BEM 101 1 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

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EXHIBIT I - LIST OF SSI-RELATED MA CATEGORIES

MA Category

BEM Item Unique Nonfinancial Eligibility Factor

Program Code Financial Eligibility Group Automatic MA Eligibility SSI Recipients 150 Aged, blind or disabled A, B, E 1 Yes Appealing SSI Termination 150 Appealing SSI termination M, O, P 1 No 503 Individuals 155 Aged, blind or disabled M, O, P 1 No Early Widow(er)s 157 Blind or disabled O, P 1 No DAC 158 Aged, blind or disabled M, O, P 1 No AD-Care 163 Aged or disabled M, P 1 No Extended-Care 164 Aged, blind or disabled M, O, P 1 No Medicare Savings Programs 165 Medicare Part A M, O, P - No Group 2 Aged, Blind and Disabled 166 Aged, blind or disabled M, O, P 2 No QDWI 169 Type of Medicare P - No Home Care Children 170 Disabled P 1 No Children’s Waiver 171 Disabled P 1 No Breast and Cervical Cancer Prevention and Treatment Program

173 Health department cancer screening

O

1

No

EXHIBIT II - SSI-RELATED MA CODING

Eligible for: Case

Recipient

Regular MA BEM MSP PT * SC * PT * ES * AD-Care 163 Full QMB 0 1F 4 4 AD-Care 163 None 0 1F/1E 5 4 Extended-Care 164 Full QMB 8 1F 0 4 Extended-Care 164 Limited QMB (SLMB) 1 1F 1 4 Extended-Care 164 None 1 1F/1E 0 4 Group 2 166 Full QMB 9 2F 0 3 Group 2 166 Limited QMB (SLMB) 0 2F 2 3

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Eligible for: Case

Recipient

Regular MA BEM MSP PT * SC * PT * ES * Group 2 166 None 0 2F/2E 0 3 Active Deductible 545 Full QMB 9 2B 0 7 Active Deductible 545 Limited QMB (SLMB) 0 2C 2 7 Active Deductible 545 None 0 20 0 7 Active Deductible 545 Full ALMB 0 2H 0 7 None NA Full QMB 9 2B 0 3 None NA Limited QMB (SLMB) 0 2C 2 3 Appealing SSI termination 150 ** 0 1F 0 4 503 Individual 155 ** 5 1F 0 4 Early Widow(er) 157 None 7 1F 0 4 DAC 158 ** 4 1F 0 4 Home Care Child 170 ** 0 1F 0 4 Children’s Waiver 171 ** 0 1F 0 4 QDWI 169 None 0 1Q 0 4 Freedom to Work (FTW) 174 None 0 1D 0 4 Freedom to Work (FTW) 174 Full QMB 8 1D 0 4 Freedom to Work (FTW) 174 Limited QMB (SLMB) 0 1D 2 4 Freedom to Work (FTW) premium level 174 None 0 1K 0 4 None NA Full ALMB 0 2H 0 3

DATA ELEMENT KEY  Case level Program Type (PT) on format page one.  Scope/Coverage (SC).  Recipient level Program Type (PT) starting on format page two.  Eligibility Status (ES). Note: When adding coverage to an active deductible case, the ES remains 7.

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EXHIBIT III - QMB DESK AID There are four categories of assistance available to help people pay their Medicare premiums. These categories are referred to by a variety of names. Full Name Also Known As BEM Benefit Key Nonfinancial Test Qualified Medicare Beneficiaries  QMB  Full-QMB  Medicare Assis- tance Programs  Medicare Savings Programs 165 Pays Medicare:  Premiums (Part A and B)  Coinsurance  Deductibles  Receiving Medicare Part A* or  Refused free Part A (claim number suffix is M1) or  Entitled to buy Part A. Social Security calls this Premium HI. *(claim number suffix is M) Specified-Low Income Medicare Beneficiaries  SLMB/SLM  Limited-QMB  Medicare Assis- tance Programs  Medicare Savings Programs 165 Pays Medicare Part B premiums Receiving Medicare Part A free (claim number suffix is not M1 or M) Additional Low- Income Medicare Beneficiaries Type 1  ALMB  Q1 (Type 1)  Medicare Assis- tance Programs  Medicare Savings Programs 165 Type Q1 pays Medicare Part B premiums

Receiving Medicare Part A free (claim number suffix is not M1 or M) * See BEM 169, Qualified Disabled Working Individual, if the person is under age 65 and paying a premium for Part A Situation Medicare Part A Code Person is not entitled to Medicare Part A. 4 Part A premium being charged and person is under age 65. 4* Claim number suffix is M and person age 65 or older. 3 Claim number suffix is M1. 2 Claim number suffix is not M or M1/ no Part A premium being charged. 1

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EXHIBIT IV - CODES

Name

BEM Program Group Type BEM Program Code Scope Coverage Code Eligibility Status Code BEM 150 Recipients A/B/E Recipients A/B/E Transferred to M/O/P MA While Appealing SSI Termination LOCAL OFFICE M, O AND P OPEN- INGS” 150 SSI TSO TSI TSI A,B,E M,O,P M,O,P M,O,P 1F 1F 1F 1F 4 4 4 4 503 Individuals 155 503 M, O, P See EXHIBIT II, SSI- Related MA coding Early Widow(er)s 157 EW O,P See EXHIBIT II, SSI- Related MA coding Disabled Adult Child 158 DAC O,P See EXHIBIT II, SSI- Related MA coding AD-Care 163 AD M, P See EXHIBIT II, SSI- Related MA coding Extended Care 164 EC M,O,P See EXHIBIT II, SSI- Related MA coding Medicare Savings Programs (MSP) 165 QMB SLMB ALMB1 See EXHIBIT II, SSI-Related MA coding Group 2 Aged, Blind and Disabled 166 G2S M,O,P See EXHIBIT II, SSI- Related MA coding Qualified Disabled Working Individual (QDWI) 169 QDWI P 1Q 4 Home Care Child 170 HCC P 1F, 1E1 4 Children’s Waiver 171 CHW P 1F, 1E1 4 SED Waiver 172

P 1F, 1E 4 Breast and Cervical Cancer Prevention and Treatment Program 173 BCCP O 1F, 1E1 4 Refugee Assistance Program - Medical (Refugee Assistance, not Medicaid) 630 RAPM I 202, 1F, 2F 4, 3, 73

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1. Coverage code E identifies coverage limited to emergency services due to alien status (BEM 225). 2. Scope/coverage 20 indicates that the person is in deductible status. If the person was in deductible status and eligible for a Medicare Savings Program (MSP) the scope/coverage would show MSP eligibility;0see Exhibit III in BEM 105. 3. ES code 7 is used for deductible status. It tells Bridges to switch scope/coverage 2F/2E back to the previous codes for the month after the deductible was met. Note: PG Category types for SSI-related MA are AG (aged), BL (blind) and DI (disabled). However, BL and DI do not necessarily mean blind or disabled per BEM 260.

EXHIBIT V OTHER INSURANCE CODES Codes Description 90 - 96 Medicare 89 HMO/PPO 05 Blue Cross/Blue Shield (BCBS) 87 Pharmacy Only 88 Dental Only 83 Long-Term Care 84 Indemnity 78 Recipient Monitoring

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Medical Insurance Code Description 00 None Known (initial Value) 01 Aetna US Healthcare 02 American Association of Retired Persons (AARP) 03 American Community Mutual 04 Bankers 05 Blue Cross/Blue Shield of Michigan, Blue Cross/Blue Shield Federal and Blue Cross/Blue Shield - Other States 06 Benefit Services 07 Connecticut General Life and Equitable Life (aka CIGNA or Equicor) 08 CAN 09 General American 10 Wausau Insurance 11 Benefit Source 12 Reserved for future use 13 Great West Life/The New England 14 American Medical Security 15 Pyramid Life Insurance Company/The One Benefit Source 16 Unicare (aka John Hancock Mutual Life and Massachusetts Mutual)

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Medical Insurance Code Description 17 Harrington Benefit Services 18 Reserved for future use 19 Michigan Education Special Services Association (MESSA) 20 Group Benefit 1 Regency Medical Administration 22 Mutual of Omaha 23 John Alden Life Insurance Company 24 United Teachers Associates 25 Golden Rule Insurance 26 HRM Claim Management 27 Federated Mutual Insurance Company 28 NGS American, Inc 29 Physicians Mutual 30 Cigna Healthcare 31 Prudential Insurance Company 32 Reserved for future use 33 Teamsters

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Medical Insurance Code Description 34 United HealthCare/Benesight (aka Travelers and Metropolitan) 35 Automated Benefit Service 36 Ameraplan 37 Reserved for future use 38 Other Carriers Not Listed 39 First Health 40 Number not assigned 41 Federal Employee Health Insurance Programs 42 Activa Benefit 43 Weyco Incorporated 44 Trustmark 45 Principal Financial Group 46 Reserved for futre use 47 Central States 48 United American Insurance Co. 49 JFP Benefit Management 51 Reserved for furture use Medical Insurance

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Medical Insurance Code Description Code Description 512 Reserved for future use 53 United Furniture Workers 54 Mutual Protective Medico Life 54 Employee Benefit 56 Strategic Resource Company (SRC Services, Inc.) 57 State Farm Insurance 58 Group Health Managers, Inc. 59 Pioneer Life Insurance Co of Illinois 60 Reserved for future use 61 Reserved for future use 62 Humana 63 Reserved for future use 64 United Food & Commercial Workers (includes Michigan United Food & Commercial Workers) 65 Mid America Associates 66 Administration System Research (ASR 67 Trades, Services & Union Carriers/Plans (except United Food & Commercial Workers)

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Medical Insurance Code Description Medical Insurance Code Code 68 Self-Funded Administration/Group/Plans 69 Fortis Benefits Insurance Company 70 Group Marketing 71 United Medical Resources 72 Corporate Benefit Services 73 Secure One Benefit Admin., Inc. 74 SET/SEG 75 Claim Management Services 76 Core Source/Cambridge 77 Reserved for future use 78 Medicaid Recipient Monitoring 79 Guardian 80 - 82 Reserved for future use 83 Long-Term Care 84 Indemnity (fixed price paid per day/stay for outpatient, inpatient, home health and nursing homes, such as., AARP, Connecticut General, Physicians Mutual)

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Laboratory Only Plans Code Code Description 85 Laboratory Only Plans Code

Vision Only Plans Code Description 86 Vision Only Plans Pharmacy Only Plans Code Description 87 Pharmacy Only Plans Dental Only Plans

Code Description 88 Dental Only Plans Code (includes Delta Dental Plan of Michigan)

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Private Enrollments Only - Managed Care Plans/HMOs

Code Description

Do not use for Medicaid enrollments. Private enrollments only - Managed Care Plans/Health Maintenance Organizations (includes HMO, PPO and POS plans). Carriers assigned this code include, but are not limited to:

 Aetna Health Plans of Northern California  Advantage Health Plan  Alliance Health & Life Insurance  Alternative Health  Anthem BCBS - Canton Region  Beech Street PPO  Blue Care Network  Blue Choice Network  Care Choices  CHAMPUS (aka CHAMPVA and Tricare)  Choice Care  CNA Health Partners  Community Blue  DayMed HMP, Inc.  Electronic Data Systems Corp (aka EDS)  Fallon Community Health Plan

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89 Do not use for Medicaid enrollments. Private enrollments only - Managed Care Plans/Health Maintenance Organizations (includes HMO, PPO and POS plans). Carriers assigned this code include, but are not limited to:

 Family Health Care Plan of Ohio  FHP Health Care  Grand Valley Health  Health Alliance Plan (aka HAP)  Health America  Health Maintenance Plan  Health Plan of Nevada  Health Plus of Michigan  HMO Health Ohio  HMO Illinois  Humana Health Care Plan  IBA Self-Funded Group  Maxicare Indiana, Inc.  MCARE  McAuley Health Plan (HMO)  MetraHealth Care Plan of Texas  Multiplan WPPN  Mutually Preferred HMO  NGS American  OmniCare, Inc.  Paramount Health Care  Partners National Health Plans  PHP Plus, Inc.  Physicians Health Plans (aka PHP)  Physicians Plus HMO  Planned Administrators, Inc.  PPOM Claims Department  Preferred Choices  Principal Health Care of Florida  Principal Health Care of Illinois  Principal Health Care of Indiana

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Private Enrollments Only - Managed Care Plans/HMOs

Code Description 89 Do not use for Medicaid enrollments. Private enrollments only - Managed Care Plans/Health Maintenance Organizations (includes HMO, PPO and POS plans). Carriers assigned this code include, but are not limited to:

 Priority Health  Prudential Health Care  Qual Med  Security Health Plan  SelectCare  Select Health Plan  Share Health Plan of Illinois  Total Health Care  Tricare Champus  Tuft Associated Health Plan  United Health Care  Wellness Plan  Wisconsin Health Organization

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Medicare Code Description 50 Medicare Excluded Alien (entered only by the Medicare Buy-In Unit) 90 Eligible for Medicare, but not confirmed. Indicates that a beneficiary has reached age of 65 and needs to be referred to SSA to apply for Medicare, or the beneficiary’s Medicare coverage has not been confirmed by CMS. 91 Enrolled in Medicare Part A, B or D, - anyone or a combination. 95 Enrolled or eligible for Medicare plus any commercial insurance. 96 Enrolled in Medicare Advantage Plan (Part C) (to be identified by TPL staff and updated by the Medicare Buy-In Unit).

BEM 105 1 of 8 MEDICAID OVERVIEW BPB 2024-001 1-1-2024

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DEPARTMENT POLICY MA Only The goal of the Medicaid program is to ensure that essential health care services are made available to those who otherwise could not afford them. Medicaid is also known as Medical Assistance (MA).The Medicaid program comprise several sub-programs or categories. To receive MA under an SSI-related category, the person must be aged (65 or older), blind, disabled, entitled to Medicare or formerly blind or disabled. Medicaid eligibility for children under 19, parents or caretakers of children, pregnant or recently pregnant women, former foster children, MOMS, MIChild, Flint Water Group and Healthy Michigan Plan is based on Modified Adjusted Gross Income (MAGI) methodology. GROUP 1 AND GROUP 2 In general, the terms Group 1 and Group 2 relate to financial eligibility factors. For Group 1, net income (countable income minus allowable income deductions) must be at or below a certain income limit for eligibility to exist. The income limit, which varies by category, is for nonmedical needs such as food and shelter. Medical expenses are not used when determining eligibility for MAGI-related and SSI-related Group 1 categories. For Group 2, eligibility is possible even when net income exceeds the income limit. This is because incurred medical expenses are used when determining eligibility for Group 2 categories. Group 2 categories are considered a limited benefit because a deductible is possible. BEM 110 THROUGH 174 BEM 110 through 174 describe all of the MA categories and the eli- gibility factors for each category. BEM 110 through 148 describe the MAGI-related and Group 2 categories. BEM 150 is for SSI recipients and certain former SSI recipients. BEM 155 through 174 describe SSI-related categories. EXHIBIT I - LIST OF ALL SSI-Related MA CATEGORIES.

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Note: Certain non-Medicaid medical programs are described in various BEM 600 series items. Some of these programs are administered by MDHHS local offices and some are administered by MDHHS/Medical Services Administration (MSA). MONTHLY DETERMINATIONS Medicaid eligibility is determined on a calendar month basis. Unless policy specifies otherwise, circumstances that existed, or are expected to exist, during the calendar month being tested are used to determine eligibility for that month. When determining eligibility for a future month, assume circumstances as of the processing date will continue unchanged unless you have information that indicates otherwise. Children Under 19 Do not shorten a beneficiary's 12-month eligibility period. Once eligible, children Under 19 years of age will remain eligible until the next redetermination unless any of the following occurs: • Reaches age 19-aged out • Moves out of state • Death • Requests closure • Eligibility was based on erroneous information A member may be added to an existing case even though the rede- termination date is less than 12 months in the future. Note: If a child on CHIP (MIChild) becomes eligible for and transfers to a Medicaid program, they must remain on Medicaid for the duration of the 12-month period. Exceptions: Continuous Eligibility does not apply to the following; Children in TMA Children in Presumptive Eligibility Children in a Group 2 Medically needy category (spend-down)

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CHOICE OF CATEGORY Persons may qualify under more than one MA category. Federal law gives them the right to the most beneficial category. The most beneficial category is the one that results in eligibility, the least amount of excess income or the lowest cost share. Note: Persons may receive both Medicare Savings Program benefits (BEM 165) and coverage under another MA category; see Medicare Savings Program in this item. However, clients are not expected to know such things as: • Ineligibility for a cash grant does not mean MA coverage must end. • The LIF category is usually the most beneficial category for families because families who become ineligible for LIF may qualify for TMA or Special N/Support. • The most beneficial category may change when a client’s circumstances change. Therefore, you must consider all the MA category options in order for the client’s right of choice to be meaningful. Medicare Savings Program A person entitled to Medicare Part A, Hospital Insurance, may be eligible for a Medicare Savings Program described in BEM 165. The person may be eligible for just a Medicare Savings Program or a Medicare Savings Program in addition to regular MA benefits. See BEM 165 about when to do an eligibility determination for Medicare Savings Programs. APPLICATION/ RENEWAL FORMS The DCH-1426, Application for Health Coverage & Help Paying Costs, is used for all Medicaid categories. • The DHS-4574, Medicaid Application (Patient of Nursing Facility), is completed by LTC patients. This application is used to determine MA eligibility for the LTC patient only.

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• The MDHHS-1010, Redetermination is a Bridges generated form that is sent at the time of an annual renewal. • The DHS-1004, Health Care Coverage Supplemental Questionnaire, is used to gather additional information when an applicant is not found eligible for any MAGI-related eligibility group or indicates a disability on the DCH-1426. To apply online see the Michigan Department of Health and Human Services (MDHHS) website/Online Services/MI Bridges Apply for Assistance & Manage Your Account. MAGI-Related Medicaid The following categories are considered MAGI related groups. • Pregnant Women (PW, MOMS). • Infants and Children under age 19 (LIF, Newborn, HK1, OHK HKE, MIChild). • Parents and caretaker relatives (PCR, LIF). • Adult Group age 19-64 (HMP). • Former Foster Care Children (FCTM). • Flint Water Group (FWG). • Plan First. Non-MAGI Medicaid Full Coverage • Transitional Medicaid Assistance (TMA). • Special N Support (SNS). • Refugee Medical Assistance (RMA). Non-MAGI Medicaid Limited Coverage • Group 2 Pregnant Women (G2P). • Group 2 Under 21 (G2U).

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• Group 2 Caretaker Relative (G2C, G2S). SSI-RELATED MA PRIORITY 1. BEM 150 addresses MA for SSI recipients and persons appealing an SSI disability termination. The other SSI-related categories must be considered in the following order: BEM 154, Special Disabled Children 2. Special categories: • BEM 157, Early Widow(er)s. • BEM 158, Disabled Adult Children (DAC) 3. BEM 155, 503 Individuals. 4. BEM 170, 171, or 172 Home Care or Children’s Waiver, SED Waiver. BEM 163, AD-Care. 5. BEM 164, Extended-Care and BEM 165, Medicare Savings Programs (QMB, SLMB). 6. BEM 166, Group 2 Aged, Blind and Disabled and BEM 165, Medicare Savings Programs (QMB, SLMB). 7. BEM 169, Qualified Disabled Working Individuals. 8. BEM 165, Additional Low-Income Medicare Beneficiaries (ALMB). 9. BEM 174, Freedom to Work. The determinations for Medicare Savings Programs and Extended- Care or Group 2 are separate; see BEM 165. Note: BEM 173, Breast and Cervical Cancer Prevention and Treatment Program, is not listed because MDHHS local office does not determine eligibility for this program. BCCPTP eligibility is determined by MDHHS/MSA. FIP AND SSI TERMINATIONS Most terminations of cash assistance or SSI benefits must include an evaluation of MA eligibility. See BEM 110, Low Income Family (LIF) for cash assistance terminations and BEM 150 for SSI terminations.

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MA-ONLY TERMINATIONS Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. Consider eligibility under all other MA-only categories before termi- nating benefits under a specific category. In addition, when Group 1 eligibility does not exist but all eligibility factors except income are met for a Group 2 category, activate deductible status; see BEM 545. Exception: Close the case when benefits are terminating: • For Medicare Savings Programs-only (BEM 165). • For QDWIs (BEM 169).

MA-Only Lock-Out To address beneficiary fraud and consistent with federal law, the Michigan Department of Health and Human Services (MDHHS) will pursue restrictions on Medicaid eligibility for individuals who are convicted of certain crimes related to the Medicaid program. Specifically, MDHHS may limit, restrict or suspend, for a period not exceeding one year, the Medicaid eligibility of any beneficiary who is convicted of an offense related to false statements or representations in connection with the Medicaid program, as described §1128B of the Social Security Act.

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EXHIBIT I - SSI-RELATED MA CATEGORIES

LEGAL BASE MA

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Social Security Act, Sections 1128, 1902, and 1905 42 CFR Part 435 MCL 400.106 The Affordable Care Act of 2010 is the collective term for the Patient Protection and affordable Care Act (Pub. L. 111-148) and the Health Care and Education Reconciliation Act (Pub. L. 111- 152).

BEM 106 1 of 10 MA WAIVER FOR ELDERLY AND DISABLED BPB 2026-024 8-1-2026

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DEPARTMENT POLICY MA Only This waiver is called the MI Choice Waiver Program. This waiver program provides home and community-based services for aged and disabled persons who, if they did not receive such services, would require care in a nursing home. Services provided under this waiver program must be less costly for Medicaid (MA) than the cost of nursing home services for the total number of waiver participants, not per person. The MI Choice waiver is not an MA category, but there are special eligibility rules for people approved for the waiver. TARGETED GROUP Waiver services are covered for MA recipients who: • Are age 65 or over, or • at least age 18 years and disabled. • Medically qualify, and • Have needs that cannot be met by the Home Help program and may be addressed with MI Choice services. • Seek or have an expanded Home Help Program exception grant of $1000 or more per month. WAIVER ADMINISTRATION The Medical Services Administration (MSA) administers the waiver through contracts with Pre-paid Ambulatory Health Plans. See Exhibit I in this item for a list of these waiver agencies. The agency's functions are described below. Assisting Participants The agent will assist prospective waiver participants in applying for MA and for initial asset assessments. The agent will also help the person obtain requested information and verification.

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WAIVER PROCESS The waiver process includes: Assessment The agent completes an assessment to verify medical eligibility for the waiver. Plan of Service A written plan of services is developed by the agency and the waiver participant if the assessment confirms medical eligibility for the waiver. The participant may choose to receive home and community-based services from the waiver agency. At a minimum, the plan includes: • Types of services to be furnished; and • The amount, frequency, and duration of each service; and • The type of provider to furnish each service and • Participant goals, preferences, and outcomes: and • Participant approval of the plan; and • The signature of the supports coordinator assisting with developing the plan. Supports Coordination The agent is responsible for arranging for planned services to be provided. APPROVED FOR THE WAIVER Approved for the waiver means: • The agent conducted the assessment, and • There is an available wavier slot for the individual's placement and

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• A waiver agent has developed a person-centered plan of service and • The participant has already received appropriate waiver services for more than 30 consecutive days or is currently receiving appropriate waiver services that are expected to continue more than 30 consecutive days, or expects to receive appropriate waiver services from the agent for at least 30 consecutive days. Approval and Termination Dates The agent determines the waiver approval date and termination date. The agent is responsible for advising the appropriate local Michigan Department of Health and Human Services (MDHHS) office of these dates. The agent is responsible for advising the appropriate local MDHHS office the dates of enrollment and disenrollment information in CHAMPS. Waiver enrollment automatically terminates when the participant enters an LTC facility; see BEM 547 for instructions. MDHHS LOCAL OFFICE RESPONSIBILITIES The local MDHHS office is responsible for completing an initial asset assessment and determining MA eligibility for potential waiver participants. Waiver Participant Defined A waiver participant is a person who is approved to receive or receives waiver services in the month being tested for Medicaid eligibility. Waiver Month Defined A waiver month is a calendar month containing at least one day that the participant is (was) approved for the waiver. The agent determines the waiver approval date.

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NONFINANCIAL ELIGIBILITY FACTORS The eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS Use special MA policies in the MA eligibility determination: • A waiver participant is a group of one even when he lives with his spouse; see BEM 211. • The Special MA Asset Rules in BEM 402 apply when completing the Initial Asset Assessment. See special initial asset assessment rules for waiver applicants in this item for rules on determining the first period of continuous care. • The MA divestment policy in BEM 405 applies to waiver participants. • The extended-care category is available to waiver participants; see BEM 164. • Income eligibility exists when gross countable income does not exceed 300 percent of the SSI benefit rate. • Income eligibility cannot be established with a patient-pay amount or by meeting a deductible. see BEM 500. A waiver participant may no longer qualify for waiver services; however, they may still qualify for MA. Note: An ex-parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change

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unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex-parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. Initial Asset Assessment for Waiver Applicants An Initial Asset Assessment (IAA) may be needed for potential waiver participants with a spouse. The IAA is used to protect a certain amount of the couple's combined resources for the community spouse. It does not determine the start of Medicaid eligibility. Use policy in BEM 402 to determine if an IAA is appropriate. An IAA uses a first day of continuous care (See BEM 402 for a definition). The first period of continuous care is a period of at least 30 consecutive days where the institutionalized spouse/applicant has been or is expected to be: • In a hospital and/or LTC facility and/or • Approved for the waiver. • The period is no longer continuous when none of the above is true for 30 or more consecutive days; see BEM 402 for examples. • The first period of continuous care may have occurred in the past; however, the applicant must be currently receiving services to complete an IAA. • If there is no past period of continuous care, then the IAA date must start on the first day that meets the definition of continuous care in BEM 402. Start of a Divestment Penalty Period The penalty period begins on the date which all the criteria listed under the approved for the waiver section in this item has been confirmed.

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Notices Waiver activities are performed by agents who meet the federal definition of administering the MA program. Therefore, you can share the following information with the agents without a signed release from the participant: • A copy of the DHS-3503, Verification Checklist. • A copy of the DHS-4588, Initial Asset Assessment Notice. The original DHS-3503, and DHS-4588 must be sent to the participant or the guardian, court or agency that is legally responsible for the participant. Do not enter waiver agencies in Bridges as a third-party type. Only the participant's legal guardian, court, or agency legally responsible for the participant can be entered as a third-party type. HOSPICE SERVICES Waiver participants may receive hospice services and waiver ser- vices simultaneously. The waiver agency and the hospice coordinate their plans of care to avoid overlapping services. MSA is responsible for assuring correct payments are made. MANAGED CARE PLANS MA recipients must choose either waiver services or enrollment in a health maintenance organization (HMO). They cannot receive both waiver services and be enrolled in an HMO. Recipients cannot be enrolled in more than one program (MI Choice, PACE, MI Health Link, or Home Help) at the same time. LIST OF SOME HOME AND COMMUNITY BASED SERVICES

• Adult Day Health. • Chore Services. • Community Health Worker. • Community Living Supports.

BEM 106 7 of 10 MA WAIVER FOR ELDERLY AND DISABLED BPB 2026-024 8-1-2026

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• Community Transportation. • Counseling. • Environmental Accessibility Adaptations. • Fiscal Intermediary. • Goods and Services. • Home Delivered Meals. • Nursing Services. • Personal Emergency Response System. • Private Duty Nursing/Respiratory Care. • Respite. • Specialized Medical Equipment and Supplies. • Supports Coordination. • Training. MSA WAIVER SERVICE AGENTS

WAIVER AGENCIES COUNTIES SERVED Detroit Area Agency on Aging 1333 Brewery Park Blvd, Suite 200 Detroit, MI 48207 Phone: 313-446-4444 Fax: 313-446-4446 Web: www:daaa1a.org Cities of: Detroit, Hamtramck, Highland Park, Grosse Pointe, Grosse Pointe Park, Grosse Pointe Shores, Grosse Pointe Woods, Grosse Pointe Farms, Harper Woods The Senior Alliance 5454 Venoy Road Wayne, MI 48184 Phone: 734-722-2830 1-800-815-1112 Fax: 734-722-2836 Web: www.aaa1c.org All of Wayne County excluding those areas served by the Detroit Area Agency on Aging The Information Center, Inc. 20400 Superior Road Taylor, MI 48180 Phone: 734-282-7171 Fax: 734-282-7105 Web: www.theinfocenter.info All of Wayne County excluding those areas served by the Detroit Area Agency on Aging Area Agency on Aging 1B 29100 Northwestern Hwy, Suite 400 Southfield, MI 48034 Phone: 248-357-2255 1-800-852-7795 Fax: 248-948-9691 Web: www.aaa1b.org Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw

BEM 106 8 of 10 MA WAIVER FOR ELDERLY AND DISABLED BPB 2026-024 8-1-2026

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WAIVER AGENCIES COUNTIES SERVED Macomb-Oakland Regional Center, Inc. 16200 Nineteen Mile Road PO Box 380710 Clinton Township, MI 48038-0070 Phone:586-263-8700 Fax: 586-228-7029 Web: www.MORChomecare.org Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw Region 2 Area Agency on Aging

102 North Main Street PO Box 189 Brooklyn, MI 49230 Phone: 517-592-1974 Fax: 517-592-1975 Web: www.r2aaa.net Jackson Hillsdale Lenawee Senior Services, Inc. 918 Jasper Street Kalamazoo, MI 49001 Phone: 269-382-0515 Fax: 269-382-3189 Web:www.seniorservices1.org Barry, Branch, Calhoun, Kalamazoo, St. Joseph Region 3B Area Agency on Aging/Care Well Services 200 West Michigan Avenue Suite 102 Battle Creek, MI 49017 Phone: 269-966-2450 1-800-626-6719 Fax: 269-966-2493 Web: www.region3b.org Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren Region IV Area Agency on Aging 2900 Lakeview Avenue St. Joseph, MI 49085 Phone: 269-983-0177 1-800-442-2803 Fax: 269-983-5218 Web: www.areaagencyonaging.org Berrien Cass Van Buren Valley Area Agency on Aging 225 E. Fifth Street, Flint, MI 48502 Phone: 810-239-7671 1-800-978-6275 Fax: 810-239-8869 Web: www.valleyaaa.org Genesee Lapeer Shiawassee

