280 of 1939.
because of race, religion, age, national origin, color, height, weight, marital status, sex,
COMPLETION: Voluntary.
sexual orientation, gender identity or expression, political beliefs or disability. If you need
CONSEQUENCE FOR NOT RESPONDING: Comments cannot
help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are
be considered.
invited to make your needs known to a DHS office in your area.
DHS-311 (Rev. 5-09) Previous editions obsolete. MS Word

BPB 2010-00A 1 of 1 INTERIM POLICY BULLETIN EX PARTE REVIEWS
EFFECTIVE July 1, 2010
SUBJECT Ex Parte Reviews of Medicaid Closures
All MA Categories
Effective July 1, 2010, individuals who are no longer eligible for Medic-
aid under their current MA category will be reviewed for eligiblity in all
other Medicaid categories before the individual’s current Medicaid cov-
erage ends. The review will be ex parte (see definition with this bulletin)
unless information needed to determine eligibility in another category is
required from the individual. The ex parte review will be based on the
information currently found in the individual’s case record and informa-
tion available to the dapartment. If the review determines there is no eli-
giblity in another category, the current coverage will be allowed to end.
If the individual is found eligible for MA coverage in another category,
the case will transfer to the new category and notice of continued eligi-
bility will be sent to the individual. Directions for the process can be
found in the following BAM and BEM items.
BAM 115, 210, 220. Glossary, BEM 105, 106, 110, 111, 113, 117, 118,
124, 125, 126, 129, 131, 132, 135, 145, 150, 154, 155, 156, 157, 158,
163, 164, 165, 166, 167, 169, 170, 171, 172, 173, 174, 630, 640, 647.
Issued: STATE OF MICHIGAN

Distribution: DEPARTMENT OF HUMAN SERVICES
BEM 106 1 of 6 MA WAIVER FOR ELDERLY AND DISABLED
DEPARTMENT
POLICY MA Only
This waiver is called the MI Choice Waiver Program. This waiver pro-
gram provides home and community-based services for aged and dis-
abled persons who, if they did not receive such services, would require
care in a nursing home.
Services provided under this waiver program must be less costly for MA
than the cost of nursing home services for the total number of waiver
clients, not per person.
The MI Choice waiver is not an MA category, but there are special eli-
gibility rules for people approved for the waiver. See “DHS Local Office
Responsibilities” below.
TARGETED GROUP Waiver services are covered for MA recipients who:
• Medically qualify, or
• Seek or have an expanded Home Help Program exception grant

of $1000 or more per month, and
• Are age 65 or over, or
• At least age 18 and disabled.
WAIVER
ADMINISTRATION The Department of Community Health (DCH) administers the waiver
through contracts with organized health care delivery systems. See
“Exhibit I” in this item for a list of these waiver service agents. The
agent’s functions are described below.
Assisting Patients The agent will assist prospective waiver participants in applying for MA
and for initial asset assessments. The agent will also help the person
obtain requested information and verification.
WAIVER PROCESS The waiver process includes:
Assessment The agent completes an assessment to verify medical eligibility for the
waiver.
Care Plan A written care plan is developed by the agent and the waiver participant
if the assessment confirms medical eligibility for the waiver. The partici-
pant may choose to receive home and community-based services from
the waiver service provider.
At a minimum, the plan includes:
• Types of services to be furnished; and

• The amount, frequency and duration of each service; and
BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN
DEPARTMENT OF HUMAN SERVICES
• The type of provider to furnish each service.
Care Management The agent is responsible for arranging for plan services to be provided.
APPROVED FOR
THE WAIVER Approved for the waiver means:
• The agent conducted the assessment, and

• The participant received, or expects to receive, supports coordina-
tion services from the agent with appropriate waiver services for at
least 30 consecutive days.
Approval and The agent determines the waiver approval date and termination date.
Termination Dates The agent is responsible for advising the appropriate local DHS office of
these dates.
The waiver automatically terminates when the patient enters an LTC

facility. See BEM 547 for instructions.
DHS LOCAL
OFFICE
RESPONSIBILITIES Local offices' primary responsibilities are doing initial asset assess-
ments and determining MA eligibility for waiver patients.
Waiver Patient A waiver participant is a person whose month being tested is a waiver
Defined month.
Waiver Month A waiver month is a calendar month containing at least one day that the
Defined participant is (was) approved for the waiver. The agent determines the
waiver approval date.
Note: For purposes of MA eligibility, a month remains a waiver month

even if the waiver participant enters a LTC facility and/or hospital in the
same calendar month. A waiver month does not become a L/H month
(See BPG).
Eligibility Special MA policies to use in the eligibility determination are:
• A waiver participant is a group of one even when he lives with his

spouse (BEM 211).
• The Special MA Asset Rules in BEM 402 apply.
• MA divestment policy in BEM 405 applies to waiver participants.
• The extended-care category is available to waiver participants

(BEM 164).
• Income must be at or below 300% of the SSI Federal Benefit Rate.

A waiver client may no longer qualify for waiver services, however, they
may still qualify for MA.
Note: An ex parte review (see glossary) is required before Medicaid

closures when there is an actual or anticipated change, unless the
change would result in closure due to ineligibility for all Medicaid. When
possible, an ex parte review should begin at least 90 days before the
anticipated change is expected to result in case closure. The review
includes consideration of all MA categories. See BAM 115 and 220.
Notices Waiver activities are performed by agents who meet the federal defini-
tion of administering the MA program. Therefore, you can share the fol-
lowing information with the agents without a signed release from the
client:
• A copy of the DHS-3503, Verification Checklist.

• A copy of the DHS-4598, Medical Program Eligibility Notice.
• A copy of the DHS-1175, MA Determination Notice.
• A copy of the DHS-4588, Initial Asset Assessment Notice.
The original DHS-3503, DHS-4598, DHS-1175 and DHS-4588 must be

sent to the client or the guardian, court or agency who is legally respon-
sible for the client.
Do not enter waiver service agents in Bridges as a third party type .

Only the person's legal guardian, court or agency legally responsible for
the participant can be entered as a third party type.
HOSPICE
SERVICES Waiver participants may receive hospice services and waiver services
simultaneously.
The waiver services provider and the hospice coordinate their plans of
care to avoid overlapping services. DCH is responsible for assuring cor-
rect payments are made.
MANAGED CARE
PLANS MA recipients must choose either waiver services or enrollment in an
health maintenance organization (HMO). They cannot receive both
waiver services and be enrolled in an HMO.

EXHIBIT I - DCH
WAIVER SERVICE
AGENTS
WAIVER SERVICE AGENTS COUNTIES SERVED

Detroit Area Agency on Aging Cities of: Detroit, Hamtramck, Highland Park,
1333 Brewery Park Blvd, Suite 200 Grosse Pointe, Grosse Pointe Park, Grosse
Detroit, MI 48207 Pointe Shores, Grosse Pointe Woods, Grosse
Phone: 313-446-4444 Fax: 313-446-4446 Pointe Farms, Harper Woods
The Senior Alliance All of Wayne County excluding those areas
3850 Second Street, Suite 201 served by the Detroit Area Agency on Aging
Wayne, MI 48184-1755
Phone: 734-722-2830 1-800-815-1112
Fax: 734-722-2836
The Information Center, Inc. All of Wayne County excluding those areas
20500 Eureka Road, Suite 110 served by the Detroit Area Agency on Aging
Taylor, MI 48180
Phone: 734-282-7171 Fax: 734-282-7105
Area Agency on Aging 1B Livingston, Macomb, Monroe, Oakland, St.
29100 Northwestern Hwy, Suite 400 Clair, Washtenaw
Southfield, MI 48034
Phone: 248-357-2255 1-800-852-7795
Fax: 248-948-9691
Macomb-Oakland Regional Center, Inc. Livingston, Macomb, Monroe, Oakland, St.
16200 Nineteen Mile Road Clair, Washtenaw
PO Box 380710
Clinton Township, MI 48038-0070
Phone:586-263-8953 Fax: 586-228-7029
Region 2 Area Agency on Aging Jackson
8363 US 12 Hillsdale
P.O. Box 303 Lenawee
Onsted, MI 49265-0303
Phone: 517-467-2204 1-800-335-7881
Fax: 517-467-8214
Senior Services, Inc. Barry, Branch, Calhoun, Kalamazoo, St.
918 Jasper Street Joseph
Kalamazoo, MI 49001
Phone: 269-382-0515 Fax: 269-382-3189
Burnham Brook Center Barry, Berrien, Branch, Calhoun, Cass, Kalam-
200 West Michigan Avenue Suite 100 azoo, St. Joseph, Van Buren
Battle Creek, MI 49017
Phone: 269-966-2475 1-800-626-6719
Fax: 269-966-2493


Region IV Area Agency on Aging Berrien
2900 Lakeview Avenue Cass
St. Joseph, MI 49085 Van Buren
Phone: 269-983-0177 1-800-442-2803
Fax: 269-983-5218
Valley Area Agency on Aging Genesee
711 North Saginaw Street, Suite 207 Lapeer
Flint, MI 48503 Shiawassee
Phone: 810-239-7671 1-800-978-6275
Fax: 810-239-8869
Tri-County Office on Aging Clinton
5303 South Cedar Street Eaton
Lansing, MI 48911-3800 Ingham
Phone: 517-887-1440 1-800-405-9141
Fax: 517-887-8071
Area Agency on Aging of Western Michigan, Allegan, Ionia, Kent, Lake, Mason, Mecosta,
Inc. Montcalm, Newaygo, Osceola
1279 Cedar Street NE
Grand Rapids, MI 49503-1378
Phone: 616-456-5664 1-888-456-5664
Fax: 616-456-5692
HHS, Health Options Allegan, Ionia, Kent, Lake, Mason, Mecosta,
5363 44th Street SE Montcalm, Muskegon, Newaygo, Oceana,
Grand Rapids, MI 49512 Osceola, Ottawa
Phone: 616-954-1547 1-800-634-2712
Fax: 616-285-2588
Region VII Area Agency on Aging Bay, Clare, Gladwin, Gratiot, Huron, Isabella,
126 Washington Avenue Midland, Saginaw, Sanilac, Tuscola
Bay City, MI 48708
Phone: 989-893-4506 1-800-858-1637
Fax: 989-893-3770
A&D Home Health Care, Inc. Bay, Clare, Gladwin, Gratiot, Huron, Isabella,
3150 Enterprise, Suite 200 Midland, Saginaw, Sanilac, Tuscola
Saginaw, MI 48603
Phone: 989-249-0929 1-800-884-3335
Fax: 989-249-1147
Northeast Mich Comm. Service Agency, Inc. Alcona, Alpena, Arenac, Cheboygan, Craw-
Region IX Area Agency on Aging ford, Iosco, Montmorency, Ogemaw, Otsego,
2375 Gordon Road Presque Isle, Roscommon
Alpena, MI 49707
Phone: 989-356-3474 1-800-219-2273
Fax: 517-354-5909


Northern Michigan Regional Health System Alcona, Alpena, Arenac, Cheboygan, Craw-
416 Connable Avenue ford, Iosco, Montmorency, Ogemaw, Oscoda,
Petoskey, MI 49770-2297 Otsego, Presque Isle, Roscommon
Phone: 231-487-7194 or 231-487-5308 Fax:
231-448-4480
Area Agency on Aging of Northwest Michigan Antrim, Benzie, Charlevoix, Emmet, Grand
1609 Park Drive Traverse, Kalkaska, Leelanau, Manistee, Mis-
PO Box 5946 saukee, Wexford
Traverse City, MI 49696-5946
Phone: 231-947-8920 1-800-442-1713
Fax: 231-947-6401
Northern Lakes Community Mental Health Antrim, Benzie, Charlevoix, Emmet, Grand
105 Hall Street, Suite D Traverse, Kalkaska, Leelanau, Manistee, Mis-
Traverse City, MI 49684 saukee, Wexford
Phone: 231-933-4917 or 231-933-4913 Fax:
231-995-7900
Senior Resources Muskegon
255 West Sherman Boulevard Oceana
Muskegon Heights, MI 49444 Ottawa
Phone: 231-739-5858 1-800-442-0054
Fax: 231-739-4452
U.P. Area Agency on Aging (UPCAP) Alger, Baraga, Chippewa, Delta, Dickinson,
2501 14th Avenue South Gogebic, Houghton, Iron, Keweenaw, Luce,
PO Box 606 Mackinac, Marquette, Menominee, Onton-
Escanaba, MI 49829 agon, Schoolcraft
Phone: 906-786-4701 1-800-338-7227
Fax: 906-786-5853
LEGAL BASE MA
Social Security Act, Section 1915

42 CFR Part 435.217, 441.350,.400
JOINT POLICY
DEVELOPMENT
Medicaid, Adult Medical Program (AMP) also known as Adult Benefit Waiver (ABW), Transi-
tional Medical Assistance (TMA/TMA-Plus), and Maternity Outpatient Medical Services
(MOMS) policy has been developed jointly by the Department of Community Health (DCH) and
the Department of Human Services (DHS).

BEM 110 2 of 17 LOW-INCOME FAMILY MA (LIF)
• BEM 530, MA Income Budgeting.

• “EXHIBIT V - LIF INCOME TEST GROUP.”
• “EXHIBIT VI - LIF INCOME LIMIT.”
• “EXHIBIT VII - LIF INCOME.”
LOW INCOME
FAMILY
TERMINATION You must determine if MA eligibility exists under any other category
before terminating MA for LIF or FIP recipients. Commonly applicable
policies are mentioned below.

FIP Ineligibles Families no longer eligible for FIP may continue eligibility for Medicaid
under LIF. Always consider LIF first, before determining eligibility for
other categories.
There are some situations in which group composition for FIP and LIF
differ. Be sure to check LIF group composition when:
• The FIP group includes three generations, or
• The FIP group includes a stepparent with no children of his or her

own in the group, or
• The FIP group includes a person absent for more than 30 days in
a residential substance abuse treatment center, or
• The FIP group includes a child living apart from a parent more than
30 days when the parent is residing in a domestic violence shelter,
or
• The FIP group’s only dependent child is in foster care, or
• A child has been excluded from the FIP group because the child is
emancipated, but the child lives with the group and is:
•• Under age 18, or

•• Age 18 or 19 and a full-time high school student who is
expected to graduate before age 20.
Family with Families who become ineligible for FIP or LIF due to income and have
Earnings Losing earnings must be considered for Transitional MA (BEM 111).
LIF/FIP

BEM 111 2 of 3 TRANSITIONAL MA
TMA recipients who become pregnant must be transferred to Healthy

Kids for Pregnant Women (HKP). This will ensure that her coverage
continues for the length of her pregnancy and two month post-partum
period.
She may return to TMA coverage for the remaining months of the 12-
month TMA eligibility period.
CONTINUED
ELIGIBILITY TMA eligibility continues until the end of the 12-month TMA period
unless:
• FIP is approved; or
• A change is reported, such as decreased income, and the family is
eligible for LIF; or
Note: The family might qualify for TMA or Special N/Support if they
again become ineligible for LIF.
• For individual members, information is reported indicating that a

member does not meet the MA requirements in:
•• BEM 220, Residence.

•• BEM 257, Third Party Resource Liability.
•• BEM 265, Institutional Status.
If a member loses TMA eligibility during the 12-month period

based on BEM 220, 257 or 265, but the reason for ineligibility
ceases, TMA eligibility exists again. Eligibility restarts the month
ineligibility ceased and continues for the remainder of the 12-
month period. The client is responsible for reporting the change
that reestablishes eligibility and must update the following items on
the DHS-1171, Assistance Application:
•• Section A. Address Information.
•• Section C. Information About You and Your Household (com-

plete one household block for each person living in the
home).
•• Section F. Medical Coverage (third party resource liability).
•• Section V. Representative, Guardian, Conservator or Person

Helping With Application.
•• Section W. Affidavit. The client is to read the affidavit before

signing the application.


BEM 111 3 of 3 TRANSITIONAL MA
Redetermination Complete a determination of eligibility for other MA categories and for

TMA-Plus at least 40 days before the end of the 12-month TMA period.
See BEM 647 for a complete explanation.
LEGAL BASE MA
Social Security Act, Section 1925, 1931
JOINT POLICY
DEVELOPMENT
Medicaid, Adult Medical Program (AMP), Transitional Medical Assistance (TMA/TMA-Plus),

and Maternity Outpatient Medical Services (MOMS) policy has been developed jointly by the
Department of Community Health (DCH) and the Department of Human Services (DHS).

BEM 113 2 of 2 SPECIAL N/SUPPORT
CONTINUED
ELIGIBILITY During the four-month period, each Special N/Support group member
remains eligible unless it is reported that he is no longer a Michigan res-
ident according to the MA policy in BEM 220. A group member who
leaves home but remains a Michigan resident is still eligible for Special
N/Support.
If Special N/Support eligibility is lost during the four-month period due to

residence and the group member regains Michigan residence during
the four-month period, Special N/Support eligibility exists beginning the
month Michigan residency is regained and extends for the remainder of
the four-month period. The client is responsible for reporting his return
to Michigan and must update the following items on the DHS-1171,
Assistance Application:
• Section A. Address Information.
• Section C. Information About You and Your Household (complete

one household block for each person living in the home).
• Section F. Medical Coverage (third party liability).
• Section V. Representative, Guardian, Conservator or Person Help-

ing With Application.
• Section W. Affidavit. The client is to read the affidavit before sign-

ing the application.
Note: Newborns eligible under BEM 145 may be added to the Special
N/Support case but are not Special N/Support recipients.

LEGAL BASE MA
Social Security Act, Section 1902(a)(10)(A)(i)(I), 1931
JOINT POLICY
DEVELOPMENT
Medicaid, Adult Medical Program (AMP), Transitional Medical Assistance (TMA/TMA-Plus), and
Maternity Outpatient Medical Services (MOMS) policy has been developed jointly by the

BEM 117 1 of 5 DEPARTMENT WARDS, TITLE IV-E AND ADOPTION
ASSISTANCE RECIPIENTS
DEPARTMENT
POLICY MA Only
As explained in detail below, the following persons are automatically eli-

gible for Group 1 MA.
• Department wards.
• Title IV-E foster care (FC) recipients.
• Children with title IV-E adoption assistance agreements.
• Special needs children with adoption assistance agreements.
Adoption assistance agreements are also called adoption support sub-

sidy agreements.
Other children, i.e. court wards, may be eligible under other MA catego-
ries such as Healthy Kids (see BEM 105). MA coverage for court wards
is not automatic. Local office specialists are responsible for opening
and maintaining these cases.

DEPARTMENT
WARDS Department wards are automatically eligible for Group 1 MA. A depart-
ment ward is any child who:
• Has been committed to, or placed with, the department by a court

order; and
• Does not live with his parent(s); and
• Is not a title IV-E recipient; or
• Is a former permanent court ward or state (MCI) ward, placed for

adoption, but not finalized (adoption supervision period), and who
is not receiving an adoption support subsidy.
• Does not have a special needs adoption assistance agreement,

and
• Is not placed in J.W. Maxey, Shawono Center or Adrian Training

School.
Authorizing MA The local office children's services workers will open and maintain cur-
rent MA for a department ward. See CFF 902-11, Determination of
Medical Assistance Eligibility. Current MA eligibility begins with the first

BEM 118 1 of 2 FOSTER CARE TRANSITION MEDICAID (FCTMA)
DEPARTMENT
POLICY MA Only
Children in this category are transitioning from foster care to adulthood.

Children aging out of foster care on their 18th birthday are eligible for
Foster Care Transition Medicaid (FCTMA) from age 18 through their
21st birthday.
Note: These cases must remain open regardless of changes in non-

financial eligibility, income or assets.
NON-FINANCIAL
ELIGIBILITY
FACTORS The MA eligibility factors in the following items must be met:
• BEM 220, Residence.

• BEM 221, Identity.
• BEM 223, Social Security Numbers.
• BEM 225, Citizenship/Alien Status.
• BEM 257, Third Party Resource Liability.
• BEM 265, Institutional Status.
• BEM 270, Pursuit of Benefits.
Note: Cases in this category MUST not close if it is discover that one of
these eligibility factors was not met.
Eligibility Criteria Youth who age out of foster care are eligible for FCTMA if they meet the
following criteria:
• In a foster care placement under the responsibility of the Michigan

Department of Human Services or a Tribal Court on the individ-
ual’s 18th birthday, and
• Under 21 years of age, and
• The youth is not placed in a locked facility.
Continued Eligibility must continue unless one of the following occurs:

Eligibility
• Death.
• Moves out-of-state.
• Case closure is requested.
• Another MA program is more beneficial.
Clients can contact (517) 335-3627 for change of address, etc., or fax a
copy of the change to (517) 335-6112.


BEM 118 2 of 2 FOSTER CARE TRANSITION MEDICAID (FCTMA)

Annual Annual redeterminations are conducted through a centralized unit for

Redetermination this group. Contact:
Department of Human Services

PO Box 30037
235 S. Grand Ave., Suite 1406
Lansing, MI 48909
Or
Email: fctma@michigan.gov
FINANCIAL
ELIGIBILITY
FACTORS
Groups A client eligible under the Foster Care Transition Group category is a
fiscal and asset group of one.
Assets No asset test.
Income Eligibility No income test.
INSTRUCTIONS Refer to ‘How Do I’ for CIMS coding instructions.
LEGAL BASE MA
Foster Care Independence Act of 1999, HR 3443.
JOINT POLICY
DEVELOPMENT

BEM 124 1 of 4 PLAN FIRST! FAMILY PLANNING PROGRAM
DEPARTMENT
POLICY MA Only
The Plan First! Family Planning Program is a health coverage program

operated by the Department of Community Health (DCH).
Plan First! will enable DCH to provide family planning services to

women who would not have coverage for these services and do not
have other comprehensive health insurance.
The program is administered by the centrally located Plan First! Unit. All
eligibility factors in this item must be met. All nonfinancial eligibility fac-
tors must be met in the calendar month being tested.
TARGETED
POPULATION Non-pregnant women who are:
• 19-44 years of age, and
• Not currently covered by Medicaid, including deductible cases, or

Adult Medical Program (AMP), and
• Not covered by any other comprehensive health insurance.
Note: If the other health insurance does not include family planning
services the client may be eligible for Plan First! .
• Have family income at or below 185% of the federal poverty level,

and
• Residents of Michigan, meet residency requirements, and
• Meet Medicaid citizenship requirements.
APPLICATION FOR
PLAN FIRST The MSA-1582, Plan First! Family Planning Program, application is
used for this program. The MSA-1582 must be sent to the Plan First!
Unit.
MSA-1582’s received in the local office should be forwarded to the Plan

First Unit.
Applications for Plan First! may be submitted to:
Plan First!
PO Box 30412
Lansing, MI 48909
Applications may be faxed to Plan First! at 517-324-0710.
Applications are also accepted online at Healthcare4mi.com.

QUESTIONS Refer questions regarding Plan First! to 1-800-642-3195. For persons

with hearing difficulties the TTY number is 1-866-501-5656.
ELIGIBILITY
DETERMINATION The Plan First! Unit will determine eligibility for Plan First! when they
receive an MSA-1582, no other MA programs will be considered.
The Plan First! Unit will register the application and determine MA eligi-
bility at application and redetermination. Once the client has been
determined eligible they will be issued a mihealth card.
The Plan First! Unit is responsible for:
• Completing a Bridges clearance to determine if the client has a

deductible case. If so, the Plan First! application is denied.
• Issuing a denial letter and sending a new Plan First! application to

the client, instructing them to have their deductible case closed if
they wish to pursue Plan First!
• Evaluating the applicant for other Medicaid programs based on the

information provided, which may provide more comprehensive
services and refer the client to the local DHS office.
• Registering the application in Bridges and completing an eligibility

determination.
• Sending a DHS-3503, Verification Checklist, when additional infor-

mation is needed.
• Sending notices to the client regarding her eligibility.
• Maintaining the case record, including processing an address

change if the client is active Plan First! only.
Note: Address changes for clients with other active DHS programs will
be referred to the local office.
COVERAGE
PERIOD Once a client is determined eligible for Plan First! eligibility will be for a
12-month period. An annual redetermination will be completed by the
Plan First! Unit. Coverage may continue for the duration of the waiver
as long as the eligibility criteria is met.
The begin date of eligibility for Plan First! is the first day of the month
the application is received via U.S. mail, fax, online or interoffice trans-
fer.

NONFINANCIAL
ELIGIBILITY
FACTORS
Residence The client must be a resident of the State of Michigan. A person is con-
sidered a resident if she lives in Michigan and intends to remain in
Michigan.
Age The woman must be age 19 through 44.
Citizenship The client must be a U.S. citizen or have acceptable alien status.
Persons whose alien status limits them to emergency services Medicaid

(ESO) do not have acceptable status.
The MA eligibility factors in the following items must also be met.

• BEM 256, Spousal/Parental Support.
FINANCIAL
ELIGIBILITY
FACTORS
Fiscal Group The fiscal group policies for FIP-related groups in BEM 211 apply.
Assets There is no asset test.
Divestment Policy in BEM 405 applies as income can be divested.
Income Eligibility The adjusted gross income must be at or below 185% of the Federal
Poverty Level (FPL). All income (earned and unearned) of the fiscal
group must be reported on the application. The income limit’s are in
RFT 246. Apply MA policy in BEM 500, 501, 502, 503, 504, 530 and
536 to determine net income.
ONGOING
ELIGIBILITY Once eligible, eligibility continues until redetermination unless the-
woman:Reaches age 45, or
• Moves out of state, or

• Is ineligible due to Institutional Status (BEM 265), or
• Obtains comprehensive health insurance, or
• Dies.

closure when there is an actual or anticipated change, unless the

COVERED
SERVICES Family planning services are defined as any medically approved
means, including diagnostic evaluation, drugs, and supplies, for volun-
tarily preventing or delaying pregnancy.
ELIGIBILITY FOR
OTHER
PROGRAMS When a Plan First! recipient is determined eligible for Medicaid (includ-
ing a deductible case), AMP, or FIP, contact the Plan First! worker to
request case closure.
Women can receive Plan First! services or Medicaid/AMP but not both.
Worker contact information is available in Bridges.
If MA coverage must be added to Bridges for the same months the cli-
ent received Plan First! coverage, contact the exception unit (1-800-
292-9570) for a Plan First! override. Plan First! must be closed prior to
requesting an override.
LEGAL BASE Social Security Act, Section 1115 Waiver, Section 1905(a)(4)(C) and
Section 1902(a)(10)(A)
JOINT POLICY
DEVELOPMENT
Medicaid, Adult Medical Program (AMP), Transitional Medical Assistance (TMA/TMA-Plus), and

BEM 125 2 of 3 HEALTHY KIDS FOR PREGNANT WOMEN

FINANCIAL
ELIGIBILITY
FACTORS
Groups Use the fiscal group policies for FIP-related groups in BEM 211.
Divestment Policy in BEM 405 applies because income can be divested.
Income Eligibility Income eligibility exists when net income does not exceed 185% of the
poverty level. The income limit is in RFT 246.
Disregard all parental income for all pregnant women applying for or
receiving MA under the Healthy Kids for Pregnant Women category.
Apply MA policies in BEM 500, 531, and 536 to determine net income.
Applications for Healthy Kids. A woman who is income eligible for

one calendar month based on the income limit is automatically income
eligible for each following calendar month through the second calendar
month after the month her pregnancy ends.
Category Transfer. An income test is not required when determining

continuing eligibility for a pregnant woman whose eligibility under
another MA category (including FIP and SSI) is terminating. This
includes a woman who is Group 2 eligible for only a portion of a month
due to incurred medical expenses (see BEM 545). The woman who is
eligible for and receiving under another MA category is automatically
income eligible for Healthy Kids through the second calendar month
after the month her pregnancy ends
Note: Pursue eligibility for other MA categories when a client’s cover-

age based on pregnancy is ending. When the current application is the
DCH-0373-D, you must send a DHS-1171 to the client to transfer to a
non-Healthy Kids MA category or start additional benefits.


BEM 126 1 of 2 GROUP 2 PREGNANT WOMEN
DEPARTMENT
POLICY MA Only
This is a FIP-related Group 2 MA category.
MA is available to a pregnant woman who meets the nonfinancial and

financial eligibility factors in this item.
A woman who is eligible for, and receiving, MA when her pregnancy

ends and remains otherwise eligible may continue receiving MA bene-
fits for the two calendar months following the month her pregnancy
ended. The postpartum extension is available when the pregnancy
ends for any reason (e.g., live birth, miscarriage, stillborn). The eligibility
requirements for the postpartum extension of MA eligibility are dis-
cussed later in this item.
All eligibility factors must be met in the calendar month being tested.
If the month being tested is an L/H month and eligibility exists, go to

BEM 546 to determine the post-eligibility patient-pay amount.
NONFINANCIAL
ELIGIBILITY
FACTORS The woman must be pregnant. The MA eligibility factors in the following
items must be met.

FINANCIAL
ELIGIBILITY
FACTORS
Income Eligibility Income eligibility exists when net income does not exceed Group 2
needs in BEM 544. Apply the MA policies in BEM 500, 530 and 536 to
determine net income.

BEM 126 2 of 2 GROUP 2 PREGNANT WOMEN
If the net income exceeds Group 2 needs, MA eligibility is still possible.

See BEM 545.
POSTPARTUM
EXTENSION The postpartum extension period is the two calendar months following
the month a pregnancy ends. The postpartum extension of MA eligibility
is available to a woman who:
• Was eligible for, and receiving, MA (including FIP) on the day her
pregnancy ended; and
• Meets the nonfinancial eligibility factors in this item except preg-

nancy; and
• Is not currently eligible for MA under any category other than post-
partum extension.
Note: The woman who is eligible for and receiving under another MA
category is automatically income eligible for Healthy Kids through the
second calendar month after the month her pregnancy ends.

CIMS INPUT Refer to ‘How Do I’ for CIMS coding instructions.
LEGAL BASE MA
42 CFR 435.301.
Deficit Reduction Act of 2005.
JOINT POLICY
DEVELOPMENT

BEM 129 1 of 3 HEALTHY KIDS UNDER AGE 1
DEPARTMENT
POLICY MA Only
Healthy Kids Under Age 1 (HK1) is a FIP-related Group 1 MA category.
MA is available to a child under age 1 whose fiscal group's net income

does not exceed 185% of the poverty level. All eligibility factors must be
met in the calendar month being tested. However, only certain eligibility
factors apply before redetermination. If the month being tested is an L/H
month and eligibility exists, go to BEM 546 to determine the post-eligi-
bility patient-pay amount.
Note: Safe Delivery Babies do not need to meet any of the non-finan-
cial eligibility factors listed below.
Presumptive Presumptive eligibility is determined based on income reported at the

Eligibility time of application. Presumptive eligibility will be determined for a child
whose HK1 application is filed online, by a trained qualified entity.
Qualified entities include public health department employees, and eli-

gibility counselors at health clinics designated by DCH to process
Healthy Kids applications.
Healthy Kids central unit employees enter the eligibility determination in

Bridges. This determination must be completed within one business
day.
Presumptive eligibility is effective the date the eligibility is determined

by the qualified entity. Presumptive eligibility ends when the regular eli-
gibility becomes effective based on a determination by local DHS staff,
or if required verifications (i.e. citizenship requirements) are not
received.
A regular eligibility determination must be made within 60 days of the

date of the presumptive eligibility determination.
Children with presumptive eligibility receive the full benefits of Healthy

Kids Medicaid. Presumptive eligibility is limited to one period of eligibil-
ity during any consecutive 12 month period.
NONFINANCIAL
ELIGIBILITY
FACTORS The child must be under age 1 (see BEM 240, Age). See “CHILD IN
HOSPITAL OR LTC” below for an exception to the age limit. The MA
eligibility factors in the following items must be met.

• BEM 255, Child Support.


FINANCIAL
ELIGIBILITY
FACTORS
Groups Use fiscal group policy for a FIP-related child in BEM 211.
ONGOING
ELIGIBILITY Once eligible, a recipient’s eligibility continues until redetermination
unless the child:
• Reaches age 19.

• Moves out of state.
• Is ineligible due to Institutional Status (BEM 265).
• Dies.
Continue using HK1 “Income Eligibility” at redetermination when a

child:
• Is eligible for and receiving MA under this category, and

• Is an inpatient in a hospital or in LTC, and
• Attained age one while in the facility.
Note: The stay in the facility must be uninterrupted since age one.

CHILD IN HOSPITAL
OR LTC A child eligible for, and receiving, MA under this category who is a hos-
pital inpatient or in LTC on his first birthday remains eligible for the dura-
tion of his inpatient stay provided he meets all eligibility factors except
age. The stay must be uninterrupted. Eligibility under this category no
longer exists when a child stops receiving inpatient hospital or LTC ser-

vices. Transfers between hospitals and/or LTC facilities are not consid-
ered interruptions of a stay.
LEGAL BASE MA
Social Security Act, Section 1902(a)(10)(A)(i)(IV),1920 joint policy

development

BEM 131 1 of 3 OTHER HEALTHY KIDS
DEPARTMENT
POLICY MA Only
Other Healthy Kids(OHK) is a FIP-related Group 1 MA category.
MA is available to a person who is under age 19 when net income does

not exceed 150% of the poverty level. A person age 16-18 years old
with net income between 101-150% of the poverty level is a Healthy
Kids Expansion (HKE) recipient.
However, only certain eligibility factors apply before redetermination. If
the month being tested is an L/H month and eligibility exists, go to BEM
546 to determine the post-eligibility patient-pay amount.
Presumptive Presumptive eligibility is determined based on income reported at the

Eligibility time of application. Presumptive eligibility will be determined for a child
whose OHK/HKE application is filed online, by a trained qualified entity.
Qualified entities include public health department employees, and eli-

gibility counselors at health clinics designated by DCH to process
Healthy Kids applications.
Healthy Kids central unit employees enter the eligibility determination in

Bridges. This determination must be completed within one business
day.
Presumptive eligibility is effective the date the eligibility is determined

by the qualified entity. Presumptive eligibility ends when the regular eli-
gibility becomes effective based on a determination by local DHS staff,
or if required verifications (i.e. citizenship requirements) are not
received.
A regular eligibility determination must be made within 60 days of the

date of the presumptive eligibility determination.
Children with presumptive eligibility receive the full benefits of Healthy

Kids Medicaid. Presumptive eligibility is limited to one period of eligibil-
ity during any consecutive 12 month period.
NONFINANCIAL
ELIGIBILITY
FACTORS The person must be under age 19. The MA eligibility factors in the fol-
lowing items must be met.



AGE NOTIFICATION Persons (except pregnant women) who will reach the age limit in the
following month are listed on Report AA-712, Age Notification. Consider
eligibility for all other MA categories before closing OHK.
FINANCIAL
ELIGIBILITY
FACTORS
A individual whose income exceeds 150% of the poverty level may be

eligible for MIChild. See BEM 531 for information regarding the referral
process.
ONGOING
ELIGIBILITY Once eligible, eligibility continues until redetermination unless the per-
son:
• Reaches age 19, or

• Moves out of state, or
• Is ineligible due to Institutional Status (BEM 265), or
• Dies.
BEM 546 instructs you how to determine the post-eligibility patient-pay

amount if the month being tested is an L/H month and eligibility exists.

LEGAL BASE MA
Social Security Act, Section 1902(a)(10)(A)(i)(III); 1902(r)(2),1920.


JOINT POLICY
DEVELOPMENT

BEM 132 1 of 2 GROUP 2 PERSONS UNDER AGE 21
DEPARTMENT
POLICY This is a FIP-related Group 2 MA category.
MA is available to a person who is under age 21 and meets the eligibil-

ity factors in this item. All eligibility factors must be met in the calendar
month being tested.
If the month being tested is an L/H month and eligibility exists, go to

BEM 546 to determine the post-eligibility patient-pay amount.
NONFINANCIAL
ELIGIBILITY
FACTORS The person must be under age 21 (BEM 240, Age). The MA eligibility
factors in the following items must be met.

AGE NOTIFICATION Persons (except pregnant women) who will reach the age limit in the
following month are listed on Report AA-712, Age Notification.
Consider eligibility for all other MA categories when a person reaches

age 21 or otherwise becomes ineligible for this category.

FINANCIAL
ELIGIBILITY
FACTORS
Assets Countable assets cannot exceed the asset limit in BEM 400. Countable
assets are determined using BEM 400 and BEM 401.

BEM 132 2 of 2 GROUP 2 PERSONS UNDER AGE 21
Income Eligibility Income eligibility exists when net income does not exceed the Group 2

See BEM 545.
VERIFICATION
REQUIREMENTS Verification requirements for all eligibility factors are in the appropriate
manual items.
LEGAL BASE MA
42 CFR 435.308.
MCL 400.106.
JOINT POLICY
DEVELOPMENT

BEM 135 1 of 6 GROUP 2 CARETAKER RELATIVES
DEPARTMENT
POLICY MA Only
This is a FIP-related Group 2 MA category.
MA is available to parents and other caretaker relatives who meet the

eligibility factors in this item. All eligibility factors must be met in the cal-
endar month being tested. If the month being tested is an L/H month
and eligibility exists, go to BEM 546 to determine the post-eligibility
patient-pay amount.
NONFINANCIAL
ELIGIBILITY
FACTORS A caretaker relative is a person who meets all of the following require-
ments:
• Except for temporary absences, the person lives with a dependent

child. Use “CARETAKER RELATIVE NONFINANCIAL TEMPO-
RARY ABSENCE” below. Dependent child is defined later in this
item.
• The person is:
•• The parent of the dependent child; or

•• The specified relative (other than a parent) who acts as par-
ent for the dependent child. Specified relative is defined later
in this item. Acts as parent means provides physical care
and/or supervision.
• The person is not participating in a strike; and, if the person lives

with his spouse, the spouse is not participating in a strike. Use the
FIP striker policy in BEM 227.
• The MA eligibility factors in the following items must be met.

•• BEM 221, Identity.
•• BEM 223, Social Security Numbers.
•• BEM 225, Citizenship/Alien Status.
•• BEM 255, Child Support.
•• BEM 256, Spousal/Parental Support.
•• BEM 270, Pursuit of Benefits.
When a dependent child lives with both parents, both parents may be
caretaker relatives.
Occasionally, a specified relative (other than a parent) who claims to act

as parent for the dependent child and the child's parent both live with

the child. The client’s statement regarding who acts as parent must be
accepted. If both the parent and other specified relative claim to act as
parent, assume the parent is the caretaker relative. When only the other
specified relative claims to act as parent, both the other specified rela-
tive and the parent(s) may be caretaker relatives.
Except as explained in the two preceding paragraphs, a child can have

only one caretaker relative. This means that if a person is an MA appli-
cant or recipient based on being a caretaker relative, no other person
can apply for or receive MA based on being a caretaker relative for the
same dependent child.

FINANCIAL
ELIGIBILITY
FACTORS
assets are determined using BEM 400 and BEM 401.

See BEM 545.
DEPENDENT CHILD
DEFINED A child is a dependent child when he meets all of the following condi-
tions:
• The child is born.
• The child meets the FIP eligibility factors in the following items:

•• BEM 227, Strikers.

• The child is a resident using MA policy in BEM 220.
• The child meets the following age or age and school attendance
requirement:
•• He must be under age 18; or

•• He must be age 18 and a full-time student in a high school or
in the equivalent level of vocational or technical training as
defined in FIP policy in BEM 245. He must be expected to
complete his educational or training program before age 19.
• The child is:
•• A FIP recipient.
•• A SSI recipient.
•• A MA applicant.
•• Active MA deductible.
•• A MA recipient.
•• A MIChild recipient.
CARETAKER
RELATIVE
NONFINANCIAL
TEMPORARY
ABSENCE Living together or living with others means sharing a home, where
family members usually sleep, except for temporary absences. A tem-
porarily absent person is considered in the home.
A person’s absence is temporary if:
• His location is known; and

• There is a definite plan for his return; and
• He lived with the group before the absence;
Note: Newborns and unborns are considered to have lived with

the group; and
• The absence has lasted, or is expected to last, 30 days or less.
Exceptions:
• “Joint Custody” below.
• A person in a medical hospital is considered in the home.
• A person is considered in the home when absent for training or

education.

• A dependent child (defined above) in a psychiatric hospital is

considered in the home for up to 12 calendar months after the
admission date.
Presume that a placement in a residential facility (other than a medical

hospital) will last over 30 days. The absence begins with the admission
date and ends with a discharge to the person’s home. It is not inter-
rupted by home visits or admission to a medical hospital.
Consider the stay temporary only if the facility provides a signed state-
ment that includes an expected discharge within 30 days after the
admission.
Residential facilities provide 24-hour care, maintenance and supervi-

sion. Examples:
• Long-term care facilities.

• Homes for the aged.
• Licensed child foster care homes.
• Child caring institutions.
• Mental health facilities.
Joint Custody Sometimes a court awards custody of children to both parents jointly.
Separated parents may practice joint custody informally in the absence
of a court order. A child is considered to be living with only one parent in
a joint custody arrangement. This person is the primary caretaker. This
is the person who provides the home where the child sleeps more than
half of the days in a month, averaged over a twelve month period. The
twelve month period begins at the time the determination is being
made. This is the parent who is responsible for the child’s day-to-day
care and supervision.
In a joint custody arrangement, one parent must be the primary care-

taker. The other parent is considered absent from the home. For pur-
poses of determining a primary caretaker accept the client’s statement
unless questionable or disputed by the other parent.
When parenting time is disputed or questionable, base your determina-

tion on a court order that addresses custody or visitation, if one is avail-
able. In the absence of a court order, give each parent an opportunity to
present evidence of their claim. See Verification Sources in this item.
SPECIFIED
RELATIVE DEFINED A specified relative is any of the following:
• Parent.
• Aunt or uncle.
• Niece or nephew.

• Any of the above relationships prefixed by grand, great or great-

great.
• Stepparent.
• Sister or brother.
• Stepsister or stepbrother.
• First cousin.
• First cousin once removed (i.e., a first cousin’s child).
• The spouse of any person above, even after marriage is ended by

death or divorce.
The above includes relationships established by adoption.
Note: Termination of parental rights is a court order that ends a par-

ent’s rights and responsibilities to the child.
A person whose parental rights are terminated by a court is not a speci-

fied relative. The child’s relationships to other specified relatives are
not affected.
VERIFICATION
REQUIREMENTS The client's statements regarding relationship, primary caretaker, pres-
ence in the home and school attendance for the dependent child(ren)
may be accepted. Verification is required only if the client's statements
are inadequate or inconsistent with other information.
Verification requirements for all other eligibility factors are in the appro-
priate manual items.
Verification
Sources
Relationship • Birth certificate.
• Hospital certificate of birth.
• Official records containing relationship information. Examples:

court, school, church or medical records; marriage certificate;
insurance policy.
• Newspaper account containing relationship information.
• Written statements by at least two persons with direct knowledge

of the relationship.

Presence in the • Home call.

Home
• Written statements by at least two persons who do not live with the
group but have direct knowledge of the living arrangement.
• School contact confirming where and with whom the child lives.
DHS-3380, School Enrollment Verification, may be used.
• Court, medical or other official records confirming the child’s pres-

ence in the home.
• Written statement from the landlord if he has direct knowledge of

the living arrangement.
Primary • School records indicating who enrolled the child in school, first
Caretaker: person called in an emergency, who arranges for the child’s trans-
portation to and from school.
• Day care records showing who makes and pays for the day care
arrangements and who drops off and picks up the child.
• Medical records showing where the child lives and who generally
takes the child to medical appointments.
LEGAL BASE MA
42 CFR 435.310, .510.

