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BAM 720 4 of 19 INTENTIONAL PROGRAM VIOLATION BPB 2026-009 4-1-2026

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

IPV DETERMINATION Family Independence Program (FIP), State Disability Assistance (SDA), Refugee Cash Assistance (RCA), CDC and FAP The client/authorized representative (AR) is determined to have committed an IPV by: • A court decision. • An administrative hearing decision. • The client/AR signing and dating a MDHHS-826, Request for Waiver of Disqualification Hearing, or MDHHS-830, Disqualification Consent Agreement, or other overpayment and disqualification agreement form. Note: A signed and dated MDHHS-4350, IPV Repayment Agreement, alone does not determine IPV. FIP Only IPV disqualifications for the program formerly known as Aid to Families with Dependent Children (ADC) are to be taken into consideration when imposing subsequent disqualifications for the program now known as the Family Independence Program (FIP) FAP Only IPV exists when an administrative hearing decision, signed and dated disqualification agreement or court decision determines FAP benefits were misused or trafficked. Medicaid (MA) Only IPV exists when the beneficiary or AR: • Is found guilty by a court, or • Signs a MDHHS-4350, Intentional Program Violation Repayment Agreement, and the prosecutor or the Office of Inspector General (OIG), authorizes repayment in lieu of prosecution, or • Is found responsible for the IPV by an administrative law judge (ALJ) conducting an IPV or debt establishment hearing.

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Official source

BAM 720 4 of 19 INTENTIONAL PROGRAM VIOLATION BPB 2026-009 4-1-2026

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

IPV DETERMINATION Family Independence Program (FIP), State Disability Assistance (SDA), Refugee Cash Assistance (RCA), CDC and FAP The client/authorized representative (AR) is determined to have committed an IPV by: • A court decision. • An administrative hearing decision. • The client/AR signing and dating a MDHHS-826, Request for Waiver of Disqualification Hearing, or MDHHS-830, Disqualification Consent Agreement, or other overpayment and disqualification agreement form. Note: A signed and dated MDHHS-4350, IPV Repayment Agreement, alone does not determine IPV. FIP Only IPV disqualifications for the program formerly known as Aid to Families with Dependent Children (ADC) are to be taken into consideration when imposing subsequent disqualifications for the program now known as the Family Independence Program (FIP) FAP Only IPV exists when an administrative hearing decision, signed and dated disqualification agreement or court decision determines FAP benefits were misused or trafficked. Medicaid (MA) Only IPV exists when the beneficiary or AR: • Is found guilty by a court, or • Signs a MDHHS-4350, Intentional Program Violation Repayment Agreement, and the prosecutor or the Office of Inspector General (OIG), authorizes repayment in lieu of prosecution, or • Is found responsible for the IPV by an administrative law judge (ALJ) conducting an IPV or debt establishment hearing.