BEM 106 9 of 10 MA WAIVER FOR ELDERLY AND DISABLED BPB 2026-024 8-1-2026

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WAIVER AGENCIES COUNTIES SERVED Tri-County Office on Aging 5303 South Cedar Street Lansing, MI 48911-3800 Phone: 517-887-1440 1-800-405-9141 Fax: 517-887-8071 Web: www.tcoa.org Clinton Eaton Ingham Area Agency on Aging of Western Michigan, Inc. 3215 Eaglecrest Dr. NE Grand Rapids, MI 49525 Phone: 616-456-5664 1-888-456-5664 Fax: 616-456-5692 Web: www.aaawm.org Allegan, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Newaygo, Osceola Reliance Community Care Partners 2100 Raybrook SE Suite 203 Grand Rapids, MI 49546 Phone: 616-956-9440 1-800-447-3007 Fax: 616-954-1520 Web: www.relianceccp.org Allegan, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa Region VII Area Agency on Aging 1615 S. Euclid Ave. Bay City, MI 48706 Phone: 989-893-4506 1-800-858-1637 Fax: 989-893-3770 Web: www.region7aaa.org Bay, Clare, Gladwin, Gratiot, Huron, Isabella, Midland, Saginaw, Sanilac, Tuscola A&D Home Health Care, Inc. 3150 Enterprise, Suite 200 Saginaw, MI 48603 Phone: 989-249-0929 1-800-884-3335 Fax: 989-249-1147 Web: www.a-dhomecare.com Bay, Clare, Gladwin, Gratiot, Huron, Isabella, Midland, Saginaw, Sanilac, Tuscola Northeast Mich Comm. Service Agency, Inc. Region IX Area Agency on Aging 2375 Gordon Road Alpena, MI 49707 Phone: 989-356-3474 1-800-219-2273 Fax: 517-354-5909 Web: www.nemcsa.org Alcona, Alpena, Arenac, Cheboygan, Craw- ford, Iosco, Montmorency, Ogemaw, Otsego, Presque Isle, Roscommon

BEM 106 10 of 10 MA WAIVER FOR ELDERLY AND DISABLED BPB 2026-024 8-1-2026

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WAIVER AGENCIES COUNTIES SERVED Area Agency on Aging of Northwest Michigan 1609 Park Drive PO Box 5946 Traverse City, MI 49696-5946 Phone: 231-947-8920 1-800-442-1713 Fax: 231-947-6401 Web: www.aaanm.org Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Kalkaska, Leelanau, Manistee, Mis- saukee, Wexford Northern Lakes Community Mental Health/ Northern Health Care Management 105 Hall Street, Suite D Traverse City, MI 49684 Phone: 231-933-4917 or 800-640-7478Fax: 231-995-7900 Web: www.northernlakescmh.org Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Kalkaska, Leelanau, Manistee, Mis- saukee, Wexford Senior Resources 560 Seminole Rd. Muskegon, MI 49444 Phone: 231-739-5858 1-800-442-0054 Fax: 231-739-4452 Web: www.seniorresourceswmi.org Muskegon Oceana Ottawa U.P. Area Agency on Aging (UPCAP) 2501 14th Avenue South PO Box 606 Escanaba, MI 49829 Phone: 906-786-4701 1-800-338-7227 Fax: 906-786-5853 Web: www.upcap.org Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Menominee, Onton- agon, Schoolcraft

LEGAL BASE MA Social Security Act, Section 1915 42 CFR Part 435.217, 441.350,.400

BEM 110 1 of 1 LOW-INCOME FAMILY MA (LIF) BPB 2018-007 4-1-2018

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

DEPARTMENT POLICY MA Only This is a MAGI-related MA category. Low Income Family (LIF) eligibility under the ACA will be a MAGI- related eligibility subgroup. Eligibility for LIF will be derived after a successful MAGI-related eligibility determination for either Parent/Caretaker Relative or Children Under 19. Adults with a dependent child and income under 54 pecent of the Federal Poverty Level will be considered LIF eligible. Children with Income under 54 percent of the federal poverty level will be considered LIF eligible. LIF LEGAL BASE Social Security Act, Sections 1902(a) (63), 1931 The Patient Protection and Affordable Care Act (Publication L. 111- 148) and the Health Care and Education Reconciliation Act (Publication L. 111-152).

BEM 111 1 of 2 TRANSITIONAL MA BPB 2018-007 4-1-2018

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

DEPARTMENT POLICY Medicaid (MA) Only Transitional Medical Assistance (TMA) is an automatic coverage group. Transitional Medical Assistance (TMA) eligibility is only considered after Low Income Family (LIF) MA. Individuals may receive TMA for up to 12 months when ineligibility for LIF relates to income from employment of a caretaker relative. TMA starts the month in which LIF ineligibility began regardless of when the LIF eligibility actually ended. A new or updated application for healthcare coverage is not required to transfer to Transitional Medical Assistance (TMA). INITIAL TMA ELIGIBILITY LIF must be transferred to TMA when all of the requirements below are met. 1. At least one LIF qualified group member was eligible for and received LIF for three of the six calendar months immediately preceding the month of LIF ineligibility. 2. LIF ineligibility resulted from excess earned income only. 3. Earnings of the caretaker relative, caretaker relative’s spouse or a dependent child’s parent in the LIF ineligibility determination are greater than zero. TMA Group The TMA group is those individuals who were in the LIF group at the time of transfer to TMA. Note: Newborns eligible under BEM 145 may be added to the TMA case, but are not TMA group members. CONTINUED ELIGIBILITY TMA eligibility continues until the end of the 12-month TMA period unless:

BEM 111 2 of 2 TRANSITIONAL MA BPB 2018-007 4-1-2018

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

• A change is reported, such as decreased earned income, and the family is eligible for LIF; or Note: The family might qualify for TMA or Special N/Support if they again become ineligible for LIF. • For individual members, information is reported indicating that a member does not meet the MA requirements in: BEM 220, Residence. BEM 257,Third Party Resource Liability. BEM 265, Institutional Status. If a member loses TMA eligibility during the 12-month period based on BEM 220, 257 or 265, but the reason for ineligibility ceases, TMA eligibility exists again. Eligibility restarts the month ineligibility ceased and continues for the remainder of the 12-month period. The beneficiary is responsible for reporting the change that re-establishes eligibility. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1925, 1931

BEM 113 1 of 2 SPECIAL N/SUPPORT BPB 2019-012 10-1-2019

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

DEPARTMENT POLICY Medicaid Only Special N/Support (SNS) is an automatic coverage group.When ineligibility for LIF results wholly or in part from spousal support payments, the individual may continue eligible for Medicaid for four months. Individuals receiving Medicaid on this basis are referred to as Special N/Support beneficiaries. Special N/Support eligibility can be considered only after Low Income Family (LIF) MA. Divorce or separation agreements executed or modified after December 31, 2018, exclude spousal support as countable income in a MAGI Medicaid eligibility determination. INITIAL SPECIAL N/ SUPPORT ELIGIBILITY LIF must be transferred to Special N/Support when all of the following criteria are met. • The LIF group is not eligible for continued Medicaid as Transitional MA. • At least one LIF group member was a LIF beneficiary in three of the six calendar months before the month in which LIF will terminate. • LIF ineligibility resulted from excess earned income and countable spousal support income. A new or updated application for healthcare coverage is not required to transfer to Special N/Support. Special N/Support Group The Special N/Support group is those persons who were in the LIF group at the time of transfer to Special N/Support.

BEM 113 2 of 2 SPECIAL N/SUPPORT BPB 2019-012 10-1-2019

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

Four-Month Period The four-month period begins with the calendar month following the month in which LIF terminates. For example, coverage begins August 1 if LIF terminates in July. In this example, the four-month period would end November 30. CONTINUED ELIGIBILITY During the four-month period, each Special N/Support group mem- ber remains eligible unless it is reported that a member does not meet the Medicaid requirements in : • BEM 220, Residence. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. If Special N/Support eligibility is lost during the four-month period based on BEM 220, 257, or 265, but the reason for ineligibility ceases, SNS eligibility exists again. Eligibility restarts the month ineligibility ceased and continues for the remainder of the 4 month period. The individual is responsible for reporting the change that re-establishes eligibility. Note: Newborns eligible under BEM 145 may be added to the Special N/Support case but are not Special N/Support recipients. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1902(a)(10)(A)(i)(I), 1931

BEM 117 1 of 6 DEPARTMENT WARDS, TITLE IV-E AND ADOPTION ASSISTANCE RECIPIENTS BPB 2018-007 4-1-2018

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

DEPARTMENT POLICY Medicaid (MA) Only As explained in detail below, the following persons are automatically eligible for Group 1 MA. • Department wards. • Social Security Act title IV-E foster care (FC) recipients. • Children with title IV-E adoption assistance agreements. • Special needs children with adoption assistance agreements. Adoption assistance agreements are also called adoption support subsidy agreements. Other children,for example court wards, may be eligible under other MA categories such as Healthy Kids U-19; see BEM 105. MA coverage for court wards is not automatic. Local office specialists are responsible for opening and maintaining these cases. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. DEPARTMENT WARDS Department wards are automatically eligible for Group 1 MA. A department ward is any child who: • Has been committed to, or placed with, the department by a court order; and • Does not live with his parent(s); and • Is not a title IV-E recipient; or • Is a former permanent court ward or state (MCI) ward, placed for adoption, but not finalized (adoption supervision period), and who is not receiving an adoption support subsidy.

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• Does not have a special needs adoption assistance agreement. Authorizing MA The local office children's services workers will open and maintain current MA for a department ward; see FOM 803, Medicaid Foster Care. Current MA eligibility begins with the first day of the month the court order was received by the agency. Applications are not required for department wards for current MA. Local office specialists are responsible for retro MA determinations. Applications are required for retro MA. TITLE IV-E FOSTER CARE Any child for whom FC maintenance payments are made under title IV-E of the Social Security Act is eligible for Group 1 MA. A title IV- E FC maintenance payment is ADC-FC. The child is eligible for Group 1 MA in the state where he is physically present even if the ADC-FC payments are made by another state. Authorizing MA Local office children's services workers will open and maintain cur- rent MA for children receiving title IV-E FC who are physically present in Michigan; see FOM 803. Applications are not required for children receiving title IV-E foster care for current MA. Specialists are responsible for retro MA determinations. Applications are required for retro MA. ADOPTION ASSISTANCE AGREEMENTS There are federally-funded adoption agreements and state-funded adoption agreements. These arrangements are also called adoption support subsidy agreements. Federally-funded adoption agreements are agreements under title IV-E of the Social Security Act.

BEM 117 3 of 6 DEPARTMENT WARDS, TITLE IV-E AND ADOPTION ASSISTANCE RECIPIENTS BPB 2018-007 4-1-2018

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Title IV-E Adoption Assistance Agreements Any child for whom there is an adoption assistance agreement in effect under title IV-E of the Social Security Act is eligible for Group 1 MA. The child is eligible for MA in the state where he/she is physically present even if the adoption assistance agreement is with another state. The adoption assistance agreement need not provide for an actual adoption assistance payment. Special Needs Adoption Assistance Agreement A child for whom there is a special needs adoption assistance agreement in effect is eligible for Group 1 MA. A special needs adoption assistance agreement means a state-funded adoption assistance agreement for a child who: • Has special needs for medical, mental health or rehabilitative care, and • Cannot be placed without medical assistance. The child is eligible for MA in the state where he/she is physically present even if the adoption assistance agreement is with another state. The adoption assistance agreement need not provide for an actual adoption assistance payment. Authorizing MA The MDHHS Adoption and Guardianship Assistance Offrice in central office authorizes and maintains current MA for a child with an adoption assistance agreement. An application is not required for DAS to authorize current MA. Local office specialists are responsible for retro MA determinations. An application is required for retro MA.

BEM 117 4 of 6 DEPARTMENT WARDS, TITLE IV-E AND ADOPTION ASSISTANCE RECIPIENTS BPB 2018-007 4-1-2018

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OUT-OF-STATE ADOPTION ASSISTANCE AGREEMENTS A child with an adoption assistance agreement with another state who moves to Michigan may contact the local office requesting MA. In that situation use the following procedure. 1. Follow the policies in BAM 110, Application Filing and Registration.

The purpose of obtaining an application is to protect the appli- cation date in case it is determined that the child does not have a qualified adoption assistance agreement.

A complete application for MA for a child eligible based on an adoption assistance agreement is an application containing: • Family's address and telephone number. • Parent's name and birthdate. • Child's name, social security number (if he has one), birthdate and sex. • Name of any health insurance for the child. • Signature. 2. Obtain the date the child came to Michigan. 3. Follow the procedure in BEM 257 to identify any third party resource liability and complete the DCH-0078. 4. Obtain a copy of the adoption assistance agreement. 5. Send a memo requesting an MA eligibility determination to the Adoption Subsidy Program in central office. The memo should include: • The date the child came to Michigan. • The name, address and telephone number of the child's parents. • The adopted child's name, social security number (if he has one), date of birth and sex.

BEM 117 5 of 6 DEPARTMENT WARDS, TITLE IV-E AND ADOPTION ASSISTANCE RECIPIENTS BPB 2018-007 4-1-2018

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• The name, address and telephone number of the out-of- state agency who is a party to the adoption assistance agreement. • A copy of the adoption assistance agreement. • All copies of the DCH-0078.The EXHIBIT in this item shows a format for the memo. Send the memo via ID mail to:

Department of Health and Human Services

Adoption Subsidy Program

Division of Adoption Services

235 S Grand Avenue

PO Box 30037

Lansing, MI 48909 LEGAL BASE MA P.L. 99-272, Sections 9529 and 12305 42 CFR 435.115; .227; .403

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EXHIBIT STATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES =================================================== ------------------------------ MEMORANDUM ------------------------------ ===================================================

TO:

DATE:

FROM: SUBJECT: Adoption Assistance Agreement

(Case Number) Medicaid has been requested for the child named below. A copy of his adoption assistance agreement is attached. All copies of any MSA-1354 or MSA-1354A are also attached. Child:

(Name)

(Date of Birth)

(Social Security Number)

(Sex)

(Date Came to Michigan) Parents:

(Name)

(Street)

(City)

(State) (Zip Code)

(Area Code) (Telephone Number) Out-of-State Agency:

(Name)

(Street)

(City)

(State) (Zip Code)

(Area Code) (Telephone Number)

BEM 118 1 of 3 FOSTER CARE TRANSITION MEDICAID (FCTMA) BPB 2023-003 1-1-2023

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

DEPARTMENT POLICY Medicaid (MA) Only Individuals in this category are transitioning from foster care to adulthood. Children aging out of foster care on their 18th birthday are eligible for Foster Care Transition Medicaid (FCTMA) from age 18 until their 26th birthday. Note: These cases must remain open regardless of changes in non-financial eligibility, income or assets. NON-FINANCIAL ELIGIBILITY FACTORS The MA eligibility factors in the following items must be met: • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. Note: Cases in this category must not close if it is discovered that one of these eligibility factors was not met. Eligibility Criteria Youth who age out of foster care are eligible for FCTMA if they meet both of the following criteria: • In a foster care placement in any state on the individual’s 18th birthday and receiving Medicaid at the time of aging out. • Under 26 years of age. Continued Eligibility Eligibility must continue unless one of the following occurs: • Death. • Reaches age 26.

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• Moves out-of-state. • Case closure is requested. • Another MA program is more beneficial. Individuals may contact 800-343-7320 for change of address, etc., or fax a copy of the change to 517-346-9888. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. Annual Redetermination Annual redeterminations are conducted through a centralized unit for this group. Contact: Department of Human Services PO Box 30037 235 S. Grand Ave., Suite 1406 Lansing, MI 48909 Or Email: fctma@michigan.gov FINANCIAL ELIGIBILITY FACTORS

Groups An individual eligible under the Foster Care Transition Group category is a fiscal and asset group of one. Assets No asset test. Income Eligibility No income test.

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LEGAL BASE MA Foster Care Independence Act of 1999, HR 3443.

BEM 124 1 of 2 PLAN FIRST BPB 2023-013 7-1-2023

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

DEPARTMENT POLICY Medicaid Only Plan First Medicaid (MA) is a MAGI-related limited coverage Medicaid group available to any United States citizen or individual with an immigration status entitling them to full Medicaid coverage residing in Michigan. All eligibility factors in this item must be met. The fiscal group's net income cannot exceed 195 percent of the federal poverty level. All nonfinancial eligibility factors must be met in the calendar month being tested. NONFINANCIAL ELIGIBILITY FACTORS There are no gender or age requirements to be eligible for Plan First. Only United States citizens or individuals with an immigration status that entitles them to full Medicaid coverage are eligible for this group. There is no emergency services only (ESO) benefit plan available for this group. Note: If an individual reports a pregnancy while enrolled in Plan First, rerun eligibility to ensure that they are moved to the most beneficial group. The eligibility factors in the following items must be met: • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizen/Alien Status. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. FINANCIAL ELIGIBILITY FACTORS

Household Composition Household composition follows tax filing rules; see BEM 211.

BEM 124 2 of 2 PLAN FIRST BPB 2023-013 7-1-2023

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Assets There is no asset test. Income Eligibility Income eligibility exists when net income does not exceed 195 percent of the federal poverty level; see BEM 500 to determine net income. Ex Parte Review An ex parte review (see glossary) is required before Medicaid closures where there is an actual or anticipated change. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1902(a)(10)(A)(ii)(XXI),1920. The Affordable Care Act of 2010 is the collective term for the Patient Protection and Affordable Care Act (Publication L. 111-148) and the Health Care and Education Recovery Act (Publication L. 111-152).

BEM 125 1 of 3 PREGNANT WOMEN BPB 2022-009 4-1-2022

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

DEPARTMENT POLICY Medicaid Only Pregnant Women (PW) Medicaid (MA) is a MAGI-related Medicaid category. Medicaid is available to a woman while she is pregnant, the month her pregnancy ends, and during the twelve calendar postpartum months following the month her pregnancy ended regardless of the reason (for example, live birth, miscarriage, stillborn). Medicaid cannot be terminated during pregnancy or postpartum period unless the woman requests the closure, moves out of state or dies. If initial eligibility was granted based on incorrect or fraudulent information, continuous eligibility may be interrupted. All eligibility factors in this item must be met. Her fiscal group's net income cannot exceed 195 percent of the federal poverty level. All nonfinancial eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. Presumptive Eligibility Refer to BEM 136 for presumptive eligibility policy. Nonfinancial Eligibility Factors The woman must be pregnant. The MA eligibility factors in the following items must be met: • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status.

BEM 125 2 of 3 PREGNANT WOMEN BPB 2022-009 4-1-2022

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FINANCIAL ELIGIBILITY FACTORS

Household Composition Household composition follows tax filing rules see BEM 211. Assets There is no asset test. Divestment Policy in BEM 405 applies because income can be divested. Income Eligibility Income eligibility exists when net income does not exceed 195 percent of the federal poverty level. Refer to BEM 500 and 536 to determine net income. Applications for Pregnant Women A woman who is income eligible for one calendar month based on the income limit is automatically income eligible for each following calendar month through the twelfth calendar month after the month her pregnancy ends. Category Transfer An income test is not required when determining continuing eligibility for a pregnant woman whose eligibility under another MA category is terminating. This includes a woman who is Group 2 eligible for only a portion of a month due to incurred medical expenses; see BEM 545. The woman who is eligible for and receiving under another MA category is automatically income eligible for Pregnant Women through the twelfth calendar month after the month her pregnancy ends Note: Pursue eligibility for other MA categories when a beneficiary's coverage based on pregnancy is ending.

BEM 125 3 of 3 PREGNANT WOMEN BPB 2022-009 4-1-2022

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Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1902(a)(10)(A)(i)(IV),1920. Deficit Reduction Act of 2005. The Affordable Care Act of 2010 is the collective term for the Patient Protection and Affordable Care Act (Publication L. 111-148) and the Health Care and Education Reconciliation Act (Publication L. 111-152). American Rescue Plan Act of 2021 Sections 9812 and 9822, (ARP) (Pub. L. 117-2)

BEM 126 1 of 3 GROUP 2 PREGNANT WOMEN BPB 2022-009 4-1-2022

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

DEPARTMENT POLICY Medicaid Only This is a Group 2 Medicaid (MA) category. Medicaid is available to a pregnant woman who meets the nonfinancial and financial eligibility factors in this item. A woman who is eligible for, and receiving, Medicaid when her pregnancy ends and remains otherwise eligible may continue receiving Medicaid benefits for the twelve calendar postpartum months following the month her pregnancy ended. The postpartum extension is available when the pregnancy ends for any reason (for example, live birth, miscarriage, stillborn). The eligibility requirements for the postpartum extension of Medicaid eligibility are discussed later in this item. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. NONFINANCIAL ELIGIBILITY FACTORS The woman must be pregnant. The Medicaid eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits.

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FINANCIAL ELIGIBILITY FACTORS

Groups Use the fiscal group policies for Group 2 Medicaid in BEM 211. Assets There is no asset test. Divestment Policy in BEM 405 applies because income can be divested. Income Eligibility Income eligibility exists when net income does not exceed Group 2 needs in BEM 544. Apply the Medicaid policies in BEM 500, 530 and 536 to determine net income. If the net income exceeds Group 2 needs, Medicaid eligibility is still possible. The deductible for a pregnant woman is usually met at the first office visit because the woman incurs the full cost of the obstetric (OB) services (including labor and delivery) at her first OB visit. Her coverage should then be updated to MAGI-related Pregnant Women (PW) for the remainder of the pregnancy and twelve months post-partum; see BEM 545. POSTPARTUM EXTENSION The postpartum extension period is the twelve calendar months following the month a pregnancy ends. The postpartum extension of Medicaid eligibility is available to a woman who: • Was eligible for, and receiving, Medicaid on the day her pregnancy ended; and • Meets the nonfinancial eligibility factors in this item except pregnancy; and • Is not currently eligible for Medicaid under any category other than postpartum extension. Note: The woman who is eligible for and receiving under another Medicaid category is automatically income eligible for Pregnant

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Women (PW) through the twelfth calendar month after the month her pregnancy ends. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all Medicaid categories; see BAM 115 and 220. LEGAL BASE MA 42 CFR 435.301. Deficit Reduction Act of 2005. American Rescue Plan Act of 2021 Sections 9812 and 9822, (ARP) (Pub. L. 117-2)

BEM 129 1 of 3 MEDICAID UNDER AGE 1 BPB 2025-001 1-1-2025

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

DEPARTMENT POLICY Medicaid (MA) Only Medicaid for children under age one (HK1) is part of the U-19 Medicaid Expansion program. It is a MAGI related Medicaid category. HK1 Medicaid is available to children under one year of age whose household income is between 55 -195 % of the Federal Poverty Level (FPL). All eligibility factors must be met in the calendar month being tested. However, only certain eligibility factors apply before annual renewal. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. Note: Safe Delivery Babies do not need to meet any of the non- financial eligibility factors listed in this item. Presumptive Eligibility Refer to BEM 136 for presumptive eligibility policy. NONFINANCIAL ELIGIBILITY FACTORS The child must be under age one; see BEM 240. See CHILD IN HOSPITAL OR LTC in this item for an exception to the age limit. The MA eligibility factors in the following items must be met: BEM 220, Residence. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status. BEM 270, Pursuit of Benefits.

BEM 129 2 of 3 MEDICAID UNDER AGE 1 BPB 2025-001 1-1-2025

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FINANCIAL ELIGIBILITY FACTORS Household Composition Household composition follows tax filing rules refer to BEM 211, Medicaid Group Composition. Assets There is no asset test. Divestment Policy in BEM 405 applies because income can be divested. Income Eligibility Income eligibility exists when net income does not exceed 195% of the federal poverty level. Refer to BEM 500 to determine income. ONGOING ELIGIBILITY Once eligible, a beneficiary's eligibility continues until annual renewal unless the child: • Moves out of state. • Is ineligible due to institutional status; see BEM 265. • Is eligible for Foster Care Department Ward (FCDW) coverage. • Dies. Note: If eligibility was granted based on incorrect or fraudulent information, continuous eligibility may be interrupted. Continue using Under Age 1 income eligibility at renewal when a child is: • Currently eligible for and receiving Under Age 1 MA. • An inpatient in a hospital or in long term care (LTC) facility and attained age one while in the facility. Note: The stay in the facility must be uninterrupted since age one.

