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BAM 210 24 of 25 REDETERMINATION/EX PARTE REVIEW BPB 2026-016 7-1-2026

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

• FIP, SDA, MA, CDC, and FAP cases that are due in two months. • FAP and MA cases that are due for a mid-certification contact. RD-093, Long Term Care (LTC) Case Identification MA Only The LTC-application indicator (4574) on the RD-093 identifies MA LTC cases. Bridges sends the DHS-4574, Medicaid Application (Patient of Nursing Facility), in the redetermination packet for the MA redetermination when a DHS-4574 was filed at application. RD-093, Deductible Case Identification MA Only The deductible indicator (#) identifies active deductible cases. This indicator will be printed when the member of an MA EDG has a deductible amount. LEGAL BASE FIP MCL 400.32, MCL 400.43, MCL 400.55(f), MCL 400.57d(5) SDA Annual Appropriations Act Mich Admin Code, R 400.3151-400.3180 FAP 7 CFR 273.10(g)(2) 7 CFR 273.12(a)(5)(iii)(C) 7 CFR 273.14 7 U.S.C. 2020 MA 42 CFR 435.916(a)

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Official source

BAM 210 24 of 25 REDETERMINATION/EX PARTE REVIEW BPB 2026-016 7-1-2026

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

• FIP, SDA, MA, CDC, and FAP cases that are due in two months. • FAP and MA cases that are due for a mid-certification contact. RD-093, Long Term Care (LTC) Case Identification MA Only The LTC-application indicator (4574) on the RD-093 identifies MA LTC cases. Bridges sends the DHS-4574, Medicaid Application (Patient of Nursing Facility), in the redetermination packet for the MA redetermination when a DHS-4574 was filed at application. RD-093, Deductible Case Identification MA Only The deductible indicator (#) identifies active deductible cases. This indicator will be printed when the member of an MA EDG has a deductible amount. LEGAL BASE FIP MCL 400.32, MCL 400.43, MCL 400.55(f), MCL 400.57d(5) SDA Annual Appropriations Act Mich Admin Code, R 400.3151-400.3180 FAP 7 CFR 273.10(g)(2) 7 CFR 273.12(a)(5)(iii)(C) 7 CFR 273.14 7 U.S.C. 2020 MA 42 CFR 435.916(a)