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BAM 115 1 of 36 APPLICATION PROCESSING BPB 2026-003 2-1-2026
BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
DEPARTMENT POLICY Family Independence Program (FIP), State Disability Assis- tance (SDA), Refugee Cash Assistance (RCA), Medicaid (MA) Magi-Related, SSI-Related MA, Refugee Medical Assistance (RMA), Child Development and Care (CDC), and Food Assis- tance Program (FAP) All Programs Individuals must complete and sign one of the following application forms: • MDHHS-1171, Assistance Application, and program specific supplement form(s): MDHHS-1171-CASH, Supplement-Cash Assistance. MDHHS-1171-CDC, Supplement-Child Development and Care. MDHHS-1171-HCC, Supplement-Health Care Coverage. MDHHS-1171-FAP, Supplement-Food Assistance Program. Note: A MI Bridges online application is considered the same as the MDHHS-1171 and program specific supplement form(s) or a DCH-1426. • DHS-4574, Medicaid Application (patient of nursing facility). • DHS-4574-B, Assets Declaration (for initial asset assessment); see Bridges Eligibility Manual (BEM) 402, Special MA Asset Rules. • DCH-1426, Application for Health Coverage & Help Paying Costs. Any application or the MDHHS-1171, Filing Form, with the minimum information, must be registered in Bridges; see Bridges Administrative Manual (BAM) 110, Application Filing and Registration. Following registration of the application, do all the following: