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MDHHS-1557 (Rev. 12-22) Nondiscrimination The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group on the basis of race, national origin, color, sex, disability, religion, age, height, weight, familial status, partisan considerations, or genetic information. Sex-based discrimination includes, but is not limited to, discrimination based on sexual orientation, gender identity, gender expression, sex characteristics, and pregnancy. Further, MDHHS:  Provides free aids and services to people with disabilities to communicate with us, such as: ▫ Qualified sign language interpreters ▫ Written information in other formats (large print, audio, accessible electronic formats, other formats); and  Provides free language services to people whose primary language is not English, such as: ▫ Qualified interpreters ▫ Information written in other languages If you need these services, contact the Section 1557 Coordinator. The contact information is found below. If you believe that MDHHS has not provided the above services, or discriminated in another way, you can file a grievance with the Section 1557 Coordinator. You can file a grievance by mail, fax, or email. If you need help filing a grievance, the Section 1557 Coordinator is available to help you.  In person or mail: MDHHS Section 1557 Coordinator Compliance Office, Suite 411 PO Box 30037 Lansing, MI 48909  Phone: 517-284-1018 (Main), TTY users call 711  Fax: 517-335-6146  Email: MDHHS-Section-1557@michigan.gov

You can also file a civil rights complaint with the responsible federal agency. If your grievance or complaint is about your Medicaid application, benefits or services you can file a civil rights complaint with the U.S. Department of Health and Human Services at https://bit.ly/2pBS4YG, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at https://bit.ly/2IKsHMS. If your grievance or complaint is about your application for or current food assistance benefits, you can file a discrimination complaint with the U.S. Department of Agriculture (USDA) Program by:

Completing a Complaint Form, (AD-3027) found online at: https://bit.ly/2g9zzpU or at any USDA office, or write a letter addressed to USDA at the address below. In your letter, provide all the information requested in the form.

To request a copy of the complaint form, call 866-632-9992. Send your completed form or letter to USDA by mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410

Fax: 202-690-7442; or Email: program.intake@usda.gov

MDHHS is an equal opportunity provider.