JOINT POLICY
DEVELOPMENT

BEM 145 2 of 2 NEWBORNS
Local Office Eligibility specialists are responsible for taking appropriate case action
Responsibilities even if DCH has added newborn coverage when changes, such as an
address change are reported.
REDETERMINA- Determine eligibility for all other MA categories no later than the month
TION of the child's first birthday. Proof of U.S. citizenship is not required at
redetermination.

LEGAL BASE MA
Social Security Act, Section 1902(e)(4)
Children’s Health Insurance Program Reauthorization Act of 2009

(CHIPRA), Public Law 111-3.

BEM 154 1 of 4 SPECIAL DISABLED CHILDREN (SDC)
DEPARTMENT
POLICY MA Only
This is a Group 1 SSI-related MA category.
MA is available to children who were being paid SSI benefits on August

22, 1996, and who would still be eligible for SSI benefits except for the
1996 change in the definition of disability. That 1996 change was made
by section 211(a) of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (P.L. 104-193).
This category may also be referred to as former Zebley children.
All eligibility factors must be met in the calendar month being tested,
except as explained under “INITIAL ELIGIBILITY.” If the month being
tested is an L/H month and eligibility exists, go to BEM 546 to determine
the post-eligibility patient-pay amount.
INITIAL ELIGIBILITY Immediately reopen MA for anyone identified as meeting all the follow-
ing criteria (see Exception below). Do not delay reopening MA for any
additional information.
• The person’s MA terminated before February 1998.

• The person was receiving MA from Michigan when MA terminated.
• The Social Security Administration considers the person as having
been paid SSI benefits on August 22, 1996, and to have become
ineligible as a result of the 1996 change in the definition of disabil-
ity.
Recipient level Program Type (PT) code 9 on CIMS identifies

such persons. The code is entered on CIMS by central office
based on information provided by the Social Security Administra-
tion.
See “VERIFICATION REQUIREMENTS” below if a person claims

to meet this eligibility factor, but does not have recipient level PT
code 9.
Exception: Do not reopen MA if the previous termination was due to

residence (BEM 220) or death.
Authorize MA back to July 1, 1997 for any month the person has not
already received MA under another category. Set the redetermination
date as July 1998.



NONFINANCIAL
ELIGIBILITY
FACTORS 1. The person must be under age 18. Marital status does not affect
this nonfinancial eligibility factor.
2. The Social Security Administration must consider the person as

having been paid SSI benefits on August 22, 1996, and to have
become ineligible as a result of the 1996 change in the definition of
disability.
Recipient level Program Type (PT) code 9 on CIMS identifies

such persons. The code is entered on CIMS by central office
based on information provided by the Social Security Administra-
tion. Do not remove code 9 even if the person receives MA under
a different category (example, FIP) or is inactive. This is to ensure
that SDC eligibility is considered before MA is denied or termi-
nated in the future.
See “VERIFICATION REQUIREMENTS” below if a person claims

to meet this eligibility factor, but does not have recipient level PT
code 9.
3. The MA eligibility factors in the following items must be met:
• BEM 220, Residence

• BEM 223, Social Security Numbers
• BEM 225, Citizenship/Alien Status
• BEM 255, Child Support
• BEM 256, Spousal/Parental Support
• BEM 257, Third Party Resource Liability
• BEM 265, Institutional Status
• BEM 270, Pursuit of Benefits
4. The person must be disabled based on the SSI definition of dis-

ability in effect on August 21, 1996 (i.e., prior to the 1996 change).
Exception: Do not do a disability determination the first time eligibility

is being determined under this category. However, enter a medical
review date on CIMS equal to the next redetermination date.
Medical Review Indicate on the DHS-49A, Medical - Social Eligibility Certification, that
the medical review is for this category. That is important because the
criteria are special.

FINANCIAL
ELIGIBILITY
FACTORS
Groups Use fiscal and asset group policies for SSI-related groups in BEM 211.
assets are determined based on the MA policies in BEM 400, 401 and
402.
Divestment Policy in BEM 405 applies.
Income Eligibility Income eligibility exists when net income does not exceed the special
protected income level in RFT 245. Income eligibility cannot be estab-
lished with a patient-pay amount or by spending-down.
Determine countable income according to MA policies in BEM 500 and

BEM 530. Apply the deductions in BEM 540 (for children) or BEM 541
(for adults) to countable income to determine net income.
VERIFICATION
REQUIREMENTS SSA can verify whether a person who does not have recipient level PT
code 9 on CIMS:
• Was being paid SSI benefits on August 22, 1996, and

• Became ineligible for SSI as a result of the change in the definition
of disability.
Please notify central office if you identify such a person so the PT code
may be updated. Send a copy of the verification to the address below.
Include:
• The client’s name, and

• The client’s case number or client ID, and
• Your name and telephone number.

Bureau for Adult & Family Services
Medicaid and SSI Unit
235 S. Grand Ave, Suite 1317
PO Box 30037
Lansing, MI 48909
Verification requirements for all other eligibility factors are in the appro-
priate manual items.
LEGAL BASE Social Security Act, section 1902(a)(10)(A)(i)(II)

JOINT POLICY
DEVELOPMENT

BEM 155 1 of 3 503 INDIVIDUALS
DEPARTMENT
POLICY MA Only
This is an SSI-related Group 1 MA category.
MA is available to former SSI recipients who receive RSDI benefits and

would now be eligible for SSI if RSDI cost-of-living increases paid since
SSI eligibility ended were excluded. The reason for SSI ineligibility does
not matter.
All eligibility factors must be met in the calendar month being tested. If
503 individuals eligible for Medicare are covered by the Buy-In Program
(see BAM 810) and are considered eligible for QMB (BEM 165).
Nationally, this MA category is referred to as Medicaid under the Pickle

Amendment.
NONFINANCIAL
ELIGIBILITY
FACTORS • The person must:
•• Currently receive RSDI benefits, and

•• Have stopped receiving SSI benefits after April 1977, and
•• Have been entitled to RSDI benefits in the last month he was
eligible for and received SSI.
Note: RSDI benefits paid retroactively can be considered. An SSI

recipient who receives retroactive RSDI benefits does not become
retroactively ineligible for SSI even when the retroactive RSDI
monthly benefit was more than his SSI benefit.
• The person must be:
•• Age 65 or older (BEM 240), or

•• Blind (BEM 260), or
•• Disabled (BEM 260).
• The MA eligibility factors in the following items must be met:



FINANCIAL
ELIGIBILITY
FACTORS
402.
lished with a patient-pay amount or by meeting a deductible.

BEM 530, except as explained in “503 COUNTABLE RSDI” below.
Apply the deductions in BEM 540 (for children) or BEM 541 (for adults)
to countable income to determine net income.
503 COUNTABLE
RSDI LOA2 does this calculation. Enter current RSDI in LOA2.
RSDI cost-of-living allowances are called COLAs. For all persons

whose income is considered, do not count COLAs received since the
503 individual's last month of concurrent RSDI/SSI.
Exception: If the client objects to the amount used, request a COLA

history from the SSA district office. Send a DHS-3471, DHS/SSA Refer-
ral to the SSA district office with the following request:
• Client objects to our determination of Medicaid eligibility under the

Pickle Amendment. Please supply each amount of Title II COLA
paid since * .
*Enter month and year of the last concurrent RSDI/SSI benefit.
If a fiscal group contains more than one potential 503 individual and
their last month of concurrent RSDI/SSI differs, do separate budgets for
each 503 individual.

VERIFICATION
REQUIREMENTS Verify current RSDI. Verify the last month of concurrent RSDI entitle-
ment and SSI eligibility and receipt. BENDEX has such information.
The verification requirements for all other eligibility factors are specified
in the appropriate manual items.
LEGAL BASE MA
42 CFR 435.135
Deficit Reduction Act (2005), Social Security Act 1903(x) PL 109-171.
JOINT POLICY
DEVELOPMENT

BEM 156 2 of 3 COBRA WIDOW(ER)S
2. The person must be:
• Age 65 or older (BEM 240), or

• Blind (BEM 260), or
• Disabled (BEM 260).

• BEM 256, Spousal/Parental Support
FINANCIAL
ELIGIBILITY
FACTORS
Groups Use the fiscal and asset group policies for SSI-related groups in BEM
211.
402.
lished with a patient-pay amount or by meeting a deductible.

530 except as explained in “COUNTABLE RSDI” below. Apply the
deductions in BEM 541 to countable income to determine net income.
COUNTABLE RSDI Countable RSDI for the COBRA widow(er) is his gross RSDI benefit
amount for December 1983 which was received in his January 1984
check. Gross RSDI means the amount before any deductions such as
Medicare. The standard Medicare Part B premium in December 1983
was $12.20 per month.
For all other persons, countable RSDI is the person's gross RSDI for
the month being tested.


BEM 156 3 of 3 COBRA WIDOW(ER)S
VERIFICATION
REQUIREMENTS The verification requirements specified in the appropriate manual items
apply. Gross RSDI for December 1983 must be verified.
Verification Verification sources for the December 1983 RSDI benefit amount
Sources include:
• “COBRA Widow(er)” list issued with L-87-59.

• Existing case record verification.
• SSA-1610-U2, Public Assistance Agency Information Request
(see BAM 800).
LEGAL BASE MA
Social Security Act, Section 1634(b)

Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109-171
JOINT POLICY
DEVELOPMENT

BEM 157 1 of 5 EARLY WIDOW(ER)S
DEPARTMENT
POLICY MA Only
MA is available to any person who:
1. Is not entitled to Medicare Part A (hospital insurance), and
2. Receives RSDI benefits some or all of which are early widow(er)'s

benefits under section 202(e) or (f) of the Social Security Act, or
under any other provision of section 202 if they are also eligible
under subsections (e) or (f), and
Note: Sections 202(e) and (f) provide the same benefits; (e) is for
widows and (f) is for widowers.
3. Was terminated from SSI because of RSDI received under section

202 of the Act, and
4. Received SSI in the month before the month he began receiving

RSDI under section 202 of the Act, and
5. Would be eligible for SSI if all RSDI under section 202 of the Act
were excluded.
This category differs from COBRA widow(er)s because the amount of

RSDI excluded is different. Also, eligibility under this category is avail-
able on an ongoing basis.
The Social Security Administration notifies central office when SSI ter-
minates for a person meeting the criteria in 1-4 above. Notification is via
a code on State Data Exchange (SDX) tapes. Central office sends a
memo (see Exhibit II) to the appropriate local office. It is sent at about
the same time the person's case is transferred from program code B or
E to program code O or P. See “SSI TERMINATIONS” in BEM 150.
This category is also referred to as “Kennelly Widows.”
NONFINANCIAL
ELIGIBILITY
FACTORS The person must meet all the following:
• Is not entitled to Medicare Part A, Hospital Insurance.
• Receives:

•• Early widow(er)'s RSDI under section 202(e) or (f) of the

Social Security Act, or
•• RSDI under another provision of section 202 but is also eligi-

ble under section 202(e) or (f)
• Was terminated from SSI because of RSDI received under section

202 of the Act.
• Received SSI in the month before the month he began receiving

RSDI under section 202 of the Act.
• Is blind or disabled (BEM 260).Receipt of RSDI will not always

verify blindness or disability. A widow(er) who is at least age 60
may be entitled to RSDI without being blind or disabled.
• Meets the MA eligibility factors in the following items:

IDENTIFICATION Persons receiving early widow(er)'s RSDI have a social security claim
number suffix of W, W1-W9, WB, WC, WF, WG, WJ, WR or WT.
In addition, the SSI termination notice or central office memo may indi-
cate potential MA eligibility. See EXHIBITS I and II.
FINANCIAL
ELIGIBILITY
FACTORS
402.
lished with a patient-pay amount or by meeting the deductible.


530 except as explained in “COUNTABLE RSDI” below. Apply the
deductions in BEM 541 to countable income to determine net income.
COUNTABLE RSDI Exclude all RSDI benefits for the early widow(er).
For all other persons, countable RSDI is the person's gross RSDI for
the month being tested. Gross RSDI means the amount before any
deductions such as Medicare.

VERIFICATION
REQUIREMENTS Verification of the following factors unique to this category is required at
application, redetermination and whenever there is a change in RSDI
benefits:
• Receipt of (or eligibility for) benefits under section 202(e) or (f) of

the Social Security Act. Not entitled to Medicare Part A.Verification
policies for other eligibility factors are in the appropriate manual
items.
Verification Receipt of (or eligibility for) RSDI benefits under section 202(e) or (f) of
Sources the Social Security Act:
• Social security claim number suffix from BENDEX, SOLQ, or other

Social Security Administration document. See “Identification.”
• Memo or other communication from central office.
• Social Security Administration.Medicare Part A eligibility:
• BENDEX.
• SOLQ.
• SSA-1610-U2.
• Social Security Administration.
EXHIBIT I - SSI
NOTICE This is the information about Medicaid which appears on SSI denial/ter-
mination notices when SSI ineligibility resulted from early widow(er)'s
RSDI benefits.
You may be receiving Medicaid from your state. If you are, you may be
able to keep Medicaid even though your SSI payments are stopping.
You may receive Medicaid under special rules if all the following are
true.
• You are a widow (widower) age 50 through 64;

• You no longer receive SSI because of Social Security payments;
• You do not have hospital insurance under Medicare; AND
• You meet the other state rules for Medicaid.
If these are not true about you, you may still be able to receive Medicaid
under other state rules.
To apply for Medicaid, call or visit the Department of Human Services. If

you visit, please bring this letter. If you call, tell them you received a
widow's or widower's Medicaid letter. That will help them answer your
questions.
EXHIBIT II -
CENTRAL OFFICE
MEMO STATE OF MICHIGAN
________________________________________________________
MEMORANDUM
________________________________________________________
DATE:________________
TO: ________________ Department of Human Services
Attn: ______ ____________________
Grantee Name:
Grantee Client ID
District Section Unit Specialist
FROM:SSI Coordinator
SUBJECT:BEM 157, Early Widow(er)s
SSI benefits have been terminated for this client. The

Social Security Administration has identified this client as potentially eli-
gible for continued MA as an early widow(er).

Therefore, please give first consideration to eligibility

based on BEM 157, Early Widow(er)s, when determining this client's
continued MA eligibility.
LEGAL BASE MA
Social Security Act, Section 1634(d)

JOINT POLICY
DEVELOPMENT

BEM 163 1 of 2 AD-CARE
DEPARTMENT
POLICY MA Only
Consider eligibility under this category only if eligibility does not exist
under BEM 154 through 158. Use this category before using Extended-
Care (BEM 164) or any Group 2 MA category.
This category is available to persons who are aged or disabled (AD).

Net income cannot exceed 100% of the poverty level.
All eligibility factors in this item must be met in the calendar month
being tested. If the month being tested is an L/H month and eligibility
exists, go to BEM 546 to determine the post-eligibility patient-pay
amount.
NONFINANCIAL
ELIGIBILITY
FACTORS 1. The person must not be eligible for MA under BEM 154 through
158.
2. The person must be aged (BEM 240, Age) or disabled (BEM 260,
MA Disability/Blindness).
Note: Blindness is not a basis of eligibility. However, a blind per-

son who is also aged or disabled meets this eligibility factor.
3. The MA eligibility factors in the following items must be met.

• BEM 223, Social Security Numbers
• BEM 225, Citizenship/Alien Status
FINANCIAL
ELIGIBILITY
FACTORS
assets are determined based on MA policies in BEM 400, 401 and 402.

BEM 163 2 of 2 AD-CARE
Income Eligibility Income eligibility exists when net income does not exceed the income
limit in RFT 242. Income eligibility cannot be established with a patient-
pay amount or by meeting a deductible.
Determine countable income according to SSI-related MA policies in

BEM 500 and 530 except as explained in “COUNTABLE RSDI” below.
Apply the deductions in BEM 540 (for children) or 541 (for adults) to
countable income to determine net income.
COUNTABLE RSDI Gross amount means the amount of RSDI before any deduction such
as Medicare.
Countable RSDI for fiscal group members is the gross amount for the
previous December when the month being tested is January, February
or March. Federal law requires that the cost-of-living increase received
in January be disregarded for these three months. For all other months,
countable RSDI is the gross amount for the month being tested.
For all other persons whose income must be considered, countable

RSDI is always the gross amount for the month being tested.

VERIFICATION
manual items.
LEGAL BASE MA
Social Security Act, Section 1902(m), 1902(r)(2)

JOINT POLICY
DEVELOPMENT

BEM 164 1 of 2 EXTENDED-CARE
DEPARTMENT
POLICY MA Only
Consider eligibility under this category only if eligibility does not exist
under BEM 154 through 163. Use this category before using a Group 2
category.
Consider Medicare Savings Program eligibility in addition to this cate-

gory. See BEM 165.
This category is available only to L/H and waiver clients who are aged
(65 or older), blind or disabled. See PRG for the definition of L/H
patients. See BEM 106 for the definition of waiver clients. Gross income
cannot exceed $2022.
All eligibility factors in this item must be met in the calendar month
being tested. If the month being tested is an L/H month and eligibility
exists, go to BEM 546 to determine the post-eligibility patient-pay
amount.
NONFINANCIAL
ELIGIBILITY
FACTORS • The person must not be eligible for MA under BEM 154 through
163 but may be eligible for a Medicare Savings Program under
BEM 165.
• The person must be an L/H or waiver client.
• The person must be aged, blind or disabled (see BEM 240, Age,
or BEM 260, MA Disability/Blindness). The MA eligibility factors in
the following items must be met:

FINANCIAL
ELIGIBILITY
FACTORS
Groups Use fiscal and asset group policies for SSI-related MA groups in BEM
211.

BEM 164 2 of 2 EXTENDED-CARE
Income Eligibility Income eligibility exists when gross income does not exceed:
• $1911 for months in calendar year 2008.

Apply the MA policies in BEM 500 and 530 to determine gross income.
Do not apply the deductions in BEM 540 and 541.
Income eligibility cannot be established with a patient-pay amount or

by meeting a deductible.
Third Party Complete MSA-1354 for clients with other insurance including long term
Liability care/nursing home insurance and submit with a copy of insurance card
if available.

VERIFICATION
manual items.
LEGAL BASE MA
42 CFR 435.217 and .236

JOINT POLICY
DEVELOPMENT

BEM 165 1 of 9 MEDICARE SAVINGS PROGRAMS
DEPARTMENT
POLICY MA Only
Medicare Savings Programs are SSI-related MA categories. They are

neither Group 1 nor Group 2.
This item describes the three categories that make up the Medicare
Savings Programs. The three categories are:
1. Qualified Medicare Beneficiaries
This is also called full-coverage QMB and just QMB. Program

group type is QMB.
2. Specified Low-Income Medicare Beneficiaries
This is also called limited-coverage QMB and SLMB. Program

group type is SLMB.
3. Q1 Additional Low-Income Medicare Beneficiaries
This is also referred to as ALMB and as just Q1. Program group

type is ALMB.
There are both similarities and differences between eligibility policies

for the three categories. Benefits among the three categories also differ.
Income is the major determiner of category.
QMB Net income cannot exceed 100% of

poverty.
SLMB Net income is over 100% of poverty,
but not over 120% of poverty.
ALMB Net income is over 120% of poverty,
(Q1) but not over 135% of poverty.
A person who is eligible for one of these categories cannot choose to

receive a different Medicare Savings Program category. For example, a
person eligible for QMB cannot choose SLMB instead.
MEDICARE
SAVINGS
PROGRAMS
BENEFITS
QMB Benefits QMB pays:
• Medicare premiums, and

Note: QMB pays Medicare Part B premiums and Part A premiums

for those few people that have them.
• Medicare coinsurances, and
• Medicare deductibles.
SLMB Benefits SLMB pays Medicare Part B premiums.
ALMB Benefits ALMB pays Medicare Part B premiums provided funding is available.
The Department of Community Health decides whether funding is avail-
able.
MEDICARE AND
BUY-IN
INFORMATION See BAM 810 for general information about Medicare and information
about the Buy-In program.
WHEN TO DO
MEDICARE
SAVINGS
PROGRAMS
DETERMINATIONS
Separate Medicare Do Medicare Savings Programs determinations for the following clients
Savings Programs if they are entitled to Medicare Part A:
Determination
• Medicare Savings Programs-only.
• Group 2 MA (FIP-related and SSI-related).
• Extended Care (BEM 164).
• Healthy Kids.
• TMA-Plus.
See “INSTRUCTIONS FOR QMB AND SLMB” and “INSTRUCTIONS

FOR ALMB” about proper CIMS coding.
Automatic QMB Person’s receiving MA under the following categories and entitled to
Medicare Part A are considered QMB eligible without a separate QMB
determination.
• BEM 110, Low-Income Families and FIP recipients.

• BEM 111, Transitional MA.
• BEM 113, Special N/Support.
• BEM 150, SSI Recipients.
• BEM 154, Special Disabled Children.
• BEM 155, 503 Individuals.
• BEM 156, COBRA Widow(er)s.
• BEM 158, DAC.
• BEM 163, AD-Care.

Use Client Program Type (PT) code 4 on CIMS in order for Buy-In
to work for AD-Care recipients.
Note: The Buy-In Unit will correct the PT code for AD-Care recipi-
ents who are entitled to Medicare Part A, but have PT code 5 on
CIMS if the situation is discovered. The Buy-In Unit will change PT
code 5 to PT code 4.
MEDICARE
SAVINGS
PROGRAMS
COVERAGE BEGIN
DATES
QMB Begin Date Begin QMB coverage the calendar month after the processing month.
The processing month is the month during which you make the eligibil-
ity determination. QMB is not available for past months or the process-
ing month.
SLMB Begin Date SLMB coverage is available for retro MA months and later months.
Note: SLMB is only available for months income exceeds the QMB
limit. A person cannot choose SLMB in place of QMB in order for cov-
erage to start sooner (example, to get retro MA).
ALMB Begin Date ALMB coverage is available for retro MA months and later months;
however, not for time in a previous calendar year (see below).
ALMB and Do not approve ALMB for any month that is in a previous calendar year,
Previous Year even if application was made in the previous calendar year.
Limit
Example: Application was made December 27, 2005. Eligibility was
determined on January 3, 2006. ALMB cannot be approved for any
time before January 1, 2006.
MEDICARE
SAVINGS
PROGRAMS
INQUIRY A person may wish to know whether MA will pay Medicare premiums
before enrolling in Medicare. The person may even contact the Depart-
ment before reaching age 65 (example, during the three months before
the person’s 65th birthday).
Advise persons listed under “Automatic QMB” above that MA will pay
their Medicare premium.
Do a determination of eligibility for all other persons. In doing this deter-

mination:
• Explain the nonfinancial eligibility factors. Assume they will be met.

• Use current information to determine financial eligibility. Do not

ask for verification.
• Explain that changes may affect the actual determination of eligi-

bility. Be sure to discuss asset policy thoroughly if the person’s
assets exceed the limit.
NONFINANCIAL
ELIGIBILITY
FACTORS
Entitled to The person must be entitled to Medicare Part A. That means something
Medicare Part A different for QMB than it does for SLMB and ALMB.
Entitled to For QMB, entitled to Medicare Part A means the person meets condi-
Medicare Part A for tion 1, 2 or 3:
QMB
1. Is receiving Medicare Part A with no premium being charged.
Note: A premium is being charged even when it is being paid by

the Buy-In program.
BENDEX and State Online Query (SOLQ) indicate whether a

Medicare Part A premium is being charged.
LOA2. Use Medicare code 1 on SSI-related LOA2.
2. Refused premium-free Medicare Part A.
Suffix. Claim number suffix is always M1.
3. Is eligible for, or receiving, Premium HI (Hospital Insurance).
Premium HI is what the Social Security Administration calls Medi-

care Part A when it is not free of charge.
Suffix. Claim number suffix is M.
Exception: Medicare Part A under section 1818A of the Social Secu-

rity Act does not meet this eligibility factor. See “Part A Identification”
below.
Entitled to For SLMB and ALMB, entitled to Medicare Part A means the person is
Medicare Part A for receiving Medicare Part A with no premium being charged.
SLMB and ALMB
BENDEX and SOLQ indicate whether a Medicare Part A premium is
being charged.

A premium is being charged even when it is being paid by the Buy-In

program.
Exception: Medicare Part A under section 1818A of the Social Secu-

rity Act does not meet this eligibility factor. See “Part A Identification”
below.
ALMB and Other A person is not eligible for ALMB if the person is eligible for MA under
MA another category. However, for deductible clients:
• Persons in active deductible status (scope/coverage 20) are not

considered eligible for another MA category, and
• Persons coded on CIMS as ALMB eligible at the time they report

meeting their deductible remain ALMB eligible. This is because
ALMB eligibility cannot be terminated retroactively.
Persons who are eligible for MA benefits under another category

(example, scope/coverage 2F), but do not want such assistance can be
eligible for ALMB.
Note: Persons can receive QMB or SLMB and full Medicaid benefits
under another category.
Other Nonfinancial The MA eligibility factors in the following items must be met:
Factors
Part A Absent evidence to the contrary (example, SSA document), use the fol-
Identification lowing guidelines to distinguish between Medicare for Medicare Sav-
ings Programs and Medicare under section 1818A of the Social
Security Act.
• There is no charge for the person’s Medicare Part A - Medicare

Savings Program
• The person is at least age 65 - Medicare Savings Programs
• The person is under age 65 and there is a premium charged for

Medicare Part A -not Medicare Savings Programs. See BEM 169,
Qualified Disabled Working Individuals.

BENDEX and SOLQ indicate whether a Medicare Part A premium is

being charged.
FINANCIAL
ELIGIBILITY
FACTORS
Assets Countable assets cannot exceed the limit in BEM 400. Countable
Divestment Policy in BEM 405 applies to QMB because there could be a Medicare
coinsurance or deductible for LTC or home and community-based ser-
vices.
Income Eligibility Income eligibility exists when net income is within the limits in RFT 242
or 249. Income eligibility cannot be established with a patient-pay
amount or by meeting a deductible.
Determine countable income according to the SSI-related MA policies

in BEM 500 and 530, except as explained in “COUNTABLE RSDI”
below. Apply the deductions in BEM 540 (for children) and 541 (for
adults) to countable income to determine net income.
COUNTABLE RSDI Federal law requires that for January, February and March:
• The RSDI cost-of-living increase received starting in January be

disregarded for fiscal group members, and
• The income limits for the preceding December be used.
For all other months, countable RSDI means the countable amount for
the month being tested.
For all other persons whose income must be considered, the RSDI
cost-of-living increase is not disregarded.
Countable RSDI Enter countable RSDI for the month being tested. When the month
and LOA2 being tested is January, February or March LOA2 automatically:
• Computes and deducts the RSDI cost-of-living increase for fiscal

group members, and
• Uses the limits for the preceding December.



VERIFICATION
manual items.
INSTRUCTIONS
FOR QMB, SLMB,
AND ALMB Refer to ‘How Do I’ for CIMS coding instructions.
Annual A redetermination of ALMB eligibility must be completed before the end

Redetermination of each calendar year. Set the ALMB redetermination date as Septem-
ber, October, November or December. ALMB cannot have a 24 month
certification.
MEDICARE PART A
LOA2 INPUT Answer the Medicare Part A question on SSI-related MA LOA2 based
on the following:
• 1- Receiving Medicare Part A with no premium being charged.
• 2- Refused premium-free Medicare Part A. Claim number suffix is

M1.
• 3- Entitled to buy Medicare Part A. The Social Security Administra-

tion calls this Premium HI. Claim number suffix is M.
Enter countable RSDI for the month being tested. LOA2 automatically
deducts the RSDI cost-of-living increase for fiscal group members if the
month being tested is January, February or March.
Enter the person’s claim number on the Recipient Information Screen

when it is requested. It will then be printed on any memo generated for
the Buy-In coordinator.
NOTIFICATION Send a DHS-4660 Medicare Savings Program notice to clients eligible

for:
• BEM 154, Special Disabled Children.

• BEM 155, 503 Individuals.
• BEM 156, COBRA widow(er)s.
• BEM 158, DAC.
LOA2 does not generate a memo as these categories are automatically

eligible without a separate determination.
Send the LOA2-generated memo (or a copy of the completed DHS-

4660) to the Buy-In Coordinator when full-coverage QMB or limited-
coverage QMB (QMB or SLMB) is:

• Approved, or
• Changed, or
• Terminated.
Use ID mail if available or email the information to Buyinunit@michi-

gan.gov.
The address is:
Lewis Cass Building

320 South Walnut
Buy-In Unit, 3rd Floor
Lansing, MI 48913
The Buy-In Coordinator will send a memo (see “EXHIBIT” below) to the
local office when CIMS coding and the DHS-4660 do not agree. The
local office is responsible for:
• Correcting CIMS, and

• Completing section 2 of the memo, and
• Returning the memo to the Buy-In Coordinator using ID mail
where available.
EXHIBIT
TO: ____________COUNTY DHS Date:
TO: Lewis Cass Building

320 South Walnut
Buy-In Unit, 3rd Floor
LANSING, MI 48913
FROM: ____________COUNTY DHS
RE: ____________RECIPIENT ID
Your memo about QMB eligibility does not agree with the coding on
CIMS. CIMS must be coded correctly before the buy-in process
can begin.
LEGAL BASE Social Security Act sections:
• 1902(a)(10)(E)(i) for QMB.

• 1902(a)(10)(E)(iii) for SLMB.
• 1902(a)(10)(E)(iv) for ALMB.
• 1902(r)(2).
• 1905(a) for retro MA.

• 1933 for ALMB funding.
JOINT POLICY
DEVELOPMENT

BEM 166 1 of 2 GROUP 2 AGED, BLIND AND DISABLED
DEPARTMENT
POLICY MA Only
Consider eligibility under this category only when eligibility does not
exist under BEM 155 through 164, 170 or 171.
Consider Medicare Savings Program eligibility (BEM 165) in addition to

Group 2 MA.
MA is available to a person who is aged (65 or older), blind or disabled.

NONFINANCIAL
ELIGIBILITY
FACTORS 1. The person must not be eligible for MA under BEM 155 through
164, 170 or 171, but may be eligible for a Medicare Savings Pro-
gram under BEM 165.
2. The person must be aged, blind or disabled (BEM 240, Age, or

BEM 260, MA Disability/Blindness). The MA eligibility factors in the
following items must be met.

FINANCIAL
ELIGIBILITY
FACTORS
needs in BEM 544. Apply the MA policies in BEM 500, 530, 540 (for
children) or 541 (for adults), and 544 to determine net income.

BEM 166 2 of 2 GROUP 2 AGED, BLIND AND DISABLED
If the net income exceeds Group 2 needs, MA eligibility is still possible

per BEM 545.

VERIFICATION
manual items.
LEGAL BASE MA
42 CFR 435.320, .322 and .324

MCL 400.106
JOINT POLICY
DEVELOPMENT

BEM 167 1 of 3 PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY
(PACE)
DEPARTMENT
POLICY MA Only
The Program of All Inclusive Care for the Elderly (PACE) is a managed
care program designed for the frail, elderly population. PACE enroll-
ment is always prospective. The Department of Community Health
(DCH) administers the program through contracts with PACE organiza-
tions.
The PACE organization receives referrals from medical providers in the

community who believe a person meets the Medicaid eligibility and
nursing facility level of care criteria. PACE is currently operating in sev-
eral counties in southern Michigan.
The PACE program is not an Medicaid category, but there are special
eligibility rules for clients approved for PACE services.
TARGETED GROUP The person must meet all of the following:
• Be medically qualified.
• Be 55 years of age or older.
• Live within an approved geographic area of the PACE provider.
• Not reside in a nursing facility at the time of enrollment
• Not be enrolled in the MIChoice Waiver.
• Not be enrolled in an HMO.
NONFINANCIAL
ELIGIBILITY
FACTORS The eligibility factors in the following items must be met.

• BEM 223, Social Security Numbers,
• BEM 225, Citizenship/Alien Status,
FINANCIAL
ELIGIBILITY
FACTORS
A PACE participant is a group of one even when living with a spouse.
assets are determined based on MA policies in BEM 400, 401, and 402.

(PACE)
Income Income eligibility exists when gross income does not exceed 300% of
the Federal Benefit Rate. Income eligibility cannot be established with a
patient- pay amount or by meeting a deductible.

PATIENT-PAY
AMOUNT A patient-pay amount will be calculated if a PACE enrollee is admitted
to a nursing facility or hospital. The PACE organization is responsible
for collecting the patient-pay amount. Notice of the start, effective date,
and any changes to the amount must be sent to the PACE organization.
NOTICES PACE organizations have received federal and state approval for
administering the program. Therefore, you may share the following
information without a signed release from the client:
• A copy of the DHS-3503, Verification Checklist.
• A copy of the DHS-4598, Medical Program Eligibility Notice, or the

system equivalent.
• A copy of the DHS-1175, MA Determination Notice.
The original DHS-3503, DHS-4598, DHS-1175 must be sent to the cli-

ent or the guardian, court or agency who is legally responsible for the
client.
PACE PROVIDERS CareResources (800) 610-6299

1471 Grace St. S.E.
Grand Rapids, MI 49506
Centers for Senior Independence (313) 653-2020

7800 W. Outer Drive Suite 240
Detroit, MI 48235-3458
LifeCircles (888) 204-8626

560 Seminole Rd,
Muskegon, MI 49444
CentraCare
200 West Michigan Ave.
Battle Creek, MI 49017

(PACE)
LEGAL BASE MA
Title XIX of the Social Security Act. 42 CFR 460, 462, 466, 473, and
476.
JOINT POLICY
DEVELOPMENT


BEM 169 1 of 3 QUALIFIED DISABLED WORKING INDIVIDUALS
DEPARTMENT
POLICY MA Only
This is an SSI-related MA category. It is neither a Group 1 nor a Group

2 MA category. MA pays only the recipient's Medicare Part A premium.
A person eligible under this category is called a Qualified Disabled

Working Individual (QDWI). A QDWI is a person who:
• Receives, or is eligible to enroll in, Medicare Part A under section

1818A of the Social Security Act, and
• Is not eligible for MA under any other category, and
• Meets the eligibility factors specified in this item.
BEM 546, Post-Eligibility Patient-Pay Amounts, does not apply.
INQUIRY A person may wish to know whether MA will pay Medicare Part A pre-
miums before enrolling. If the person is not an MA, FIP or SSI recipient,
do a determination of QDWI eligibility. Advise the person whether he
might be eligible. In doing this determination:
• Explain the nonfinancial eligibility factors. Assume they will be met.
• Determine financial eligibility using current information. Verification

is not required.
• Explain that changes may affect the actual determination of eligi-

bility. Be sure to discuss asset policies thoroughly if the person's
current assets exceed the limit.
NONFINANCIAL
ELIGIBILITY
FACTORS 1. The person must receive or be eligible to enroll in Medicare Part A
under section 1818A of the Social Security Act (Act). See "1818A
Identification" below.
2. The MA eligibility factors in the following items must be met.

3. The person must not be eligible for any other MA category.
Presume a person eligible for Medicare Part A under section

1818A of the Social Security Act is not disabled for purposes of
BEM 260 unless the person reports a change and claims he is
again unable to perform a substantial gainful activity.
1818A BAM 810 describes eligibility factors for Medicare Part A under section
Identification 1818A of the Act. The Social Security Administration is responsible for
determining eligibility for Medicare and authorizing Medicare coverage.
Assume a person who is eligible for Medicare Part A is eligible under

section 1818A if he is:
• Under age 65, and

• Charged a premium for his Medicare Part A, Hospital Insurance.
BENDEX, Wire Third Party and TPQY indicate whether a Medi-

care Part A, Hospital Insurance, premium is being charged.
Other sources of identification include correspondence from, or contact

with, the Social Security Administration.
FINANCIAL
ELIGIBILITY
FACTORS
assets are determined based on the MA policies in BEM 400 and 401.
Divestment Do not apply policy in BEM 405.
Income Eligibility Income eligibility exists when net income does not exceed the income
limit in RFT 246. Income eligibility cannot be established with a patient-
pay amount or by spending-down.
Apply the MA policies in BEM 500, 530, 540 (for children) and 541 (for
adults) to determine net income.
COVERAGE The only MA benefit is payment of Medicare Part A premiums. The mi

health card, is not issued.

TERMINATING
BENEFITS Consideration of continued eligibility under other categories is not
required prior to terminating MA benefits for a QDWI.

VERIFICATION
manual items.
LEGAL BASE MA
Social Security Act, Sections 1902(a)(10)(E), 1905(p)(3), 1905(s)
JOINT POLICY
DEVELOPMENT

BEM 170 1 of 3 HOME CARE CHILDREN
DEPARTMENT
POLICY MA Only
MA is available to a child who requires institutional care but can be

cared for at home for less cost.
The child must be under age 18, unmarried and disabled. The income
and assets of the child's parents are not considered when determining
the child's eligibility.
The Department of Community Health (DCH) and DHS share responsi-

bility for determining eligibility for Home Care Children. All eligibility fac-
tors must be met in the calendar month being tested.
NONFINANCIAL
ELIGIBILITY
FACTORS
DCH DCH determines if medical eligibility exists. That is:

Responsibilities
• The child requires a level of care provided in a medical institution
(i.e., hospital, skilled nursing facility or intermediate care facility);
and
• It is appropriate to provide such care for the child at home; and
• The estimated MA cost of caring for the child at home does not
exceed the estimated MA cost for the child's care in a medical
institution.
DCH also obtains necessary information to determine whether the child

is disabled and forwards it to the DHS State Review Team (SRT). If the
criterion in BEM 260 are met, disability will be certified on a DHS-49-A,
Medical-Social Eligibility Certification, by the SRT.
Communication to If the child is disabled and requirements (a) through (c) above are met,
the Local Office DCH Central Office sends a Policy Decision (MSA-1785) and the medi-
cal packet to the appropriate DHS local office. The MSA-1785 certifies
that the medical requirements in “DCH Responsibilities” above are
met.
DCH will also notify the DHS local office when this category can no
longer be used for a child. Pursue eligibility for other MA categories
when a child is no longer eligible for this category.
Local Office Do not authorize MA under this category without a MSA-1785

Responsibilities instructing you to do so. Use this category when the child is not

an SSI or FIP recipient. Use this category before using a Group 2

category.
If a MSA -1785 is received for a child who is not an MA applicant or

recipient, treat the MSA -1785 as a request for assistance. Contact the
child's parents concerning an MA application for the child.
Determine if the child meets the MA eligibility factors in the following

items:

Local offices are responsible for disability reviews. See BEM 260.

includes consideration of all MA categories. See BAM 115 and220.
INQUIRIES Inquiries from medical providers or parents concerning medical eligibil-

ity (requirements in “DCH Responsibilities” above) under this category
should be directed to a Nurse Consultant at:
Department of Community Health

Public Health Administration
Bureau of Family, Maternal & Child HealthChildren’s Special
Health Care Services
Lewis Cass Building, 6th Floor
320 S. Walnut Street
Lansing, MI 48913
Phone: (517) 335-8983
FINANCIAL
ELIGIBILITY
FACTORS Financial eligibility is determined by the DHS local office. Only the
child's own income and assets are counted. Do not deem income and
assets from the child's parents to the child.
Groups The child is a fiscal and asset group of one.
Assets The child's countable assets cannot exceed the asset limit in BEM 400.
Countable assets are determined based on MA policies in BEM 400
and BEM 401.

Income Eligibility Apply the MA policies in BEM 500, 530, and 540 to determine net
income. Income eligibility exists when the child's net income is equal to
or less than:
• $637 for months in calender year 2008.

• $623 for months in calender year 2007.
VERIFICATION
manual items.
LEGAL BASE MA
Tax Equity and Fiscal Responsibility Act of 1982 (P.L. 97-248), Section
134
JOINT POLICY
DEVELOPMENT

BEM 171 1 of 3 CHILDREN’S WAIVER
DEPARTMENT
POLICY MA Only
MA is available to a child who requires care in an Intermediate Care

Facility for the Mentally Retarded (ICF/MR), but can be cared for at
home for less cost.
The child must be under age 18, unmarried and disabled. (Exception:
Children medically approved by the Department of Community Health
(DCH) before 10/1/96 must be under age 26.)
The income and assets of the child's parents are not considered when
determining the child's eligibility.
The DCH and DHS share responsibility for determining eligibility for the
Children’s Waiver. All eligibility factors must be met in the calendar
month being tested.
NONFINANCIAL
ELIGIBILITY
FACTORS
DCH DCH determines if medical eligibility exists. That is:

Responsibilities
• The child requires a level of care provided in an ICF/MR, and
• It is appropriate to provide such care for the child at home, and
• The average estimated MA cost of caring for the child at home
does not exceed the average estimated MA cost for the child's
care in an ICF/MR.
Mental Health Services to Children and Families in DCH is responsible

for the following at application and medical review:
• Obtaining medical evidence of the disability.

• Certifying disability on the DHS-49-A, Medical-Social Eligibility
Certification.
DCH certifies that the requirements in (a) through (c) above are met on
an MSA-1785, Policy Decision.
If the child is not receiving MA, DCH will send the family:
• A copy of the MSA-1785 and the DHS-49-A, and

• A DHS-1171 with the address of the local office to mail the com-
pleted application.
Communication to DCH will send the MSA-1785 and the DHS-49A to the local DHS office
the Local Office when:

• A child is an MA recipient, or
• A child is not an MA recipient. DCH will also notify the local DHS
office when this category can no longer be used for a child. Pursue
eligibility for other MA categories when a child is no longer eligible
for this category.
Local Office Do not authorize MA under this category without a DHS-49-A and
Responsibilities MSA-1785 instructing you to do so. Use this category when the
child is not an SSI or FIP recipient. Use this category before using
a Group 2 category.
Treat the MSA-1785 as a request for assistance, if it is received for a

child who is not an MA applicant or recipient.

items:

• BEM 260, MA Disability/Blindness.
Note: DCH is responsible for obtaining medical evidence and cer-

tifying disability on the DHS-49-A. See “DCH Responsibilities.”

INQUIRIES Inquiries from medical providers or parents concerning medical eligibil-

ity (requirements (a) through (c) above) under this category should be
directed to your local Community Mental Health Services Program,
Developmental Disabilities Division.
FINANCIAL
ELIGIBILITY
FACTORS Financial eligibility is determined by the DHS local office. Count only
the child's own income and assets. Do not deem income and assets
from the child's parents to the child.
Assets The child's countable assets cannot exceed the asset limit in BEM 400.
and 401.
Income Eligibility Income eligibility exists when the child's gross income is equal to or
less than:

Gross income is the amount determined after applying the MA policies

in BEM 500 and 530. Do not apply the deductions in BEM 540 and 541.
VERIFICATION
manual items.
INSTRUCTIONS Refer to ‘How Do I’ for CIMS instructions.
LEGAL BASE MA
Social Security Act, Section 1915 (c)
JOINT POLICY
DEVELOPMENT

BEM 172 1 of 4 CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
(SED) WAIVER
DEPARTMENT
POLICY MA ONLY
MA is available to a child who requires care in the state psychiatric hos-

pital, (Hawthorn Center) but can be cared for in the community for less
cost.
The SED waiver is available in the following counties:
Clare Kalamazoo Midland

Gladwin Leelanau Osceola
Grand Traverse Livingston Saginaw
Ingham Macomb Van Buren
Isabella Mecosta
The child must be under age 18, unmarried, a current patient in a psy-
chiatric hospital or at risk of such placement; must demonstrate serious
functional limitations that impair ability to function in the community; and
must have a Child and Adolescent Functional Assessment Scale
(CAFAS) score of 90 or greater (if under age 13) or have a CAFAS
score of 120 or greater (if age 13 or older), as determined by the local
Community Mental Health Services Program (CMHSP)
The income and assets of the child’s parents are not considered when
determining the child’s eligibility.
The DCH and DHS share responsibility for determining eligibility for the
SED Waiver. The DCH, in cooperation with the local CMHSP, has
responsibility for determining non-financial eligibility factors for the SED
Waiver. Financial eligibility is determined by DHS.
NONFINANCIAL
ELIGIBILITY
FACTORS
DCH DCH determines that clinical eligibility exists. That is:

Responsibilities
• The child requires a level of care provided in the state psychiatric
hospital (Hawthorne Center); and
• It is appropriate to provide such care for the child in the commu-

nity; and

(SED) WAIVER
• The average estimated cost to Medicaid of caring for the child in

the community does not exceed the average estimated cost to
medicaid for the child’s care in the state psychiatric hospital.
Mental Health Services to Children and Families within DCH is respon-

sible for the following at application and medical review:
• Obtaining and reviewing clinical evidence of the child’s serious

emotional disturbance and functional limitations from the local
CMHSP, and
• Certifying disability on the DHS-49-A, Medical-Social Eligibility

Certification.
DCH certifies on the MSA-1785, Policy Decision that the requirements

in “DCH Responsibilities” above are met.
If the child is not receiving MA, DCH will send the family:
• A copy of the MSA-1785, and

• A DHS-1171, Assistance Application, with the address of the local
office to mail the completed application.
Communication to DCH will send the MSA-1785 and the DHS-49-A to the local DHS and
the Local Office CMHSP offices whether or not a child is an MA recipient. DCH will send
a letter of termination when a child is no longer eligible for this category.
Pursue eligibility for other MA categories when a child is no longer eligi-
ble for the waiver.
Local Office Do not authorize MA under this category without a MSA-1785 and
Responsibilities DHS-49-A instructing you to do so. Use this category when the
child is not an SSI or FIP recipient. Use this category before using
a Group 2 category.
Treat the receipt of the MSA-1785 as a request for assistance, if it is

received for a child who is not an MA applicant or recipient.

items:

• BEM 260, MA Disability/Blindness.
Note: DCH is responsible for obtaining clinical evidence and for certify-
ing disability on the DHS-49-A. See “DCH Responsibilities” above.

(SED) WAIVER

INQUIRIES Inquires from medical providers or parents concerning clinical eligibility

under this category should be directed to the local CMHSP.
FINANCIAL
ELIGIBILITY
FACTORS Financial eligibility is determined by the local office. Count only the
child’s own income and assets. Do not deem income and assets
from the child’s parents to the child.
Assets The child’s countable assets cannot exceed the asset limit in BEM 400.
and 401.
Income Eligibility Income eligibility exists when the child’s gross income is equal to or less
than:

Gross income is the amount determined after applying MA policies in

BEM 500 and 530. Do not apply the deductions in BEM 540 and 541.
VERIFICATION
manual items.
CIMS
INSTRUCTIONS Refer to “How Do I”
LEGAL BASE MA
Social Security Act, Section 1915 (c)
JOINT POLICY
DEVELOPMENT

(SED) WAIVER

BEM 173 1 of 4 BREAST AND CERVICAL CANCER PREVENTION AND
TREATMENT PROGRAM
DEPARTMENT
POLICY MA
The Breast and Cervical Cancer Prevention and Treatment Program

(BCCPTP) is a Group 1 MA category for women.
The Department of Community Health (DCH) is responsible for estab-

lishing MA under this category.
This category is not included on the priority lists in BEM 105 because
DHS does not determine eligibility.
Eligibility for this MA category is related to screening through a health

department program called the Breast and Cervical Cancer Control
Program.
Breast and The Breast and Cervical Cancer Control Program is a health depart-
Cervical Cancer ment program.The program may be more commonly known as the
Control Program breast and cervical screening program. People seeking screening
should refer to the name Breast and Cervical Cancer Control Program
or the Breast and Cervical Screening Program.
Do not use the MA category name to refer to the health department pro-
gram, even though this program provides complete MA coverage to the
client.
Not all local heath departments participate and there are sites enrolled
in the program that are not local health departments.
A woman may request screening from a participating agency if her local

health department does not participate.
More information about the health department program through the

DCH website. Use the link on the DHS Authorized Internet Sites on the
DHS-Net, or:
• Go to www.michigan.gov/mdch.
• Type bcccp in the Search box.
• That will give you a link to the BCCCP page. Scroll down on that
page for a link to the agency list.
The health department program has its own financial test for BCCCP.
Income cannot exceed 250% of the federal poverty level. However,
that determination is not an DHS responsibility.
BCCPTP
APPLICATION AND
ELIGIBILITY
DETERMINATION A simplified application form (DCH-1088, Medicaid Breast and Cervical
Cancer Prevention and Treatment Program) has been created for this

TREATMENT PROGRAM
MA category. It will be completed by a health department program coor-

dinator or case manager and sent to DCH. DCH will register the appli-
cation.
DCH will determine MA eligibility for this MA category at application

(including any retro MA eligibility), redetermination and when a change
is reported.
BCCPTP is the only MA category considered when the DCH-1088 is

used.
BCCPTP AND
OTHER MEDICAL
ASSISTANCE A woman who is already receiving MA (coverage code F or E) will not
be approved for BCCPTP.
If a woman receiving BCCPTP is found eligible for FIP, notify DCH by:
• Calling the BCCPTP coordinator, Michele Barton at (517) 241-

8164.
• Sending an DHS-45, DHS to DCH/MIChild/FTW Transmittal. The

address is on the form or fax form to (517) 373-9305.
If a woman found eligible under BCCPTP is in MA deductible status,

DCH will end the MA deductible status, open BCCPTP and notify the
local office.

BCCPTP REPORTS
RECEIVED AT
LOCAL OFFICE The DHS local office in the county of residence will receive system gen-
erated reports (example, RD-093) which include BCCPTP recipients.
The local office may also happen to receive change of address informa-
tion for these recipients (example, woman is also receiving Food Assis-
tance Program).
Send reports (or copies) for unit 78/specialist 88 and address changes
to DCH using an DHS-45. The address is on the form.

BCCPTP Coordinator
P.O. Box 30479
Lansing, MI 48909-7979

TREATMENT PROGRAM
Telephone: (517) 241-8164
Fax: (517) 373-9305
BCCPTP
HEARINGS All hearing requests for BCCPTP applicants and recipients will be han-
dled by DCH. If received by DHS, such hearing requests must be faxed,
then mailed, to DCH’s Administrative Tribunal. See “Role of DHS Staff”
in BAM 600.
BCCPTP
NONFINANCIAL
ELIGIBILITY
FACTORS DCH determines eligibility.
The person must:
• Be female, and
• Be age 18 through 64, and
• Have been screened for breast or cervical cancer under the Cen-
ters for Disease Control and Prevention’s Breast and Cervical
Cancer Early Detection program established under Title XV of the
Public Health Services Act, and
Note: This is a health department program called the Breast and

Cervical Cancer Control Program.
• Have been diagnosed with breast or cervical cancer or a precan-

cerous condition through that health department screening pro-
gram, and
Note: A finding by a woman’s doctor that she has breast or cervi-

cal cancer is not a substitute for a diagnosis through the screening
program.
• Not have creditable health insurance coverage [as the term is

used under 42 U.S.C. 300gg(c)] that covers breast or cervical can-
cer or precancerous conditions.
Examples of creditable health insurance are Medicare, Armed

Forces insurance, group health plan, state health risk pool, medi-
cal care under a hospital or medical services policy or certificate,
hospital or medical service plan or contract, and health mainte-
nance organization contract.
Being in MA deductible status is not creditable coverage. How-

ever, someone already receiving MA (coverage F or E) is not eligi-
ble under the BCCPTP category.

TREATMENT PROGRAM
A woman who has Medicare cannot receive MA under BCCPTP

because Medicare is creditable health insurance. Therefore, a
woman eligible under BEM 165, Medicare Savings Programs,
cannot be BCCPTP eligible.
The woman must also meet the eligibility requirements in the following
items:

• BEM 223, Social Security Number.
FINANCIAL
ELIGIBILITY
FACTORS There are no financial eligibility factors for the BCCPTP Medicaid cate-
gory.
Note: There is a financial test for the health department’s Breast and
Cervical Cancer Control Program. Income cannot exceed 250% of the
federal poverty level. However, that determination is not an DHS
responsibility.
LEGAL BASE Social Security Act, Sections 1902(a)(10)(ii)(XVIII) and 1902(aa)

DCH Appropriations Act.
Deficit Reduction Act 2005, Social Security Act 1903 (x), PL 109-171
JOINT POLICY
DEVELOPMENT

BEM 174 1 of 3 FREEDOM TO WORK (FTW)
DEPARTMENT
POLICY MA Only
Do not consider Freedom to Work (FTW) eligibility if the month being

tested is before January 2004.
Consider client’s eligibility for all other MA categories before consider-

ing eligibility for Freedom to Work (FTW).
FTW is available to a disabled client age 16 through 64 who has earned

income.
Eligibility begins the first day of the calendar month in which all eligibility
criteria are met. All eligibility factors must be met in the calendar month
being tested.
Note: SSI recipients whose SSI eligibility has ended due to financial
factors are among those who should be considered for this program.
NON-FINANCIAL
ELIGIBILITY
FACTORS 1. The client must be MA eligible before eligibility for FTW can be
considered.
2. The client does not access MA through a deductible.
3. The client must be disabled according to the disability standards of

the Social Security Administration, except employment, earnings,
and substantial gainful activity (SGA) cannot be considered in the
disabilty determination.
4. The client must be employed.
Note: A client may have temporary breaks in employment up to

24 months if the break is the result of an involuntary layoff or is
determined to be medically necessary and retain FTW eligibility.


FINANCIAL
ELIGIBILITY
FACTORS
Groups Clients eligible under the FTW category is a fiscal and asset group of
one.
Assets Once a client is determined eligible for FTW, the countable assets can-
not exceed the asset limit for FTW in BEM 400.
Refer to BEM 400 for jointly owned assets.
Income Eligibility Income eligibility exists when the client’s net unearned income does
not exceed 100% of the Federal Poverty Level (FPL), which is:
• $867 effective April 1, 2008.

• $903 effective April 1, 2009.
If the client’s net earned income is above 250% of the FPL, refer the cli-
ent to FTW. See” FTW Referrals” below.
Determine countable earned and unearned income according to SSI-

related MA policies in BEM 500, 530, 540 (for children) or 541 (for
adults). Unemployment compensation benefits are not countable
income for FTW.
PREMIUM
PAYMENTS A client with net earned income exceeding 250% of the FPL is required
to pay a monthly premium based on earned income to keep MA cover-
age. Premiums will be billed and collected by the Department of Com-
munity Health (DCH) through FTW.
Monthly FTW
Premiums Monthly FTW Premiums
Effective 04/01/09
Premium Level Monthly Countable Premium Amount

Earned Income
Level 1 $2257 to $3158 $50

Level 2 $3159 to $4512 $190
Level 3 $4513 to $6249 $460
Level 4 (max. $75,000) $6,250 and over $920
FTW Referrals If you determine that a client’s earned income exceeds 250% of the
FPL and meets all other financial and non-financial factors in this item,
use a DHS-45, DHS to DCH/MIChild/FTW Transmittal, and send a legi-
ble photocopy of the FTW budget sheet to the address below:

Freedom to Work
PO Box 30412
Lansing, MI 48909
FTW will use the budget information to determine the premium pay-
ment. When the client’s income increases to the point they would be
required to pay a different premium amount, send a copy of the new
budget to the above address.
Use a DHS-14, MIChild/Freedom to Work Referral, to inform the client

of the referral to FTW. This notice also informs the client if a premium is
required.
Do not end the client’s medical assistance on CIMS. FTW will notify the
client of the premium payment and collection process. If the premium is
not paid, DCH’s Exception Unit will close the case and notify DHS staff.

MEDICARE
SAVINGS
PROGRAM (MSP) MSP and FTW have different group composition, income and asset lim-
its. A separate determination must be done when there is a spouse.
Reminder: A client eligible for MA under FTW is not eligible for ALMB.
INSTRUCTIONS Refer to ‘How Do I’ for CIMS coding instructions
LEGAL BASE MA
Title XIX of the Social Security Act

Public Act 33 of 2003
JOINT POLICY
DEVELOPMENT

BEM 630 1 of 12 REFUGEE ASSISTANCE PROGRAM
DEPARTMENT
PHILOSOPHY The Refugee Assistance Program (RAP) is a federal program which
helps refugees to become self-sufficient after their arrival in the U.S.
RAP has two components; Refugee Assistance Program Cash (RAPC)
and Refugee Assistance Program Medical (RAPM).
DEPARTMENT
POLICY RAPC is a cash program for refugees who are not eligible for the Family
Independence Program (FIP). RAPM is a medical program for refugees
who are not eligible for Medicaid (MA). When the term RAP is used in
policy, it refers to both RAPC and RAPM.
In addition to refugees, eligibility for RAP is available to certain other

non U.S. citizens with specified immigration statuses, identified in the
section REFUGEES below. Treat these individuals as refugees, for
purposes of this item.
RAP ELIGIBILITY
PERIOD RAPC and/or RAPM is available only during the eight months immedi-
ately following the refugee’s date of entry into the U.S. or date asylum is
granted. Month one is the month containing date of entry or date of
adjustment to refugee status.
PROGRAM
ADMINISTRATION RAP
DHS Central Office Refugee Services in central office administers RAP, the Refugee Unac-
companied Minor Program, and Refugee Health Screenings. The Office
of Program Policy is responsible for RAPC and RAPM policy.
Refugee Refugee Resettlement Agencies also known as Voluntary Agencies

Resettlement (VOLAGs) may provide the following services:
Agencies
• Reception and placement services to newly arrived refugees
including orientation, counseling, resettlement grants, translation/
interpretation, and related services.
• Employment services such as English language instruction, trans-

portation, day care, citizenship and employment authorization doc-
ument assistance, translation/interpretation, and related services.
Note: Refugee applicants and recipients who are determined by

the resettlement agency to be proficient in English and who are
work ready, may be referred back to DHS for referral to JET for
employment services.
• Matching Grants (MG) to help refugees attain economic self-suffi-

ciency without accessing public cash assistance.
DHS Local Office DHS specialists determine eligibility for the following programs:

• FIP.
• MA.
• RAPC.
• RAPM.
• Refugee employment services.
CONCURRENT
RECEIPT OF
BENEFITS At application, all refugees must provide the name of the resettlement
or other agency that assisted them.
RAPC
Individuals may voluntarily leave the MG program by applying for cash

assistance. An individual may not receive MG and FIP/SDA/RAPC
concurrently.
Notify the resettlement agency when a refugee applies for cash assis-
tance. MG case if any, will be closed.
RAPM
An individual may receive MG and MA/RAPM concurrently.
Notify the resettlement agency when MA/RAPM has been approved.
REFUGEES RAP
Only a person who is a refugee (or is treated as a refugee) and who is

not a U.S. citizen can be eligible for RAP.
United States Citizenship and Immigration Services (USCIS) deter-

mines immigration status. If the status of a refugee cannot be verified
through immigration documents, contact the local resettlement agency
that provided for the refugees initial resettlement.
Individuals with the following statuses may be eligible for RAP:
• Refugee or Asylee. An individual from any country admitted into

the U.S. with the status of refugee or asylee.
Documentation is an I-94, Arrival/Departure Record, indicating the

Individual is one of the following:
•• Admitted as a refugee under section 207 of the Immigration

and Nationality Act (INA).
•• Granted asylum under section 208 of the INA.
• Afghan and Iraqi. Individuals granted a special immigrant visa

(SIV).

• Cuban/Haitian Entrant. An individual admitted into the U.S. from

Cuba or Haiti who meets entrant criteria.
Documentation is an I-94, Arrival/Departure Record, indicating the

Individual was admitted into the U.S. from Cuba or Haiti and one of
the following:
•• Document is annotated as a Cuban/Haitian Entrant (Status

Pending), parole, 212(d)(5) or Form I-589 Filed.
•• Individual has letter or notice from USCIS indicating ongoing

(not final) deportation, exclusion or removal proceedings.
• Amerasian. An individual admitted into the U.S. under P.L. 100-

202.
Documentation is one of the following documents annotated with

class code AM.
•• I-94.
•• I-551.
•• U.S. or Vietnamese Passport.
•• Vietnamese Exit Visa (Laissez Passer).
• Parolee. An individual from any country paroled into the U.S.

under INA section 212(d)(5) for at least one year.
Documentation is an I-94 annotated with INA section 212(d)(5)

which has a parole end date (duration) at least one year later than
the date of entry.
• Permanent Resident. An individual admitted for permanent resi-

dence, provided the individual previously held one of the refugee
or asylee statuses identified above.
Documentation is an I-551 annotated with class code RE, AS, SI

or SQ.
• Victim of Trafficking. An individual determined by the federal

Office of Refugee Resettlement (ORR) to be a victim of trafficking.
Documentation is both of the following:
•• The original certification letter from ORR, or for victims

under age 18, an original eligibility letter from ORR (see
Exhibits II and III).
•• Telephone contact with the ORR trafficking verification line at

1-866-401-5510 verifying the validity of the letter(s).

Note: No other immigration documents are necessary for victims

of trafficking.
DATE OF ENTRY RAP
USCIS determines an individual's date of entry into the U.S. and enters
it on the I-94 or other immigration document. This USCIS determination
is not subject to the DHS fair hearing process.
For Asylees, acceptable alien status begins on the date asylum is

granted on the I-94 regardless of arrival date. If the date of arrival and
the date asylum is granted are different, notify central office via the pol-
icy emailbox: Policy-FIP-SDA-RAP@michigan.gov.
For victims of trafficking, the date of entry is the date on the ORR cer-
tification/eligibility letter.
For Afghan and Iraqi special immigrants, acceptable alien status begins
with the month containing the date SIV was granted. See BEM 225A.
ELIGIBILITY
Choice of Category RAPC
RAPC eligibility factors are listed in BEM 209, Cash Assistance General
Requirements.
When a family/individual applies for cash assistance, Bridges deter-

mines group composition and builds an eligibility determination group
(EDG) for these programs in the following order: FIP, RAPC, then SDA.
Under certain conditions, some FIP EDGs may qualify for and choose
Short-Term Family Support (STFS) instead of FIP. See BEM 218,
Short-Term Family Support.
RAPM
RAPC recipients who are not eligible for MA are automatically eligible
for RAPM.
RAPC and RAPM
Bridges uses the following guidelines when determining eligibility for

RAP:
• Bridges determines eligibility for FIP and MA before determining

eligibility for RAPC and/or RAPM.
Note: Excess income for MA resulting in a deductible is not con-

sidered MA eligible.

• Bridges determines FIP and MA eligibility when a RAP recipient

reports a change that indicates potential FIP or MA eligibility (for
example, when RAP recipient becomes pregnant).
See RAP EXTENDED MEDICAL COVERAGE in this item about when

RAPM may be extended.

Group RAPC
Composition
See BEM 215 for RAPC group composition policy.
RAPM
See FIP-related MA group composition policy in BEM 211 for refugees/

asylees who are not eligible for MA.
FINANCIAL
ELIGIBILITY
FACTORS
Assets RAPC
Use FIP policy in BEM 400 to evaluate assets.
Note: the following special RAPC asset rules:
• Do not consider the assets of a refugee’s sponsor in determining

the refugee’s eligibility.
• Cash assistance given to a refugee from a resettlement agency is

not an asset.
RAPM
There is no asset test for RAPM.
Income RAP
Follow income policy in BEM 500.
RAPC
Income eligibility exists when net income of individuals with a RAPC

EDG participate status of eligible or disqualified is less than the needs

of the certified group (CG). RAPC uses the same payment standard as
FIP; see RFT 210.
RAPM Only
Income eligibility exists when net income does not exceed 200% of the
poverty level. The income limit is in EXHIBIT I of this item.
• Do not count any income received by the refugee from a refugee

resettlement agency or the refugee’s sponsor.
• Apply policy in BEM 546 if an eligible person is an L/H individual.
• If net income exceeds the income limit, RAPM eligibility is still pos-
sible using policy in BEM 545.
• See EXTENDED MEDICAL COVERAGE in this item for recipients

who lose eligibility due to excess income.
Income at RAPM
Application
At application, determine eligibility based on the group’s income on the
date of application. Do not prospect income from a source if no income
has been received by the date of application.
Example: The Smith family applies on November 6, 2009. Mr. Smith

has started a job but has not received his first paycheck. Do not pros-
pect any earned income for Mr. Smith in determining initial eligibility.
Income After RAPM

Application
After initial eligibility has been established, exclude earned income for
RAPM recipients. Bridges uses policy in BEM 536 to determine the
group’s net income.
Example: Mr. Smith (example above) reports receiving his first pay-
check on November 7, 2009. These earnings are not counted to deter-
mine initial or ongoing eligibility.
EXTENDED
MEDICAL
COVERAGE Bridges will continue RAPM coverage for RAPC recipients when all of
the following are true:
• RAPC eligibility is lost due to excess earned income.
• Members are within eight months of their date of entry into the
U.S. or date asylum was granted.
• Members are not eligible for MA.

Do not require a new application. See Redetermination Date.
RAPM Termination Bridges will only terminate RAPM for a group member who is either of
the following:
• No longer meets the MA eligibility factors found in BEM 220, Resi-

dence.
• Becomes eligible for MA.
STANDARD OF
PROMPTNESS RAPC
You must approve or deny an application for RAPC and mail the individ-
ual a notice within 30 days from the date of application. Use FIP policy
in BAM 115 for all other application processing policies.
REDETERMINA-
TION DATE RAP
Bridges sets the redetermination date based on date(s) of entry.
Bridges follows-up to remove each group member whose RAP eligibility

ends before the redetermination date. Bridges automatically stops
RAPC and RAPM benefits effective the month when the last group
member has been in the U.S. for eight months.
BENEFIT
ISSUANCE RAPM
RAPM recipients receive a MiHealth card. Covered services for RAPM

are the same as in Medicaid. Medicaid reimbursement procedures,
such as billing instructions and prior authorization procedures, are used
for RAPM.
DHS-848 RAP
Use the DHS-848, Certification of Translation/Interpretation for Non-

English Speaking Applicants or Recipients, whenever an individual who
is non-English speaking or has limited English proficiency (LEP) is pro-
vided translation/interpretation services. The 848 is documentation an
individual has been provided written or verbal notice in a language they
can understand.
DHS-940, Refugee RAPC and RAPM

Reporting
The DHS-940, Refugee Reporting, (see RFF 940) registers refugees
with the DHS Refugee Assistance Program Office.

Complete an DHS-940 at case opening, reopening and member add for

refugee groups determined eligible for RAPC, RAPM, FIP, SDA, MA,
CDC, AMP or FAP.
Forward the completed form to:
Michigan Department of Human Services

Refugee Services Program Office
Suite 1313
235 S. Grand
P.O. Box 30037
Lansing, MI 48933
Phone: (517) 241-7824
VERIFICATION
REQUIREMENTS RAPC and RAPM
Verify the refugee status of each individual at application or member

add. See the REFUGEES section in this item for documents that verify
refugee status.
Verify each refugee's date of entry into the U.S. Use the I-94, other per-
tinent USCIS document, or contact with USCIS to verify date of entry.
RAPM
Use FIP-related MA verification requirements for all other eligibility fac-

tors.

EXHIBIT I - RAPM
INCOME LIMITS
RAPM Income Limits
Number in Fiscal Group Limit Effective

April 1, 2009
1 $1805
2 $2429
3 $3052
4 $3675
5 $4299
6 $4922
7 $5545
8 $6169
9 $6793
10 $7417
For each additional Individual $624
add:

EXHIBIT II -
SAMPLE ADULT
VICTIM OF
TRAFFICKING ORR
CERTIFICATION
LETTER

EXHIBIT III -
SAMPLE CHILD
VICTIM OF
TRAFFICKING ORR
ELIGIBILITY
LETTER
LEGAL BASE 45 CFR 400

P.L. 106-386 of 2000, Section 107

JOINT POLICY
DEVELOPMENT

BEM 647 1 of 11 TRANSITIONAL MA PLUS (TMA-PLUS)
DEPARTMENT
POLICY TMAP
TMA-Plus is a state-funded medical program.
TMA-Plus is available to families after Transitional MA (TMA) ends to

assist families who are unable to purchase employer-sponsored health
care. TMA-Plus offers a way to extend medical coverage through a pre-
mium-payment plan (see “PREMIUM PAYMENTS”).
Each local office must designate a TMA-Plus contact person to assist in

coordination and act as a liaison with the Department of Community
Health (DCH).
Important: This item contains special deadlines for completing work

and special coding instructions. It is important to meet the deadlines
and enter proper coding.
TMA-PLUS GROUP The TMA-Plus group includes all TMA group members excluding
those who:
• No longer live with the group (see BEM 110 for the definition of
“live with”), or
• No longer meet age and school attendance requirements.
A child must be under age 18, or age 18 or 19 and a full-time high

school student expected to graduate before age 20. See BEM 245
for the definition of full-time high school.
Note: A child in the existing TMA group who no longer meets the defi-
nition of a child (e.g., turned age 20 during the period), is not TMA-Plus
eligible. However, you must determine eligibility for other MA categories
(e.g., Group 2 Persons Under Age 21).
NONFINANCIAL
ELIGIBILITY
FACTORS
Child in TMA-Plus The TMA-Plus group must contain a child who is:
Group
• Under age 18.
• Age 18 or 19 and a full-time high school student expected to grad-
uate before age 20. See BEM 245 for the definition of full-time high
school.
Other Health The TMA-Plus group members cannot have:

Insurance
• Other comprehensive health insurance.

Definition: Comprehensive health insurance is insurance that

covers, at a minimum, inpatient and outpatient hospital services,
laboratory, x-ray, pharmacy and physician services.
Note: If there is health insurance that is not comprehensive, send

the completed MSA-1354, Third Party Liability Health Insurance
Information, to:

Medical Services Administration
Managed Care Support Division
Eligibility Quality Assurance Section
PO Box 30479
Lansing, MI 48909
• Other comprehensive health insurance currently available through

their employer, unless the other health insurance premium is more
than the monthly TMA-Plus premium.
Note: If the premium is paid more than once a month (including

payroll deduction), convert the amount to a monthly amount based
on four weeks per month.
If the premium payment covers more than one month, convert the
amount to a monthly amount by dividing by the number of months the
payment covers (e.g., quarterly payment divided by three).
Private health insurance may be cancelled if the premium is more than

the TMA-Plus premium in order to qualify for TMA-Plus.
Deductibles are not considered when comparing private health insur-

ance premiums to TMA-Plus premiums.
Other Nonfinancial Members of the TMA-Plus group must meet the MA eligibility factors in
Factors the following items:

FINANCIAL
ELIGIBILITY
FACTORS
Income Eligibility Income eligibility exists when net income of the TMA-Plus income group
does not exceed 185% of the poverty level for the income group. The
income limit is in RFT 246.

TMA-Plus Income The TMA-Plus income group is:

Group
• TMA-Plus group members, and
• TMA disqualified adults who still live with the TMA-Plus group.
Disqualified adults are persons who were disqualified from FIP or LIF
and thus from TMA for child support non-cooperation (BEM 255).
Net Income Determine net income as follows:

Determination
• Use BEM 500 to determine countable earned and unearned
income.
• Prospect income for future months. Use amounts that will be, or
are likely to be, received in the future month. See “Prospecting
Income.”
Exception: Do not include overtime pay, bonus pay or an extra check

(e.g., 5th check for a person paid weekly).
• Deduct the $90.00 standard work expense from the countable

earnings of each employed TMA-Plus income group member.
• Deduct $50.00 from the income group’s total child support income.
Prospecting Estimate what income will be received in a future month. Your estimate
Income may not be the exact amount of income received in that month.
Some of the reasons income fluctuates is because the hours worked

fluctuate and tips vary from pay to pay.
Use the following as a guideline for prospecting income:
• Paystubs showing year-to-date earnings and frequency of pay are

usually as good as multiple paystubs to verify income.
• A certain number of paystubs is not required to verify income. If

even one paystub reflects the hours and wages indicated on the
application, that is sufficient verification of income.
• If a person reports a pay raise, use that amount even if the

increase is not yet reflected on paystubs.
TMA-PLUS
QUALIFIED GROUP The TMA-Plus qualified group is:
• TMA-Plus group members who have met all eligibility require-

ments, and
• Are not eligible for any other MA category.

Example: The TMA-Plus group meets all the TMA-Plus eligibility

requirements. The adults in the TMA-Plus group are not MA eligible,
but the children in the TMA-Plus group are Healthy Kids eligible. The
TMA-Plus qualified group is the adults.
The TMA-Plus qualified group is TMA-Plus eligible when the initial pre-
mium payment is paid by the due date. See “Initial Premium Pay-
ment.”
Note: The group decides whether to pay the premium for all the quali-
fied group members or only some members. However, if someone’s
premium is not paid, they cannot re-enroll in TMA-Plus unless the
group member is once again TMA eligible.
ONGOING
ELIGIBILITY During each 12-month period between redeterminations, eligibility con-
tinues unless:
• Premiums are not paid on or before the due date (see “PREMIUM
PAYMENTS”).
Note: A TMA-Plus eligible group member may choose to end his/

her eligibility without affecting the eligibility of other members.
• Payment received is less than the full premium amount or consid-

ered to be “non-sufficient funds” (NSF).
• The TMA-Plus group no longer contains a child who meets age

and school attendance requirement.
• Other comprehensive health insurance is obtained or is available

from an employer for the same or less than the TMA-Plus premium
amount.
• Residence/institutional status factors in “NONFINANCIAL ELIGI-

BILITY FACTORS” are no longer met by a TMA-Plus eligible
group member.
• A TMA-Plus eligible group or group member is approved for an MA

category including FIP. A pregnant woman must be transferred to
Healthy Kids for Pregnant Woman (HKP). She may regain her
TMA-Plus eligibility after the pregnancy ends.
A group member who loses TMA-Plus eligibility cannot re-enroll in

TMA-Plus unless the group member is once again TMA eligible.



Ongoing Financial Financial eligibility is only considered at initial eligibility and at annual
Eligibility redetermination. Income and income limit changes are not considered
until the next redetermination.
Continuity of The intent is that there be no break in coverage between when TMA
Coverage ends and TMA-Plus begins. TMA-Plus must begin the first day of the
month following TMA.
If TMA continues beyond the 12-month period, (for example, the TMA
group requests an administrative hearing):
• TMA-Plus coverage will be authorized retroactively if the initial pre-

mium payment is paid by the due date.
• TMA-Plus coverage will not be authorized retroactively if the initial

premium payment is not paid by the due date.
PREMIUM
PAYMENTS The monthly premium payment changes at 12, 18 and 24 months. After
two years the premium remains constant.
The following are monthly TMA-Plus premiums:
• $50.00 per person for the first year.

• $83.00 per person for the next six months.
• $110.00 per person thereafter.
Initial Premium You must send the DHS-1075, TMA-Plus Eligibility Notice, to the quali-
Payment fied TMA-Plus group at least 40 calendar days before the last day of
TMA. This allows:
• The TMA-Plus group time to pay the initial premium payment, and
• DCH time to activate TMA-Plus eligibility in Bridges.
The initial premium payment must be received by DCH not more than
30 days after the date that the DHS-1075 is sent to the TMA-Plus group
notifying them that they qualify for TMA-Plus.
Subsequent Subsequent premium payments must be paid in full and received by

Premium DCH on or before the first day of each month.
Payments
LOCAL DHS
RESPONSIBILITIES The administration and implementation of the TMA-Plus program is a
joint effort between the DHS and DCH. This section describes local
DHS responsibilities.

Redetermination A determination of continuing MA eligibility must be completed at least

(TMA Ends) 40 days before the last day of the 12-month TMA period (see BEM 111
and 645). See “Initial Premium Payment.”
The RD-210, TMA Redetermination Report, will first identify TMA cases
in the fourth month before the end of TMA eligibility. For example, a
TMA case whose TMA ends in September 2008 will first be listed on the
report in the month of June 2008.
You must begin redetermination procedures immediately so that all

DHS actions are completed at least 40 days before the end of the 12-
month TMA eligibility period.
Follow normal redetermination procedures in BAM 210 except for the

following:
• Send MSA Publication 213, TMA-Plus, along with the DHS-1171,

Assistance Application.
• The due date for return of the DHS-1171 and verifications is the
negative action effective date in RFS 103 which corresponds to
the processing date.
• If the application and/or verifications are returned incomplete, you

must allow the group additional time to complete the application
and/or obtain verifications. The due date is the negative action
effective date in RFS 103 which corresponds to the processing
date.
Most children are eligible under Healthy Kids (BEM 129, 131). If the
children are not Healthy Kids eligible due to income, use an DHS-45,
DHS to DCH/MIChild/FTW Transmittal and send legible photocopies of
the following to MIChild via U.S. mail at the address below:
• The DHS-1171.
• The Healthy Kids budget sheet.
• Any other Healthy Kids-related eligibility information.
• Any Healthy Kids-related verifications.
MIChild
PO Box 30412
Lansing, MI 48909
No MA or TMA- If the adults (including children age 19) in the TMA group are not eligi-
Plus Eligibility ble for other MA categories or TMA-Plus (for example, the family did not
return the DHS-1171), follow normal procedures in BAM 220 except
you must enter the last day of the TMA redetermination month as the
negative action date.

All TMA Group If all members of the TMA group are eligible for LIF, run EDBC in
Members MA Bridges and update the coverage:
Eligible
• Eligible for other MA categories (not deductible) - follow normal
procedures except the MA begin date for the other MA categories
is the first day of the month after the 12-month TMA period.
Qualify for TMA- If the adults qualify for TMA-Plus, proceed as follows:
Plus
• Send the DHS-1075, TMA-Plus Eligibility Notice, and one MSA-
652-TMA payment envelope to the family. The DHS-1075 advises
the group that:
•• Ongoing MA eligibility is being terminated.

•• The group qualifies for TMA-Plus.
•• The amount of the initial premium payment.
•• The due date for the initial premium payment.
•• The consequences if the initial premium payment is not paid
timely.
• Forward a copy of the DHS-1075, TMA-Plus Eligibility Notice, to

DCH at the address below. You may also email the DHS-1075,
TMA-Plus Eligibility Notice, to TMA-Plus@michigan.gov. This will
give DCH notice that the group qualifies for TMA-Plus and the due
date of the initial premium payment.

TMA-Plus Coordinator
PO Box 30656
Lansing, MI 48909-9635
Example: The Jones’ family, consisting of the parents and two chil-
dren, are on TMA. TMA ends August 2008.
• May 1 - You receive the TMA Redetermination Report identifying

the case with TMA ending August 31, 2008.
• May 5 - You mail an DHS-1171, Assistance Application, an DHS-

3503, Verification Checklist, and the TMA-Plus publication to the
Jones’ family on May 5, 2008 with a due date of May 17, 2008 (the
negative action effective date for May 5, 2008).
• May 16 - You receive the application and verifications. You do not

have income verification for Mrs. Jones.
• June 8 - You send another DHS-3503 with a due date of June 20,
2008 (the negative action effective date for June 8, 2008) to return
income verification.
• June 20 -You receive Mrs. Jones’ income verification.

• July 12 - You determine that Mr. and Mrs. Jones have excess
income for Caretaker Relative MA. There is TMA-Plus eligibility for
Mr. and Mrs. Jones. The children are both eligible for Healthy Kids.
• July 12 -You open Healthy Kids for the two children.
You send an DHS-1075 and MSA-652-TMA payment envelope to Mr.

and Mrs. Jones.
You send a copy of the DHS-1075 to DCH notifying them that the group
is eligible for TMA-Plus and the due date of the initial premium pay-
ment.
• August 11 - The due date for the initial TMA-Plus premium pay-
ment.
• August 10 - DCH receives $100.00 initial TMA-Plus premium pay-

ment from Mr. and Mrs. Jones on August 10, 2008.
DCH deletes the pending negative action and changes the TMA to
TMA-Plus effective September 1, 2008.
DCH sends you the DHS-1076, DHS/DCH TMA-Plus Transmittal, as

notice that the Jones’ have an active TMA-Plus case.
TMA-Plus Changes Send an DHS-1076 to DCH if:
• The TMA-Plus group reports an address change.

• You remove a TMA-Plus group member from the TMA-Plus case.
TMA-Plus Closures Send an DHS-1076 to DCH if you terminate TMA-Plus. Send the DHS-
1076 to DCH after the effective date of closure.
Reminder: You may terminate TMA-Plus eligibility only for the following:
• The TMA-Plus group no longer contains a child.
• Other comprehensive health insurance is obtained or is available

from an employer at less than the TMA-Plus premium amount.
• The TMA-Plus group no longer meets residence or institutional

status.
• The TMA-Plus group is eligible for another MA category including

FIP.
• The TMA-Plus group has excess income at annual redetermina-

tion.

TMA-Plus DCH will send an DHS-1076 when TMA-Plus is reinstated. Send an

Reinstatements DHS-1074, TMA-Plus Notice, to the TMA-Plus group in these situa-
tions. See “DCH RESPONSIBILITIES.”
TMA-Plus Follow redetermination procedures in BAM 210. Begin the redetermina-

Redetermination tion process the first time that the TMA-Plus case appears on the RD-
093, Redetermination Report. This will allow you to complete the rede-
termination process before the end of the TMA-Plus 12-month period.
• The due date for return of the application and verifications is the
negative action effective date in RFS 103 that corresponds to the
processing date.
• The due date for return of an incomplete application and/or verifi-

cations is the negative action effective date in RFT 103 that corre-
sponds to the processing date or the last day of the TMA-Plus 12-
month period, whichever is earlier.
• If TMA-Plus eligibility continues at redetermination, send an DHS-

1074, TMA-Plus Notice, to the TMA-Plus group.
• If, at redetermination, you find that there is no TMA-Plus eligibility,

send an DHS-1074 to the TMA-Plus group. Determine eligibility for
MA categories. End the TMA-Plus even if MA eligible.
• Forward the DHS-1076, DHS/DCH TMA-Plus Transmittal, to DCH

after the effective date of closure notifying them of the TMA-Plus
closure effective date.
DCH
RESPONSIBILITIES The administration and implementation of the TMA-Plus program is a
joint effort between the DHS and DCH. This section describes DCH
responsibilities.
DCH is responsible for monitoring the initial and subsequent premium

payments from the TMA-Plus group.
Initial Premium DCH is responsible for monitoring that the initial TMA-Plus premium
Payment payment is paid by the due date. If the initial premium payment is paid
Collection by the due date, DCH will:
• Delete the pending negative action (the TMA transfer to deduct-

ible), and
• Change TMA to TMA-Plus in Bridges effective the day after TMA

eligibility ends, and
• Send you an DHS-1076 as notice of TMA-Plus eligibility.

DCH will not take any action if payment was not made by the due date.
The case will become an active deductible.
Subsequent DCH is responsible for monitoring that each subsequent premium pay-
Premium Payment ment is received by the first of each month and is the correct premium
Collection amount.
If the payment is not received by the first of the month or if the payment
received is for an amount less than the premium amount, DCH will:
• Send the TMA-Plus group an MSA-710 with the closure date.

• Run EDBC in Bridges.
If the premium payment is received DCH will:
• Delete the pending negative action if the premium payment is

received prior to the negative action effective date.
• Reinstate the TMA-Plus if the correct premium payment is

received after the negative action effective date, but with a post-
mark prior to the negative action effective date.
• Send you an DHS-1076 as notice of:
•• Reinstatement so that you can send an DHS-1074 to the

TMA-Plus group.
•• TMA-Plus closure if premium is not paid.
Note: DCH will refund premium payments postmarked after the

closure date.
Other Insurance DCH checks Bridges monthly for Other Insurance (OI) codes. If the
Codes Third Party Liability Division in DCH adds an OI code to Bridges for a
TMA-Plus recipient, DCH sends an MSA-710 to the TMA-Plus group
requesting other insurance information. If the other insurance premium
is less than the TMA-Plus premium, DCH initiates closure of TMA-Plus
and notifies you of this on the DHS-1076 after the effective date of case
closure.
REPORTING
RESPONSIBILITIES The TMA-Plus group must report certain changes within 10 days of the
change. Such changes are:
• Address.
• Family composition.
• A child in the family age 18 or 19 is no longer a full-time high

school student.

• Availability of comprehensive health insurance coverage.
• Cost of comprehensive health insurance coverage.
HEARING RIGHTS See BAM 600 for DHS/DCH responsibilities when a hearing is
requested regarding TMA-Plus eligibility or payment of premiums.
INSTRUCTIONS When a group initially qualifies for TMA-Plus, DHS does not enter TMA-
Plus coverage in Bridges. DCH updates the data elements to input
TMA-Plus in Bridges once a qualified group pays the initial premium.
LEGAL BASE DCH Appropriations Act
JOINT POLICY
DEVELOPMENT

BEM 150 1 of 8 MA FOR SSI RECIPIENTS
DEPARTMENT
POLICY MA Only
Supplemental Security Income (SSI) is a cash benefit for needy individ-

uals who are aged (at least 65), blind or disabled. The Social Security
Administration (SSA) determines SSI eligibility.
In Michigan, DHS supplements federal SSI payments based on the cli-

ent’s living arrangement. Thus, in this item SSI recipient means a
Michigan resident who receives the basic federal payment, the state
supplement, or both.
To be automatically eligible for Medicaid (MA) an SSI recipient must:
• Be a Michigan resident, and

• Cooperate with third-party resource liability requirements.
DHS administers MA for SSI recipients, including a continued MA eligi-

bility determination when SSI benefits end.
Ongoing MA eligibility begins the first day of the month of SSI entitle-
ment. Some clients also qualify for retroactive (retro) MA coverage for
up to three calendar months prior to SSI entitlement. See BAM 115.
The following individuals are considered SSI recipients for MA pur-

poses even though they do not receive an SSI cash grant:
• Individuals appealing termination of SSI because SSA has deter-

mined they are no longer disabled or blind. DHS local offices are
responsible for determining initial and continuing eligibility. See
“MA While Appealing Disability Termination” below.
• 1619 Recipients - Certain blind or disabled SSI recipients who

work and have too much income for an SSI cash grant may be eli-
gible for continued MA coverage. SSA determines eligibility.
These recipients are the same as other SSI recipients in Bridges.
DATA EXCHANGE
SYSTEM Central office receives SSI client information daily from SSA through
the State Data Exchange (SDX), which lists SSI:
• Applications.
• Denials.
• Appeals.
• Openings and reopenings.
• Closures.
• Address and other changes.

