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BAM 110 2 of 28 APPLICATION FILING AND REGISTRATION BPB 2025-003 1-1-2025

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Response to Requests All Programs For a request in person, the local office must do all of the following: • Give the requester an application the same day. • Explain the right to file the application (or the filling form in the MDHHS-1171, with the minimum information) that day and encourage the client to do so. • Explain that the application date might affect the amount of benefits. Encourage the person to complete the entire application that day. Persons who cannot complete the entire application should com- plete the filing form in the MDHHS-1171, to protect their application date. BAM 105 Rights and Responsibilities lists the minimum information to file an application. The filling form in the MDHHS-1171, is not acceptable for Medicaid. For a request by letter or telephone, mail the application by the end of the next workday. If the application is not returned, the requester must be contacted according to local office procedures. See BAM 105 for the minimum information necessary to register an application. Applicants must be informed of their option to obtain a MDHHS- 1171, Assistance Application, which includes a filing form and program specific supplement form(s) or a DCH-1426, Application for Health Coverage and Help Paying Costs, at www.michigan.gov/dhs-forms. Note: Local offices may register requests for assistance in Bridges; see the Requests section in this item. The applicant may withdraw the request for assistance at any time. CDC Only For a request in person, the local office must: • Give the client the following forms:

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Official source

BAM 110 2 of 28 APPLICATION FILING AND REGISTRATION BPB 2025-003 1-1-2025

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Response to Requests All Programs For a request in person, the local office must do all of the following: • Give the requester an application the same day. • Explain the right to file the application (or the filling form in the MDHHS-1171, with the minimum information) that day and encourage the client to do so. • Explain that the application date might affect the amount of benefits. Encourage the person to complete the entire application that day. Persons who cannot complete the entire application should com- plete the filing form in the MDHHS-1171, to protect their application date. BAM 105 Rights and Responsibilities lists the minimum information to file an application. The filling form in the MDHHS-1171, is not acceptable for Medicaid. For a request by letter or telephone, mail the application by the end of the next workday. If the application is not returned, the requester must be contacted according to local office procedures. See BAM 105 for the minimum information necessary to register an application. Applicants must be informed of their option to obtain a MDHHS- 1171, Assistance Application, which includes a filing form and program specific supplement form(s) or a DCH-1426, Application for Health Coverage and Help Paying Costs, at www.michigan.gov/dhs-forms. Note: Local offices may register requests for assistance in Bridges; see the Requests section in this item. The applicant may withdraw the request for assistance at any time. CDC Only For a request in person, the local office must: • Give the client the following forms: