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BAM 110 4 of 28 APPLICATION FILING AND REGISTRATION BPB 2025-003 1-1-2025

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

ASSET VERIFICATION PROGRAM At the time an application for healthcare coverage is received and declared assets have been entered into data collection, electronic asset detection will be performed. MDHHS will request electronic asset detection by sending the required fields; name, social security number, and address to the asset detection program. This request may occur at any day or time during the month. Asset detection must be completed with all results returned before healthcare coverage may be certified. This process may take up to 10 days. The balance returned by the program for a given account is always as of the first of the month. APPLICATION All Programs The MDHHS-1171 and program specific supplement forms are used for most applications and may also be used for redeterminations; see Redeterminations in this item. The assistance application and program specific supplement forms are available at www.michigan.gov/dhs-forms. Note: An MDHHS-1171 that does not have a program selected, and is not accompanied by a program supplement form, should be considered a request for assistance. CDC Only The MDHHS-1171 and MDHHS-1171-CDC, or the MI Bridges application may be used to apply for CDC. Medicaid The DCH-1426 or FFM application may be used for all MA categories. In addition, the following application may be used for LTC residents, DHS-4574, Medicaid Application for Nursing Facility Patients. The following persons are automatically eligible without complet- ing an application: • Department wards; see Bridges Eligibility Manual (BEM) 117.

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Official source

BAM 110 4 of 28 APPLICATION FILING AND REGISTRATION BPB 2025-003 1-1-2025

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

ASSET VERIFICATION PROGRAM At the time an application for healthcare coverage is received and declared assets have been entered into data collection, electronic asset detection will be performed. MDHHS will request electronic asset detection by sending the required fields; name, social security number, and address to the asset detection program. This request may occur at any day or time during the month. Asset detection must be completed with all results returned before healthcare coverage may be certified. This process may take up to 10 days. The balance returned by the program for a given account is always as of the first of the month. APPLICATION All Programs The MDHHS-1171 and program specific supplement forms are used for most applications and may also be used for redeterminations; see Redeterminations in this item. The assistance application and program specific supplement forms are available at www.michigan.gov/dhs-forms. Note: An MDHHS-1171 that does not have a program selected, and is not accompanied by a program supplement form, should be considered a request for assistance. CDC Only The MDHHS-1171 and MDHHS-1171-CDC, or the MI Bridges application may be used to apply for CDC. Medicaid The DCH-1426 or FFM application may be used for all MA categories. In addition, the following application may be used for LTC residents, DHS-4574, Medicaid Application for Nursing Facility Patients. The following persons are automatically eligible without complet- ing an application: • Department wards; see Bridges Eligibility Manual (BEM) 117.