This information is available in Bridges through the SDX Individual

Inquiry, located under Interfaces in left navigation. See BAM 800, Data
Exchanges.
MA-SSI OPENINGS/
TRANSFERS
Central Office SDX An automated process tries to match new SSI recipients on the SDX file
Actions with persons active in other programs on Bridges. What happens next
depends on what type of match is found.
• Exact match found:
•• If the individual is receiving MA in Bridges, EDBC is run in

mass update to close MA under the current case and open
ongoing SSI under a new case number.
• Possible match found:
•• The case is reported to the SSI Coordination Unit for manual

processing.
•• The SSI Coordination Unit completes the manual SSI open-

ing and transfers the SSI case to the appropriate local office.
• No possible match:
•• Bridges opens a new SSI case and assigns it to a specialist

in the appropriate local office based on the individual’s resi-
dence.
LOCAL OFFICE
TRANSITIONAL SSI
OPENINGS An SSI recipient may come to the local office asking for MA coverage
before the SDX process opens SSI in Bridges. Local offices should
open Transitional SSI (TSSI) when:
• The SSI recipient is not currently active for full coverage MA, or
• The SSI recipient is receiving MA under another Type of Assis-
tance (TOA.)
See “Opening TSSI” below.
Note: It is the local office responsibility to complete the TSSI opening.

The SSI Coordination Unit is unable to process manual SSI opening
requests timely due to the limited resources available.
Opening TSSI Do all of the following before opening TSSI for an SSI recipient:
• Obtain a signed DHS-1171 Filing Form (page 19 of the information

booklet) and all of the following:
•• Recipient’s name.
•• Recipient’s birth date.
•• Recipient’s address.
•• Recipient’s/authorized representative’s signature.
Note: Do not require completion of the entire DHS-1171 Assistance

Application for TSSI. Only the DHS-1171 filing form (page 19 of the
information booklet) is needed.
• If there are other family members receiving Medicaid in the SSI

recipient’s household and the applicant is a responsible relative
(e.g., spouse, parent) of the SSI Recipient, change the SSI Recip-
ient’s individual program status to ‘Requested’ to apply for MA on
the family’s case.
• If the SSI recipient is receiving other programs but not MA, use the
Program Request screen in the existing case to apply for MA.
• If there are no active cases into which the SSI Recipient’s MA

request can be added, register an application for Medicaid in
Bridges.
• Determine the SSI Recipient’s state of residence. See BEM 220 if

the SSI Recipient does not receive a state supplement from Mich-
igan.
• Verify current receipt of SSI and/or state supplement and most

recent entitlement date. Acceptable verification includes a current
award letter from SSA (showing SSI eligibility for the current and
ongoing month), information on a DHS-3471, DHS/SSA Referral,
or contact with SSA (see RFF 3471).
Note: When an SSI EDG is open based on an individual SOLQ inquiry,

nothing more should be needed.
To ensure transfer of TSSI to SSI:
• Copy the EDG Summary screen from Bridges Eligibility Results

that displays the TSSI indicator for the SSI Recipient, and
• Current (within 30 days) verification of SSI eligibility using one of

the following:
•• Copy of the award letter the client submitted

•• Copy of an SOLQ print from Bridges
•• DHS-3471, DHS/SSA Referral.
Send to:

SSI Coordination Unit

235 S Grand Ave, Suite 1301
PO Box 30037
Lansing, MI 48909
You may also fax to (517)335-6112, email:SSI @michigan.gov or

call (517)335-3627.
All communication with SSI Coordination must include:
• Client’s name.
• Client’s individual ID.
• Client’s case number.
• Explanation of the issue or problem.
• Your name, title, location, and your telephone number or email
address.
LOCAL OFFICE
RESPONSIBILITIES Central office does not automatically update Bridges when SSA reports
an address and county code change. You must:
• Update Bridges and transfer the case (see BAM 305), or

• Notify SSA via DHS-3471 if the address and county code do not
agree.
You also have the following case responsibilities based on information

you receive from all sources:
• Update any address, residence county code, and residence dis-

trict changes in Bridges.
• Send a copy of the current Bridges individual demographics

screen and supporting documentation (e.g., birth certificate, SSN
card) to the SSI Coordination Unit (see above) when a name, date
of birth or social security number is incorrect.
• Enter facility and living arrangement changes for LTC and waiver
patients.Transfer the case, if necessary. See BAM 305.
• Notify SSA via DHS-3471 of changes or corrections to:
•• Name.
•• Birthdate.
•• Marital status.
•• Address.
•• County code.
•• Living arrangement.
SSA Follow-ups If case information you sent to SSA does not appear on the HR-070
within 45 days, send copies of the DHS-3471 and documentation to the

SSI Coordination Unit (see LOCAL OFFICE TRANSITIONAL SSI

OPENINGS) for follow-up. Clearly mark your request “Follow-up Report
of Change.”
The SSI Coordinator contacts SSA and, after verifying that the informa-
tion is acted on, responds to you.
Redeterminations SSI recipients who are Michigan residents receive MA-SSI in Bridges
for the duration of SSI eligibility. You do not have to conduct redetermi-
nations. However, if SSI stops, you may have to determine continued
MA eligibility. See SSI TERMINATIONS below.
ELIGIBILITY FOR
OTHER SERVICES SSI recipients may qualify for food benefits, state emergency relief or
other benefits. Make referrals as appropriate.
Note: SSI recipients may apply for FAP at SSA or the DHS local office.
BAM 116 explains joint application processing.
Categorically eligible FAP groups automatically meet FAP asset and

income limits. See BEM 213 for a definition of categorically eligible
FAP groups.
SSA may refer SSI recipients with prepaid funeral contracts to DHS.
BAM 805 explains how to certify the contract as irrevocable.
SSI TERMINATIONS When SSI benefits stop, central office evaluates the reason based on
SSA's negative action code, then does one of the following:
• SSI Closure. MA-SSI is closed in Bridges if SSI stopped for a rea-

son that prevents continued MA eligibility (e.g., death, moved out
of state). Bridges sends the recipient an DHS-1605.
• Transfer to SSIT. SSI cases not closed due to the policy above
are transferred to the SSI Termination (SSIT) Type of Assistance.
A redetermination date is set for the second month after transfer to
allow for an ex parte review. (See glossary).
Bridges sends a Redetermination Packet, including a DHS-1010,

and sets the second month after transfer as the redetermination
date (and the medical review date if SSI was based on blindness
or disability).
Local Office Based on current circumstances, determine whether the client qualifies
Responsibilities for MA under:
for Cases
Transferred to • “MA While Appealing Disability Termination” below, or
SSIT • Any other MA category (see BEM 105).


When an SSI-T EDG is set in Bridges, the specialist will receive the fol-
lowing Task/Reminder (T/R): “Send DHS-1171 to client as Medicaid
Transitional SSI case newly Certified” The T/R has a 15 day due date.
On or before the Task/Reminder due date the specialist should mail a
redetermination packet to the client and authorized representative. The
redetermination packet should include the DHS-1171 Assistance Appli-
cation and the Word version of the DHS-3503 Verification Checklist.
The specialist should mark the verifications required for Medicaid on the
DHS-3503.If the client is receiving other programs, a current applica-
tion form in the other case record may be updated and resigned if the
client returns the DHS-1010 sent with the Redetermination Packet, treat
the DHS-1010 as an application to add a program if the client has pro-
grams on another case number. Otherwise, it must be registered as a
new application for assistance. The SSI case cannot be used for an add
a program and the SSI case number cannot be used for other programs
or non-SSI MA categories.
Process the application through Initiate Interview, Intake, in Bridges.

Generate the appropriate disability forms Do not require an updated or
new application form when you know eligibility exists under “MA While
Appealing Disability Termination” below.
Complete the review by the end of the redetermination during the sec-
ond month of the SSI-T. Document all factors in the case record, includ-
ing disability and blindness.
If continued MA eligibility does not exist, use standard negative action

procedures.
MA While MA eligibility continues for an individual who:

Appealing
Disability • Has been terminated from SSI because he is no longer considered
Termination disabled or blind, and
Note: See BEM 260 about SSI denial codes.
• Has filed an appeal of the termination with SSA within SSA’s 60-
day time limit, and
Note: See BEM 260 for information about the SSA appeal pro-
cess and appeal codes.
• Is a Michigan resident.
Other eligibility factors such as income, assets and third party resource
liability are not an issue.
MA eligibility continues until the person:
• Exhausts his SSA appeal rights, or

• Fails to file an appeal at any step within SSA’s 60-day time limit, or
• Is no longer a Michigan resident.
When you run EDBC, Bridges will determine whether the individual
qualifies under other MA categories (BEM 105) when eligibility ends
based on this policy.
Administrative SSI cases with PAY STAT code N20 on SOLQ are closed due to
Case Closures administrative reasons and might reopen within three weeks. Consider
this in deciding when to begin evaluating continued MA eligibility and
watch for an SSI reopening during the evaluation process.
SSI Closures E-mail or fax the SSI Coordination Unit to close an SSI case if the cli-
ent is:
• Deceased.
• No longer a Michigan resident.
When reporting a death, include a copy of the client’s death certificate,

obituary or other proof the client is deceased with the e-mail or fax.
VERIFICATION
REQUIREMENTS Verify current receipt of SSI and/or state supplement and the most
recent entitlement date before authorizing TSSI for an SSI recipient.
Verify the following for MA based on the “MA While Appealing Dis-
ability Termination” policy.
• SSI was terminated because the person was no longer considered

disabled or blind.
• Timely appeal filed at SSA.
VERIFICATION
SOURCES
Current Receipt of • Copy of a current SSI award letter from SSA.

SSI • DHS-3471, DHS/SSA Referral.
• Contact with SSA.
• SOLQ.
Note: See BEM 260 for a list of appropriate codes.
SSI Termination • SOLQ.

Reason Note: See BEM 260 for a list of appropriate codes.

• Contact with SSA.

• Copy of SSI Termination Notice.
Timely Appeal at Note: See BEM 260 for a list of appeal codes.
SSA • SOLQ
• Copy of the SSI appeal form (SSA-561 or HA-501).
• Correspondence from SSA.
• Legal document indicating appeal filed.
LEGAL BASE MA
42 CFR 435.120,.230
MCL 400.106
JOINT POLICY
DEVELOPMENT

BEM 158 3 of 6 DISABLED ADULT CHILDREN
the letter C. The C may be followed by another letter or number

(CA, CB, C1, etc.).
• He is more than 19 years 2 months old and his social security

claim number suffix contains the letter C. The C may be followed
by another letter or number (CA, CB, C1, etc.).
• He is age 18 or older, not a full-time student in elementary or sec-

ondary school and his social security claim number contains the
letter C. The C may be followed by another letter or number (CA,
CB, C1, etc.).
Note: When an individual meets a bullet listed you must request a

screening for DAC eligibility from central office unless a determination
has already been completed by central office. After you receive verifica-
tion of DAC RSDI from central office you still need to determine all other
factors for MA eligibility (income and asset etc., listed on page 1 of this
item) are met. You should retain the copy of the verification from central
office as you only need to verify DAC RSDI once.
Requests must be made through your management or central special-

ized staff (include titles). Send requests to:
DHS-DAC-Determination-Mailbox@michigan.gov and include the ben-

eficiary’s name, case number, SSN, SS claim number and any other
information pertaining to the request.

VERIFICATION
REQUIREMENTS Verification of the following factors unique to DAC eligibility is required
prior to authorizing DAC MA eligibility:
• Receipt of SSI on the basis of blindness or a disability.

• Termination of SSI on or after July 1, 1987 because of entitlement
to DAC RSDI benefits or an increase in such benefits.
Verification of receipt of DAC RSDI benefits under section 202(d) of the

Act is required prior to authorizing DAC MA eligibility and at redetermi-
nation.
Verification policies for other eligibility factors are in the appropriate

manual items.

BEM 640 1 of 6 ADULT MEDICAL PROGRAM
DEPARTMENT
POLICY DETERMINE IF AN ENROLLMENT FREEZE IS IN EFFECT BEFORE
CONSIDERING ELIGIBILITY FOR THIS PROGRAM.
AMP Only
The Adult Medical Program (AMP) is available to individuals who meet

all the eligibility factors in this item. Certain aliens are limited to cover-
age of emergency services (ESO).
ENROLLMENT
FREEZE
INSTRUCTIONS Specialists must send or give the client a DHS-283, Adult Medical Pro-
gram Eligibility Notice to inform them of the freeze.
Applications received during the freeze on AMP enrollments must be

registered and denied using “applicant did not meet other eligibility
requirements” as the denial reason.
ELIGIBILITY FOR
OTHER MEDICAL
PROGRAMS AMP-H and AMP-G
Consider eligibility for Medical Assistance (MA), Medical Aid for refu-
gees before authorizing AMP coverage. Clients eligible for MA or
other DHS medical benefits are not eligible for AMP.
Exceptions:
• AMP should be approved in cases where determination of disabil-

ity or blindness is delayed.
Clients clearly not eligible for any other medical assistance pro-
grams do not have to apply for them.
• There are MA categories for clients who are:
•• Age 65 or older, blind, or disabled.

•• Pregnant or recently pregnant.
•• Caretaker relatives of dependent children.
•• Under age 21.
•• Refugees.
See SIC, MA Desk Aids, Exhibit I for a list of MA categories.


anticipated change is expected to result in case closure.The review

CATEGORIES There are two categories of AMP.
• G program (AMP-G) - SDA cash payment recipients are eligible

for AMP when they:
•• Are not eligible for MA (see “Exceptions” on page 1) or

other Department medical programs, and
•• Do not have private health care coverage (see “Private

Health Coverage” below), and
•• There is not an enrollment freeze in effect in the month of

application.
• H program (AMP-H) - Clients receive medical benefits only. Cli-

ents must meet all eligibility factors in this item.
NONFINANCIAL
ELIGIBILITY
FACTORS AMP-H
Private Health Care A person who has private health care coverage is not eligible for AMP.
Coverage Health care coverage includes comprehensive health insurance (see
PRG) and enrollment in a medical care plan such as a health mainte-
nance organization (HMO).
Medicare is considered health insurance for AMP purposes. Persons

whose coverage is limited to dental and/or vision coverage are eligible
for AMP.
Note: The Indian Health Service and VA health benefits are not private
health care coverage.
Other Nonfinancial The AMP eligibility factors in the following items must be met:
Eligibility Factors
• BEM 240, Age.
Follow the SDA application process and other administrative policies

unless otherwise instructed in specific items or sections.

FINANCIAL
ELIGIBILITY
FACTORS AMP-H
Group Use AMP policy in BEM 214.
Assets Determine countable assets based on AMP policy in BEM 400.
The program group's countable assets cannot exceed the AMP asset
limit in BEM 400.
Income Eligibility Application
Income eligibility exists when the program group’s net income does not
exceed the program group’s AMP income limit.
Income Limit. The AMP income limits are in RFT 236. When the cli-
ent’s living arrangement changes during a month, use the living
arrangement with the higher income limit.
COUNTABLE
INCOME AMP-H
Use only countable income. Countable income is income remaining

after applying AMP policy in BEM 500, 501, 502, 503, 504.
AVAILABLE
INCOME AMP-H
Use only available income. Available means income which is received

or can reasonably be anticipated. Available income includes amounts
garnisheed from income, joint income, and income received on behalf
of a person by his representative. See BEM 500 for details.
EXTRA CHECK AMP-H
Do not budget income that results from an extra check (e.g., 5th check
for a person who is paid weekly).
AVERAGED
INCOME AMP-H
Average income received in one month which is intended to cover sev-

eral months. Divide the income by the number of months it covers to
determine the monthly available income. The average amount is con-
sidered available in each of the months.

BUDGET MONTH
INCOME AMP-H
Past Month Non-averaged income: Use amount actually received in the past
month. Do not budget an “EXTRA CHECK.”
Averaged income: Use the monthly average amount if this month is

one of the months used to compute the average.
Processing Month Non-averaged income: At application, use amounts already received

in the processing month. In addition, estimate amounts likely to be
received during the remainder of the month. Base these estimated
amounts on information provided by the client. Do not budget an
“EXTRA CHECK.”

Future Month Non-averaged income: Use amounts that will be, or are likely to be,
received in the future month.
Exceptions:
• Do not budget an extra check (e.g., fifth check for person paid
weekly).
• Base estimate of daily income (e.g., insurance pays $40 for every
day in hospital) on a 30-day month.
When the amount of income from a source changes from month to

month, estimate the amount that will be received in the future month.
Example: For fluctuating earned income, use the expected hourly

wage and hours to be worked, as well as the pay day schedule, to esti-
mate gross earnings.

Income Individual Deduction. Deduct $200 from a program group member's

Deductions gross earnings. Then deduct 20% of the person’s remaining gross earn-
ings. The total disregard cannot exceed the person’s gross earnings.
Group Deduction. Deduct the amount of court-ordered support paid by

program group members in the month being tested from the program
group's remaining income. The deduction can be no greater than the
amount ordered for the month. Do not deduct arrearage payments.

REPLACING AMP
WITH FULL MA AMP-H and AMP-G
When an AMP recipient becomes eligible for full-coverage MA:
• close AMP effective the end of the current month, and

• open an MA case in Bridges effective the first day of the next
month.
Verification AMP-H and AMP-G

Requirements
Follow the AMP verification requirements in the appropriate manual
items. If AMP is not specified, use SDA verification requirements.
EXHIBIT I - AMP
COVERED
SERVICES AMP Covered Services:
• Physician services (covered by the Medicaid program) provided by

an MD or DO.
• Prescribed drug products ordered by an MD, DO, Dentist (covered

by the Medicaid program).
• Laboratory tests and radiology (x-ray) services ordered by an MD,

DO, or Nurse Practitioner for diagnostic and treatment pur-
poses.Hospital outpatient services.
• Non-emergency services rendered in the hospital emergency

room require a written medical authorization. Diabetes patient
education is covered in the outpatient setting.
• Limited medical supplies.
• Ambulance.
• Annual physical exams, including a pelvic exam, breast exam and

pap test.
• Mental health services through CMHSP.
• Physician services rendered by an oral surgeon who is enrolled as

a Medicaid provider.
• Substance abuse treatment through CMHSP.
EXHIBIT II -
COUNTIES WITH
HEALTH PLANS The county participating health plans are:
• Barry B-E Healthy Program.

• Bay Health Plus Options.

• Clinton Mid-Michigan Health Plan.
• Eaton B-E Healthy Program.
• Genesee Health Plan.
• Gratiot Mid-Michigan Health Plan.
• Ingham Health Plan.
• Jackson Health Plan.
• Kalamazoo County Health Plan.
• Kent Health Plan.
• Marquette Medical Care Access Coalition.
• Midland Health Plan.
• Montcalm Mid-Michigan Health Plan.
• Muskegon County Community Health Project.
• Saginaw HealthPlus Options.
• Washtenaw County Health Plan.
• Wayne PLUS Care.
LEGAL BASE AMP
Title XIX Section (1115) (a) (1)
.JOINT POLICY
DEVELOPMENT


BPB 2010-00A 1 of 1 INTERIM POLICY BULLETIN EX PARTE REVIEWS
EFFECTIVE July 1, 2010
SUBJECT Ex Parte Reviews of Medicaid Closures
All MA Categories
Effective July 1, 2010, individuals who are no longer eligible for Medic-
aid under their current MA category will be reviewed for eligiblity in all
other Medicaid categories before the individual’s current Medicaid cov-
erage ends. The review will be ex parte (see definition with this bulletin)
unless information needed to determine eligibility in another category is
required from the individual. The ex parte review will be based on the
information currently found in the individual’s case record and informa-
tion available to the dapartment. If the review determines there is no eli-
giblity in another category, the current coverage will be allowed to end.
If the individual is found eligible for MA coverage in another category,
the case will transfer to the new category and notice of continued eligi-
bility will be sent to the individual. Directions for the process can be
found in the following BAM and BEM items.
BAM 115, 210, 220. Glossary, BEM 105, 106, 110, 111, 113, 117, 118,
124, 125, 126, 129, 131, 132, 135, 145, 150, 154, 155, 156, 157, 158,
163, 164, 165, 166, 167, 169, 170, 171, 172, 173, 174, 630, 640, 647.
Issued: STATE OF MICHIGAN

Distribution: DEPARTMENT OF HUMAN SERVICES
BAM 115 1 of 26 APPLICATION PROCESSING
DEPARTMENT
POLICY All Programs
Clients must complete and sign one of the following application forms:
• DHS-1171, Assistance Application (all programs).
• DHS-4583, Child Development and Care Application (CDC).
• DHS-4574, Medicaid Application (patient of nursing home).
• DHS-4574-B, Assets Declaration (for initial asset assessment).

See BEM 402.
• DCH-0373, MIChild/Healthy Kids Application (Healthy Kids cate-

gories).
• The MIChild renewal form. This is a Healthy Kids application.

MIChild sends the form to DHS when MIChild determines a person
may be eligible for Healthy Kids.
Note: If the applicant is applying for Child Development and Care

(CDC) only, the DHS-4583 or DHS-1171 may be used.
Any application or the DHS-1171 Filing Form, with the minimum infor-
mation, must be registered in Bridges; see BAM 110, Response to
Applications.
Following registration of the application, you must do all of the follow-

ing:
• Interview clients when required by policy. See INTERVIEWS in this

item.
• Certify eligibility results for each program within the applicable

standard of promptness (SOP); see Standards Of Promptness and
Processing Delays in this item.
• Bridges automatically generates a client notice informing them of

the eligibility decision. BAM 220 explains the use of client notices.
Helping Clients All Programs
The local office must assist clients who need and request help to com-
plete the application form.
The time limit to respond to requests for help completing the application
form depends on the circumstance:
• For clients in the local office, respond within one workday.
BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

DEPARTMENT
POLICY All Programs
Clients must complete and sign one of the following application forms:
• DHS-1171, Assistance Application (all programs).
• DHS-4583, Child Development and Care Application (CDC).
• DHS-4574, Medicaid Application (patient of nursing home).
• DHS-4574-B, Assets Declaration (for initial asset assessment).

See BEM 402.
• DCH-0373, MIChild/Healthy Kids Application (Healthy Kids cate-

gories).

Note: If the applicant is applying for Child Development and Care

(CDC) only, the DHS-4583 or DHS-1171 may be used.
Any application or the DHS-1171 Filing Form, with the minimum infor-
mation, must be registered in Bridges; see BAM 110, Response to
Applications.
Following registration of the application, you must do all of the follow-

ing:
• Interview clients when required by policy. See INTERVIEWS in this

item.
• Certify eligibility results for each program within the applicable

standard of promptness (SOP); see Standards Of Promptness and
Processing Delays in this item.
• Bridges automatically generates a client notice informing them of

the eligibility decision. BAM 220 explains the use of client notices.
Helping Clients All Programs
The local office must assist clients who need and request help to com-
plete the application form.
The time limit to respond to requests for help completing the application
form depends on the circumstance:
• For clients in the local office, respond within one workday.

• For clients who send a letter, respond by a return letter or phone

call within five workdays.
• For clients who telephone, respond by either of the following:
•• Return phone call within one workday.

•• Send letter within five workdays.
When help cannot be provided by phone call or letter within specified

time frames, complete a home call within five workdays.
The local office must have designated staff to make home calls to help
complete applications at all of the following:
• Sufficient help cannot be provided by telephone or letter.

• The client is physically unable to come to the office.
• The client has no one else to help or to come to the office on their
behalf.
Note: The cover page of DHS application forms advises clients of their
right to receive help and includes the phone number of the DHS Cus-
tomer Service Unit (517-373-0707) to report a refusal of help.
Signature All Programs

Requirement
Before the application or DHS 1171 Filing Form is registered, it must be
signed by the client or authorized representative (AR).
Note: The signature(s) establishes both of the following:
• Client and/or AR understands their rights and responsibilities.

• Client and/or AR prepared the application or filing form truthfully
under penalty of perjury.
CDC
An applicant who is unable to write may sign with an X, witnessed by

one other person such as a relative, friend, department specialist etc.
If the DHS-1171 is updated by the client to request CDC, it must be

resigned and dated.
FIP, SDA and FAP Only
If an in-person interview is required, the client and/or AR must sign and

date the application in your presence, even if it was already signed.
Sign and date the application as a witness; see In-Person Interviews in
this item.

• For clients who send a letter, respond by a return letter or phone

call within five workdays.
• For clients who telephone, respond by either of the following:
•• Return phone call within one workday.

•• Send letter within five workdays.
When help cannot be provided by phone call or letter within specified

time frames, complete a home call within five workdays.
The local office must have designated staff to make home calls to help
complete applications at all of the following:
• Sufficient help cannot be provided by telephone or letter.

• The client is physically unable to come to the office.
• The client has no one else to help or to come to the office on their
behalf.
Note: The cover page of DHS application forms advises clients of their
right to receive help and includes the phone number of the DHS Cus-
tomer Service Unit (517-373-0707) to report a refusal of help.
Signature All Programs

Requirement
Before the application or DHS 1171 Filing Form is registered, it must be
signed by the client or authorized representative (AR).
Note: The signature(s) establishes both of the following:
• Client and/or AR understands their rights and responsibilities.

• Client and/or AR prepared the application or filing form truthfully
under penalty of perjury.
CDC
An applicant who is unable to write may sign with an X, witnessed by

one other person such as a relative, friend, department specialist etc.
If the DHS-1171 is updated by the client to request CDC, it must be

resigned and dated.
FIP, SDA and FAP Only
If an in-person interview is required, the client and/or AR must sign and

date the application in your presence, even if it was already signed.
Sign and date the application as a witness; see In-Person Interviews in
this item.

FIP and SDA Only
The client's spouse and other adult EDG members in the home must
also sign the application in your presence if physically able.
FAP Only
If the group does not have an adult or an AR, a minor group member
must sign the application.
INCOMPLETE
APPLICATIONS All Programs
An incomplete application contains the minimum information required

for registering an application. However, it does not contain enough
information to determine eligibility because all required questions are
not answered for the program(s) for which the client is applying; see
BAM 105.
When an incomplete application is filed, retain the application and give

or send the client the DHS-3503, Verification Checklist. Inform the client
of the:
• Request for contact to complete missing information.

• Due date for missing information.
• Interview date, if applicable.
If an interview is necessary, conduct it on the day of the filing, if possi-

ble. Otherwise, schedule it for no later than 10 calendar days from the
application date.
Application All Programs

Completed Later
When an incomplete application becomes complete, explain the situa-
tion in the case notes section of the application form or in case com-
ments in Bridges.
Example: Incomplete application filed 10/3/09; became complete 10/

17/09.
When the applicant or the representative completes a previously incom-

plete application, the application must be re-signed and re-dated on the
signature page.
Bridges retains the original registration date, regardless of how or when

the application becomes complete.

FIP and SDA Only
The client's spouse and other adult EDG members in the home must
also sign the application in your presence if physically able.
FAP Only
If the group does not have an adult or an AR, a minor group member
must sign the application.
INCOMPLETE
APPLICATIONS All Programs
An incomplete application contains the minimum information required

for registering an application. However, it does not contain enough
information to determine eligibility because all required questions are
not answered for the program(s) for which the client is applying; see
BAM 105.
When an incomplete application is filed, retain the application and give

or send the client the DHS-3503, Verification Checklist. Inform the client
of the:
• Request for contact to complete missing information.

• Due date for missing information.
• Interview date, if applicable.
If an interview is necessary, conduct it on the day of the filing, if possi-

ble. Otherwise, schedule it for no later than 10 calendar days from the
application date.
Application All Programs

Completed Later
When an incomplete application becomes complete, explain the situa-
tion in the case notes section of the application form or in case com-
ments in Bridges.
Example: Incomplete application filed 10/3/09; became complete 10/

17/09.
When the applicant or the representative completes a previously incom-

plete application, the application must be re-signed and re-dated on the
signature page.
Bridges retains the original registration date, regardless of how or when

the application becomes complete.

Failure to All Programs

Complete the
Application You cannot deny an incomplete application until 10 calendar days from
Process the later of either:
• Your initial request in writing to the applicant to complete the appli-

cation form or supply missing information.
• The initial scheduled interview.
Exception: For FAP, you cannot deny an application if the client has
not participated in the initial interview until the 30th day after the appli-
cation date even if they have returned all required verifications. When
denying cases on the 30th day, navigate to the Program Request
Details screen and select Failed to Attend Food Assistance Intake
Interview as the reason for the denial. The initial interview must be
scheduled as an in-person appointment, phone appointment or home
call.
APPLICATION
AFTER DENIAL/
TERMINATION All Programs
The following applies when you deny an application or terminate eligi-

bility before the month of a scheduled redetermination or end date:
• The application on file remains valid through the last day of the
month after the month of the denial or termination. To reapply dur-
ing this time, the client/AR must do all of the following:
•• Update the information on the existing application.
•• Initial and date each page next to the page number to show
that it was reviewed.
•• Re-sign and re-date the application on the signature page.
• If eligibility exists, the updated application is valid until the origi-

nally scheduled redetermination or end date.
See BAM 120 about sending an application to MIChild for a MIChild

determination.
Reminder: An application cannot be updated or re-signed outside

the local office except as part of a home call.
REINSTATEMENT All Programs
A new application is not required to reinstate eligibility; see BAM 205,

REINSTATEMENTS.

Failure to All Programs

Complete the
Application You cannot deny an incomplete application until 10 calendar days from
Process the later of either:
• Your initial request in writing to the applicant to complete the appli-

cation form or supply missing information.
• The initial scheduled interview.
Exception: For FAP, you cannot deny an application if the client has
not participated in the initial interview until the 30th day after the appli-
cation date even if they have returned all required verifications. When
denying cases on the 30th day, navigate to the Program Request
Details screen and select Failed to Attend Food Assistance Intake
Interview as the reason for the denial. The initial interview must be
scheduled as an in-person appointment, phone appointment or home
call.
APPLICATION
AFTER DENIAL/
TERMINATION All Programs
The following applies when you deny an application or terminate eligi-

bility before the month of a scheduled redetermination or end date:
• The application on file remains valid through the last day of the
month after the month of the denial or termination. To reapply dur-
ing this time, the client/AR must do all of the following:
•• Update the information on the existing application.
•• Initial and date each page next to the page number to show
that it was reviewed.
•• Re-sign and re-date the application on the signature page.
• If eligibility exists, the updated application is valid until the origi-

nally scheduled redetermination or end date.
See BAM 120 about sending an application to MIChild for a MIChild

determination.
Reminder: An application cannot be updated or re-signed outside

the local office except as part of a home call.
REINSTATEMENT All Programs
A new application is not required to reinstate eligibility; see BAM 205,

REINSTATEMENTS.

WHEN TO USE THE

DHS-1171 All Programs
The DHS-1171, Assistance Application, must be completed:
• When applying for program benefits.

• When case management dictates, such as suspicion of unre-
ported income.
Exception: For CDC, the DHS-4583, Child Development and Care

(CDC) Application, may be completed instead of the DHS-1171.
Exception: Some MA categories use separate application forms; see

WHEN TO USE THE DCH-0373 OR DHS-4574 in this item.
At Initial All Programs

Application
A separate application is required for each group.
Exception: Only one application form is required when MA groups,

even with separate case numbers, live together such as spouses apply-
ing for different MA categories. An application may be photocopied or
cross referenced for multiple case files.
An application form is generally valid for 12 months from the date you
initially certify program approval in Bridges.
Exception: For FAP, the period might be fewer or more than 12

months; see Benefit Periods under ELIGIBILITY DECISIONS in this
item.
Exception: For migrant families who need CDC, the application is valid
only until the family moves to a new county, at which time a new appli-
cation must be completed and submitted.
MA Only
A separate application is required for anyone not in the home such as

one spouse at home and the other in long term care (LTC).
FAP Only
A group might be ineligible in the month of application but eligible for a

future month due to changes in circumstance:
• Use the same DHS-1171 to deny eligibility for the application

month and to determine eligibility for later months.
• You do not have to interview the group again, but Bridges will
request any additional needed verification.

WHEN TO USE THE

DHS-1171 All Programs
The DHS-1171, Assistance Application, must be completed:
• When applying for program benefits.

• When case management dictates, such as suspicion of unre-
ported income.
Exception: For CDC, the DHS-4583, Child Development and Care

(CDC) Application, may be completed instead of the DHS-1171.
Exception: Some MA categories use separate application forms; see

WHEN TO USE THE DCH-0373 OR DHS-4574 in this item.
At Initial All Programs

Application
A separate application is required for each group.
Exception: Only one application form is required when MA groups,

even with separate case numbers, live together such as spouses apply-
ing for different MA categories. An application may be photocopied or
cross referenced for multiple case files.
An application form is generally valid for 12 months from the date you
initially certify program approval in Bridges.
Exception: For FAP, the period might be fewer or more than 12

months; see Benefit Periods under ELIGIBILITY DECISIONS in this
item.
Exception: For migrant families who need CDC, the application is valid
only until the family moves to a new county, at which time a new appli-
cation must be completed and submitted.
MA Only
A separate application is required for anyone not in the home such as

one spouse at home and the other in long term care (LTC).
FAP Only
A group might be ineligible in the month of application but eligible for a

future month due to changes in circumstance:
• Use the same DHS-1171 to deny eligibility for the application

month and to determine eligibility for later months.
• You do not have to interview the group again, but Bridges will
request any additional needed verification.

• Do not deny and reregister the application in Bridges. Certifying

approval for the next month disposes of the registration.
At Program All Programs

Transfer
When recipients request benefits they are not currently receiving, you
may use the DHS-1171 on file if it was approved within the last 12
months.
• Update the application and data collection to add or change infor-

mation to transfer:
•• Among MA-only categories.

•• From FIP to MA-only.
•• From FIP, SDA or MA to AMP.
The client does not have to re-sign the application.
• For other transfers, update the application and have it re-signed;

see WHEN THE DHS-1171 IS NOT NEEDED in this item. Regis-
ter the new program using the date the application form was re-
signed as the application date.
Eligibility for a new program or MA category is limited to the redetermi-

nation or end date already in Bridges.
Exception: When an ex parte review of a client’s current Medicaid eli-

gibility case file shows the recipient indicated or demonstrated a disabil-
ity (see glossary), continue Medicaid until information needed to
proceed with a disability determination has been requested and
reviewed. Continue Medicaid coverage until the review of possible eligi-
bility under other Medicaid categories has been completed. See BAM
210 and BAM220.
MA Only
A recipient losing Medicaid under a category for which a DHS 1171 is

not needed may need to complete a DHS 1171 in order to transfer to
another MA category if an 1171 has not been approved for another pro-
gram within the past 12 months. Always give the recipient a reasonable
opportunity to complete the DHS 1171 and to provide verification of eli-
gibility under other categories BEFORE terminating MA. See BAM 220.
Exception: Transitional MA eligibility is 12 months from the date of

FIP/LIF ineligibility; see BEM 111, Transitional MA.
Exception: Extended FIP (EFIP) eligibility is 6 months from the date of

FIP ineligibility.

• Do not deny and reregister the application in Bridges. Certifying

approval for the next month disposes of the registration.
At Program All Programs

Transfer
When recipients request benefits they are not currently receiving, you
may use the DHS-1171 on file if it was approved within the last 12
months.
• Update the application and data collection to add or change infor-

mation to transfer:
•• Among MA-only categories.

•• From FIP to MA-only.
•• From FIP, SDA or MA to AMP.
The client does not have to re-sign the application.
• For other transfers, update the application and have it re-signed;

see WHEN THE DHS-1171 IS NOT NEEDED in this item. Regis-
ter the new program using the date the application form was re-
signed as the application date.
Eligibility for a new program or MA category is limited to the redetermi-

nation or end date already in Bridges.
Exception: When an ex parte review of a client’s current Medicaid eli-

gibility case file shows the recipient indicated or demonstrated a disabil-
ity (see glossary), continue Medicaid until information needed to
proceed with a disability determination has been requested and
reviewed. Continue Medicaid coverage until the review of possible eligi-
bility under other Medicaid categories has been completed. See BAM
210 and BAM220.
MA Only
A recipient losing Medicaid under a category for which a DHS 1171 is

not needed may need to complete a DHS 1171 in order to transfer to
another MA category if an 1171 has not been approved for another pro-
gram within the past 12 months. Always give the recipient a reasonable
opportunity to complete the DHS 1171 and to provide verification of eli-
gibility under other categories BEFORE terminating MA. See BAM 220.
Exception: Transitional MA eligibility is 12 months from the date of

FIP/LIF ineligibility; see BEM 111, Transitional MA.
Exception: Extended FIP (EFIP) eligibility is 6 months from the date of

FIP ineligibility.

At FIP, SDA, CDC, MA and AMP Only

Redetermination
A new application or DHS-1010, Redetermination form must be com-
pleted at each redetermination of eligibility.
Exception: When policy requires a benefit period shorter than 12

months, the DHS-1171 or DHS-1010 on file may be updated and re-
signed if both of the following apply:
• The application/redetermination was initially certified within the last

12 months.
• The client is interviewed (if required) and provides any needed

verification before redetermination.
WHEN THE DHS-

1171 IS NOT
NEEDED FIP Only
No DHS-1171 is required for transfer from FIP to EFIP or EFIP to FIP;

see BEM 519, EXTENDED FIP.
MA Only
No DHS-1171 is required for:
• Transfers to:
•• Transitional MA (BEM 111).

•• Special N Support (BEM 113).
•• RAP Medical Aid (See BEM 630, REFUGEE ASSISTANCE
PROGRAM).
• Transfers between Medicaid categories. See At Program Trans-

fer, above.
• SSI recipients.
• Automatically eligible newborns; see BEM 145, NEWBORNS.

Authorize the newborn's MA as soon as the child's birth is
reported. Contact the newborn's mother if you do not have enough
information to obtain a client ID for the child in Bridges.
• Clients who complete the DCH-0373, DHS-4574 or MIChild

renewal form.
• Department wards, title IV-E recipients and special needs adop-

tion assistance recipients; see BEM 117, DEPARTMENT WARDS,
TITLE IV-E AND ADOPTION RECIPIENT.

At FIP, SDA, CDC, MA and AMP Only

Redetermination
A new application or DHS-1010, Redetermination form must be com-
pleted at each redetermination of eligibility.
Exception: When policy requires a benefit period shorter than 12

months, the DHS-1171 or DHS-1010 on file may be updated and re-
signed if both of the following apply:
• The application/redetermination was initially certified within the last

12 months.
• The client is interviewed (if required) and provides any needed

verification before redetermination.
WHEN THE DHS-

1171 IS NOT
NEEDED FIP Only
No DHS-1171 is required for transfer from FIP to EFIP or EFIP to FIP;

see BEM 519, EXTENDED FIP.
MA Only
No DHS-1171 is required for:
• Transfers to:
•• Transitional MA (BEM 111).

•• Special N Support (BEM 113).
•• RAP Medical Aid (See BEM 630, REFUGEE ASSISTANCE
PROGRAM).
• Transfers between Medicaid categories. See At Program Trans-

fer, above.
• SSI recipients.
• Automatically eligible newborns; see BEM 145, NEWBORNS.

Authorize the newborn's MA as soon as the child's birth is
reported. Contact the newborn's mother if you do not have enough
information to obtain a client ID for the child in Bridges.
• Clients who complete the DCH-0373, DHS-4574 or MIChild

renewal form.
• Department wards, title IV-E recipients and special needs adop-

tion assistance recipients; see BEM 117, DEPARTMENT WARDS,
TITLE IV-E AND ADOPTION RECIPIENT.

CDC ONLY
The DHS-1171 is not needed when the client is only applying for CDC
and has completed a DHS-4583.
WHEN TO USE THE

DHS-4583 CDC
The DHS-4583, Child Development and Care (CDC) Application, may

be used at any time to request CDC and for CDC redeterminations.
WHEN TO USE THE

DCH-0373-D OR
DHS-4574 MA Only
Instead of the DHS-1171, the following application forms may be used:
• DHS-4574, Medicaid Application (Patient of Nursing Facility), for

LTC clients.
• DCH-0373, MIChild/Healthy Kids Application, for Healthy Kids cat-

egories.

An approved application is current for 12 months from the original dis-

position date.
RETRO MA
APPLICATIONS MA Only
Retro MA coverage is available back to the first day of the third calen-
dar month prior to:
• The current application for FIP and MA applicants and persons

applying to be added to the group.
• The most recent application (not redetermination) for FIP and MA

recipients.
• For SSI, entitlement to SSI.
• For department wards; see BEM 117, DEPARTMENT WARDS,

TITLE IV-E AND ADOPTION RECIPIENT, the date DHS received
the court order for a department ward.
• For title IV-E and special needs adoption assistance recipients;

see BEM 117, DEPARTMENT WARDS, TITLE IV-E AND ADOP-

CDC ONLY
The DHS-1171 is not needed when the client is only applying for CDC
and has completed a DHS-4583.
WHEN TO USE THE

DHS-4583 CDC
The DHS-4583, Child Development and Care (CDC) Application, may

be used at any time to request CDC and for CDC redeterminations.
WHEN TO USE THE

DCH-0373-D OR
DHS-4574 MA Only
Instead of the DHS-1171, the following application forms may be used:
• DHS-4574, Medicaid Application (Patient of Nursing Facility), for

LTC clients.
• DCH-0373, MIChild/Healthy Kids Application, for Healthy Kids cat-

egories.

An approved application is current for 12 months from the original dis-

position date.
RETRO MA
APPLICATIONS MA Only
Retro MA coverage is available back to the first day of the third calen-
dar month prior to:
• The current application for FIP and MA applicants and persons

applying to be added to the group.
• The most recent application (not redetermination) for FIP and MA

recipients.
• For SSI, entitlement to SSI.
• For department wards; see BEM 117, DEPARTMENT WARDS,

TITLE IV-E AND ADOPTION RECIPIENT, the date DHS received
the court order for a department ward.
• For title IV-E and special needs adoption assistance recipients;

see BEM 117, DEPARTMENT WARDS, TITLE IV-E AND ADOP-

TION RECIPIENT, entitlement to title IV-E or special needs adop-

tion assistance.
Exception: Full-coverage QMB eligibility cannot be retroactive. ALM

cannot be authorized for a previous calendar year. See BEM 165.
A person might be eligible for one, two or all three retro months, even if
not currently eligible. The DHS-3243, Retroactive Medicaid Application,
is used to apply for retro MA. Only one DHS-3243 is needed to apply for
one, two or all three retro MA months.
Exception: Do not get a DHS-3243 if the person is eligible under

Healthy Kids Retro MA Eligibility Requirements.
Healthy Kids Retro Healthy Kids

MA Eligibility
Requirements Determine eligibility for the application month first. A client who is eligi-
ble for Healthy Kids (See BEM 125, HEALTHY KIDS FOR PREGNANT
WOMEN, 129, and 131, OTHER HEALTHY KIDS) for the application
month is eligible for retro MA when all of the following conditions are
met. This applies even if the retro MA question on the application is not
answered or is answered no.
1. The client is eligible for Healthy Kids for the application month.
2. For a pregnant woman, the woman was pregnant or under age 19

for the retro MA month.
3. The person was a Michigan resident. Retro MA cannot be

approved for a month if you know the person was not a Michigan
resident for the retro MA month. However, assume a person was a
Michigan resident unless you have information to the contrary,
such as information on the application indicating the person lived
in another state.
4. The person is not ineligible because of BEM 265, INSTITU-

TIONAL STATUS. Retro MA cannot be approved for a retro MA
month if you know the person would be ineligible because of insti-
tutional status. However, assume a person was not institutional-
ized unless you have information to the contrary.
5. Any applicable post-eligibility patient-pay amount has been com-

puted. An application month may be an L/H month or you may
have information suggesting that a retro MA month is an L/H
month (example: MSA-2565-C, Facility Admission Notice). In such
situations, decide whether a retro MA month is an L/H month and
compute the post-eligibility patient-pay amount. Do not approve
retro MA coverage for a month until that decision and/or computa-
tion is completed.

