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BAM 125 3 of 8 VOTER REGISTRATION SERVICES BPB 2025-001 1-1-2025

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

• DHS-4575, Medicaid Application (Patient of Nursing Facility). • DHS-4574-B, Assets Declaration. • DHS-1011, Medicaid Supplemental Application. • With a redetermination, including, but not limited to: • MDHHS-1010, Redetermination Form. • DHS-542, MiCAP Redetermination Form. • Upon request. • When a change of physical address is reported to the local office. Exception: The only time an NSP-938-B is not distributed is when an individual declines in writing by checking the No box on page seven of the MDHHS-1171, Assistance Application, or declines in writing on another MDHHS form that asks whether the individual would like to register to vote. If this question is unanswered (left blank), distribute an NSP-938-B. Note: An NSP-938-B is automatically generated and mailed when Yes-out of office transaction is selected, and when an individual reports a change of physical address. • When an individual applies for assistance, redetermination or reports a change of physical address in the local office, distrib- ute an NSP-938-B in person. If for any reason, an NSP-938-B is not distributed while the individual is in the local office, and the individual has not declined to register to vote, select Yes-out of office transaction, so an NSP- 938-B is automatically mailed. For forms that do not include the voter registration question, mail an NSP-938-B to the individual. Note: Individuals using MI Bridges to apply for or renew benefits are automatically offered an NSP-938-B and the response is pre filled in Bridges. Note: The ED-121a only needs to be distributed upon request.