TION RECIPIENT, entitlement to title IV-E or special needs adop-

tion assistance.
Exception: Full-coverage QMB eligibility cannot be retroactive. ALM

cannot be authorized for a previous calendar year. See BEM 165.
A person might be eligible for one, two or all three retro months, even if
not currently eligible. The DHS-3243, Retroactive Medicaid Application,
is used to apply for retro MA. Only one DHS-3243 is needed to apply for
one, two or all three retro MA months.
Exception: Do not get a DHS-3243 if the person is eligible under

Healthy Kids Retro MA Eligibility Requirements.
Healthy Kids Retro Healthy Kids

MA Eligibility
Requirements Determine eligibility for the application month first. A client who is eligi-
ble for Healthy Kids (See BEM 125, HEALTHY KIDS FOR PREGNANT
WOMEN, 129, and 131, OTHER HEALTHY KIDS) for the application
month is eligible for retro MA when all of the following conditions are
met. This applies even if the retro MA question on the application is not
answered or is answered no.
1. The client is eligible for Healthy Kids for the application month.
2. For a pregnant woman, the woman was pregnant or under age 19

for the retro MA month.
3. The person was a Michigan resident. Retro MA cannot be

approved for a month if you know the person was not a Michigan
resident for the retro MA month. However, assume a person was a
Michigan resident unless you have information to the contrary,
such as information on the application indicating the person lived
in another state.
4. The person is not ineligible because of BEM 265, INSTITU-

TIONAL STATUS. Retro MA cannot be approved for a retro MA
month if you know the person would be ineligible because of insti-
tutional status. However, assume a person was not institutional-
ized unless you have information to the contrary.
5. Any applicable post-eligibility patient-pay amount has been com-

puted. An application month may be an L/H month or you may
have information suggesting that a retro MA month is an L/H
month (example: MSA-2565-C, Facility Admission Notice). In such
situations, decide whether a retro MA month is an L/H month and
compute the post-eligibility patient-pay amount. Do not approve
retro MA coverage for a month until that decision and/or computa-
tion is completed.

Use the Standard Retro MA Eligibility Requirements below to determine

retro MA eligibility if the client is not eligible for Healthy Kids for the
application month.
Standard Retro MA MA Only

Eligibility
Requirements Use this policy for Healthy Kids determinations only when the client is
not eligible for the application month; see Healthy Kids Retro MA Eligi-
bility Requirements above.
Determine eligibility for each retro MA month separately.
To be eligible for a retro MA month, the person must:
• Meet all financial and nonfinancial eligibility factors in that month,

and
• Have an unpaid medical expense incurred during the month, or
Note: Do not consider bills that the person thinks may be paid by
insurance as paid bills. It is easier to determine eligibility sooner
rather than later.
• Have been entitled to Medicare Part A.
Reminder: There is no asset test for Healthy Kids and Group 2 Preg-
nant Women MA categories.
Note: Financial eligibility policies might affect a pregnant woman's

Healthy Kids eligibility for retro months; see BEM 125, HEALTHY KIDS
FOR PREGNANT WOMEN.
When a client is eligible for a retro month that is also an L/H month,
determine the post-eligibility patient-pay amount; see BEM 546.
UPDATING THE
APPLICATION All Programs
An application is never returned to the client or AR to update.
While an application is considered valid, the client may update the cur-
rent application rather than complete a new one to add or transfer pro-
grams or add a member.
Exception: When the current application is the DCH-0373, you must

send a DHS-1171 to the client to transfer to a non-Healthy Kids MA cat-
egory or start additional benefits.
Allow updating only if it can be done without obliterating the previous

information and there is sufficient room to legibly add the new informa-

Use the Standard Retro MA Eligibility Requirements below to determine

retro MA eligibility if the client is not eligible for Healthy Kids for the
application month.
Standard Retro MA MA Only

Eligibility
Requirements Use this policy for Healthy Kids determinations only when the client is
not eligible for the application month; see Healthy Kids Retro MA Eligi-
bility Requirements above.
Determine eligibility for each retro MA month separately.
To be eligible for a retro MA month, the person must:
• Meet all financial and nonfinancial eligibility factors in that month,

and
• Have an unpaid medical expense incurred during the month, or
Note: Do not consider bills that the person thinks may be paid by
insurance as paid bills. It is easier to determine eligibility sooner
rather than later.
• Have been entitled to Medicare Part A.
Reminder: There is no asset test for Healthy Kids and Group 2 Preg-
nant Women MA categories.
Note: Financial eligibility policies might affect a pregnant woman's

Healthy Kids eligibility for retro months; see BEM 125, HEALTHY KIDS
FOR PREGNANT WOMEN.
When a client is eligible for a retro month that is also an L/H month,
determine the post-eligibility patient-pay amount; see BEM 546.
UPDATING THE
APPLICATION All Programs
An application is never returned to the client or AR to update.
While an application is considered valid, the client may update the cur-
rent application rather than complete a new one to add or transfer pro-
grams or add a member.
Exception: When the current application is the DCH-0373, you must

send a DHS-1171 to the client to transfer to a non-Healthy Kids MA cat-
egory or start additional benefits.
Allow updating only if it can be done without obliterating the previous

information and there is sufficient room to legibly add the new informa-

tion. The client must sign and date the application again after updating
it.
Exception: For FIP dependent child member adds, you may obtain the
information necessary to add the member and document the case
record. You need not have the client sign and date the updated applica-
tion.
Note: For FAP, you may request but cannot require an in-person inter-
view or updated application to add a member.
Example: Alexis is scheduled for an interview to add her boyfriend to

her FAP case. She supplies all requested verifications needed to deter-
mine eligibility but fails to attend the interview. Process the member
add. Do not deny the member add or close the case.
STANDARDS OF
PROMPTNESS All Programs
The standard of promptness (SOP) begins the date the department

receives an application/filing form, with minimum required information.
Exception #1: For FAP, the SOP begins when the correct local office
receives it; see BAM 110, WHERE TO APPLY/PROCESS APPLICA-
TIONS, FAP ONLY.
Exception #2: For FAP, when a person applies for SSI and FAP before
being released from a medical institution, the SOP begins on the appli-
cant's date of release.
See BAM 105, for the minimum required information for filing.
Process applications and requests for member adds as quickly as pos-

sible, with priority to the earliest application date; see Processing
Delays in this item. Requests for member adds must be entered in
Bridges.
FIP, SDA, RAP, CDC, MA and AMP Only
Certify program approval or denial of the application within 45 days.

Bridges automatically generates the client notice and if applicable, the
CDC provider notice.
Exceptions:
• 10 days for all pregnant Medicaid applicants.

• 30 days for Refugee Assistance Program (RAP) applicants.
• 60 days for SDA applicants.
• 90 days for MA categories in which disability is an eligibility factor.

tion. The client must sign and date the application again after updating
it.
Exception: For FIP dependent child member adds, you may obtain the
information necessary to add the member and document the case
record. You need not have the client sign and date the updated applica-
tion.
Note: For FAP, you may request but cannot require an in-person inter-
view or updated application to add a member.
Example: Alexis is scheduled for an interview to add her boyfriend to

her FAP case. She supplies all requested verifications needed to deter-
mine eligibility but fails to attend the interview. Process the member
add. Do not deny the member add or close the case.
STANDARDS OF
The standard of promptness (SOP) begins the date the department

receives an application/filing form, with minimum required information.
Exception #1: For FAP, the SOP begins when the correct local office
receives it; see BAM 110, WHERE TO APPLY/PROCESS APPLICA-
TIONS, FAP ONLY.
Exception #2: For FAP, when a person applies for SSI and FAP before
being released from a medical institution, the SOP begins on the appli-
cant's date of release.
See BAM 105, for the minimum required information for filing.
Process applications and requests for member adds as quickly as pos-

sible, with priority to the earliest application date; see Processing
Delays in this item. Requests for member adds must be entered in
Bridges.
FIP, SDA, RAP, CDC, MA and AMP Only
Certify program approval or denial of the application within 45 days.

Bridges automatically generates the client notice and if applicable, the
CDC provider notice.
Exceptions:
• 10 days for all pregnant Medicaid applicants.

• 30 days for Refugee Assistance Program (RAP) applicants.
• 60 days for SDA applicants.
• 90 days for MA categories in which disability is an eligibility factor.

The SOP can be extended 60 days from the date of deferral by the
Medical Review Team.
For CDC, also send a notice to the client and provider applicant within
six workdays of receiving the DHS-220-A/220-A-SP, Day CareChild
Development and Care AideProvider Application, from a person apply-
ing to be an day care aide the DHS-220-R/220-R-SP, Relative Care
Provider Application, from a person applying to be a relative care pro-
vider. The notice must inform the client and provider applicant whether
the provider application has been approved, denied or withdrawn (See
BEM 704).
MA Only
The SOP for an initial asset assessment begins the date the local
office receives a signed DHS-4574-B, Assets Declaration. Complete
the assessment and mail the client and spouse a notice within 45 days;
see BEM 402.
FAP Only
Expedited FAP benefits must be available to the group by the seventh

calendar day after the application date. The SOP for all other eligible
FAP groups is 30 days. Available means clients must have a Bridge
card and access to their benefits by the seventh day for expedited
groups and the 30th day for all other eligible groups.
The expedited due date (SOP) is six calendar days after the application
date. The regular FAP due date (SOP) is 29 calendar days after the
application date.
INTERVIEWS All Programs
The interview's purpose is to explain Department of Human Services

(DHS) program requirements to the applicant and to gather information
for determining the group's eligibility.
The interview is an official and confidential discussion. Its scope must

be limited to both of the following:
• Collecting information and examining the circumstances directly

related to determining the group's eligibility and benefits.
• Offering information on programs and services available through

DHS or other agencies.
The person interviewed may be any responsible group member or AR.

For CDC, the AR cannot be the child care provider, a department
employee, or a recruiter. The client may have any other person present.

The SOP can be extended 60 days from the date of deferral by the
Medical Review Team.
For CDC, also send a notice to the client and provider applicant within
six workdays of receiving the DHS-220-A/220-A-SP, Day CareChild
Development and Care AideProvider Application, from a person apply-
ing to be an day care aide the DHS-220-R/220-R-SP, Relative Care
Provider Application, from a person applying to be a relative care pro-
vider. The notice must inform the client and provider applicant whether
the provider application has been approved, denied or withdrawn (See
BEM 704).
MA Only
The SOP for an initial asset assessment begins the date the local
office receives a signed DHS-4574-B, Assets Declaration. Complete
the assessment and mail the client and spouse a notice within 45 days;
see BEM 402.
FAP Only
Expedited FAP benefits must be available to the group by the seventh

calendar day after the application date. The SOP for all other eligible
FAP groups is 30 days. Available means clients must have a Bridge
card and access to their benefits by the seventh day for expedited
groups and the 30th day for all other eligible groups.
The expedited due date (SOP) is six calendar days after the application
date. The regular FAP due date (SOP) is 29 calendar days after the
application date.
INTERVIEWS All Programs
The interview's purpose is to explain Department of Human Services

(DHS) program requirements to the applicant and to gather information
for determining the group's eligibility.
The interview is an official and confidential discussion. Its scope must

be limited to both of the following:
• Collecting information and examining the circumstances directly

related to determining the group's eligibility and benefits.
• Offering information on programs and services available through

DHS or other agencies.
The person interviewed may be any responsible group member or AR.

For CDC, the AR cannot be the child care provider, a department
employee, or a recruiter. The client may have any other person present.

Do the following during the interview:
• State the client's rights and responsibilities; see BAM 105.

• Review and update the application.
• Help complete application items not completed when it was filed.
• Resolve any unclear or inconsistent information.
• Request needed verification not brought to the interview.
• Advise the client of the SOP for processing.
• Make services referrals if needed.
• Confirm if the client needs a MiHealth card and/or Bridge card.
• Advise cash and/or FAP clients how and when they receive bene-
fits.
FAP Only
An interview is required before denying assistance even if it is clear

from the application or other sources that the group is ineligible.
Telephone CDC and FAP Only

Interviews
You must conduct a telephone interview at application before approving
benefits. However, conduct an in-person interview if one of the following
exists:
• The client requests one.
• You determine it is appropriate. For example, you suspect infor-

mation in the application is fraudulent.
Exception: Do not require an in-office interview if the client is

experiencing a hardship which prevents an in-office interview.
Instead, conduct the in-person interview at the client’s home or
another agreed upon location. Hardship conditions include but are
not limited to: illness, transportation difficulties, work hours etc.
• You are processing a joint cash and FAP application; see Jointly
Processed Cash/FAP Applications.
Note: When conducting a telephone interview, ask the caller a ques-

tion only the grantee could answer (such as last four digits of their
Social Security number, date of birth etc.) to ensure the identity of the
caller. The best practice is to document the case record with the answer
to your question.
In-Person FIP, SDA and RAPC

Interviews
You must conduct an in-person interview at application before approv-
ing benefits. The client/AR must sign and date the application in your
presence, even if it was already signed. Sign and date the application
as a witness.

Do the following during the interview:
• State the client's rights and responsibilities; see BAM 105.

• Review and update the application.
• Help complete application items not completed when it was filed.
• Resolve any unclear or inconsistent information.
• Request needed verification not brought to the interview.
• Advise the client of the SOP for processing.
• Make services referrals if needed.
• Confirm if the client needs a MiHealth card and/or Bridge card.
• Advise cash and/or FAP clients how and when they receive bene-
fits.
FAP Only
An interview is required before denying assistance even if it is clear

from the application or other sources that the group is ineligible.
Telephone CDC and FAP Only

Interviews
You must conduct a telephone interview at application before approving
benefits. However, conduct an in-person interview if one of the following
exists:
• You determine it is appropriate. For example, you suspect infor-

mation in the application is fraudulent.

not limited to: illness, transportation difficulties, work hours etc.
• You are processing a joint cash and FAP application; see Jointly
Processed Cash/FAP Applications.

caller. The best practice is to document the case record with the answer
to your question.
In-Person FIP, SDA and RAPC

Interviews
You must conduct an in-person interview at application before approv-
ing benefits. The client/AR must sign and date the application in your
presence, even if it was already signed. Sign and date the application
as a witness.

For FIP, SDA and RAPC, all adult group members who are physically
able, must be interviewed and must sign and date the application in
your presence.
Exception: For FIP, the local office may exempt ineligible grantees
and dependent child member adds from the in-person interview.
An in-person interview is not required before denying assistance if it is

clear from the application or other sources that the group is ineligible.
SDA
Do not deny assistance if the applicant is a resident of a juvenile justice

facility whose verified expected release date is within two weeks of the
date the SDA application was received. Schedule an in-person inter-
view with the applicant to be held within the first five days after release,
if possible.
MA and AMP Only
Do not require in-person interviews as a condition of eligibility.
Jointly FIP/FAP and SDA/FAP

Processed Cash/
FAP Applications Conduct an in-person interview at application before approving bene-
fits. The client/AR must sign and date the application in your presence,
even if it was already signed. Sign and date the application as a wit-
ness.
Exception: For FAP, do not require an in-office interview if the client is

experiencing a hardship which prevents an in-office interview. Instead,
conduct the FAP interview by telephone or at the client’s home or
another agreed upon location. Hardship conditions include but are not
limited to: illness, transportation difficulties, work hours etc.
Home Calls All Programs
If eligibility factors are questionable, schedule a home call in Bridges;

see Helping Clients in this item.
Document the reason for the home call in the case record.
For FAP only, some clients who are unable to appoint an AR for the
interview may request it be held at their home or other convenient
place. These include:
• Groups made up entirely of members age 60 or older or mentally

or physically disabled.

For FIP, SDA and RAPC, all adult group members who are physically
able, must be interviewed and must sign and date the application in
your presence.
Exception: For FIP, the local office may exempt ineligible grantees
and dependent child member adds from the in-person interview.
An in-person interview is not required before denying assistance if it is

clear from the application or other sources that the group is ineligible.
SDA
Do not deny assistance if the applicant is a resident of a juvenile justice

facility whose verified expected release date is within two weeks of the
date the SDA application was received. Schedule an in-person inter-
view with the applicant to be held within the first five days after release,
if possible.
MA and AMP Only
Do not require in-person interviews as a condition of eligibility.
Jointly FIP/FAP and SDA/FAP

Processed Cash/
FAP Applications Conduct an in-person interview at application before approving bene-
fits. The client/AR must sign and date the application in your presence,
even if it was already signed. Sign and date the application as a wit-
ness.

conduct the FAP interview by telephone or at the client’s home or
Home Calls All Programs
If eligibility factors are questionable, schedule a home call in Bridges;

see Helping Clients in this item.
Document the reason for the home call in the case record.
For FAP only, some clients who are unable to appoint an AR for the
interview may request it be held at their home or other convenient
place. These include:
• Groups made up entirely of members age 60 or older or mentally

or physically disabled.

• Groups unable to come to the local office due to a specific problem

such as illness, care of a group member, rural isolation, prolonged
severe weather or work/training hours.
Note: Migrant groups may be interviewed at the work site.
Schedule interviews outside the office in advance and hold them during
normal weekday working hours unless the client requests another time.
When requested, obtain prior supervisory approval. Do not enter a
home without permission or under false pretenses. Home searches are
prohibited.
Single Interview FIP, SDA, RAPC, CDC, and FAP Only
Clients applying for multiple programs such as cash and FAP, cannot
be required to attend separate interviews for each. However, waiver of
the in-person interview for FAP does not waive the requirement for FIP/
SDA.
Exception: For jointly processed cash/FAP applications where the cli-

ent is experiencing a hardship, the FAP interview must be conducted by
telephone, or at the client’s home or another agreed upon location.
Hardship conditions include but are not limited to: illness, transportation
difficulties, work hours, prolonged severe weather, rural isolation etc.
Scheduling All Programs

Interviews
Schedule interviews in Bridges promptly to meet the standard of
promptness.
For FAP only schedule the interview as a telephone appointment

unless specific policy directs otherwise. The interview must be held by
the 20th day after the application date to allow the client at least 10
days to provide verifications by the 30th day.
SDA Applicants For SDA applications received up to two weeks prior to the applicant’s
Exiting Juvenile expected release date from a juvenile justice facility, schedule the inter-
Justice Facilities view to be held within the first five working days after release, if possi-
ble, or, if not, as soon as possible.
Missed FAP Only

Interviews
If the client misses an interview appointment, Bridges sends a DHS-
254, Notice of Missed Interview, advising them that it is their responsi-
bility to request another interview date. It sends a notice only after the
first missed interview. If the client calls to reschedule, set the interview
prior to the 30th day, if possible. If they failed to reschedule or miss the
rescheduled interview, deny the application on the 30th day. If failure to
hold the interview by the 20th day or interview rescheduling causes the

• Groups unable to come to the local office due to a specific problem

such as illness, care of a group member, rural isolation, prolonged
severe weather or work/training hours.
Note: Migrant groups may be interviewed at the work site.
Schedule interviews outside the office in advance and hold them during
normal weekday working hours unless the client requests another time.
When requested, obtain prior supervisory approval. Do not enter a
home without permission or under false pretenses. Home searches are
prohibited.
Single Interview FIP, SDA, RAPC, CDC, and FAP Only
Clients applying for multiple programs such as cash and FAP, cannot
be required to attend separate interviews for each. However, waiver of
the in-person interview for FAP does not waive the requirement for FIP/
SDA.
Exception: For jointly processed cash/FAP applications where the cli-

ent is experiencing a hardship, the FAP interview must be conducted by
telephone, or at the client’s home or another agreed upon location.
Hardship conditions include but are not limited to: illness, transportation
difficulties, work hours, prolonged severe weather, rural isolation etc.
Scheduling All Programs

Interviews
Schedule interviews in Bridges promptly to meet the standard of
promptness.
For FAP only schedule the interview as a telephone appointment

unless specific policy directs otherwise. The interview must be held by
the 20th day after the application date to allow the client at least 10
days to provide verifications by the 30th day.
SDA Applicants For SDA applications received up to two weeks prior to the applicant’s
Exiting Juvenile expected release date from a juvenile justice facility, schedule the inter-
Justice Facilities view to be held within the first five working days after release, if possi-
ble, or, if not, as soon as possible.
Missed FAP Only

Interviews
If the client misses an interview appointment, Bridges sends a DHS-
254, Notice of Missed Interview, advising them that it is their responsi-
bility to request another interview date. It sends a notice only after the
first missed interview. If the client calls to reschedule, set the interview
prior to the 30th day, if possible. If they failed to reschedule or miss the
rescheduled interview, deny the application on the 30th day. If failure to
hold the interview by the 20th day or interview rescheduling causes the

application to be pending on the 30th day; see Processing Delays in

this item.
ELIGIBILITY
DECISIONS
Denials All Programs
If the group is ineligible or refuses to cooperate in the application pro-

cess, certify the denial within the standard of promptness to avoid
receiving an overdue task in Bridges.
Bridges sends a DHS 1605, Client Notice or the DHS-1150, Application

Eligibility Notice, with the denial reason(s); see Reference Forms &
Publications (RFF) manual.
Subsequent FAP Only

Processing
Proceed as follows when a client completes the application process
after denial but within 60 days after the application date.
On or before the • Re-register the application, using the original application date.
30th day: • If the client is eligible, determine whether to prorate benefits
according to “Initial Benefits” policy in this item.
Between the 31st • Re-register the application, using the date the client completed
and 60th days: the process.
• If the client is eligible, prorate benefits from the date the client
complied.
Approvals All Programs
Bridges sends the DHS-1605 detailing the approval at certification of

program opening.
Send the following publications, as appropriate, if not given at applica-

tion:
• MSA Pub. 141, Medicaid Health Care Coverage.

• MSA Pub. 617, Medicaid Deductible Information.
• MDCH Pub. 726, Nursing Facility Eligibility.
• MDCH Pub. 769, Getting the most out of life by getting the most
out of health care.
CDC Notices Complete and send or give a DHS-4690, Child Development and Care
Client Certificate/Notice, to the client to notify the client of the applica-
tion approval and authorization of care. The DHS-4690 provides autho-
rization information for each child for whom care has been authorized.

application to be pending on the 30th day; see Processing Delays in

this item.
ELIGIBILITY
DECISIONS
Denials All Programs
If the group is ineligible or refuses to cooperate in the application pro-

cess, certify the denial within the standard of promptness to avoid
receiving an overdue task in Bridges.
Bridges sends a DHS 1605, Client Notice or the DHS-1150, Application

Eligibility Notice, with the denial reason(s); see Reference Forms &
Publications (RFF) manual.
Subsequent FAP Only

Processing
Proceed as follows when a client completes the application process
after denial but within 60 days after the application date.
On or before the • Re-register the application, using the original application date.
30th day: • If the client is eligible, determine whether to prorate benefits
according to “Initial Benefits” policy in this item.
Between the 31st • Re-register the application, using the date the client completed
and 60th days: the process.
• If the client is eligible, prorate benefits from the date the client
complied.
Approvals All Programs
Bridges sends the DHS-1605 detailing the approval at certification of

program opening.
Send the following publications, as appropriate, if not given at applica-

tion:
• MSA Pub. 141, Medicaid Health Care Coverage.

• MSA Pub. 617, Medicaid Deductible Information.
• MDCH Pub. 726, Nursing Facility Eligibility.
• MDCH Pub. 769, Getting the most out of life by getting the most
out of health care.
CDC Notices Complete and send or give a DHS-4690, Child Development and Care
Client Certificate/Notice, to the client to notify the client of the applica-
tion approval and authorization of care. The DHS-4690 provides autho-
rization information for each child for whom care has been authorized.

Bridges sends the DHS-198, Child Development and Care Provider

Certificate/Notice of Authorization to each provider who has been
authorized to provide care for eligible children and the DHS-198-C,
Child Development and Care Client Certificate/Noticeof Authorization,
to the client. These forms notify the provider and client of the application
approval and authorization of care. each provider who has been autho-
rized to provide care for eligible children.
Designation of All Programs

Grantee/Head of
Household A member of the group must be designated as grantee/Head of House-
hold (HOH) for purposes of case identification and benefit issuance.
Normally, the group chooses the grantee/HOH. You must designate a

member if either of the following:
• Policy prohibits the group's choice from acting as grantee/HOH.

• The group fails to designate a grantee/HOH or disagrees about
who it should be.
For CDC, see BEM 205, APPLICANT; and BAM 110, Who May Apply.
FIP Only
The person designated as grantee/HOH must meet the definition of

caretaker; see BEM 210.
FIP-Related MA Only
You must designate a specified relative as grantee/HOH for any case

with an unmarried person under age 18 for whom support action is
required per BEM 255.
FAP Only
An ineligible or disqualified person can be the grantee/HOH if they are

the only adult in the group.
Note: The person is identified as a disqualified EDG member in

Bridges.
Initial Benefits FIP and SDA Only (Not AMP)
Provided the group meets all eligibility requirements, begin assistance

in the pay period in which the application becomes 30 days old.
If the application becomes 30 days old and the group has not met eligi-
bility requirements, begin assistance for the first pay period when it
does.
Bridges issues initial benefits as appropriate.

Bridges sends the DHS-198, Child Development and Care Provider

Certificate/Notice of Authorization to each provider who has been
authorized to provide care for eligible children and the DHS-198-C,
Child Development and Care Client Certificate/Noticeof Authorization,
to the client. These forms notify the provider and client of the application
approval and authorization of care. each provider who has been autho-
rized to provide care for eligible children.
Designation of All Programs

Grantee/Head of
Household A member of the group must be designated as grantee/Head of House-
hold (HOH) for purposes of case identification and benefit issuance.
Normally, the group chooses the grantee/HOH. You must designate a

member if either of the following:
• Policy prohibits the group's choice from acting as grantee/HOH.

• The group fails to designate a grantee/HOH or disagrees about
who it should be.
For CDC, see BEM 205, APPLICANT; and BAM 110, Who May Apply.
FIP Only
The person designated as grantee/HOH must meet the definition of

caretaker; see BEM 210.
FIP-Related MA Only
You must designate a specified relative as grantee/HOH for any case

with an unmarried person under age 18 for whom support action is
required per BEM 255.
FAP Only
An ineligible or disqualified person can be the grantee/HOH if they are

the only adult in the group.
Note: The person is identified as a disqualified EDG member in

Bridges.
Initial Benefits FIP and SDA Only (Not AMP)
Provided the group meets all eligibility requirements, begin assistance

in the pay period in which the application becomes 30 days old.
bility requirements, begin assistance for the first pay period when it
does.
Bridges issues initial benefits as appropriate.

RAPC Only
RAPC begins the pay period you certify initial eligibility, but:
• NOT earlier than the pay period after the pay period that includes
the application date, and
• NOT later than the pay period in which the application becomes
30 days old, and
• Provided the group meets all eligibility requirements in that pay

period.
bility requirements, Bridges begins assistance for the first pay period
when it does.
FIP and SDA Only
For member adds, see BEM 515, CHANGES IN NEED and BAM 110,
Date of Application for Member Add.
FAP Only
Bridges prorates benefits for the month of application, beginning with

the date of application, when the group is eligible for the application
month.
Exception: Migrant/seasonal farmworker groups that were active in

the Food Assistance program the month before the date of application
are eligible for a full month's benefit. This policy applies whether the
entire group (or any migrant member of the group) was last active for
FAP in Michigan or another state.
CDC Eligibility CDC

Effective Date
The first day of care that may be authorized is the eligibility effective
date. The eligibility effective date is the latest of the following:
• The CDC application receipt date.

• The date the child care need begins.
Exception: (For foster care only) 21 days prior to the CDC application
receipt date.
Benefit Periods FIP and SDA Only
The group's benefit period continues until it no longer meets the pro-
gram's eligibility requirements.

RAPC Only
RAPC begins the pay period you certify initial eligibility, but:
• NOT earlier than the pay period after the pay period that includes
the application date, and
• NOT later than the pay period in which the application becomes
30 days old, and
• Provided the group meets all eligibility requirements in that pay

period.
bility requirements, Bridges begins assistance for the first pay period
when it does.
FIP and SDA Only
For member adds, see BEM 515, CHANGES IN NEED and BAM 110,
Date of Application for Member Add.
FAP Only
Bridges prorates benefits for the month of application, beginning with

the date of application, when the group is eligible for the application
month.
Exception: Migrant/seasonal farmworker groups that were active in

the Food Assistance program the month before the date of application
are eligible for a full month's benefit. This policy applies whether the
entire group (or any migrant member of the group) was last active for
FAP in Michigan or another state.
CDC Eligibility CDC

Effective Date
The first day of care that may be authorized is the eligibility effective
date. The eligibility effective date is the latest of the following:
• The CDC application receipt date.

• The date the child care need begins.
Exception: (For foster care only) 21 days prior to the CDC application
receipt date.
Benefit Periods FIP and SDA Only
The group's benefit period continues until it no longer meets the pro-
gram's eligibility requirements.

MA and AMP Only
Benefit periods are discussed in various BEM items. Retro MA Applica-

tions are addressed later in this item.
MA Only except ALMB
Certify up to 24 months for groups in which:
• All group members are senior and/or disabled, and
• The group’s only source of income is SSI and/or RSDI benefits,

and
• The group is also receiving a 24 month benefit period for FAP.
Exception: ALMB eligibility must be completed before the end of each

calendar year. Set the ALMB redetermination date as September, Octo-
ber, November or December, but no more than 12 months.
FAP Only
The group is eligible for a specific benefit period (in calendar months)
with a begin and end date.
Begin Date At The FAP begin date depends on the group's eligibility and whether the
Application 30-day standard of promptness (SOP) has been met. See Subsequent
Processing in this item. Use the following criteria:
• When the 30-day SOP is met, or it is not met but the group is not
at fault for the delay, the begin date is either of the following:
•• The application date if the group is eligible for the application

month (even if proration causes zero benefits).
•• The first day of the month after the application month if that
is when the group becomes eligible.
• When the 30-day SOP is not met and the group is at fault for the
delay, the begin date is the date the group meets all application
requirements. See FAP Fault Determination in this item.
Exception: See BEM 610 to determine the begin date for migrant/sea-
sonal farmworkers.
Begin Date At The FAP begin date is the first day of the first month of the new benefit
Redetermination period.
End Date The end date used at application or redetermination is always the last
day of the final benefit month. Eligibility cannot continue without a rede-

MA and AMP Only
Benefit periods are discussed in various BEM items. Retro MA Applica-

tions are addressed later in this item.
MA Only except ALMB
Certify up to 24 months for groups in which:
• All group members are senior and/or disabled, and
• The group’s only source of income is SSI and/or RSDI benefits,

and
• The group is also receiving a 24 month benefit period for FAP.
Exception: ALMB eligibility must be completed before the end of each

calendar year. Set the ALMB redetermination date as September, Octo-
ber, November or December, but no more than 12 months.
FAP Only
The group is eligible for a specific benefit period (in calendar months)
with a begin and end date.
Begin Date At The FAP begin date depends on the group's eligibility and whether the
Application 30-day standard of promptness (SOP) has been met. See Subsequent
Processing in this item. Use the following criteria:
• When the 30-day SOP is met, or it is not met but the group is not
at fault for the delay, the begin date is either of the following:
•• The application date if the group is eligible for the application

month (even if proration causes zero benefits).
•• The first day of the month after the application month if that
is when the group becomes eligible.
• When the 30-day SOP is not met and the group is at fault for the
delay, the begin date is the date the group meets all application
requirements. See FAP Fault Determination in this item.
Exception: See BEM 610 to determine the begin date for migrant/sea-
sonal farmworkers.
Begin Date At The FAP begin date is the first day of the first month of the new benefit
Redetermination period.
End Date The end date used at application or redetermination is always the last
day of the final benefit month. Eligibility cannot continue without a rede-

termination (see BAM 210, Redetermination) and authorization of a

new benefit period.
Assigning a Bridges assigns the longest benefit period possible based on the
Benefit Period group's circumstances. Certain groups are given a specific minimum or
maximum benefit period. Unless a specific period is required, benefit
periods are assigned to accommodate the group's circumstances. The
prorated month counts as the first calendar month of the benefit period.
Use the following guidelines and the group's circumstances to establish

the group's benefit period.
Benefit Period to Apply the following policy only to FAP groups that do not have count-
Coordinate with able earned income. For FAP groups with countable earnings, see
Other Programs Twelve Month Benefit Period in this item.
If the FAP program was opened prior to the other program and the cli-
ent applied for both programs at the same time, you may do either of
the following:
• Redetermine eligibility for the other program when the FAP bene-
fits are due to expire (this may result in an 11-month redetermina-
tion for the other program).
• Redetermine FAP so the end date is extended to the last day of

the other program’s redetermination month, provided this does
not exceed 12 months.
Exception: You may not be able to coordinate FAP benefit periods for
groups that qualify for 24-month benefit periods or groups that require a
shorter benefit period.
24-Month Benefit Bridges assigns a 24-month benefit period for groups in which all group
Period members are senior and/or disabled and the group's only source of
income is SSI and/or RSDI benefits.
Note: The annual mass update in RSDI and SSI benefit amounts does
not affect this certification.
If a group reports a change in circumstances that affects their benefit

period, such as a non-disabled/non-senior person joining the house-
hold, Bridges does all of the following:
• Shortens the benefit period according to policy in BAM 220.

• Schedules a redetermination.
• Sets a new (12 months or less) benefit period consistent with the
group's circumstances.

termination (see BAM 210, Redetermination) and authorization of a

new benefit period.
Assigning a Bridges assigns the longest benefit period possible based on the
Benefit Period group's circumstances. Certain groups are given a specific minimum or
maximum benefit period. Unless a specific period is required, benefit
periods are assigned to accommodate the group's circumstances. The
prorated month counts as the first calendar month of the benefit period.
Use the following guidelines and the group's circumstances to establish

the group's benefit period.
Benefit Period to Apply the following policy only to FAP groups that do not have count-
Coordinate with able earned income. For FAP groups with countable earnings, see
Other Programs Twelve Month Benefit Period in this item.
If the FAP program was opened prior to the other program and the cli-
ent applied for both programs at the same time, you may do either of
the following:
• Redetermine eligibility for the other program when the FAP bene-
fits are due to expire (this may result in an 11-month redetermina-
tion for the other program).
• Redetermine FAP so the end date is extended to the last day of

the other program’s redetermination month, provided this does
not exceed 12 months.
Exception: You may not be able to coordinate FAP benefit periods for
groups that qualify for 24-month benefit periods or groups that require a
shorter benefit period.
24-Month Benefit Bridges assigns a 24-month benefit period for groups in which all group
Period members are senior and/or disabled and the group's only source of
income is SSI and/or RSDI benefits.
Note: The annual mass update in RSDI and SSI benefit amounts does
not affect this certification.
If a group reports a change in circumstances that affects their benefit

period, such as a non-disabled/non-senior person joining the house-
hold, Bridges does all of the following:
• Shortens the benefit period according to policy in BAM 220.

• Schedules a redetermination.
• Sets a new (12 months or less) benefit period consistent with the
group's circumstances.

You must have a mid-certification contact with the FAP group once
each year. You will be notified when a contact is due on the RD-093,
Redetermination Report - Worker Listing; see BAM 210.
Twelve-Month Bridges assigns a maximum 12 months for FAP groups that do not
Benefit Period qualify for a 24-month benefit period or that do not require a shorter
benefit period. For example:
• FIP groups with no earnings.

• Group has unearned income such as UCB, child support, etc.
Note: FAP groups with countable earnings must have a twelve-month

benefit period. You must have a mid-certification contact with the FAP
group once each year. You will be notified when a contact is due on the
RD-093, Redetermination Report - Worker Listing; see BAM 210.
Three-Month If a group’s circumstances are not stable and do not fit any other benefit
Benefit Period period, you may assign a three month benefit period. Benefit periods
for these groups should be determined on a case-by-case basis.
Always assign the longest benefit period possible. Three months is the
minimum benefit period which can be assigned.
Example: Kathy has no income but has a shelter obligation. You may
assign a three-month benefit period or a 12-month benefit period based
on the case circumstances. If based on her case circumstances you
determine a three-month benefit period is warranted, indicate this on
the Unstable Circumstances Details Screen. Document your rationale
for choosing the benefit period given.
Example: Kathy has no income and no obligation for rent and utilities
because she is living with friends. After discussion with the client, you
determine a 12-month benefit period is appropriate.
Example: Kathy has no income but has a shelter obligation. She has
applied for FIP. You may give her a 12-month benefit period.
Deferred Actions All Programs
To speed eligibility determinations, you may defer completion of

required actions listed below.
FIP, SDA, MA and AMP Only
• Referral to the prosecutor of spouses or parents of minor grantees

living outside the home. The referral must be made within 14 days
of the case opening.
• Receipt of a reply to an interstate inquiry regarding clients who

moved to Michigan within 30 days before applying. You must
make the interstate inquiry before approving the application.

You must have a mid-certification contact with the FAP group once
each year. You will be notified when a contact is due on the RD-093,
Redetermination Report - Worker Listing; see BAM 210.
Twelve-Month Bridges assigns a maximum 12 months for FAP groups that do not
Benefit Period qualify for a 24-month benefit period or that do not require a shorter
benefit period. For example:
• FIP groups with no earnings.

• Group has unearned income such as UCB, child support, etc.
Note: FAP groups with countable earnings must have a twelve-month

benefit period. You must have a mid-certification contact with the FAP
group once each year. You will be notified when a contact is due on the
RD-093, Redetermination Report - Worker Listing; see BAM 210.
Three-Month If a group’s circumstances are not stable and do not fit any other benefit
Benefit Period period, you may assign a three month benefit period. Benefit periods
for these groups should be determined on a case-by-case basis.
Always assign the longest benefit period possible. Three months is the
minimum benefit period which can be assigned.
Example: Kathy has no income but has a shelter obligation. You may
assign a three-month benefit period or a 12-month benefit period based
on the case circumstances. If based on her case circumstances you
determine a three-month benefit period is warranted, indicate this on
the Unstable Circumstances Details Screen. Document your rationale
for choosing the benefit period given.
Example: Kathy has no income and no obligation for rent and utilities
because she is living with friends. After discussion with the client, you
determine a 12-month benefit period is appropriate.
Example: Kathy has no income but has a shelter obligation. She has
applied for FIP. You may give her a 12-month benefit period.
Deferred Actions All Programs
To speed eligibility determinations, you may defer completion of

required actions listed below.
FIP, SDA, MA and AMP Only
• Referral to the prosecutor of spouses or parents of minor grantees

living outside the home. The referral must be made within 14 days
of the case opening.
• Receipt of a reply to an interstate inquiry regarding clients who

moved to Michigan within 30 days before applying. You must
make the interstate inquiry before approving the application.

FAP Only
When processing expedited service applications both of the following

actions are deferred:
• Verifications, other than identity.

• For FIP/SDA/RAP-related Food Assistance groups, actions
required for the other program.
See BAM 117.
Follow-Ups All Programs
Create a manual task in Bridges or other follow-up device when either

of the following occur:
• Information indicates a potential change in circumstances.

• An action has been deferred.
Bridges will automatically display the task for follow-up on the date you
specify.
Department Errors All Programs
As soon as possible, document and correct benefits approved or denied

in error by changing Data Collection, running Eligibility Determination
Benefit Calculation (EDBC) and certifying the results. Bridges sends the
client a timely or adequate notice as appropriate for department error
corrections resulting in:
• Program eligibility or ineligibility.

• Increased or decreased need.
• Higher or lower patient-pay amount.
FIP, SDA, RAPC and FAP Only
See BAM 405, FIP, RAPC AND SDA SUPPLEMENTAL BENEFITS and
406, SUPPLEMENTAL FOOD ASSISTANCE BENEFITS, regarding
supplemental benefits.
See BAM 705, AGENCY ERROR OVERISSUANCES and BAM 715,

CLIENT/CDC PROVIDER OVERISSUANCE regarding recoupment.
CDC
See BAM 705, AGENCY ERROR OVERISSUANCES, for procedures

to be followed when a department error has occurred.

FAP Only
When processing expedited service applications both of the following

actions are deferred:
• Verifications, other than identity.

• For FIP/SDA/RAP-related Food Assistance groups, actions
required for the other program.
See BAM 117.
Follow-Ups All Programs
Create a manual task in Bridges or other follow-up device when either

of the following occur:
• Information indicates a potential change in circumstances.

• An action has been deferred.
Bridges will automatically display the task for follow-up on the date you
specify.
Department Errors All Programs
As soon as possible, document and correct benefits approved or denied

in error by changing Data Collection, running Eligibility Determination
Benefit Calculation (EDBC) and certifying the results. Bridges sends the
client a timely or adequate notice as appropriate for department error
corrections resulting in:
• Program eligibility or ineligibility.

• Increased or decreased need.
• Higher or lower patient-pay amount.
FIP, SDA, RAPC and FAP Only
See BAM 405, FIP, RAPC AND SDA SUPPLEMENTAL BENEFITS and
406, SUPPLEMENTAL FOOD ASSISTANCE BENEFITS, regarding
supplemental benefits.
See BAM 705, AGENCY ERROR OVERISSUANCES and BAM 715,

CLIENT/CDC PROVIDER OVERISSUANCE regarding recoupment.
CDC
See BAM 705, AGENCY ERROR OVERISSUANCES, for procedures

to be followed when a department error has occurred.

MA and AMP Only
The period of erroneous coverage cannot be removed from or reduced

in Bridges.
Service Referrals All Programs
Clients may be in need of referrals to Adult Services, Adult Protective

Services, Preventive Services For Families, or Children’s Protective
Services. Be alert to those needs and refer cases when indicated or
required. If there is a disclosure of domestic violence, and the client is
not receiving services, refer the client to the appropriate community ser-
vice.
Refer a case to services using a current Individual Household screen

copy and a DHS-133A. Local office procedures may permit a less for-
mal referral to the services unit for certain purposes. Some policies
require a services referral and specify the form.
Refer cases to Children’s Protective Services (CPS) when there is an

indication of abuse or neglect. When you learn that an applicant is
active CPS in another county, notify CPS in your county on the same
day.
FIP and MA Only
Inform clients under 21 of the Early and Periodic Screening, Diagnosis

and Treatment (EPSDT) program. At an in-person interview, give the
client MSA Pub. 491 or 498. (RFF, describes these.) Use local office
procedures for EPSDT scheduling and/or transportation.
CASE
ASSIGNMENT All Programs
Bridges assigns cases to the next available specialist based on the spe-
cialist’s Manage Office Resources profile and/or special skills such as
language, long-term care etc.
Application assignment does not differentiate between case managers

and non-case managers (NCM). If a cash application is assigned to an
NCM, and Bridges builds a FIP or RAPC Eligibility Determination Group
(EDG), reassignment to a case manager must be accomplished manu-
ally.
PROCESSING
DELAYS All Programs
If an application is not processed by the standard of promptness (SOP)

date, document the reason(s) in the case record. Document further
delays at 30-day intervals.

MA and AMP Only
The period of erroneous coverage cannot be removed from or reduced

in Bridges.
Service Referrals All Programs
Clients may be in need of referrals to Adult Services, Adult Protective

Services, Preventive Services For Families, or Children’s Protective
Services. Be alert to those needs and refer cases when indicated or
required. If there is a disclosure of domestic violence, and the client is
not receiving services, refer the client to the appropriate community ser-
vice.
Refer a case to services using a current Individual Household screen

copy and a DHS-133A. Local office procedures may permit a less for-
mal referral to the services unit for certain purposes. Some policies
require a services referral and specify the form.
Refer cases to Children’s Protective Services (CPS) when there is an

indication of abuse or neglect. When you learn that an applicant is
active CPS in another county, notify CPS in your county on the same
day.
FIP and MA Only
Inform clients under 21 of the Early and Periodic Screening, Diagnosis

and Treatment (EPSDT) program. At an in-person interview, give the
client MSA Pub. 491 or 498. (RFF, describes these.) Use local office
procedures for EPSDT scheduling and/or transportation.
CASE
ASSIGNMENT All Programs
Bridges assigns cases to the next available specialist based on the spe-
cialist’s Manage Office Resources profile and/or special skills such as
language, long-term care etc.
Application assignment does not differentiate between case managers

and non-case managers (NCM). If a cash application is assigned to an
NCM, and Bridges builds a FIP or RAPC Eligibility Determination Group
(EDG), reassignment to a case manager must be accomplished manu-
ally.
PROCESSING
DELAYS All Programs
If an application is not processed by the standard of promptness (SOP)

date, document the reason(s) in the case record. Document further
delays at 30-day intervals.

Exceeding the SOP cannot be the sole reason for a denial.
When one program approval/denial will exceed the SOP, certify eligibil-
ity results for any others such as FAP within the SOP, if possible.
FAP Fault FAP Only

Determination
For a pended application, determine who is at fault for the delay every
30 days after the application date.
Note: This affects an approval of benefits for the months of delay, but
not necessarily a denial; see Denials under Eligibility Decisions in this
item.
FAP Group at If the 30-day SOP is not met and the group is at fault, the following
Fault applies:
• Select yes for the Extend SOP due to group at fault question on
the Program Request Details screen for FAP.
• Bridges sends a DHS-1150-E, Food Assistance Application

Notice, to inform the group that the EDG is pended and will be
denied on the 60th day unless the needed actions are taken.
• Bridges prorates benefits from the date the group complies with all
application requirements.
The group is at fault when you have taken all required actions but the
group has not complied with either of the following:
• Provided all verifications by the 30th day, despite 10 days or more

to provide them.
• Participated in the scheduled interview; see Interviews in this item.
Local Office at If you have not taken all necessary actions and the application will
Fault pend beyond the 30th day, the following apply:
• Bridges sends the DHS-1150-E to inform the group of the pending

status and any action required to complete the process.
Note: The group has 10 days from the DHS-1150-E mailing to

provide verifications.
• Take prompt action to correct the cause of the delay.
• If eligible, the group's benefits begin with the application date.
The local office is at fault if you fail to:

Exceeding the SOP cannot be the sole reason for a denial.
When one program approval/denial will exceed the SOP, certify eligibil-
ity results for any others such as FAP within the SOP, if possible.
FAP Fault FAP Only

Determination
For a pended application, determine who is at fault for the delay every
30 days after the application date.
Note: This affects an approval of benefits for the months of delay, but
not necessarily a denial; see Denials under Eligibility Decisions in this
item.
FAP Group at If the 30-day SOP is not met and the group is at fault, the following
Fault applies:
• Select yes for the Extend SOP due to group at fault question on
the Program Request Details screen for FAP.
• Bridges sends a DHS-1150-E, Food Assistance Application

Notice, to inform the group that the EDG is pended and will be
denied on the 60th day unless the needed actions are taken.
• Bridges prorates benefits from the date the group complies with all
application requirements.
The group is at fault when you have taken all required actions but the
group has not complied with either of the following:
• Provided all verifications by the 30th day, despite 10 days or more

to provide them.
• Participated in the scheduled interview; see Interviews in this item.
Local Office at If you have not taken all necessary actions and the application will
Fault pend beyond the 30th day, the following apply:
• Bridges sends the DHS-1150-E to inform the group of the pending

status and any action required to complete the process.
Note: The group has 10 days from the DHS-1150-E mailing to

provide verifications.
• Take prompt action to correct the cause of the delay.
• If eligible, the group's benefits begin with the application date.
The local office is at fault if you fail to:

• Request necessary verifications at least 10 days before the 30th

day.
• Provide requested help to complete the application process or

secure verifications.
• Schedule a timely interview, resulting in less client time than policy

requires to take an action; see Interviews in this item.
• Run EDBC and certify results to authorize benefits.
FAP Delays FAP Only

Beyond 60 Days
If the application pends beyond 60 days, obtain missing information, if
possible, and process the application. There are three possible conse-
quences:
• Case information complete. If the group is eligible and the local

office was at fault on the 30th day, authorize benefits from the
application date. If the group was at fault on the 30th day, benefits
begin on the date the group completes the application process.
• Local office at fault, case information not complete. Request

missing information via DHS-1150, Application Eligibility Notice,
and verification checklist if appropriate. Give the group 10 days to
provide verifications. Authorize benefits as for complete cases
above.
• FAP Group at fault, case information not complete. This

occurs only if verification requested between the 30th and 50th
day was not provided, and the application is still pending. Deny
the application by running EDBC and certifying the results immedi-
ately.
LEGAL BASE FIP
MCL 400.25
45 CFR 260.10
R 400.3107, 400.3108, 400.3110, 400.3111, 400.3155, 400.3156 MAC
CDC
Child Care and Development Block Grant of 1990.

45 CFR Parts 98 and 99
Social Security Act, as amended. Title IVA (42 USC 601 et. seq.); Title
IVE (42 USC 670 et. seq.); Title XX (42 USC 1397 et. seq.)
SDA
Current Annual Appropriations Act

• Request necessary verifications at least 10 days before the 30th

day.
• Provide requested help to complete the application process or

secure verifications.
• Schedule a timely interview, resulting in less client time than policy

requires to take an action; see Interviews in this item.
• Run EDBC and certify results to authorize benefits.
FAP Delays FAP Only

Beyond 60 Days
If the application pends beyond 60 days, obtain missing information, if
possible, and process the application. There are three possible conse-
quences:
• Case information complete. If the group is eligible and the local

office was at fault on the 30th day, authorize benefits from the
application date. If the group was at fault on the 30th day, benefits
begin on the date the group completes the application process.
• Local office at fault, case information not complete. Request

missing information via DHS-1150, Application Eligibility Notice,
and verification checklist if appropriate. Give the group 10 days to
provide verifications. Authorize benefits as for complete cases
above.
• FAP Group at fault, case information not complete. This

occurs only if verification requested between the 30th and 50th
day was not provided, and the application is still pending. Deny
the application by running EDBC and certifying the results immedi-
ately.
LEGAL BASE FIP
MCL 400.25
45 CFR 260.10
R 400.3107, 400.3108, 400.3110, 400.3111, 400.3155, 400.3156 MAC
CDC
Child Care and Development Block Grant of 1990.

Social Security Act, as amended. Title IVA (42 USC 601 et. seq.); Title
SDA

MA
42 CFR 431, 435
AMP
Title XIX of the Social Security Act (1115) (a) (1)
FAP
7CFR 273.2
7CFR 274.12
JOINT POLICY
DEVELOPMENT
Medicaid, Adult Medical Program (AMP),Transitional Medical Assistance (TMA/TMA-Plus), and


MA
42 CFR 431, 435
AMP
Title XIX of the Social Security Act (1115) (a) (1)
FAP
7CFR 273.2
7CFR 274.12
JOINT POLICY
DEVELOPMENT
Medicaid, Adult Medical Program (AMP),Transitional Medical Assistance (TMA/TMA-Plus), and


BAM 210 1 of 14 REDETERMINATION/ EX PARTE REVIEW
DEPARTMENT
POLICY All Types of Assistance (TOA)
The Department of Human Services must periodically redetermine an

individual’s eligibility for active TOA. The redetermination process
includes thorough review of all eligibility factors.
Redetermination, semi-annual and mid-certification forms are often

used to redetermine eligibility of active TOA. However, the client must
complete a DHS-1171, Assistance Application, to request a TOA that is
not active at the time of redetermination.
Local offices must assist clients who need and request help to
complete applications, forms and obtain verifications; see BAM
130, Obtaining Verification.
EX PARTE REVIEW MA Only
An ex parte review (see glossary) is required before Medicaid closures

when there is an actual or anticipated change, unless the change would
result in closure due to ineligibility for all Medicaid. When possible, an
ex parte review should begin at least 90 days before the anticipated
change is expected to result in case closure. The review includes con-
sideration of all MA categories. See BAM 115 and 220.
REDETERMINA-
TION CYCLE All TOA
A complete redetermination is required at least every 12 months.

Bridges sets the redetermination date according to benefit periods,
see eligibility decisions in BAM 115. Redeterminations may be
scheduled early or are scheduled less than 12 months apart when nec-
essary for:
• Error-prone cases, in response to supervisory case readings,

quality assurance data or quality enhancement data.
• Medicaid (MA) only, newborn cases must be redetermined no

later than the month of the child’s first birthday; see BEM 145.
• Transitional Medicaid (TMA) redeterminations must be com-

pleted at least 40 days before the end of the 12-month eligibility
period to accommodate TMA-Plus (TMAP); see BEM 647.
• Food Assistance Program (FAP) cases with unstable circum-

stances assigned a three-month benefit period.
Exception #1: Some MA groups do not require a redetermination. See

No MA Redetermination in this item.

Exception #2: Some FAP and MA groups are assigned a 24-month

benefit period and require only a mid-certification contact in the 12th
month. See Mid-Certification Contact in this item. For MA, a compan-
ion case for a spouse may also be given the extended benefit period
once the mid-certification notice has been received and reviewed.
FAP Only
Benefits stop at the end of the benefit period unless a redetermination

is completed and a new benefit period is certified. If the client does not
complete the redetermination process, allow the benefit period to
expire. The redetermination process begins when the client files a DHS-
1171, Assistance Application, DHS-1010, Redetermination, DHS-1171,
Filing Form, or DHS-2063B, Food Assistance Benefits Redetermination
Filing Record.
Child Development and Care (CDC) Only
If a CDC group is active for other programs, Bridges will set the CDC
redetermination date to be the same redetermination date as the other
program if 12 months or less.
Example: You are opening CDC in May 2009 for a case that is already
active Family Independence Program (FIP). The redetermination date
for the FIP program is December 2009. The CDC redetermination date
will be December 2009.
MA and TMAP
Benefits continue until a redetermination of eligibility under all catego-

ries has been completed. See BAM 220. The redetermination month
is 12 months from the date the most recent complete application
was submitted.
In a Group 2 Persons Under 21 case, if a member will reach age 21

before the month the case is scheduled to close or be redetermined,
his MA eligibility end date will be the month he reaches 21, see BEM
132. an ex parte review (see glossary) should begin at least 90 days
prior to the date the member turns age 21. (See BAM 220)
In a Special N Support, Title IV-E or FCTMA case, an ex parte review

should begin at least 90 days prior to the date the case is scheduled to
close. (See BAM 220),
No MA MA Only
Redetermination
You do not need to redetermine the following:
• Special N/support, see BEM 113.

• Title IV-E,see BEM 117.

• Special needs adoption assistance recipients, see BEM 117.

• Department wards, see BEM 117.
• SSI recipients, see BEM 150.
INTERVIEW
REQUIREMENTS All TOA
Interview requirements are determined by the type of assistance that is

being redetermined.
CDC Only
An interview is not required as a condition of eligibility.
FAP Only
An interview is required before denying a redetermination even if it is

clear from the DHS-1010/1171 or other sources that the group is ineligi-
ble.
Indicate on the individual interviewed/applicant-details screen in

Bridges who was interviewed and how the interview was held such as
by telephone, in person etc.
Telephone FAP Only
The individual interviewed may be the client, the client’s spouse, any
other responsible member of the group or the client’s authorized repre-
sentative. If the client misses the interview, Bridges sends a DHS-254,
Notice of Missed Interview.
You must conduct a telephone interview at redetermination before

determining ongoing eligibility. However, conduct an in-person interview
if one of the following exists:
• You determine it is appropriate. For example, you suspect informa-

tion in the application is fraudulent.

not limited to: illness, transportation difficulties, work hours.
• You are processing a joint cash and FAP redetermination. (See

Jointly Redetermined Cash/FAP Cases in this item.)

caller.
In-Person FIP and State Disability Assistance (SDA)
All individuals with a FIP or SDA Eligibility Determination Group (EDG)

participation status of eligible or disqualified adult, who are physically
able, must be interviewed and must sign and date the DHS-1010 or
DHS-1171 in your presence.
Interviews are usually conducted at the local office but may be held in a
group's home if:
• The grantee's physical condition precludes an office interview.

• A home call would result in better information.
FIP Only
Note: An ineligible grantee is not required to attend an in-person inter-

view at redetermination.
MA, Adult Medical Program (AMP), and TMAP
Do not require an in-person interview as a condition of eligibility.
Jointly FIP/FAP, SDA/FAP

Redetermined
Cash/FAP Cases Conduct an in-person interview at redetermination before determining
ongoing eligibility. The grantee or authorized representative must sign
and date the DHS-1010/1171 in your presence even if it was already
signed. Sign and date the application as a witness.

conduct the in-person interview by telephone or at the client’s home or
SCHEDULING All TOA
Bridges generates a redetermination packet to the client three days

prior to the negative action cut-off date in the month before the redeter-
mination is due, see RFS 103. Bridges sends a DHS-2063B, Continuing
Your Food Assistance Benefits, to FAP clients for whom FIP, SDA, MA,
AMP, and/or TMAP are not active. The packet is sent to the mailing
address in Bridges. The packet is sent to the physical address when
there is no mailing address. The packet is also sent to the MA Autho-
rized Representative on file.
Redetermination/review forms may include:

• DHS-574, Redetermination Telephone Interview (FAP).

• DHS-1010, Redetermination (all TOA).
• DHS-1045, Simplified Six-Month Review (FAP).
• DHS-1046, Semi-Annual Contact Report (FAP).
• DHS-1171, Assistance Application (all TOA).
• DHS-2240-A, Mid-Certification Contact Notice (MA and FAP).
• DHS-2063-B, Continuing Your Food Assistance Benefits (FAP).
• DHS-4574, Medicaid Application for Long-Term Care.
• DCH-0373-D, MI Child and Healthy Kids Application.
The packet includes the following as determined by the TOA to be rede-

termined:
• Redetermination/review form indicated above.

• Notice of review as determined by policy.
• Interview date.
• Interview type.
• Place and time.
• Required verifications.
• Due date.
• Return envelope.
FAP Only
If you must manually send a DHS-1171 and the DHS-2063-B, if applica-

ble, mail them no later than two workdays before the first day of the
redetermination month. If you do not mail the forms within that time
period, adjust the timely filing date, see FAP Timely And Untimely Filing
Date in this item.
Clients may be, but are not required to be, interviewed before the timely
filing date.
Early All TOA

Redetermination
Redetermination of an active TOA may be scheduled up to three
months before the review date. Redetermination of active TOA may be
necessary for one of the following reasons:
• Case is found to be error-prone as a result of supervisory case

reading, quality assurance data or quality enhancement data.
• Specialist’s schedule requires early redetermination of active TOA.
• Align dates to simultaneously process redeterminations for multi-

ple TOA. Bridges does this automatically for all programs except
certain MA programs such as TMA.
Initiate redetermination early by selecting that option from the Bridges

left navigation. Enter the case number and select the program(s) to be

redetermined early from the list of options that are determined by the
case number.
FAP Only
When a redetermination is scheduled early, FAP benefits cannot be ter-

minated prior to the end of the benefit period for failure to complete the
redetermination process.
Healthy Kids Only
You may not shorten a person’s period of eligibility.
Once eligible for Healthy Kids under age 1 (HK1) and Other Healthy
Kids (OHK), a recipient remains eligible until the next redetermination
unless any of the following occur:
• Reaches age 19.

• Moves out of state.
• Is ineligible due to institutional status, see BEM 265.
• Dies.
A member may be added to an existing case even though the redeter-

mination date is less than 12 months in the future.
Mid-Certification/ FAP and MA except Additional Low-Income Medicare Beneficiaries

Semi-Annual (ALMB)
Contact
FAP and MA groups assigned a 24-month benefit period must have a
mid-certification contact. FAP groups with countable earnings and a 12-
month benefit period must also have a semi-annual contact; see BAM
115, Benefit Periods.
For programs assigned a 24-month benefit period, the contact require-

ment is met by receipt of a completed DHS-2240-A, Mid-Certification
Contact Notice. For FIP or FAP groups with countable earnings and a
12-month benefit period and all CDC groups, the contact requirement is
met by receipt of a completed DHS-1046, Semi-Annual Contact Report
and received verifications from the client or the clients authorized repre-
sentative.
A report is considered complete only when all of the sections (including

the signature section) on the DHS-1046 are answered completely and
required verifications are returned. The only necessary verification for a
complete report is proof of income, if applicable.
Note: If an expense has changed and the client does not return proof
of the expense but all of the sections on the report are answered com-
pletely, remove the expense from the appropriate data collection screen
in Bridges before running EDBC.

The DHS-1046 and DHS-2240A may be completed by the client, or cli-

ent’s authorized representative or by the specialist (during a telephone
call, home call or interview with the client). However, the form must be
signed by the client or authorized filing representative.
Upon receipt of a DHS-1046 or DHS-2240-A, update data collection,

run eligibility determination/benefits calculation (EDBC), and certify
results to affect benefit issuance.
Bridges sends a DHS-2240-A for groups assigned a 24-month benefit

period during the eleventh month of their benefit period and a DHS-
1046 the beginning of the fifth month for cases assigned a 12-month
benefit period.
24-Month Benefit The mid-certification contact must be completed and EDBC results cer-
Period tified in Bridges by the last day of the twelfth month after receipt of a
completed DHS-2240-A and all required verifications.
12-Month Benefit The semi-annual mid-certification contact must be completed and

Period EDBC results certified in Bridges by the last day of the sixth month of
the benefit period to effect benefits no later than the seventh month.
The contact is met by receipt of a completed DHS-1046 and required
verifications.
REDETERMINA-
TION PACKET
RECEIVED All TOA
A redetermination/review packet is considered complete when all of the

sections of the redetermination form including the signature section are
completed.
When you receive a complete redetermination/review form, record the

receipt in Bridges as soon as administratively possible. Under redeter-
mination/packet received do all of the following:
• Select the form type.

• Enter the date received.
• Click the submit button.
• Record changes in circumstances.
• Enter verifications received.
• Run EDBC.
It is a best practice to accomplish these steps as early in the month as

possible, to increase the chances of completing the redetermination
timely.

Failure to Record FIP, SDA, and CDC

Receipt of
Redetermination If the redetermination packet is not logged in on the packet received
Packet screen by the negative action cut-off date of the redetermination month,
Bridges generates a DHS-1605, Notice of Case Action, and automati-
cally closes the EDG.
FAP only
If the redetermination packet is not logged in on the Packet Received

screen by the last working day of the redetermination month, Bridges
automatically closes the EDG. A DHS-1605 is not generated.
MA only
Benefits are not automatically terminated for failure to record receipt of

the redetermination packet. Instead, review the RD MA redetermination
packet overdue from the left navigation to confirm which MA programs
should be terminated. Multiple cases may be submitted for termination
in the next monthly batch. Notice is sent to the client.
Failure to Record FAP Only

Receipt of the Mid-
Certification If the DHS-2240A is not entered in Bridges as completed, Bridges auto-
Contact Notice matically generates a redetermination packet and shortens the FAP
benefit period according to policy in BAM 220, Shortening a 24-Month
FAP Benefit Period.
Failure to Record If the DHS-1046 is not logged in by the tenth day of the sixth month,
Receipt of the Bridges will generate a DHS-1046A, Potential Food Assistance (FAP)
Semi-Annual Closure, to the client. This reminder notice explains that the client must
Contact Report return the DHS-1046 and all required verifications by the last day of the
month or the case will close.
If the client fails to return a complete DHS-1046 by the last day of the
sixth month, Bridges will automatically close the case. If the client reap-
plies, treat it as a new application and Bridges will prorate the benefits.
Case Management Tip: Be especially careful to record the receipt of

the completed forms as you receive them to prevent the incorrect gen-
eration of the DHS-1046A and/or closure of the case.
If the completed DHS-1046 and verifications are returned by the last

day of the sixth month, process the changes to ensure the client’s ben-
efits are available no later than 10 days after their normal issuance date
in the seventh month of the benefit period.
Conducting the FIP, SDA and FAP

Interview
• Obtain a complete redetermination/review packet from the client.

• Compare the redetermination/review document to the existing

DHS-1171 or previous DHS-1010 and other case data.
•• Reconcile any discrepancies and ensure anything omitted is

completed.
• Review the verifications and reconcile discrepancies.
• Confirm the client understands sections of the DHS-1010 informa-

tion booklet:
•• Things You Must Do.

•• Important Things To Know.
•• Repay Agreements.
•• Information About Your Household That Will Be Shared.
• Have the client re-sign and date the DHS-1010 as part of in-per-
son interview.
Exception: For FAP, re-signing the DHS-1010 is required only for

jointly processed FIP/FAP and SDA/FAP cases.
• Sign and date the DHS-1010 as a witness as part of in-person

interview.
FIP Only
• Review the Family Self-Sufficiency Plan (FSSP) for compliance.
• Identify any barriers to the family's self-sufficiency and strategies

for client to overcome them.
• Update each FSSP to identify the specific steps the individual will
take towards family self-sufficiency.
FAP TIMELY AND

UNTIMELY FILING
DATE FAP Only
Timely Filing Date In order to receive uninterrupted benefits, (benefits available on their
scheduled issuance date) the client must file either a DHS-1010, Rede-
termination, DHS-1171, Assistance Application, or a DHS-2063B, Con-
tinuing Food Assistance Benefits, by the 15th of the redetermination
month.
Exception: If you mail the client's redetermination materials late, the

timely filing date is 17 days after you mailed the materials.
Example: Madison’s FAP redetermination is due in July. You mail the

redetermination materials July 6th with a due date of July 16th on the
DHS-3503. Madison returns all necessary items needed to complete
her review on July 20th. Her filing date is timely because you mailed her
review materials late. Her benefits must be available to her on the
scheduled issuance date.
When processing a redetermination for FAP and FIP, SDA, MA, or

AMP, consider the FAP redetermination filed timely if it is filed timely for
the other program. See FAP Client Failure to Meet Redetermination
Requirements.
Untimely Filing FAP Only

Date
Any FAP redetermination form not submitted timely (see above) has
the same processing timeframe as an initial application (30 days). See
Client Failure to Meet Redetermination Requirements.
VERIFICATIONS
DEADLINE FIP, SDA, CDC, MA, AMP, and TMAP
Verifications are due the same date as the redetermination/review inter-

view. When an interview is not required, verifications are due the date
the packet is due.
Bridges allows clients a full 10 calendar days from the date the verifica-
tion is requested (date of request is not counted) to provide all docu-
ments and information. If the 10th day falls on a weekend or holiday, the
verification would not be due until the next business day.
Bridges gives timely notice of the negative action if the time limit is not
met.
Exception: See LOCAL DHS RESPONSIBILITIES in BEM 647 for

deadlines and notices in regards to TMA redetermination.
Exception: See TMA-Plus Redetermination in BEM 647 for dead-

lines for TMA-Plus redeterminations.
FAP Only
Verifications must be provided by the end of the current benefit period

or within 10 days after they are requested, whichever allows more time.
If the 10th day falls on a weekend or holiday, the verification will not be
due until the next business day.
If verifications are provided by the required deadline but too late for nor-
mal benefit issuance, benefits must be issued within five workdays.
Note: If an expense has changed and the client does not return proof
of the expense but all of the sections on the report are answered com-
pletely, end date the expense from the appropriate data collection
screen(s) in Bridges before running EDBC.

COMPLETING THE
REDETERMINA-
TION All TOA
To complete the redetermination process, do all of the following:
• Obtain a DHS-1171, DHS-1010 or other review document,
• Record packet received by selecting that item from the left naviga-
tion in Bridges and entering the date you received the requested
review form.
• Review, document and verify eligibility factors as required.
• Except for Healthy Kids, check all available automated systems

matches to see if income has started, stopped or changed such as
consolidated inquiry, SOLQ, etc.
• Update data collection by recording changes in circumstances and

entering verifications received.
• Run EDBC in Bridges.
• Certify EDBC results if appropriate.
• Review the need for services and other assistance programs.
Bridges generates a verification checklist (VCL) for any missing verifi-

cations.
Upon Certification • Prepare the case record, see BAM 300.
• Send Pub 280, Reporting Changes - When To Report - How To

Report - What To Report.
Exception: Do not send to FAP groups assigned to Simplified

Reporting or TMA Plus groups.
• See BEM 647 regarding notices to TMA-Plus qualified persons.
• Bridges sends a DHS-2240, Change Report Form as needed.
Exception: A DHS-2240, Change Report Form, is not sent to FAP

groups assigned to Simplified Reporting, Healthy Kids or TMA-
Plus clients.
• Bridges sends a DHS-1605, explaining simplified reporting and

household income limit, and a DHS-1045, Simplified Six-Month
Review, to FAP groups assigned to simplified reporting.

• Bridges produces and sends a DHS-198C, Child Development

and Care Certificate Client Notice, to the client.
• Bridges produces and sends a DHS-198, Child Development and

Care Certificate/Notice of Authorization, to the provider(s).
STANDARD OF
PROMPTNESS All TOA
Bridges generates a redetermination packet to the client three days

prior to the negative action cut-off date in the month before the redeter-
mination is due. This allows time to process the redetermination before
the end of the redetermination month.
Reinstatements in Month Prior to Redetermination Month
If an EDG closes and is due for redetermination the following month

and is subsequently reinstated at least three days prior to the current
month’s negative action cut-off date, the redetermination packet will be
generated as usual.
If an EDG closes and is due for redetermination the following month

and is subsequently reinstated on or after three days prior to the current
month’s negative action cut-off date, the redetermination packet will be
generated at month end.
FAP Only
The FAP redetermination must be completed by the end of the current

benefit period so that the client can receive uninterrupted benefits by
the normal issuance date.
If timely redetermination procedures are met but too late to meet the
normal issuance date, issue benefits within five workdays.
Bridges will issue a payment for lost benefits if the client is not at fault
for delayed processing that prevented participation in the first month.
FAP CLIENT FAIL-

URE TO MEET
REDETERMINA-
TION REQUIRE-
MENTS FAP Only
Delays The group loses their right to uninterrupted FAP benefits if they fail to do
any of the following:
• File the FAP redetermination by the timely filing date.

• Participate in the scheduled interview.

• Submit verifications timely, provided the requested submittal date

is after the timely filing date.
Any of these reasons can cause a delay in processing the redetermina-

tion. When the group is at fault for the delay, you have 30 days to com-
plete the redetermination.
If there is no refusal to cooperate and the group complies by the 30th

day, issue benefits within 30 days. Benefits are not prorated.
REPORT OF REDE-
TERMINATIONS All TOA
RD-093 The monthly RD-093, Redetermination Report - Worker Listing, lists the
following:
• FIP, SDA, MA, CDC, AMP, and TMA-Plus cases that are past due
more than one month;
• FIP, SDA, MA, CDC, AMP, and TMA-Plus cases that are past due
one month;
• FIP, SDA, MA, CDC, AMP, TMA-Plus and FAP cases that are due
this month;
next month;
in two months;
• FAP and MA cases that are due for a mid-certification contact.
RD-093, Long Term MA Only

Care (LTC) Case
Identification The LTC-application indicator (4574) on the RD-093 identifies MA LTC
cases. Bridges sends the DHS-4574, Medicaid Application (Patient of
Nursing Facility), in the redetermination packet for the MA redetermina-
tion when a DHS-4574 was filed at application.
RD-093, Deductible MA Only

Case Identification
The deductible indicator (#) identifies active deductible cases. This indi-
cator will be printed when the member of an MA EDG has a deductible
amount.
TMA TMA Only

Redetermination
report TMA cases appear on the RD-210 in the fourth month before TMA eligi-
bility ends. Bridges sends the redetermination packet at that time so the
family can have an opportunity to get TMA-Plus. You must complete all

DHS actions at least 40 days before the end of the 12-month TMA eligi-
bility period. See BEM 647 for details about when actions must be com-
plete
LEGAL BASE FIP
MCL 400.32, .43, .55(f)
SDA
Annual Appropriations Act
FAP
7 CFR 273.14
MA
42 CFR 435.916(a)
CDC
Child Care and Development Block Grant of 1990

Social Security Act, as amended.Title IVA (42 USC 601 et. seq.); Title
R400.5001 - 400.5015 MAC
TMAP
DCH Appropriations Act
AMP
Chapter XXI of the Social Security Act.

(1115)(a)(1)of the SSA.
JOINT POLICY
DEVELOPMENT

BAM 220 1 of 19 CASE ACTIONS
DEPARTMENT
POLICY All Programs
You must process the following case actions:
• Initial applications and reapplications (BAM 115).

• Redeterminations (BAM 210).
• Reinstatements (BAM 205).
Bridges will evaluate each change reported and entered in the system
to determine if it affects eligibility.
Exception: For MA only, the Department of Community Health shares

responsibility for Medical Services Authorization and certain related
determinations when a recipient in managed care (Level of Care 07)
becomes an L/H patient. See BAM 120 for details.
Changes in circumstances may be reported by the client, via computer

tape matches, through quality assurance (QA) reviews, or by other
means.
A positive action is a DHS action to approve an application or increase

a benefit.
A negative action is a DHS action to deny an application or to reduce,

suspend or terminate a benefit. This includes an increase in a post-eli-
gibility patient-pay amount for MA or an increase in the client pay for a
special living arrangement.
NOTICE OF CASE
ACTIONS All Programs
Upon certification of eligibility results, Bridges automatically notifies the

client in writing of positive and negative actions by generating the
appropriate notice of case action. The notice of case action is printed
and mailed centrally from the consolidated print center.
For FAP Only, see Actions Not Requiring Notice in this item.
Exception: Written notice is not required to implement a hearing deci-

sion or policy hearing authority decision.
Refer to policy in BAM 600 if a client contacts you to dispute a case

action.
There are two types of written notice: adequate and timely.
A notice of case action must specify the following:
• The action(s) being taken by the department.

• The reason(s) for the action.
• The specific manual item which cites the legal base for an action
or the regulation or law itself.
• An explanation of the right to request a hearing.
• The conditions under which benefits are continued if a hearing is

requested.
Adequate Notice An adequate notice is a written notice sent to the client at the same time
an action takes effect (i.e., not pended). Adequate notice is given in the
following circumstances:
All Programs
• Approval/denial of an application.
• Increase in benefits.
FIP, RAPC, SDA, MA, CDC and AMP Only
• A recipient or his legal guardian or authorized representative

requests in writing that the case be closed.
• Factual information confirms a recipient's death.
• You verify that a recipient has been approved for assistance in

another state.
• You verify that an eligible child, or in MA, an eligible group mem-

ber of any age, has been removed from the home as a result of
court action.
FIP, SDA, AMP and FAP Only
• An intentional program violation (IPV) disqualifies the only eligible

member or reduces/terminates other members' benefits. See the
DISQUALIFICATION section in BAM 720 for notice procedures
and forms.
FIP and MA Only
• Denial of request for medical transportation.
SDA and AMP Only
• Case transferred from AMP to emergency MA.

• Case closure due to a member's receipt of SSI.

CDC
• The client or provider reports, orally or in writing, that a child is no

longer in the care of that provider.
• The client or provider reports, orally or in writing, a need for fewer

authorized hours.
• You verify that a child member of the program group was voluntar-
ily placed in foster care.
• Information verifies the provider is no longer eligible to receive

payments.
MA and TMAP Only
• Case opening with a deductible or patient-pay amount.

• Decrease in post-eligibility patient-pay amount.
• Recipient removed due to his eligible status in another case.
• Divestment penalty when level of care (LC) code is blank or 20.
• Addition of MA coverage on a deductible case.
• Increase in medical benefits. Coverage changes:
From To
B,C,E,H,J,K,P,Q,U,V D,F,T
C,H,J B
J C,H
U P
FAP Only
• Negative action results from information on the DL-060, Child Sup-

port Information Report.
• The change was reported in writing and signed by an eligible

group member, and you can determine the new benefit level or
ineligibility based solely on the written information.
Note: When deleting a member, an application he files on his own

or the updated application of a group he joins is considered a
change reported in writing by an eligible member of the former
group.
• Reliable information indicates the group will leave the state before
the next issuance.
• Changes reported on a DHS-1046, Semi-Annual Contact Report.

Timely Notice All Programs
Timely notice is given for a negative action unless policy specifies ade-
quate notice or no notice. See Adequate Notice and for CDC and FAP
only, Actions Not Requiring Notice in this item. A timely notice is
mailed at least 11 days before the intended negative action takes effect.
The action is pended to provide the client a chance to react to the pro-
posed action.
Actions Not FAP Only

Requiring Notice
A notice of case action is not sent in the situations below. The action
must take effect no later than the month after the change.
• Reliable information indicates the group left the state.
• Reliable information indicates all members died. Reliable sources

generally include a newspaper, friends or relatives of the group, or
other agencies.
• Supplementation over multiple months to restore lost benefits is

completed (see BAM 406).
• From a joint FIP/SDA and FAP application, the FAP benefit began
first and the FAP approval letter indicated the benefit might
decrease if FIP/SDA were later approved.
• The FAP benefit varies from month to month within the benefit
period due to changes anticipated when the case was certified,
and the group was so notified at that time.
• Benefits are reduced for failure to repay an FAP overissuance that

resulted from IPV (BAM 720) or client error (BAM 715). Also see
BAM 725.
• The FAP certification period has expired.
• The group voluntarily requests closure in writing.
CDC Provider Notify CDC providers in writing when you:

Certificate/Notice
of Authorization • Add a new authorization for that provider.
• Shorten or lengthen an authorization period for that provider.
• Increase or decrease the authorized hours for that provider.
• Increase or decrease the department pay percent for that provider.
• Close the CDC EDG.
MASS UPDATES All Programs
Certain changes result from changes by the federal or state govern-

ment and involve mass updates of the entire or major portions of the
caseload. Central office usually processes most of the affected cases

through Bridges mass update and mails notices to client. Local offices
are often required to assist in a mass update, as specified in a program
policy bulletin.
Mass updates affecting various programs include:
• Annual FAP standards updates.

• RSDI updates.
• Periodic changes in program benefit amounts.
• Other changes in eligibility factors based on laws or regulations.
STANDARDS OF
The standard of promptness (SOP) is the maximum time allowed to

complete a required case action. Cases should be processed as quickly
as possible. The SOP sometimes varies by program.
Change Reported All Programs

Via Tape Matches
Case actions resulting from changes reported via tape match (BEN-
DEX, SDX, MESC Wage, MESC UCB, IRS, enumeration, etc.) must be
completed within 45 days of receiving the information.
Exception: Changes reported via New Hires Crossmatch must be

acted on within 21 calendar days.
All Other Reported FIP, RAPC, SDA, CDC, MA and AMP

Changes
You must act on a change reported by means other than a tape match
within 15 workdays after you are aware of the change.
Exception: Only certain changes affect eligibility for Healthy Kids

before redetermination. See ONGOING ELIGIBILITY in BEM 129 and
BEM 131.
FAP Only
You must act on a change reported by means other than a tape match
within 10 days after you are aware of the change.
Benefit Increases: Changes which result in an increase in the house-

hold’s benefits must be effective no later than the first allotment issued
10 days after the date the change was reported, provided any neces-
sary verification was returned by the due date. A supplemental issu-
ance may be necessary in some cases. If necessary verification is not
returned by the due date, take appropriate action based on what type of
verification was requested. If verification is returned late, the increase
must affect the month after verification is returned.

Example: Rich reports on 3-23 that he now has a shelter expense. You
must act on the change by 4-2. May’s benefits will be the first month
affected because the 10th day after the change is reported falls in the
next benefit period. You may affect the April issuance if you can com-
plete the action by 3-31.
If verification is required or deemed necessary you must allow the

household 10 days from the date the change is reported to provide the
verification. The change must still affect the correct issuance month, ie.,
the month after the month in which the 10th day after the change
occurs.
Example: Rich reports a shelter change on 3-21. You request verifica-

tion of his new shelter obligation on 3-23. Rich provides the verification
on 4-2. You must make the change to affect April’s benefits, by using a
supplemental issuance.
If verification is required or deemed necessary but the client fails to

return the verification within 10 days after the change was reported, but
does provide the verification at a later date, you must act on the change
within 10 days after the verification is provided.
Example: Using the previous example, Rich does not supply the shel-
ter verification until 4-6. You must act on the change by 4-16 to affect
May’s benefits. No supplement is issued for April, due to Rich’s failure
to return the verification within 10 days.
Benefit Decreases: If the reported change will decrease the benefits or

make the household ineligible, action must be taken and a notice
issued to the client within 10 days of the reported change.
Example: Debra calls on 3-22 and reports that her husband left the
home. You must act on the change and issue the negative action notice
by 4-1. The change will be effective for May’s benefits.
Example: Mary calls on 3-19 and reports that her rental expense went
from $300.00 per month to $250.00 per month. Even though you must
allow Mary 10 days to return verification of her decreased shelter costs,
you must act on this change and issue the negative action notice by 3-
29. If the verification is not returned within 10 days, you may need to
begin a second negative action to remove the expense completely.
EFFECTIVE DATE
OF CHANGE All Programs
Bridges evaluates the following dates entered in data collection to

determine positive action dates, negative action dates and effective
dates:
• Circumstance start/change date.

• Reported on.
• Verification received on.
• Date client became aware.
FIP, RAPC, SDA and FAP Only
See BEM 505 for policy regarding effective dates for income changes.
FIP, RAPC and SDA Only
See BEM 515 for policy regarding effective dates for member adds.
CDC
Act on reported changes as soon as you can, but you must act within
the standard of promptness (see STANDARDS OF PROMPTNESS,
this item). The day you act on a reported change is not always the day
the change must take effect.
Positive Actions can be entered on Bridges to affect current, future,

and past CDC pay periods. First determine the positive action date. If
the change was reported timely, for example a change in providers,
(within 10 calendar days), the positive action date is the day the change
occurred or is expected to occur. If the change was reported late, the
positive action date is the day the change was reported. Positive
actions take effect on the positive action date.
Exception: Department pay percent increases affect the first CDC pay
period that begins on or after the positive action date.
Note: For a new or changed authorization to take effect on the positive

action date, begin it the first day of the CDC pay period that contains the
positive action date.
Negative Actions: If timely notice is required, the negative action date

must be the first work day at least 11 days after the notice was sent, or
the date the change is expected to occur if that is later. If adequate or
no notice is required, the negative action date is immediate (the day
action is taken on the change), but not before the change is expected to
occur.
The following negative changes entered on Bridges take effect as fol-

lows:
• Department pay percent decreases take effect in the first CDC pay
period that starts on or after the negative action date.
• CDC case closures and member removals (for example removing

an eligible child) take effect on the negative action date.

Case actions that end an authorization without removing a member or

close the CDC eligibility determination group (EDG) are not pended. If
the ended authorization is not being replaced, or is being replaced with
one for fewer hours, the change affects the first CDC pay period that
begins on or after the negative action date. If replacing the authorization
with one for more hours, the rules for positive actions are applied.
FAP Only
For non-income changes, complete the FAP eligibility determination

and required case actions in time to affect the benefit month that occurs
ten days after the change is reported. See BEM 212 and 550 for policy
regarding effective dates for member adds. The benefit month cannot
be earlier than the month of the change.
Example: A $30 shelter increase reported on the 15th of May would

increase the household’s June allotment. If the same increase were
reported on May 28, the household’s allotment would have to be
increased by July. (The 10th day following May 28 would be June 7.)
However, the first month we can affect is June provided the action on
the shelter change is completed by 5-31.
PROCESSING
CHANGES All Programs
Enter all changes in Bridges by changing the affected data elements.

Certify the eligibility results in Bridges for all appropriate benefits and
benefit periods.
Negative Actions A negative action is identified in Bridges with notice reason(s) in eligi-
bility results. Negative actions include:
• Decrease in program benefits, including case or EDG closure.
• Special living arrangement client pay increase.
• Inactivation of an eligible group member.
• Reduction in CDC Department Pay Percentage.
• Change in payment method to restricted payment (no code

needed). Termination of a member's medical eligibility (member
remains active but not medically eligible).
• Medical coverage cancellation or reduction.
• Inactivation resulting in an FAP benefit increase is not a FAP neg-

ative action.

• Patient-pay amount initiated (unless this occurs on the day of

case opening).
• Post-eligibility patient-pay amount increase.
• Changing the level of Care (LC) code from 02 or 08 to LC code 56

(divestment penalty). See BEM 405.
• Changing CDC eligibility from categorical to income eligible.
FAP Only
Reducing a FAP group's benefits at redetermination is treated as a pos-

itive action since the change affects the new certification, not the cur-
rent benefit period.
Notice Reasons All Programs
The notice reason(s) in Bridges indicates the reason for the action.
NEGATIVE ACTION
DATE Bridges automatically calculates the negative action date. The negative
action date on Bridges is the day after the timely hearing request date
on the Bridges notice of case action. See RFS 103 for negative action
effective dates.
Timely Hearing The timely hearing request date is the last date on which a client can
Request Date request a hearing and have benefits continued or restored pending the
hearing. It is always the day before the negative action is effective.
Immediate An immediate negative action occurs when the negative action requires
Negative Actions adequate notice based on the eligibility rules in this item. Adequate
(Adequate Notice) notice means that the action taken by the department is effective on
the date taken.
Pended Negative A pended negative action occurs when a negative action requires timely
Actions (Timely notice based on the eligibility rules in this item. Timely notice means
Notice) that the action taken by the department is effective at least 12 calendar
days following the date of the department’s action.
ACTIONS NOT
ALLOWED BY
LOCAL OFFICES Bridges automatically sets all negative action effective dates based on
the rules for each program and the date the action is processed in the
system. Occasionally there is a need to affect a negative action with
less than 12 days notice (11 days added to the current date). An excep-
tion may be requested for the specific program. Follow the procedure
for requesting exceptions found in BEM 100. The program office will
validate the need for the exception and forward the request to the
appropriate staff to enter the override in Bridges.

DELETING A
NEGATIVE ACTION All Programs
Negative actions must be deleted from Bridges in some situations.
Hearing Requests Record the hearing request date and complete all required information
on the Hearings Restore Benefits screen in Bridges. Then follow Addi-
tional Steps to Delete a Negative Action in this section. See BAM
600.
Requirement Met Enter the information the client provided to meet the requirement that
Before Negative caused the negative action, using the appropriate Bridges screens.
Action Effective Then follow Additional Steps to Delete a Negative Action in this sec-
Date tion.
Additional Steps to Take these additional steps to delete a negative action in Bridges:
Delete a Negative
Action • Reactivate the program(s) on the Program Request screen in
Bridges.
• Run eligibility and certify the results.
Bridges will automatically recalculate benefits based on the information

and dates entered in the system. See EFFECTIVE DATE OF CHANGE
in this item.
BENEFIT
SUSPENSION FIP, RAPC, SDA and FAP Only
Benefit suspension means stopping program benefits for one month

due to temporary ineligibility when allowed by policy. You must docu-
ment the reason(s) in the case record.
To suspend benefits for one month, check the TempInelig box on the
initial eligibility results screen in Bridges before continuing to the certifi-
cation screen. Do not check the box if ineligibility will continue beyond
one month.
This option is not available in Bridges if the previous month’s benefits

were suspended.
If timely notice is required, the date of the first benefit credited must be
later than 11 days from the date the DHS-176 is sent.
FIP, RAPC and SDA Only
If suspending cash assistance benefits, you must also notify any shelter
vendor(s) for the case that vendor warrants will not be produced for that
month. The client is responsible to pay any vendors directly.

CDC MEMBER
ADDS When a client reports a new person in the home, determine what, if any,
actions must be taken. An in-person interview is not required. Add the
member in data collection and run EDG to determine if the new person
must be included as a certified group (CG) member. If the person is not
a required CG member, additional information is not needed.
For new members who are mandatory CG member, enter the following
additional information in Bridges, at a minimum:
• Care arrangement.
• Age exception, if 13 through 18 years of age.
• Citizenship/alien status.
• Countable income belonging to the new person.
• Absent parent information, if applicable.
• Valid need reason.
Adding the new member may result in a positive, negative or no change

in benefits. See EFFECTIVE DATE OF CHANGE, this item. When the
completed DHS-4583, or DHS-1171, and required verifications are
received, run EDBC and certify the results.
Run EDBC to initiate a negative action to close the CDC EDG if either
of the following is true:
• Required verifications and/or an updated application are not

received by their due date.
• The verifications received do not support continued eligibility.
SHORTENING A 24
MONTH FAP
BENEFIT PERIOD FAP Only
Bridges will shorten the FAP benefit period for groups assigned a 24-
month benefit period if either of the following is true:
• A change is reported which changes the group’s status so that it

no longer meets the criteria for a 24-month benefit period.
• The DHS-2240A, Mid-Certification Contact Notice is not returned

and the Specialist is unable to complete the form during a tele-
phone call, home call or interview with the client.
Bridges sends the CG a DHS-2063A, Continuing Your Food Stamp

Benefits, to inform them of the following:
• The benefit period expiring the month after the DHS-2063A is

sent.

• Their timely application date.
See BAM 210.
SHORTENING THE
FAP BENEFIT
PERIOD DUE TO
EARNINGS FAP Only
For ongoing cases that report starting countable earned income and
qualify for FAP simplified reporting, Bridges will do all of the following:
• Shorten the benefit period to 12 months after the change is pro-

cessed, provided the number of months remaining in the FAP ben-
efit period is more than 12 months.
• Send the client a DHS-265, Shortened Benefit Period, a DHS-266,

Food Assistance Simplified Reporting Requirements and a DHS-
1045, Simplified Six-Month Review.
Example: On 8/08/09, the FAP group reports starting income. The

change is processed on 8/17/09. The current FAP benefit period ends
6/30/11. Bridges changes the FAP benefit end date to 8/31/10and
sends the FAP group a DHS-265, DHS-266 and DHS-1045.
SSI CASE ACTIONS
SSI Openings and FIP, RAPC, SDA, MA and AMP Only

Changes
Bridges generates Tasks that provide SSI data reported by the Social
Security Administration (SSA) on the State Data Exchange (SDX) sys-
tem.
Bridges acts on specific HR-070 information to prevent benefit duplica-

tion or mispayment.
SDA Only
Take appropriate action based on a Bridges Task that SSI benefits have
started or changed.
Enter amounts from the SSI AMOUNT and SSI ELIG SDX interface
fields from the SDX interface to recalculate SDA eligibility and benefits.
Note: Whenever the SSI benefit changes, a task will be generated for
SDA cases containing SSI recipients.

FIP Only
Persons cannot receive FIP and SSI at the same time. Also, central
office cannot open a manual SSI case for an SSI recipient who is a CG
member in a FIP EDG.
Run EDBC to remove the SSI recipient from the FIP CG.
MA Only
See BEM 150.
AMP Only
Central office will close AMP and open SSI for the SSI recipient. If the
SSI recipient is in his spouse's AMP group, run EDBC.
FAP Only
Enter the ongoing SSI benefits as unearned income.
SSI APPLICATION
DENIALS SSI-Related MA Only
The SDX reports SSI denials and appeals. Exhibit III in BEM 260 lists
the specific codes you need to identify appeals and disability/blindness
denials.
Eligibility for MA based on disability or blindness does not exist if the

SSA disability determination is final as defined in BEM 260. Enter
appropriate appeal information in Bridges.
If the client is no longer eligible for disability related MA, Bridges will
explore other MA categories. If the client is not eligible for any, Bridges
will close the MA. If he qualifies for a category but must meet a deduct-
ible, Bridges will close MA based on disability and open an active
deductible EDG under the new MA category.
Timely notice of benefit reduction or closure is sent by Bridges. Use a

DHS-4675, Disability Determination Notice.
SSI TERMINATIONS MA Only
Central office closes SSI MA when SDX indicates SSI benefits are ter-
minated. Bridges sets a redetermination date and continues MA eligibil-
ity when SSI stops.
Continue the client’s MA coverage until the redetermination is com-

pleted. The redetermination does not need to be completed if the cli-
ent’s SSI is reactivated in a subsequent SDX batch. In most cases this
is a local office responsibility. See BEM 150.

DEATH
NOTIFICATION All Programs
A reliable source must verify a recipient's death before action is taken

on a case. Reliable sources generally include death notices in newspa-
pers, friends and relatives of the client, and other agencies. The verifi-
cation source is entered in Bridges for the date of death.
CDC
Report all deaths of children while in the care of day care aides and rel-
ative care providers. See SRM 172, Child/Ward Death Alert Procedures
and Timeframes for specific reporting instructions.
EX PARTE REVIEW MA Only
An ex parte review (see glossary) must be completed at least 90 days

(when possible) prior to the close of any Medicaid TOA.
• When the ex parte review shows the recipient does have eligiblity
for Medicaid in another category, change the coverage.
• When the ex parte review shows that a recipient may have contin-
ued eligibility under another category, but there is not enough
information in the case record to determine continued eligibility,
send a verification checklist (including disability determination
forms as needed) to proceed with the ex parte review. If the client
fails to provide requested verification or if a review of the informa-
tion provided establishes that the recipient is not eligible under any
MA category, send timely notice of Medicaid case closure.
• When the ex parte review suggests there is no potential eligibility

under another MA category, send timely notice of Medicaid case
closure.
When it is determined that a recipient will no longer meet the eligibility

criteria for FIP related Medicaid, because of an actual or anticipated
change, determine whether the recipient has indicated or demonstrated
a disability (see glossary) as part of the ex parte review (see glossary).
• If the ex parte review reveals the recipient has already been deter-
mined disabled for purposes of qualifying for a disability based
Medicaid eligibility category, by the SSA or the department, and
the determination is still valid, continue the recipient’s Medicaid eli-
gibility under the disability based Medicaid category for which the
recipient is otherwise eligible.
• If, during the ex parte review it is determined a recipient has indi-

cated or demonstrated a disability, request from the recipient addi-
tional information needed to proceed with a disability

determination. Pending the determination, continue the recipient’s

Medicaid.
•• If the recipient fails to provide the information requested after

being given a reasonable opportunity to do so, and eligibility
under all other categories has been ruled out, send timely
notice of Medicaid case closure indicating the person is not
eligible for disability based Medicaid as well as FIP related
categories.
•• If, following the disability determination process, the recipient

is determined to not be disabled for purposes of qualifying for
disability based Medicaid categories and eligibility under all
other categories has been ruled out, send timely notice of
Medicaid case closure indicating the person is not eligible for
disability based Medicaid as well as FIP related categories.
•• If, following the disability determination process, the recipient

is determined disabled for purposes of qualifying for disability
based Medicaid categories continue the recipient’s Medicaid
under the disability based Medicaid category for which the
recipient is otherwise eligible.
Medicaid coverage will continue until the client no longer meets the eli-
gibility requirements for any other Medicaid TOA.
CASE CLOSURE All Programs (Except SER)
When a recipient is no longer eligible or requests case closure, do all of

the following:
• Enter all appropriate information, including verification sources, in

Bridges to document ineligibility, or the client’s request that the
program(s) be closed.
• Run EDBC in Bridges and certify the eligibility results.
• Make appropriate referrals for other programs or services.
CASE ACTION
NOTICE FORMS All Programs
Bridges sends the appropriate notice based on the case action taken.
See RFF for an explanation of the form’s use and completion instruc-
tions.
Notices are sent to Spanish or Arabic speaking clients using a Spanish/

Arabic form, if available, and if the client has indicated Spanish or Ara-
bic as the household’s written language.

A notice must be generated manually in those situations in which

Bridges is not able to generate a notice, as identified in this item.
APPLICATION
APPROVALS/
DENIALS All Programs
The following notices are used to notify the client of an application

approval or denial.
The DHS-1150, Application Eligibility Notice, is generated for withdraw-

als entered on the Program Request screen prior to data collection/
intake.
The DHS-1605, Notice of Case Action, is generated by Bridges for

automated eligibility determinations.
CDC Only
A DHS-198 is generated by Bridges when following an automated eligi-

bility determination in which a CDC approval or denial is certified and a
CDC provider(s) has been identified by the client.
When a CDC application is denied manually in data collection, use the

preprinted or electronic (Microsoft Word template) version of the DHS-
198, Child Development and Care Certificate/Notice of Authorization, to
inform the CDC provider(s) identified by the client. Complete the com-
ments section, stating the CDC application has been denied.
A manual DHS-198 must also be sent to the provider(s) identified by the

client when benefits are issued using the Manual Issuance process in
Bridges.
MA Only
A DHS-114, Deductible Notice, is generated when MA is approved with

a deductible.
Use the DHS-4675, Disability Determination Notice to notify a client

regarding the results of a disability determination.
Note: See BEM 402 for policy on notices to send regarding asset
transfer information and the results of an initial asset assessment.
POSITIVE
CHANGES All Programs
Bridges automatically generates a DHS-1605, Notice of Case Action, to

notify the client of the results of the Bridges automated eligibility deter-

mination. The results for all programs are included on a combined

notice.
CDC Only
Bridges generates a DHS-198 to notify the provider of any addition or

change to an authorization.
A manual DHS-198 must be sent to the provider(s) identified by the cli-

ent when additional benefits are issued using the Manual Issuance pro-
cess in Bridges.
See Child Development and Care Certificate/Notice of Authorization,

this item.
NEGATIVE
CHANGES AND
CASE CLOSURES All Programs
Bridges generates a combined DHS-1605, Notice of Case Action, for all

programs. Other notices are either generated by Bridges or must be
manually completed and sent in the specific circumstances listed
below.
FIP, RAPC, SDA and FAP Only
Bridges generates the following notices when a claim is created:
• DHS-4357, Client Notice of Disqualification and/or Recoupment.

• DHS-4358, Notice of Agency or Client Error Overissuance and
Recoupment Action.
FIP and MA Only
Send a DHS-301, Medical Transportation Notice, if a request for medi-

cal transportation is denied.
CDC
A DHS-198 is generated by Bridges when an automated eligibility

determination in which a CDC closure or reduction in benefits is certi-
fied and a CDC provider(s) has been identified by the client.
MA Only
Use the DHS-4675, Disability Determination Notice to notify a client

regarding the results of a disability determination.
MA EXCEPTIONS
UNIT The MA Exceptions Unit in the Department of Community Health is
responsible for the following case actions.

• Deletion of duplicate Individual ID numbers.

• SSI case closures for death or moved out-of-state.
• Case number deletions.
• LC codes 07, 14 and 88 changes.
• Addition of LC code 32.
• MA coverage when the MA End Date is more than 24 months ear-
lier than the current month and year.
Telephone The MA Exceptions Unit may be reached by calling the following:

Numbers
• 1-800-292-9570 (security card is required when calling this num-
ber). This is a voice-activated enhanced call process. You may
select from 5 menu items. The menu items are:
•• 1 - Foster Care, Child Development and Care and Patient-

Pay changes.
•• 2 - LC codes 07 or 11 questions and addition of LC code 32.
•• 3 - LC codes 07 and 88 (Note: You may call either 1-517-

241-8759 (described below) directly or 1-800-292-9570 and
press 3 to remove these LC codes.).
•• 4 - Responding to a letter about duplicate ID numbers.
•• 5 - All others (including all third-party resource concerns

(except Medicare) including the non-Medicare portions of OI
codes 92-95).
• 1-517-241-8759 - This is a voicemail line for you to use to request

removal of LC codes 07, 14 or 88. A series of questions prompts
you to leave the information necessary to remove the LC code.
You will be told when the LC code will be removed. If the LC code
CANNOT be removed or other information is needed, you will be
contacted.
LEGAL BASE FIP
P.A. 280 of 1939, as amended

R400.902 MAC
RAPC
45 CFR 400
CDC
Child Care and Development Block Grant of 1990

Social Security Act, as amended, Title IVA, IVE, XX

Michigan Administrative Rules, 400.5001 - 400.5015
SDA
MA
42 CFR 431.200-.250
42 CFR 435.912-.913, .919
AMP
Title XXI of the Social Security Act

(1115) (a) (1) of the Social Security Act.
FAP
7 CFR 273.12-.13, .21
JOINT POLICY
DEVELOPMENT

BPG 1 of 46 GLOSSARY
GLOSSARY
ACCUMULATED
BENEFIT A one-time payment of accumulated non-DHS benefits issued to cover
a retroactive period of time or to cover a future period of time. Example:
RSDI, Veterans Benefits, UI Benefits, Workers Compensation.
Related Terms: Lump Sum.
ACTUAL UTILITY
EXPENSE The amount the group is billed for utilities.
Related Terms: Utility Only Standard.
ADC-F Aid to Dependent Children - Foster Care.
ADEQUATE NOTICE A written notice sent at the time a case action is effected (not pended)
which specifies all of the following:
• The action being taken by the department.

• The reason for the action.
• The specific manual item which cites the legal basis for the action.
• An explanation of the individual's right to request a hearing.
• The circumstances under which benefits are continued if a hearing
is requested.
Related Terms: Timely Notice.
ADJOINING
PROPERTY Land and buildings located on the land, which touches the land the
homestead is on if not separated from the homestead by other persons'
property. It includes land separated only by roads, public rights-of-way,
streams, etc.
Related Terms: Homestead.
ADMINISTRATIVE
HEARING An administrative hearing (also called a fair hearing) is the impartial
review by an administrative law judge of a department decision that a
client believes is illegal or, in the case of the community spouse
resource or income allowance, is unsatisfactory. Both the client and the
department are given the opportunity to present evidence in support of
their respective positions.
ADMINISTRATIVE
HEARINGS (AH) Administrative Hearings (AH) for DHS is located in both Lansing and
Detroit. AH is responsible for conducting administrative hearings and
rendering Decisions and Orders (D&O). AH is a part of the State Office
of Administrative Hearing and Rules (SOAHR) within the Department of
Labor and Economic Growth (DLEG).
BRIDGES POLICY GLOSSARY STATE OF MICHIGAN

GLOSSARY
ADMINISTRATIVE
LAW JUDGE (ALJ) An administrative law judge (ALJ) is an employee of the State Office
of Administrative Hearing and Rules (SOAHR) within the Department of
Labor and Economic Growth (DLEG). An ALJ conducts the administra-
tive hearing.
ADMINISTRATIVE
RECOUPMENT The process by which DHS recovers a benefit overissuance by reduc-
ing current program benefits
Related Terms: Cash or Food Assistance Recoupment, Recoupment.
ADMINISTRATIVE
REVIEW Review of a hearing request and applicable policy by the local office
manager or designee prior to a hearing.
Related Terms: Administrative Hearing.
ADMINISTRATIVE
TRIBUNAL Administrative tribunal for the Department of Community Health (DCH)
is responsible for conducting administrative hearings and rendering
decisions and orders (D&O). The administrative tribunal is an employee
of the State Office of Administrative Hearing and Rules (SOAHR) within
the Department of Labor and Economic Growth (DLEG).
ADULT FOSTER
CARE HOME (AFC
HOME) A family home, small group home, large group home or congregate
facility licensed to provide supervision, protection and personal care to
ambulatory adults age 18 and over who are aged, developmentally dis-
abled, mentally ill or physically disabled and who require supervision on
an ongoing basis but do not require continuous nursing care.
Related Terms: Domiciliary Care, Personal Care, Special Living

Arrangements.
AFC Adult Foster Care.
AGENCY ERROR An incorrect action including a delayed action or no action taken on a

case by the department which results in a benefit overissuance or
underissuance. Examples are:
• Incorrect benefit.
• Erroneous denial or termination.
• Delayed certification.
• Computer or other machine errors.
• Inaccurate use of information or misapplication of policy.
• Failure to process a change timely.
Related Terms: Overissuance, Supplemental Program Benefits.

GLOSSARY
AGENT One that acts for or as the representative of another or has the power or
authority to act.
AGRICULTURE/
RELATED Employment:
• On a farm or ranch performing field work related to planting, culti-

vating or harvesting operations; or
• In canning, packing, ginning, seed conditioning, processing opera-

tions or related research.
AHR Authorized hearings representative
AIDE An individual, who is at least 18 years old, employed by the CDC par-
ent/substitute parent and enrolled by the local DHS to provide child care
for up to 4 children (unless the children are siblings or migrant children),
in the home where the child lives.
ALIEN A person who is not a United States citizen.
Related Terms: Refugee.
ALLOWABLE
MEDICAL EXPENSE The costs of certain medical-related needs which are subtracted from
income
ANNUITY A written contract, usually with an insurance company, establishing a

right to receive specified, periodic payments for life or for a term of
years.
AP Assistance payments.
APPLICANT The person(s) whose signed application for program benefits has been
received in the local office. The person remains an applicant until the
program is approved or denied, or until the application is withdrawn.
APPLICATION A signed and dated statement on a form prescribed by the department

that a person wishes to receive program benefits.
APPLICATION DATE The date an application/DHS-1171-F, Filing Document, with minimum

required information, is received by the local office or, per BAM 120,
received by DCH.
APPLICATION
NUMBER Every application in Bridges is assigned a unique eight digit application
number proceeded by a T. Example: T12345678. Once the application
is assigned to a specialist and data collection has begun, the specialist
will determine if there is an existing case number. If so, they will associ-
ate the application to that case number. If there is no existing case

GLOSSARY
number, Bridges will assign one. It will be the number assigned at appli-
cation proceeded by a 1, instead of T. Example: 112345678.
APPROVE The decision that program eligibility exists and the action(s) taken to
authorize program benefits
Related Terms: Certification, Denial, Determination of Eligibility.
AR Administrative Recoupment, Authorized Representative.
ARREARAGE
VENDORING The process by which a portion of an overdue heat and/or electric
amount is sent to the utility company as a vendor payment.
Related Terms: Vendor Payment.
ASSET LIMIT The maximum amount of countable assets the asset group is allowed.
Related Terms: Program Benefits.
ASSETS Cash, any other personal property and real property.
AUTHORIZED
HEARINGS
REPRESENTATIVE
(AHR) The person who stands in for or represents the client in the hearing pro-
cess and has the legal right to do so. This right comes from one of the
following sources:
• Written authorization, signed by the client, giving the person

authority to act for the client in the hearing process.
• Court appointment as a guardian or conservator.
• The representative's status as legal parent of a minor child.
• The representative's status as attorney at law for the client.
• For MA only, the representative's status as the client's spouse, or

the deceased client's widow or widower, only when no one else
has authority to represent the client's interests in the hearing pro-
cess.
An AHR has no right to a hearing, but rather exercises the client's right.
Someone who assists, but does NOT stand in for or represent, the cli-
ent in the hearing process need NOT be an AHR.
Note: “Stands in for” means the AHR does whatever the client could do
if the client were not represented. For example, when the client has an
AHR, the AHR must sign a hearing request withdrawal, not the client.

GLOSSARY
Do not require the signature of both the client and the AHR when the
client has an AHR representing him.
Related Terms: Authorized Representative.
AUTHORIZED
REPRESENTATIVE
(AR) A person who makes application or provides eligibility information on
behalf of a client. Also, in FAP, a person who accesses food assistance
benefits on behalf of a client. For MA purposes an authorized represen-
tative must be an adult child or stepchild, a specified relative, desig-
nated in writing by the client or court appointed.
Related Terms: Authorized Hearings Representative.
AVAILABLE
INCOME Income that is actually received or that can be reasonably anticipated.
Reasonably anticipated means that the amount can be estimated and
the date of receipt is known. It includes amounts deducted for such
things as taxes and garnishments.
BAM Bridges Administrative Manual.
BASE GROUP All persons who must be considered to determine eligibility and benefit
levels.
BEM Bridges Eligibility Manual.
BENDEX Beneficiary Data Exchange.
BENEFICIARIES The Department of Community Health (DCH) uses the term beneficia-
ries which is synonymous with the DHS term recipients.
Related Terms: Recipient.
BENEFICIARY OF A
TRUST Any person(s) designated in a trust instrument as benefiting in some
way from the trust, excluding the trustee or any other person whose
benefit consists only of reasonable fees or payments for managing or
administering the trust. The beneficiary can be the grantor himself,
another person(s), or a combination of any of these persons.
BENEFIT MONTH The calendar month for which benefits are received.
BENEFIT
OVERISSUANCE
DETERMINATION The process(es) used to determine if benefits were overissued.
Related Terms: Recoupment.
BENEFIT PERIOD The period of time for which program benefits are approved.

GLOSSARY
BIC Beneficiary identification code.
BOARDER A person(s) who:
• Lives with another and pays reasonable monthly compensation for

meals.
• Resides in a commercial room and board home.
BPG GLOSSARY The Bridges glossary contains terms and definitions pertaining to cash,
food and medical assistance along with child care and preventive family
services.
BRIDGES The goal of Bridges is to improve service delivery and workload reduc-
tion by replacing the separate automated systems (ASSIST, CIMS and
LOA2) with a single integrated service delivery system. Bridges pro-
vides a modern technology platform that will support eligibility and ben-
efit determinations for cash, medical and food assistance programs,
child care services and the state emergency relief program. Bridges
enables DHS staff to provide more timely, accurate and comprehensive
delivery of services to the citizens of Michigan.
BRIDGES POLICY Bridges Policy manual group includes the following manuals:
• Bridges Administrative Manual, BAM.

• Bridges Eligibility Manual, BEM.
• Bridges Policy Bulletin, BPB.
• Bridges Glossary, BPG.
CASCADING
ELIGIBILITY The process of Bridges evaluating a household’s eligibility for multiple
types of assistance (TOA). For example, a client’s MA program request
status is ‘yes.’ Bridges tests eligibility for all MA categories for the indi-
vidual, automatically.
CASE A Bridges case is composed of all household members, regardless of

program request status.
CASE RECORD Documents arranged in a series of packets and information related to a

given case (one or more programs) contained in a manila folder with a
numbered tab(s).
CASH BENEFIT The dollar amount of FIP/SDA program benefits that is sent to the FIP/
SDA eligible group.
Related Terms: Grant Amount.

GLOSSARY
CASH OR FOOD
ASSISTANCE
RECOUPMENT The process by which a client makes cash or food assistance payments
directly to DHS to repay a benefit overissuance.
CATEGORICAL
ELIGIBILITY FAP Only.
FAP eligibility based on authorization for, or receipt of, another pro-

gram.
A group is categorically eligible based on enhanced authorization for

domestic violence prevention services. Although applicants/recipients
are authorized for this service via PUB-859, “Domestic Violence Waiv-
ers Informational Brochure,” only households with net income at or
below 200% of the poverty level receive additional authorizations.
Exception: A group is not categorically eligible for FAP if any member

of the group is FAP disqualified for:
• Intentional program violation (IPV).

• Child support non-cooperation.
• Trafficking.
• Fugitive felons.
• Parole and probation violation.
• Employment-related activity.
Categorically eligible groups automatically meet asset, gross and

100% net income limits for FAP.
CERTIFICATION The process of documenting the disposition of a determination or rede-

termination of eligibility by completing the form prescribed by policy. In
Bridges, this is done electronically on the disposition screen.
CERTIFIED GROUP One or more individuals within a single eligibility determination group
(EDG), who are eligible for a particular type of assistance. This is a
Bridges term.
CERTIFIED
SUPPORT Court-ordered child support that the Michigan State Distribution Unit
(MiSDU) forwards to DHS when FIP is approved for child. The client
agrees to this when they sign the DHS 1171, Assistance Application.
Related Terms: Child Support.
CHAMPS Community Health Automated Medicaid System. Bridges will interface

with this DCH system to exchange information about our clients.
CHANGE(S) An alteration in the circumstances of a group member(s) which may

affect program(s) eligibility and/or the amount of program benefits.

GLOSSARY
Related Terms: Change Report Form, Determination, Redetermination.
CHANGE REPORT
FORM A department form that may be used by a client to report changes.
CHILD CARE The provision of child care for any portion of the day or night, in or out of
the child’s own home, during a 24 hour period.
Note: Child care payments may not be authorized to provide 24 hour

care. In instances where payment for 24 hour care is requested
because the usual caretaker must be absent for a short period (e.g.
hospitalization, incarceration, etc.), a referral to foster care must be
made.
CHILD CARE
CENTER A facility other than a private residence licensed by Bureau of Children
and Adult Licensing to care for one or more children for periods of less
than 24 hours a day. A child care center may be called a:
• Day care center.

• Day nursery.
• Nursery school.
• Parent cooperative preschool.
• Play group.
• Drop-in center.
• Migrant seasonal center.
CHILD
DEVELOPMENT
AND CARE
PROGRAM The department's unified child care program. Qualified families may
receive assistance when the parent(s), or substitute parent(s) is
unavailable to provide care because of employment, approved educa-
tion/training and/or because of an approved health/social condition for
which treatment is being received.
CHILD-IN-COMMON The legal child of a specified man and woman.
CHILD SUPPORT Monies paid by an absent parent for the living expenses of a child(ren).
Related Terms: Certified Support, Parent, Support Action.
CI County Infirmary, consolidated inquiry.
CLAIMANT/CLIENT In the decision & orders (D&O) issued as a result of an administrative

hearing, the term claimant is used to refer to the DHS client.
CLIENT A person(s) applying for, currently receiving program benefits, inquiring

about benefits or is part of a base group.

GLOSSARY
CLIENT ERROR The department has taken all action(s) required under normal process-
ing procedures but the client(s) has given incorrect or incomplete infor-
mation or failed to meet other requirements which impacts the amount
of program benefits and the error has not been determined as inten-
tional.
Related Terms: Department Error, IPV.
COLLATERAL
CONTACT Contact with an information source (other than the client) through writ-
ten correspondence, a telephone interview or an in-person interview.
Related Terms: Document, Documentary Evidence, Home Call, Inter-

view, In-Person Interview.
COMMERCIAL
ROOM AND BOARD
HOME A group living facility that offers meals and lodging to the public for com-
pensation with the intent of making a profit and that meets all applicable
licensing and regulatory requirements.
Related Terms: Special Living Arrangement.
COMMUNAL
DINING FACILITY A public or nonprofit private organization that prepares and serves
meals for persons 60 years of age or older and their spouses or for SSI
recipients and their spouses.
COMMUNITY
SPOUSE L/H or waiver patient's spouse when the spouse:
• Has NOT been, and is NOT expected to be, in a hospital and/or

LTC facility for 30 or more consecutive days, and
• For waiver patients only, the spouse is NOT also approved for the
waiver.
COMPLAINT
(GENERAL) A statement or inquiry by a client, an interested party or the general
public objecting to an eligibility determination, program benefits or an
assertion of an IPV.
Related Terms: Discrimination Complaint, Hearing, IPV.
CONFIDENTIALITY Restrictions on the disclosure of information concerning an DHS cli-

ent(s).
Related Terms: Release of Information.
CONTACT DAY Any day within the biweekly period in which child care is to be provided.

GLOSSARY
CONSOLIDATED
VENDOR
WARRANT A weekly warrant sent to a heat and/or utility vendor which combines
the payment for many individual clients into a single payment.
CONTRACTUAL
INCOME The amount of money paid for hours worked or activities completed as
specified in a contract.
CO-PAYMENT That portion of the cost of a service for which payment must be made
by an eligible group.
Related Terms: Patient-Pay Amount, Deductible Amount.
CORRECTIVE
ACTION PERIOD The time span between the date an DHS administrative hearing request
is filed due to a Medicaid denial and the date of an eligibility determina-
tion resulting from the hearing request.
COSTS OF
PRODUCING SELF-
EMPLOYMENT
INCOME Expenses that are directly related to producing self-employment
income.
COUNTABLE
INCOME Available income remaining after applying the policies in BEM 500.
COVERED
(MEDICAL)
SERVICES The range of health care services which will be paid for MA and/or AMP
(program code G and H) eligible group members and for recipients of
medical aid under programs I, R and J.
CSHCS Childrens Special Health Care Services (formerly Crippled Children).
DAY CARE AIDE An individual, who is at least 18 years old, employed by the CDC par-
ent(s)/substitute parent(s) and enrolled by the local DHS to provide
child care for up to 4 children, unless the children are siblings or
migrant children, in the home where the child(ren) lives.
DCH Michigan Department of Community Health.
DEBT COLLECTION
HEARING An administrative hearing requested by DHS on a closed case to estab-
lish whether Treasury collection action on a particular overissuance is
appropriate.
DECISION TABLES Policy rules within Bridges that support eligibility decisions.

GLOSSARY
DEDUCTIBLE
AMOUNT MA
The amount of income which must be applied to the cost of medical

care before MA can be authorized.
Related terms: Patient-pay amount, Deductible case, Deductible

period.
DEDUCTIBLE CASE An active MA case with no ongoing MA eligibility or coverage. The case
meets all other eligibility requirements but income exceeds allowable
limits. Periods of coverage are added when the client becomes income
eligible by incurring medical expenses.
Related terms: Patient-pay amount, Personal care co-payment,

Deductible amount, Deductible period.
DEDUCTIBLE
PERIOD Each deductible period is a calendar month.
Related terms: Patient-pay amount, Deductible amount, Deductible

case.
DEEM To consider income or assets available from one person to another

without proof of actual contribution.
DEFERRED
ACTION(S) An action(s) which must be initiated at the time of a determination but
which may be completed at a later date.
Related Terms: Expedited Services, Support Action.
DENIAL (OF
PROGRAM
BENEFITS) Disapproval of an application or reapplication for program benefits
based on a determination that one or more of the eligibility factors is not
met.
DEPARTMENT
WARD Any child who:
• Has been committed to, or placed with, the department by a court

order; and
• Does not live with his parent(s); and
• Is not a title IV-E recipient; and
• Is not placed in J.W. Maxey or Adrian Training School.

GLOSSARY
DESIGNATED
STAFF PERSON
(DSP) A local office staff person assigned to perform certain specific functions
as stated in policy.
DESTITUTE FAP
GROUP FAP groups containing migrants and/or seasonal farm workers who
have been determined eligible for expedited services and to whom spe-
cific income tests, as specified in policy, are applied.
Related Terms: Expedited Service, Migrant.
DETERMINATION
(OF ELIGIBILITY) The process of evaluating all eligibility factors to determine if eligibility
exists for program benefits.
DHS Department of Human Services.
DISABLED FAP
A person who receives one of the following:
• A federal, state or local public disability retirement pension and the

disability is considered permanent under the Social Security Act.
• Medicaid based on being blind or disabled (which require a dis-

ability determination by the medical review team (MRT) or Social
Security Administration).
Note: Breast and Cervical Cancer Prevention and Treatment Pro-

gram Medicaid cases are not considered disabled.
• Railroad Retirement and is eligible for Medicare or meets the

Social Security disability criteria.
A person who receives or has been certified and awaiting their initial
payment for one of the following:
• Social Security disability or blindness benefits.

• Supplemental Security Income (SSI), based on disability or blind-
ness, even if based on presumptive eligibility.
Related Terms: Impairment, SDV, SDV Member.
DISABLED
VETERAN FAP
A person who is:
• A veteran of the armed services with a service or non-service con-

nected disability rated or paid as total by the VA.

GLOSSARY
• A veteran considered by the VA as permanently housebound or

needing regular aid or attendance.
• A veteran's surviving spouse or child who:
•• Receives or is approved for VA disability benefits, or

•• Is entitled to VA death benefits and has a disability consid-
ered permanent under the Social Security Act.
DISCRIMINATION
COMPLAINT A written statement of grievance (protest) alleging unequal treatment by
DHS in the administration of a program(s) with respect to race, creed,
etc.
Related Terms: Complaint (General).
DISPOSITION The final process of approval or denial of an application, or the comple-

tion of a positive or negative action for an active program.
Related terms: Qualified Group, Intentional Program Violation.
DISQUALIFICATION
HEARING A hearing before an DHS administrative law judge initiated by DHS
when:
• Documentary evidence suggests that an IPV has resulted in a

benefit overissuance of $500 or more and prosecution was
declined, but lack of evidence was not cited; or
• The total OI is $35 to $499 and an OIG referral was not appropri-
ate or was returned with prosecution declined, but not for lack of
evidence, and
• The group has a previous IPV, or
• An apparent previous willful withholding OI was under $500 and so

not pursued.
Related Terms: Documentary Evidence, Hearing, IPV.
DISQUALIFICATION
PERIOD The length of time, established by DHS, during which eligibility for pro-
gram benefits does not exist.
Related Terms: Disqualified Person, Program Benefits, Support Dis-

qualified.
DISQUALIFIED
PERSON(S) A person(s) who is ineligible for program benefits because an eligibility
factor is not met or because the person refuses or fails to cooperate in

GLOSSARY
meeting an eligibility factor (e.g., child support, SSN, IPV, citizenship/

alien status, etc.).
DLEG Department of Labor and Economic Growth.
D.O. Doctor of Osteopathy.
DOB Date of Birth.
DOCUMENT The entry or recording of evidence establishing the accuracy of state-

ments in the case record.
Related Terms: Documentary Evidence, Verify.
DOCUMENTARY
EVIDENCE Written confirmation in the case record of the client's circumstances.
Related Terms: Document, Verify.
DOMICILIARY
CARE A type of care given to residents of an AFC home whose principal need
is supervision, as they are generally able to perform the basic activities
of daily living, such as eating, bathing and dressing.
Related Terms: Adult Foster Care Home, Personal Care Services.
DSP Designated staff person.
DURABLE GOODS Items that are generally useful for a long period of time.
EARLY PAYMENT A payment issued to cover only the pay period in which eligibility is cer-
tified.
Related Terms: Retroactive Benefit, Payment Period.
EARNED INCOME
CREDIT A tax credit that is available to persons with limited income who have
children living with them. The credit can be received either as part of the
person's wages or when the annual income tax forms are filed.
EDBC Eligibility determination and benefit calculation. The Bridges function

that determines program eligibility and benefit level, after data collection
has been completed.
EDG Eligibility determination group. The EDG is composed of all individuals

in a Bridges case, whose information is needed to determine eligibility
for a particular type of assistance. Within a case, there is an EDG for
each type of assistance.
EDOD Expected date of delivery.

GLOSSARY
EDUCATIONAL
EXPENSES Costs incurred specifically because of a person's school attendance
EDUCATIONAL
INCOME Income received for educational purposes, e.g., grants, fellowships,
scholarships, veterans educational benefits and certain student educa-
tional loans.
EFFECTIVE DATE Refer to Negative Action Date.
EIC Earned Income Credit.
ELECTRONIC
FORM A form on Microsoft Word in template form (requires Forms Manage-
ment, Central Office approval per Administrative Handbook manual
Directives and Policy Processes - AHH, Item 222). A template will cre-
ate a document which may be completed on the user's PC and printed,
or printed and completed by hand.
ELIGIBLE GROUP
(E.G., FAP
ELIGIBLE GROUP) The person(s) who meets all of the non-financial and financial eligibility
factors.
Related Terms: Disqualified Person(s), Fiscal Group, Program Group,

Qualified Group.
ELIGIBILITY
FACTOR A criterion or condition which must be met before eligibility can be certi-
fied. Eligibility factors are of a financial, nonfinancial or procedural
nature (e.g., citizenship, income).
EMERGENCY
SHELTER A facility that provides temporary housing for individuals or families who
are homeless or facing a crisis that prevents occupancy of their home.
EP Early Payment.
ES Eligibility Specialist.
EXCESS MEDICAL
EXPENSE FAP
A deduction from countable income for allowable medical expenses

exceeding $35 incurred by SDV members.
Related Terms: Allowable Medical Expense.

GLOSSARY
EXCESS INCOME FIP, SDA, MA, AMP
The amount by which the group's income exceeds their needs as spec-
ified in policy.
Related Terms: Income Limit.
EXCLUDED
REIMBURSEMENT That portion of a payment for past or future expenses other than normal
living expenses (e.g., rent, personal clothing, etc.) provided the pay-
ment is for a specifically identified expense and is used for the purpose
intended.
EX PARTE REVIEW A determination made by the department without the involvement of the
recipient, the recipient’s parents, spouse, authorized representative,
guardian, or other members of the recipient’s household. It is based on
a review of all materials available to the specialist that may be found in
the recipient’s current Medicaid eligibility case file.
EXPEDITED
SERVICE Adetermination of FAP eligibility that, due to the circumstances of the
applicant group, has a shorter standard of promptness and fewer verifi-
cation requirements than are normally required.
Related Terms: Standard of Promptness.
FAILURE TO
COOPERATE Neglecting (without intent) to comply with a required action.
Related Terms: Refusal to Cooperate.
FAIR HEARING See Administrative Hearing.
FAIR MARKET
VALUE The amount of money the owner would receive in the local area for his
asset (or his interest in an asset) if the asset (or his interest in the
asset) was sold on short notice, possibly without the opportunity to real-
ize the full potential of the investment.
FAMILY
AUTOMATED
SCREENING TOOL A web-based screeing tool completed by the FIP/RAP client to meet
program eligibility. Information gathered from the FAST is displayed on
the Family Self-Sufficiency Plan (FSSP).
FAMILY CHILD
CARE HOME A private home registered by Bureau of Children and Adult Licensing to
care for up to six children for periods of less than 24 hours a day. A fam-
ily child care home may be called a family day care home.

GLOSSARY
FAMILY SELF-
SUFFICIENCY
PLAN An automated plan developed with the FIP/RAP family to include activi-
ties that will lead them to self-sufficiency.
FEDERAL
SUBSIDIZED
HOUSING FOR THE
ELDERLY Housing for the elderly that was built under either Section 202 of the
Housing Act of 1959 or Section 236 of the National Housing Act.
FEID Federal Employer ID Number, commonly referred as a “38 number.”
FIELD HELP In Bridges, information about the data being requested by fields on data
collection screens. Access field help by clicking on the field label, or
using CTL/SHIFT/H.
FIM Family Independence Manager.
FINAL SSI
DISABILITY
DETERMINATION A determination made after 1/1/90 by Social Security Administration
(SSA) that a person is NOT disabled for SSI purposes which super-
sedes the DHS Medical or state review team certification that the per-
son is disabled for MA. SSA's determination becomes final when:
• No further appeals can be made at SSA, or
• The client failed to file an appeal at any step within SSA's 60 day
time limit, and
• The client is NOT claiming:
•• A totally different disabling condition than the condition SSA

based its determination on, or
•• An additional impairment(s) or change or deterioration in his

condition that SSA has NOT made a determination on.
FINANCIAL
ELIGIBILITY
FACTORS Eligibility factors dealing with income and assets.
Related Terms: Eligibility Factor(s), Nonfinancial Eligibility Factor.
FIP RECIPIENT A recipient of Family Independence Program (FIP) who is NOT an ineli-
gible grantee.
FIP-RELATED MA Those Medicaid categories for families with dependent children, care-
taker relatives, pregnant women, recently pregnant women and per-

GLOSSARY
sons under age 21. FIP-related MA does NOT mean FIP policies are
used.
FIS Family Independence Specialist.
FISCAL GROUP MA
The group of persons living with each other whose income and needs
are considered together in determining eligibility for the qualified group.
Related Terms: Eligible Group, Qualified Group.
FHA Farmers Home Administration.
FNS Food and Nutrition Service.
FUGITIVE FELON A person for whom a warrant for arrest has been issued, who is seeking
to avoid:
• Prosecution on a felony charge.

• Giving testimony regarding a felony charge.
• Custody or confinement after conviction for a felony.
• Contempt proceedings for alleged disobedience in regard to a
criminal investigation.
FULL-TIME
STUDENT A student regularly attending school for the number of hours the school
considers full-time.
Related Terms: Half-time Student, Regularly Attending, Student.
FUTURE MONTH Any calendar month for which MA eligibility is being determined that is
after the processing month.
Related Terms: Past Month, Processing Month.
GOOD CAUSE A circumstance which is considered a valid reason for not complying
with a requirement.
GRANT AMOUNT The sum of the FIP/SDA cash benefit, amount recouped and the ven-
dor payments issued on behalf of the FIP/SDA eligible group.
Related Terms: Cash Benefit, Recoupment, Vendor Payments.
GRANTEE The person who is customarily responsible for the verbal and written
communication(s) between the eligible group and DHS, and in whose
name program benefits are generated and received.

GLOSSARY
FIP
The person program benefits are issued to, but not necessarily the per-
son the benefits are intended to cover.
Related Terms: Ineligible Grantee.
GRANTOR Any person who creates a trust. It includes anyone who furnishes real
or personal property for the creation of the trust.
Related Terms: Settlor.
GROSS EARNED
INCOME The amount of earned income before taxes, union dues, etc. are
deducted or, for self-employment, the amount of earned income
remaining after the costs of producing the self-employment income are
deducted from the total proceeds.
GROUP CHILD
CARE HOME A private home licensed by Bureau of Children and Adult Licensing to
care for up to 12 children for periods of less than 24 hours a day. A
group child care home may be called a group day care home.
GUARDIAN A person lawfully invested with the power, and charged with the duty, of
taking care of the person and managing the property and rights of
another person, who, for defect of age, understanding, or self-control, is
considered incapable of administering his affairs.
One who legally has the care and management of the person, or the
estate, or both, of a child during its minority.
HALF-TIME
STUDENT A student regularly attending school for the number of hours the school
considers half-time.
HEALTH
INSURANCE An insurance policy that pays money because the insured person has a
medical expense. Long term care insurance is considered health
insurance. It does not matter if the money will be paid to the insured
person or to the provider of the medical service (e.g., nursing home).
Comprehensive health insurance covers at a minimum inpatient and

outpatient hospital services, laboratory, x-rays, pharmacy and physician
services.The following are not health insurance:
• An insurance policy which pays a flat rate without regard to actual

charges or expenses (sick and accident Insurance).

GLOSSARY
• An insurance policy which pays just because a person is unable to

work (e.g., State Employee's Long-Term Disability and Income
Protection Benefit Plan).
• Automobile insurance, even though it may cover medical

expenses.
HEARING The process whereby clients who are dissatisfied with an DHS or DCH
action may appeal the action to DHS Administrative Hearings or DCH
administrative tribunal.
Related Terms: Administrative Hearing, Administrative Review, Pre-

hearing Conference.
HEARING
DECISION The decision of an administrative law judge to uphold, modify or
reverse a department action(s) or, as a result of a disqualification hear-
ing, the administrative law judge's decision whether or not a person has
committed IPV.
Related Terms: Administrative Hearing, Debt Collection Hearing, Dis-

qualification Hearing, Hearing.
HEARINGS
COORDINATOR A hearings coordinator is a person in the local DHS office who is
responsible for logging, routing, and monitoring all hearing requests.
Refer to BAM 600, Hearings for more information.
Related Terms: Administrative Hearing.
HEAT AND UTILITY

STANDARD An amount for heat and utilities, established by policy, that is used in
determining the total shelter expense of a FAP group.
Related Terms: Shelter Expense.
HEAT/UTILITY
ARREARAGE
AGREEMENT An agreement signed by the client to pay a heat or electric arrearage to
the utility company via the arrearage vendoring process.
HMO Health Maintenance Organization.
HOME The structure in which a person lives (i.e., keeps his personal belong-
ings and sleeps), which generally contains sleeping, cooking and bath-
room facilities.
Related Terms: Homestead.
HOME CALL An in-person interview between a specialist and a client outside of the
local DHS office.
GLOSSARY
Related Terms: Collateral Contacts, In-Person Interview, Interview.
HOME EQUITY LINE

OF CREDIT A revolving line of credit in which the home serves as collateral. Also
referred to as HELOC.
HOME HELP
SERVICES Personal care provided for the client in the client's home.
Related Terms: Personal Care Services.
HOMELESS Persons that do not reside in a permanent dwelling or have a fixed mail-
ing address. A homeless person is an individual who lacks a fixed and
regular nighttime residence or whose nighttime residence is:
• A supervised public or private shelter designed to provide tempo-

rary accommodations for the homeless.
Exception: For FAP, a client is considered homeless only for the

first 90 days.
• A halfway house or similar accommodation which provides a tem-

porary residence for individuals released from institutions.
• Home of another person.

first 90 days.
• Place not designed or ordinarily used as a dwelling (e.g., building

entrance or hallway, bus station, park, campsite, vehicle).

first 90 days.
HOMELESS MEAL
PROVIDER A state approved public or private nonprofit establishment which feeds
homeless people. Any individual or organization may request FNS
authorization to accept food assistance benefits for payment of meals to
the homeless. Upon request, local offices must assist such individuals
or groups by verifying their tax exempt status, certifying that they pro-
vide meals to the homeless, providing them with a letter for FNS stating
that the above requirements are met, and directing them to the regional
FNS office for a formal application.
HOMESTEAD The place that a person owns (or is buying) where he usually lives. The
homestead includes all adjoining property.
HOSPITAL A facility (including any psychiatric ward of the facility) that is licensed
by the Department of Community Health and that offers inpatient medi-

GLOSSARY
cal care and services. (A long-term care facility and a facility operated
by the Department of Community Health are not considered hospitals.)
ICF/MR Intermediate Care Facility for the Mentally Retarded.
IMMIGRATION
STATUS The classification given by the United States Citizenship and Immigra-
tion Services (USCIS) for aliens and refugees admitted into the U.S.
Related Terms: Alien, Refugee.
IMPAIRMENT A condition resulting from anatomical, physiological or psychological

damage which can be demonstrated by medically acceptable clinical
and laboratory diagnostic techniques. This can range from mild to
severe.
INA Immigration and Nationality Act.
INCOME Benefits or payments measured in money.
INCOME LIMIT The maximum amount of net income that the group can have and
establish eligibility for or remain eligible for program benefits.
Related terms: Program Benefits.
INCOME MONTH The calendar month, determined by policy, from which income informa-
tion is used in determining eligibility for or level of program benefits.
INCOMPETENT
PERSON A person who has been adjudicated by a probate court as unable or
unfit to manage his own affairs.
INDEPENDENT
LIVING An SDA/AMP recipient not residing in an SLA, or a client residing in a
county infirmary who is not certified for domiciliary or personal care.
Related Terms: Special Living Arrangements.
INDICATED OR
DEMONSTRATED A
DISABILITY Information in the recipient’s current Medicaid eligibility case file shows
the recipient has alleged a serious mental or physical impairment or
injury. A condition, impairment, or injury will not be considered “serious”
if information in the case file shows it is so minor it cannot reasonably
be expected to interfere with the individual’s mental or physical func-
tioning, or cannot reasonably be expected to last more than a year, or
to result in death.
An individual who has indicated or demonstrated a disability may or

may not, following a disability review, be determined to meet the defin-

GLOSSARY
tion of disability used to determine eligibility for Medicaid under SSI-

related disability based Medicaid TOAs.
IINDIVIDUAL ID A ten digit number used to identify each client in legacy systems as well
as Bridges.
INELIGIBLE
GRANTEE The person who acts as grantee but who is not an eligible group mem-
ber. In Bridges terms, this means the payee/applicant who is not a
member of the Certified Group.
Related Terms: Grantee, Specified Relative.
IN-HOME CHILD
CARE Care provided in the home where the child(ren) lives by a DHS-enrolled
Day Care Aaide exempt from regulation by the Bureau of Children and
Adult Licensing. (The entire migrant camp, licensed by the Michigan
Department of Public Health, pursuant to P.A. 368 of 1978, shall be
considered as the child’s own home.)
INITIAL
APPLICATION The most recent application used to establish eligibility at the time any
currently active assistance program was opened.
Related Terms: Determination of Eligibility.
INITIAL ASSET
ASSESSMENT A determination of the total amount of countable assets owned by a cli-
ent and/or his spouse as of the day of the first continuous period of care
that began on or after 9-30-89.
IN-PERSON
INTERVIEW A face-to-face conversation with another person in which information is
obtained.
Related Terms: Collateral Contact, Interview, Home Call.
INSTITUTION An establishment which furnishes food, shelter and some treatment or

services to more than three people unrelated to the proprietor. For
example: licensed foster care homes, nursing homes, etc.
INSTITUTION OF
HIGHER
EDUCATION A college, junior college, community college, university, vocational or
technical school.
Related Terms: Post-High School Level, Post-Secondary Education

Institution.

GLOSSARY
INSTITUTION FOR
MENTAL DISEASES A hospital, nursing facility, or other institution of more than 16 beds that
is primarily engaged in providing diagnosis, treatment or care of per-
sons with mental diseases.
INTENTIONAL
PROGRAM
VIOLATION (IPV) A benefit overissuance resulting from the willful withholding of informa-
tion or other violation of law or regulation by the client or his authorized
representative.
Related Terms: Benefit Overissuance Determination.
INTER-OFFICE
CLIENT MOVE When a client moves from the jurisdiction of one local office to the juris-
diction of another local office.
INTERSTATE COR-
RESPONDENCE Communication by letter with a person or agency in another state.
INTERVIEW A conversation with another person in which information is obtained.
Related Terms: Collateral Contact, Home Call, In-Person Interview.
INTRA-STATE COR-
RESPONDENCE Communication by letter with a person or agency within the State of
Michigan.
IPV Intentional Program Violation.
Related Term: Disqualified Person(s).
IRREVOCABLE
TRUST A trust that cannot, in any way, be revoked by the grantor, court,
trustee, or any other person or entity.
LEFT NAVIGATION A menu, of possible Bridges actions, on the left side of Bridges data col-
lection screens.
LEGACY SYSTEMS DHS eligibility determination and benefit issuance systems in existence
before Bridges, (ASSIST, CIMS, LOA2).
LEGAL GUARDIAN A person either appointed by a court or designated by a will to exercise

powers over the person of an individual who is less than 18 years of
age or a legally incompetent person.
LEGALLY
INCOMPETENT
PERSON A person over the age of 18 for whom a legal guardian has been
appointed by a court.

GLOSSARY
L/H PATIENT The MA client who was in the hospital and/or LTC facility in an L/H
month. Mr. Jones in the examples below is the L/H patient.
L/H MONTH A calendar month containing:
• At least one day that is part of a period in which a person was (or
is expected to be) in an LTC facility and/or hospital for at least 30
consecutive days, and
• No day that the person was a waiver patient.
Examples:
• Mr. Jones is admitted to an LTC facility on October 5th and is dis-

charged December 1st.
October, November and December are L/H months.
• Mr. Jones is admitted to a hospital October 31st, transferred to an

LTC facility in November and discharged from the LTC facility
December 15th.
October, November and December are L/H months.
• Mr. Jones is admitted to a hospital October 28th and discharged

December 11th. He is approved for the waiver effective December
17th.
October and November are L/H months. Reminder: The Patient

Pay Amount (PPA) is not reduced or removed in the month the
person leaves the facility.
LIHEAP Low Income Home Energy Assistance Program.
LIQUID ASSETS Liquid assets include cash on hand, checking or savings accounts and
savings certificates.
Related Terms: Assets.
LIVE-IN
ATTENDANT A person who lives with a group for the purpose of providing medical,
housekeeping, child care or other similar personal services, for a mem-
ber of the group.
LO Local office.
LOGICAL UNIT OF
WORK Bridges data collection screens are divided into “Logical Units of Work”
(LUW). One LUW may contain multiple tabs across the top of the
Bridges screens. The entire LUW must be completed before the data is
saved to the data base.

GLOSSARY
LONG-TERM CARE
(LTC) LTC means being in any of the following:
• A nursing home that provides nursing care.

• A county medical care facility that provides nursing care.
• A hospital long-term care unit.
• A DCH facility that provides active psychiatric treatment.
• A special MR nursing home.
• A DCH facility for the mentally retarded that provides ICF/MR
nursing care.
A person may receive hospice care in one of these facilities. He is still

considered in LTC.
LTC Long-Term Care.
LUMP SUM A one-time payment that is not an accumulation of monthly benefits.

Examples: Income tax refunds, inheritances, insurance settlements,
injury awards.
Related Terms: Accumulated Benefits.
MAJOR WAGE
EARNER (MWE) The FAP group member (including disqualified members) who:
• Earned the greatest amount of income in the two months before

the month of the noncooperation, provided
• The job involved at least 20 hours per week or earnings of at least

the Federal minimum wage times 20 hours per week.
A person who was NOT in the group when he received the earnings
may be the MWE.
Exception: No person of any age can be considered the MWE/grantee

for purposes of determining an employment-related disqualifica-
tion if:
• There is another person in the FAP group who is an adult who is

registered or exempt, and
• At least one of the adults is a parent of children of any age, or act-

ing as a parent for a child under 18, in the FAP group.
MANDATORY FEES An educational expense that all students in a certain curriculum must
pay, e.g., uniforms, lab fees and equipment fees required for a chemis-
try course.
Related Terms: Educational Expense.

GLOSSARY
MANDATORY
PARTICIPANT A FIP applicant or recipient who must, unless temporarily deferred, ful-
fill the federal work participation requirement through employment,
school attendance and/or participation in Work First (or equivalent con-
tracted activities in a tribal, refugee or transitional housing program).
Related Terms: Work First.
MANUAL
CORRESPONDENCE Notices/forms available for the specialist to initiate in Bridges when
needed.
Related term: System-generated correspondence.
MCI Master Client Index. This is a database containing data on all clients
known to legacy systems. It is used in converting cases/clients to
Bridges, and preventing issuance of multiple individual ID’s.
MEDICAL GROUP The persons whose health insurance and medical expenses may be
considered in determining MA eligibility.
MEDICAID (MA)
ELIGIBILITY CASE
FILE All written information received or maintained electronically in the eligib-
lity determination system or in hard copy by the worker at any time in
the last 24 months, including all information available regarding all SSI
or SSDI claims and including any information in the MRT packet.
MEDICAL REVIEW
TEAM (MRT) The Medical Review Team (MRT), composed of a physician and a
medical consultant, certifies the client’s medical eligibility for assis-
tance.
MEMBER ADD The process by which a person not currently a member of an eligible
group is added to an existing eligible group and a determination of eligi-
bility is made for the new group.
MICSES Michigan Child Support Enforcement System. Office of child support

system with which Bridges exchanges data.
MIGRANT A person who:
• Works or seeks work in agriculture or a related seasonal industry,

and
• Moves away from his usual home to a temporary residence as a

condition of employment or because the distance from his usual
home is greater than 50 miles.
Migrant status continues as long as the migrant:

GLOSSARY
• Is employed in agriculture or a related seasonal industry, or

• Has a commitment of employment or is actively seeking employ-
ment.
Migrant status continues for 30 days from the date the migrant last
worked in an agricultural activity or entered Michigan whichever is more
recent.
Exception: Migrant status continues beyond 30 days when:
• Legal circumstances require a migrant to remain in the area (e.g.,

labor relations dispute, immigration, incarceration), or
• Illness or hospitalization prevents a migrant from leaving the area,

or
• Unusual agricultural circumstances affect farm work or crops in

Michigan or the migrant's home base (e.g., weather conditions or
natural disasters, etc.).
MIGRANT
RECRUITER A migrant recruiter is a person who works for a child care center who
has a written agreement with DHS to accept a CDC application on
behalf of the department.
Related Terms: Migrant.
MINOR PARENT A person under age 18 who is not emancipated and is either the parent
of a dependent child living with him/her or pregnant.
Related Terms: Teen Parent.
MMIS Michigan Medicaid Information System. Bridges interfaces with this

DCH system to exchange information about our clients.
MODEL PAYMENTS
SYSTEM (MPS) An on-line system which makes payments to certain providers who fur-
nish services to DHS clients. The following payments are made by
MPS:
• Home help services.

• SDA special living arrangements.
• AFC/HA personal care/supplement payments.
The provider must be enrolled as an MPS provider, the care or service

must be authorized and the provider must submit a billing to central
office to receive payment.
Heat and electric providers and shelter providers who receive vendored
shelter payments are enrolled on the MPS provider file, but payments
are made by the vendor payment system, not by MPS. Child Care pro-
GLOSSARY
viders are also enrolled on the MPS provider file, but payments are
made by the child care payment system, not by MPS.
Related Terms: Provider, Provider ID Number.
MONEY
MISMANAGEMENT Budgeting habits which result in money designated for basic living
expenses, e.g., food or shelter, not being used to meet these needs.
MONTH OF
APPLICATION The calendar month in which an application or DHS-1171-F, Filing Doc-
ument, is received by the local office.
Related Terms: Application, Application Date.
MPS Model Payments System.
MRT See: Medical Review Team.
MSWC Medical Social Work Consultant.
NEGATIVE ACTION An action taken by DHS to deny an application or to reduce or terminate

a benefit.
Related Terms: Positive Action.
NEGATIVE ACTION
DATE The current date plus 12 days.
If the 11th day falls on a weekend or holiday, the date is the first subse-
quent date preceded by a workday.
Related Terms: Effective Date.
NONFINANCIAL
ELIGIBILITY
FACTORS All eligibility factors except income and assets.
Related Terms: Eligibility Factor(s), Financial Eligibility Factors.
NONPROFIT
GROUP LIVING
FACILITY Facilities with nonprofit (tax exempt) status under the Internal Revenue
Code that are either a substance abuse treatment center, an adult fos-
ter care home or a shelter for battered women and children.
Related Terms: Adult Foster Care Home, Substance Abuse Treatment

Center.

GLOSSARY
NON-QUALIFIED
EXPENSE An allowable medical expense used to meet a deductible but not bill-
able to MA. Such expenses include those incurred:
• For services not covered by MA, and

• By fiscal or medical group members who are not eligible for MA
coverage.
OI Overissuance.
OUT-OF-HOME
CHILD CARE Care provided outside the child’s own home in regulated child care
facilities including family child care homes, group child care homes, and
child care centers.
OVERISSUANCE Issuance of more benefits than the eligible group is entitled to receive.
OVERLAPPING OF
NEGATIVE
ACTIONS The process of initiating one or more negative actions prior to the end
of the first negative action period, when the negative actions have dif-
ferent negative action effective dates and/or codes.
Related Terms: Negative Action, Pend Period, Pending Negative

Action.
PAGE HELP In Bridges, information about an individual data collection screen that is
accessed by clicking on the question mark icon.
PARENT FIP, MA, FAP
In FIP and MA, a person who has a legal duty to provide parental sup-
port to the child because the person:
• Gave birth to the child, or
• Was married to the woman who gave birth to the child at the time
of the child's conception or birth, or
• Legally adopted the child, or
• Had his legal duty to support the child established by paternity

action or acknowledgment and the legal duty has not been perma-
nently terminated by a court order.
PAST-DUE
AMOUNTS An unpaid expense for a period of time prior to the period of time cov-
ered by the current expense.
PAST MONTH Any calendar month for which MA eligibility is being determined that is
before the processing month.

GLOSSARY
Example:
January 28 - Application date. Application also made for the 3 retro MA

months.
March 5 - Processing date.
Past months are:
• October, November and December (retro MA months), and

• January and February (months during the current period that are
before the March processing month.
Related Terms: Future Month, Processing Month.
PATIENT-PAY
AMOUNT (PPA) The monthly amount of a person's income which Medicaid considers
available for meeting the cost of hospital or LTC services. Medicaid
reduces its payment to the hospital/LTC facility by the patient-pay
amount.
There are different types of PPAs: hospital, LTC and post-eligibility.

Hospital PPAsand LTC PPAs are used to establish income eligibility
(see BEM 545). A post-eligibility PPA is determined only after MA eligi-
bility is established. for an L/H patient (see BEM 546). A person can
have only one type of PPA for any given calendar month.
Related Terms: Co-payment; Deductible.
PAY PERIOD A semi-monthly period from the 1st of the month through the 15th or
from the 16th through the last day of the month, for which cash benefits
are paid.
PAYMENT
STANDARD FIP, SDA, RAP
The established need amount based on eligible group size which is

compared to the program group’s countable income, when determining
eligibility.
In Bridges terms: The established need amount based on certified

group size which is compared to the countable income of EDG mem-
bers with an EDG participation status of eligible or disqualified, when
determining eligibility.
PEND PERIOD The period between the date a negative action is initiated and the date
the negative action becomes effective during which the eligible group
has an opportunity to react to the proposed action.
Related Terms: Negative Action, Overlapping of Negative Actions,

Pending Negative Action, Timely Notice.
GLOSSARY
PENDING
NEGATIVE ACTION A negative action that is scheduled to be effective on a later date.
Related Terms: Negative Action, Pend Period, Timely Notice.
PERMANENT
DISABILITY A condition which is not expected to improve, certified by a physician.
PERSONAL CARE
CO-PAYMENT Group 2 MA excess income that is paid directly to a personal care ser-
vices provider by clients who meet all the criteria in BEM 545, Exhibit II.
Related Terms: Deductible Amount, Deductible Case, Deductible

Period, Patient-Pay Amount.
PERSONAL CARE
SERVICES Assistance that is provided to a person who needs help in performing
his own personal daily activities (e.g., eating, grooming, medication,
shopping, laundry, cooking).
Related Terms: Adult Foster Care Home, Home Help Services.
PERSONAL
RESPONSIBILITY
PLAN AND FAMILY
CONTRACT
(PRPFC) The Personal Responsibility Plan and Family Contract (PRPFC), DHS-
4783, is a two-part case management tool completed by the client and
the FIS to mutually arrive at a plan which helps the family reach its
goals for self-sufficiency. The plan outlines the family’s goals, strengths,
needs, options, and steps to take to reach those goals. It also highlights
department actions to support the family’s goals, such as contacting
other agencies, making referrals, and advocating for the family.
PHYSICALLY AND
MENTALLY
CAPABLE A person who does not appear to be limited by physical or mental
impairment which could cause an inability to understand and perform
the person's reporting responsibilities.
Related Terms: Impairment, Intentional Program Violation.
POLICY
EXCEPTION An instruction given by DHS or DCH central office staff to apply a spec-
ified policy in an identified case when the policy to be applied is different
than, or is not covered by, existing written policy.
Related Terms: Policy Interpretation.

GLOSSARY
POLICY
INTERPRETATION An explanation provided by DHS or DCH central office staff regarding
the application of existing policy.
Related Terms: Policy Exception.
POSITIVE ACTION An action taken by the department to approve an application or

increase a benefit.
Related Terms: Negative Action.
POSITIVE BILL
PROVIDER A child day care provider who must bill DHS for care provided to DHS-
funded children in order to receive payment.
POST-HIGH
SCHOOL LEVEL The level of education after graduation from high school.
Related Terms: Institution of Higher Education.
POST-SECONDARY
EDUCATION
INSTITUTION A public or private educational institution which admits persons who are
beyond the age of mandatory school attendance. The institution must
be legally authorized by the state to provide an educational program
beyond secondary education or to provide a program of training to pre-
pare students for gainful employment.
POWER OF
ATTORNEY An instrument authorizing another to act as one’s agent or attorney. The
agent is attorney in fact and his power is revoked on the death of the
principal by operation of law. Such power may be general or special.
PPA Patient-Pay Amount.
PREHEARING
CONFERENCE A meeting between the client, Authorized Hearings Representative
(AHR) and appropriate local office staff to discuss the reason for the
hearing request and the department's basis for its action.
Related Terms: Authorized Hearings Representative, AHR.
PRIMARY
CAREGIVER A person, other than the child's parent, who functions as a parent for
the child.
Related Terms: Parent.
PRINCIPAL The assets in a trust. The assets may be real property or personal prop-
erty.

GLOSSARY
PROCESSING DATE The date the specialist determines eligibility.
PROCESSING
MONTH The calendar month during which the specialist determines MA eligibil-
ity.
Related Terms: Future Month, Past Month.
PRODUCER A person required to be licensed under the laws of this state to sell,
solicit, or negotiate insurance.
PROGRAM (FIP/
SDA/MA/AMP/FAP)
BENEFITS All client benefits administered by DHS in the form of cash, mihealth
card, food assistance, vendor payments, etc.
Related Term: MA card replaced by mihealth card April 2003.
PROGRAM GROUP Those persons living together whose income and assets must be
counted in determining eligibility for assistance.
Related Term: Eligible Group, Fiscal Group, Qualified Group.
PROTECTIVE
PAYEE A person who receives warrants, mihealth cards and other systems-
produced correspondence that would otherwise go to the eligible group.
This person was formerly referred to as the third party payee.
PROVIDER A person or agency that furnishes a service to a client. May also be

referred to as a vendor.
Related Terms: Provider Payment, Provider ID Number.
PROVIDER ID
NUMBER A seven-digit number assigned to a provider enrolled in the Model Pay-
ments System. This number is also referred to as a vendor number.
MA
A seven-digit number assigned to an MA-enrolled provider.
Related Terms: Provider, Model Payments System, Tax Identification

Number.
PROVIDER
PAYMENT A DCH payment (for covered medical services to a client) made directly
to a provider enrolled in the MA program.
A DHS payment for SDA special living arrangement care made to a

facility enrolled as a provider in the Model Payments System.

GLOSSARY
Child Development and Care payments are also issued directly to the
provider, except for day care aide payments which are issued in the
name of the client and provider.
Related Terms: Vendor Payment.
PRT Program Reference Tables, obsolete 6/30/2007. Tables moved to Ref-

erence Tables (RFT)
Related Terms: Reference Tables (RFT).
PSYCHIATRIC
FACILITY FIP, SDA, MA
An institution primarily engaged in diagnosing or caring for persons with

mental disease. It may be privately operated or operated by the govern-
ment. It does not include the psychiatric ward of a hospital.
PURSUIT OF
BENEFITS To apply for, and try to make available, income and assets for which a
person may be eligible.
QUALIFIED GROUP The person or persons living together who meet all of the required non-
financial eligibility factors.
Related Terms: Disqualified Person(s), Eligible Group, Fiscal Group,

Program Group.
REAL PROPERTY Land and objects affixed to the land, such as buildings, trees, and
fences. Condominiums are real property.
RECIPIENT A person(s) receiving program benefits.
Related Terms: Beneficiary, Client.
RECOUPMENT The process by which DHS recovers an overissuance of program bene-

fits.
RECOUPMENT
AGREEMENT A written agreement signed by a client to repay overissued program
benefits.
REDETERMINATION FIP
The periodic case review which focuses on self-sufficiency issues and

fulfillment of the Personal Responsibility Plan and Family Contract, and
which also reestablishes the group's eligibility.

GLOSSARY
SDA, MA, AMP, FAP
The periodic, thorough re-evaluation of all eligibility factors to determine

if the group continues to be eligible for program benefits.
REDETERMINATION
MONTH The month in which the redetermination process is scheduled for com-
pletion.
REFUGEE A person who has been admitted into the U.S. with an immigration sta-
tus of refugee, asylee, parolee, conditional entrant, Cuban/Haitian
Entrant, Amerasian or victim of trafficking.
Related Terms: Alien, Immigration Status.
REFUSAL TO
COOPERATE Having the ability to comply with a required action but choosing not to
comply.
Related Terms: Failure to Cooperate.
REGULAR
ASSISTANCE
WARRANTS The semi-monthly checks received by recipients.
REGULARLY
ATTENDING Attendance at all scheduled class meetings except for excused or
acceptable absences as allowed by the school.
Related Terms: Institution of Higher Education, Secondary School, Stu-

dent.
REINSTATEMENT Restoring a closed program to active status without a new application

form for specific reasons, as defined by policy.
RELATIVE CARE
PROVIDER A relative care provider is an individual, who is at least 18 years old,
enrolled by the local DHS to provide care for up to 4 children, unless the
children are siblings or migrant children, and related to the child need-
ing care by blood, marriage, or adoption as a:
• Grandparent/step-grandparent.
• Great grandparent/step-great-grandparent.
• Aunt/step-aunt/great-aunt/step-great-aunt.
• Uncle/step-uncle/great-uncle/step-great-uncle.
• Sibling/step-sibling.
Care is not provided in the home where the child(ren) lives. Relative
care providers must provide the care in their own home, and must not

GLOSSARY
live in the same home as the child. A divorce severs/terminates a rela-

tionship gained through marriage.
RELEASE OF
INFORMATION • A DHS employee's verbal or written statements attesting to a cli-
ent's name or amount of a benefit which is furnished to an inquirer
under specific procedures as described in policy, or
• A client's written permission for DHS to obtain information from an

outside party or to provide information to an outside party.
Related Terms: Confidentiality.
REOPENING Returning an inactive program to active status when a new or updated

application form is required and the program cannot be reinstated.
REPAY
AGREEMENT • A written obligation signed by the client to repay program benefits
when a specified source of income is received, or
• Shelter and/or utility deposit agreements which are signed by

landlords or utility companies.
REPLACEMENT OF
PROGRAM
BENEFITS The process of providing the eligible group with a replacement for war-
rants, checks, food and cards which have been reported lost,
destroyed, damaged, not received or stolen. MA cards can be replaced
by contacting DCH at 1-800-642-3195.
REPORTED SSN A social security number (SSN) provided by a client when Bridges
determines that the SSN is already being used by another client, Enter
reported number in this data collection screen field until the duplicate
SSN can be resolved.
REPRESENT Represent means to present the administrative hearing case for the cli-
ent, in whole or in part, by questioning witnesses, offering exhibits and
making legal arguments.
Related Terms: Administrative Hearing, Authorized Hearings Represen-

tative (AHR).
REQUEST FOR
ASSISTANCE Any contact (by telephone, in person or by mail) with the local office in
which a person states that he wishes to apply for program benefits on
behalf of himself or someone else.
Related Terms: Authorized Representative.

GLOSSARY
RESPITE CARE Day care provided for the sole purpose of relieving the caretaker of
child care responsibilities in order to reduce stress.
Note: The Child Development and Care Program does not pay for
respite care.
RESTRICTED
PAYMENTS Payments made to someone other than the client in the form of vendor
payments or third party payments, because of third party resource dis-
qualification or money mismanagement.
Related Terms: Third Party Payments, Vendor Payments.
RETRO MA • The first, second, or third calendar month prior to the most recent
application for MA or FIP.
• The first, second or third calendar month prior to entitlement for

SSI or title IV-E.
• The first, second or third calendar month prior to the date the court
order was received by DHS for department wards.
RETROACTIVE
BENEFIT Any client benefits in the form of retroactive MA, cash assistance or
food assistance issued to cover a period from the beginning date of eli-
gibility up to the first regular food or cash assistance benefit or early
payment
REVOCABLE
TRUST A trust that can, under state law, be revoked or modified by the grantor,
court, the trustee, or any other person or entity. This includes a trust
that allows for revocation or modification only when a change occurs,
such as the grantor leaves the LTC facility or the client becomes com-
petent.
RFT Reference Tables (RFT).
ROOMER An individual(s) who pays for lodging but not meals and who is not fur-
nished meals.
Related Terms: Independent Living, Rooming House.
ROOMING HOUSE An establishment that rents, for lodging, rooms without private,
unshared kitchens and bathrooms and that does not provide the ten-
ants meals.
Related Terms: Roomer.
RR Railroad Retirement.
RSDI Retirement, Survivors, and Disability Insurance.

GLOSSARY
RUN EDBC A Bridges command that when selected initiates the process of deter-
mining program eligibility and benefit level, after data collection has
been completed.
SATC Substance Abuse Treatment Center.
SATISFACTORY
IMMIGRATION
STATUS Those immigration statuses that meet the eligibility criteria for the pro-
gram requested.
SDV Senior/Disabled/Disabled Veteran Member.
Related Terms: Senior, Disabled, Disabled Veteran.
SDV (SENIOR/
DISABLED/
VETERAN)
MEMBER A person who is senior, disabled, a disabled veteran or certain disabled
relatives of veterans.
Related Terms: SDV, Senior, Disabled, Disabled Veteran.
SDX State Data Exchange.
SEASONAL
FARMWORKER A person who:
• Works in agriculture or a related seasonal industry, and

• Is NOT required to be absent overnight from his permanent place
of residence.
SECONDARY
SCHOOL Junior high school, high school or other equivalent level of cooperative
or apprenticeship training.
SENIOR A person who is 60 years of age or older.
SENIOR IMPAIRED FAP
A senior person who meets the definition of disabled and who is unable
to purchase and prepare meals
SGA See: Substantial Gainful Activity.
SHELTER EXPENSE The amount of money that must be paid for the home for rent or for a
mortgage or land contract or for condominium or cooperative housing
fees, property taxes, home insurance and special assessments.
SHRT See: State Hearings Review Team.

GLOSSARY
SLA See: Special Living Arrangements.
SOP See: Standard of Promptness.
SPECIAL LIVING
ARRANGEMENTS
(SLA) Commercial residences and living facilities where sleeping accommo-
dations and all meals are furnished.
Related Terms: Independent Living.
SPECIAL
TRANSPORTATION Transportation for medical purposes other than by private motor vehi-
cle, e.g., ambucab.
SPONSOR OF AN
ALIEN A person who signed an affidavit or other statement accepted by the
United States Citizenship and Immigration Services (USCIS) as an
agreement to support an alien as a condition of the alien's admission
for permanent residence in the U.S.
SPONSORED
ALIEN An alien whose sponsor's income and assets must be considered in
determining the eligibility of the alien.
SPONSORED
ALIEN'S ENTRY
DATE The date established by the United States Citizenship and Immigration
Services (USCIS) as the date the sponsored alien was admitted into
the U.S. for permanent residence.
SRT See: State Review Team.
SSA Social Security Administration.
SSB Social Security Benefits.
Related Terms: RSDI.
SSI See: Supplemental Security Income.
SSI RECIPIENT Person receiving (or eligible for, as determined by SSA) an SSI benefit
issued by SSA.
SSI-RELATED MA Those Medicaid categories in which eligibility depends on a person

being aged (65 or older), blind, disabled or entitled to Medicare, or for-
merly blind or disabled.
SSN Social Security number.

GLOSSARY
STANDARD
DEDUCTION An amount, established by policy, that is subtracted from the countable
income of FAP groups.
Related Terms: Countable income, Eligible Group, Qualified Group.
STANDARD OF
PROMPTNESS
(SOP) The number of days (as prescribed in each program's policy) which a
local office is allowed for completing a determination of eligibility and/or
other case action.
Related Terms: Application Date, Approve, Denial, Determination of Eli-

gibility.
STATE HEARINGS
REVIEW TEAM
(SHRT) State Hearing Review Team (SHRT), located in the Disability Determi-
nation Service (DDS), is responsible for reviewing MRT or SRT deci-
sions that are contested by the client.
STATE REVIEW
TEAM (SRT) The State Review Team (SRT), composed of an ophthalmologist and a
designated medical consultant, certifies blindness for medical eligibility.
STARTING INCOME Income that is received for the first time and that is expected to con-
tinue indefinitely.
STATE SSI
PAYMENTS (SSP) State-funded payments issued quarterly by DHS to federal SSI recipi-
ents in independent living or household of another.
Related Terms: SSI, SSI Recipient.
STOPPED INCOME Income that was being received on a continuing basis but which will no
longer be received.
STRIKE A concerted stoppage, slowdown or interruption of work activities or

employment operations by employees (including a stoppage by reason
of the expiration of a collective- bargaining agreement).
STUDENT A person enrolled in and regularly attending a school.
Related Terms: Institution of Higher Education, Regularly Attending,

Secondary School.

GLOSSARY
SUBSTANCE
ABUSE
TREATMENT
CENTER (SATC) A special living arrangement which provides a complete program for the
treatment of addiction to drugs and/or alcohol.
Related Terms: Special Living Arrangement, SATC.
SUBSTANTIAL
GAINFUL ACTIVITY
(SGA) The performance of significant duties over a reasonable period of time
for remuneration or profit or engaging in work of a type generally per-
formed for remuneration or profit. Caring for one's self or one's house-
hold does not, in and of itself, constitute substantial gainful activity.
SUPPLEMENTAL
PROGRAM
BENEFITS Benefits authorized to correct underissuances in specific situations pre-
scribed in program policy.
SUPPLEMENTAL
SECURITY INCOME
(SSI) A cash benefit to needy aged, blind and disabled persons. In Michigan,
SSI benefits include a basic federal benefit and an additional amount
paid with state funds. SSA issues the:
• Basic federal benefit to all SSI recipients, and

• State-funded benefit to SSI recipients in AFCs, homes for the aged
and institutions.
DHS issues the state-funded benefit (state SSI payment) to SSI recipi-
ents in independent living and household of another.
Related Terms: SSI Recipient, State SSI Payments.
SUPPORT ACTION All of the activities required to obtain child support for an eligible child
from an absent parent.
Related Terms: Certified Support, Child Support, Parent.
SUPPORT-
DISQUALIFIED Ineligibility for program benefits because of failure or refusal to cooper-
ate in pursuing support action.
Related Terms: Disqualified Person(s), Failure to Cooperate, Refusal to

Cooperate, Support Action.

GLOSSARY
SYSTEM
(GENERATED)
CORRESPONDENCE Notices/forms that are produced by Bridges without the specialist
action.
TAX
IDENTIFICATION
NUMBER The federal employer identification number, Michigan temporary identi-
fication number, or social security number of a provider. The tax identifi-
cation number is used to enroll providers on the Model Payments
System (MPS). A seven digit provider ID number is assigned by MPS
upon enrollment.
Related Terms: Provider, Provider ID Number, Model Payments Sys-

tem.
TECHNICAL
COURSE A program that provides training in a specific trade or occupation and
awards the student a training certificate upon successful completion of
the course.
Related Term: Vocational Course.
TEEN PARENT A person under age 20 who is the parent of a dependent child living
with him/her or who is pregnant.
Related Terms: Minor Parent.
TEMPORARY
INELIGIBILITY Suspension of program benefits if the ineligibility is likely to exist only
for one or two months and the ineligibility is due to reasons specified in
policy.
THIRD-PARTY
PAYEE A person who receives warrants, mihealth cards and other systems-
produced correspondence that would otherwise go to the eligible group.
This person is now referred to as the protective payee.
Related Terms: MA card replaced by mihealth card April 2003.
THIRD-PARTY
PAYMENT Payment of the FIP/SDA/RAP grant to a protective payee.
Related Terms: Protective Payee, Restricted Payments, Vendor Pay-

ments.
THIRD-PARTY
RESOURCE An individual or entity that is or may be liable for all or part of a client's
medical expenses.

GLOSSARY
Related Terms: Health Insurance.
TIMELY NOTICE An adequate notice which is mailed at least 11 days prior to the effec-
tive date of an intended negative action.
Related Terms: Adequate Notice, Negative Action, Pending Negative

Action.
TIMELY HEARING
REQUEST DATE The date by which an Administrative Hearing request must be received,
to continue receipt of program benefits until a hearing decision is
issued. It is the last workday, prior to the negative action effective date.
TIMELY
REAPPLICATION
DATE Date by which the eligible group must submit an application to have its
eligibility for FAP redetermined without an interruption of program bene-
fits.
Related Terms: Application, Program Benefits, Redetermination.
TRAFFICKING The buying or selling of FAP benefits for cash or consideration other
than eligible food.
TRAINING
PROGRAM A program providing education and/or instruction for the purpose of
preparation for employment.
TREATMENT PLAN Medical treatment and rehabilitation services which will help a person
overcome the effects of impairment and improve the person's ability to
support and provide care for himself and/or others.
TRUSTS Any arrangement in which a grantor transfers property to a trustee with

the intention that it be held, managed, or administered by the trustee for
the benefit of the grantor or certain designated persons. The trust must
be valid under state law and manifested by a valid trust instrument or
agreement. This includes any legal instrument or devise that is similar
to a trust.
Related Terms: irrevocable trust, revocable trust, annuity.
TRUSTEE The person who has legal title to the assets and income of a trust and
the duty to manage the trust for the benefit of the beneficiary.
TWO-PARENT
FAMILY All Family Independence Program cases with two adults receiving
assistance. This includes cases in which a child is living with caretaker
relatives. The only exception is when one of the adults is deferred from
employment-related activities with an Employment code of NC, NS, or
DQ code A. See BEM 230A.

GLOSSARY
TYPE OF
ASSISTANCE (TOA) A subsection of Bridges programs that can be requested. E.g., When
the Bridges user indicates the client’s cash program request status is
‘yes,’ Bridges evaluates eligibility for each type of cash assistance.
UNEMPLOYMENT
BENEFITS Unemployment insurance benefits are administered by the Unemploy-
ment Insurance Agency (UIA) within the Department of Labor & Eco-
nomic Growth (DLEG). Unemployment benefits were formerly known
as unemployment compensation benefits (UCB). Disaster unemploy-
ment assistance (DUA) are also administered by UIA.
UNIFORMED
SERVICE The U.S. Army, Navy, Air Force, Marine Corps, Coast Guard and
National Guard and the National Oceanographic and Atmospheric
Administration and the Public Health Service of the U.S.
UNIT A unit of care is defined as one hour of care.
USCIS U.S. Citizenship and Immigration Services.
UNSUITABLE
EMPLOYMENT A job that is inappropriate for one of the reasons specified in policy and
for which good cause would be found for quitting.
UTILITY ONLY
STANDARD An amount for utilities, established by policy, that is used in determining
the total shelter expense of an FAP group. To qualify for the utility only
standard a combination of two of these is required: water, non-heat
electric and/or telephone.
Related Terms: Shelter Expense.
VA Department of Veterans Affairs.
VCL Verification Checklist. DHS-3503.
VENDOR PAYMENT A payment made by DHS directly to a person or company providing a

service other than medical (e.g., shelter, utilities, home repairs) to the
client.
Related Terms: Provider Payment.
VERIFICATION
CHECKLIST A DHS form telling clients what is needed to determine or redetermine
eligibility.
VERIFY Document or action taken, that provides evidence establishing the

accuracy of statements in the case record.
Related Terms: Document, Documentary Evidence.

GLOSSARY
VOCATIONAL
COURSE A program that provides training in a specific trade or occupation and
awards the student a training certificate upon satisfactory completion of
the course.
Related Term: Technical Course.
WAIVER See BEM 106.
WAIVER PATIENT Person whose month being tested is a waiver month.
WAIVER MONTH Calendar month containing at least one day that the person is (was)
approved for the waiver (see BEM 106). The Extended-Care category
(BEM 164) CANNOT be used if the person's waiver medical approval
date is unknown.
WARRANT A check issued as a regular assistance warrant, a supplemental pro-

gram benefit, or a vendor payment.
Related Terms: Regular Assistance Warrant, Supplemental Program

Benefit, Vendor Payment.
WORK FIRST A program of employment-related activities for mandatory and volun-

teer participants, administered by Michigan Works! Agencies under the
Michigan Department of Labor and Economic Growth.
Related Terms: Mandatory Participant.


Michigan Corrected Mediciaid Final Departmental Review For Crawley Lawsuit

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Michigan Corrected Mediciaid Final Departmental Review For Crawley Lawsuit

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DEPARTMENTAL CLEARANCE/FINAL DEPARTMENTAL REVIEW Author: DCH/Heffron

Michigan Department of Human Services

THIS SECTION COMPLETED BY RECEIVER

DHS-311 (Rev. 5-09) Previous editions obsolete. MS Word

EFFECTIVE July 1, 2010

SUBJECT Ex Parte Reviews of Medicaid Closures

Issued: STATE OF MICHIGAN

TARGETED GROUP Waiver services are covered for MA recipients who:

• Seek or have an expanded Home Help Program exception grant

• Are age 65 or over, or

• At least age 18 and disabled.

WAIVER PROCESS The waiver process includes:

At a minimum, the plan includes:

• Types of services to be furnished; and

• The type of provider to furnish each service.

• The agent conducted the assessment, and

The waiver automatically terminates when the patient enters an LTC

Note: For purposes of MA eligibility, a month remains a waiver month

Eligibility Special MA policies to use in the eligibility determination are:

• A waiver participant is a group of one even when he lives with his

• The Special MA Asset Rules in BEM 402 apply.

• MA divestment policy in BEM 405 applies to waiver participants.

• The extended-care category is available to waiver participants

• Income must be at or below 300% of the SSI Federal Benefit Rate.

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

Note: An ex parte review (see glossary) is required before Medicaid

• A copy of the DHS-3503, Verification Checklist.

The original DHS-3503, DHS-4598, DHS-1175 and DHS-4588 must be

Do not enter waiver service agents in Bridges as a third party type .

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

WAIVER SERVICE AGENTS COUNTIES SERVED

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

WAIVER SERVICE AGENTS COUNTIES SERVED

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

WAIVER SERVICE AGENTS COUNTIES SERVED

Social Security Act, Section 1915

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

• BEM 530, MA Income Budgeting.

Note: An ex parte review (see glossary) is required before Medicaid

• The FIP group includes three generations, or

• The FIP group includes a stepparent with no children of his or her

• The FIP group’s only dependent child is in foster care, or

•• Under age 18, or

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

TMA recipients who become pregnant must be transferred to Healthy

• For individual members, information is reported indicating that a

•• BEM 220, Residence.

If a member loses TMA eligibility during the 12-month period

•• Section A. Address Information.

•• Section C. Information About You and Your Household (com-

•• Section F. Medical Coverage (third party resource liability).

•• Section V. Representative, Guardian, Conservator or Person

•• Section W. Affidavit. The client is to read the affidavit before

Note: An ex parte review (see glossary) is required before Medicaid

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

Redetermination Complete a determination of eligibility for other MA categories and for

Social Security Act, Section 1925, 1931

Medicaid, Adult Medical Program (AMP), Transitional Medical Assistance (TMA/TMA-Plus),

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

If Special N/Support eligibility is lost during the four-month period due to

• Section A. Address Information.

• Section C. Information About You and Your Household (complete

• Section F. Medical Coverage (third party liability).