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An ex parte review is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. CHILD IN HOSPITAL OR LTC A child eligible for, and receiving, MA under this category who is a hospital inpatient or in LTC on his or her first birthday remains eligible for the duration of the inpatient stay provided all eligibility factors except age are met. The stay must be uninterrupted. Eligibility under this category no longer exists when a child stops receiving inpatient hospital or LTC services. Transfers between hospitals and/or LTC facilities are not considered interruptions of a stay. LEGAL BASE MA Social Security Act, Section 1902(a)(10)(A)(i)(IV), 1905(u)(2)(B) Social Security Act XXI, 42 CFR 457.320(A)(2) and (3). 42 CFR 435.229 and 435.4 The Affordable Care Act of 2010 is the collective term for the Patient Protection and Affordable Care Act (Publication L. 111-148) and the Health Care and Education Reconciliation Act (Publication L. 111-152).

BEM 130 1 of 3 MICHILD BPB 2024-001 1-1-2024

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OVERVIEW MIChild is a MAGI-related Medicaid Expansion program for children who are under 19 years of age and who are not enrolled in comprehensive health insurance. Children who get enrolled in comprehensive health insurance during their 12 continuous month eligibility period, cannot be closed until redetermination, with limited exceptions. Other eligibility criteria for MIChis the same as Children under 19 (U19) with the exception that MIChild beneficiaries are responsible for making monthly premium payments; see premiums in this item. Eligibility begins the first day of the month of application. The 3- month retroactive period applies unless the beneficiary was enrolled in other comprehensive medical insurance during that time. Retroactive MIChild coverage is not available prior to January 1, 2016. INCOME ELIGIBILITY • Age zero to age one is 196 percent to 212 percent of the federal poverty level (FPL). • Age one to age 19 is 161 percent to 212 percent of the FPL. PRESUMPTIVE ELIGIBILITY Refer to BEM 136 for presumptive eligibility policy. PREMIUMS Beginning January 1, 2024 MIChild beneficiaries are no longer required to pay premiums.

NONFINANCIAL ELIGIBILITY FACTORS The person must be under age 19. The MA eligibility factors in the following items must be met: • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers.

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• BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 257, Third Party Resource Liability.EM 265, Institutional Status. • BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS

Household Composition Household composition follows tax rules, refer to BEM 211. Assets There is no asset test for MIChild. Divestment Policy in BEM 405 applies regarding divestment of income in order to obtain MIChild eligibility. Income Income eligibility is determined according to MAGI rules. Countable income as determined by MAGI rules cannot exceed 212% of the federal poverty level (FPL). ONGOING ELIGIBILITY Beneficiaries remain eligible for 12 months of continuous eligibility for MIChild unless the person meets one of the following criteria: • Reaches age 19. • Moves out of state. • Is ineligible due to Institutional Status; see BEM 265. • Death. • Requests closure. Note: If eligibility was granted based on incorrect or fraudulent information, continuous eligibility may be interrupted. BEM 546 gives instruction on how to determine the post-eligibility patient-pay amount if the month being tested is an L/H month and eligibility exists.

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Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The ex parte review includes consideration of all MA categories; see BAM 115 and 220. HEARINGS MIChild applicants and beneficiaries are entitled to full hearing rights. Individuals have the right to contest a department decision affecting Medicaid eligibility whenever they believe the decision is incorrect, or when their application is not acted upon with reasonable promptness; see BAM 600, Hearings. LEGAL BASE MA

Social Security Act XXI, 1905(u)(2)(B) 42 CFR 457.320(A)(2) and (3). 1902(a)(10)(A)(ii)(XIV) 42 CFR 435.229 and 435.4

BEM 131 1 of 3 HEALTHY KIDS BPB 2022-001 1-1-2022

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DEPARTMENT POLICY Medicaid (MA) Only Other Healthy Kids (OHK) and the Healthy Kids Expansion (HKE) are two programs in the MAGI U-19 Medicaid category. OHK and HKE are available to children under the age of 19 whose household income does not exceed 160 percent of the Federal Poverty Level (FPL). Both programs are defined by age, household income, and whether the child has other comprehensive insurance. The MAGI U-19 income limits for Other Healthy Kids and the Healthy Kids Expansion are: Program Age Income (% of FPL) Has other comprehensive insurance? MAGI U-19 OHK >=1 and <=5 >54% and <144% N/A

>=1 and <=5 >=144% and <=160% Yes

>=6 and <=18 >54% and <110% N/A

>=6 and <=18 >=110% and <=160% Yes MAGI U-19 HKE >=1 and <=5 >=144% and <=160% No

>=6 and <=18 >=110% and <=160% No

All eligibility factors must be met in the calendar month being tested. However, only certain eligibility factors apply before annual renewal. If the month being tested is a Long-Term Care or Hospital (L/H) month and eligibility exists, go to BEM 546 to determine the post- eligibility patient-pay amount.

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Presumptive Eligibility Refer to BEM 136 for presumptive eligibility policy. NONFINANCIAL ELIGIBILITY FACTORS The child must be under age 19. The MA eligibility factors in the following items must be met. BEM 220, Residence. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status. BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS

Household Composition Household composition follows tax filing rules refer to BEM 211, Medicaid Group Composition. Assets There is no asset test. Divestment Policy in BEM 405 applies because income can be divested. Income Eligibility Income eligibility exists when net income does not exceed 160% of the federal poverty level. Refer to BEM 500, Income Overview to determine net income.

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ONGOING ELIGIBILITY Children under 19 (U-19) beneficiaries remain eligible for 12 months of continuous eligibility, unless the beneficiary: • Reaches age 19. • Moves out of state. • Is ineligible due to Institutional Status; see BEM 265. • Is eligible for Foster Care Department Ward (FCDW) coverage. • Dies. Note: If eligibility was granted based on incorrect or fraudulent information, continuous eligibility may be interrupted. Note: An ex parte review is required before Medicaid closures when there is an actual or anticipated change unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1902(a)(10)(A)(i)(IV), Social Security Act XXI, 42 CFR 457.320(A)(2) and (3). 1902(a)(10)(A)(ii)(XIV) 42 CFR 435.229 and 435.4 1905(u)(2)(B) The Affordable Care Act of 2010 is the collective term for the Patient Protection and Affordable Care Act (Publication L. 111-148) and the Health Care and Education Reconciliation Act (Publication L. 111-152).

BEM 132 1 of 2 GROUP 2 PERSONS UNDER AGE 21 BPB 2018-007 4-1-2018

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DEPARTMENT POLICY This is a Group 2 Medicaid (MA) category. Medicaid is available to a person who is under age 21 and meets the eligibility factors in this item. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. NONFINANCIAL ELIGIBILITY FACTORS The person must be under age 21 (BEM 240, Age). The Medicaid eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. AGE Consider eligibility for all other Medicaid categories when a person reaches age 21 or otherwise becomes ineligible for this category. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid.When possible, an ex parte reivew should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220.

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FINANCIAL ELIGIBILITY FACTORS

Groups Use the fiscal group policies for Group 2 Medicaid in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Count- able assets are determined using BEM 400 and BEM 401. Divestment Policy in BEM 405 applies because income may be divested. Income Eligibility Income eligibility exists when net income does not exceed the Group 2 needs in BEM 544. Apply the Medicaid policies in BEM 500, 530 and 536 to determine net income. If the net income exceeds Group 2 needs, Medicaid eligibility is still possible; see BEM 545. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items. LEGAL BASE MA 42 CFR 435.308. MCL 400.106. Deficit Reduction Act of 2005.

BEM 135 1 of 7 GROUP 2 CARETAKER RELATIVES BPB 2015-015 10-1-2015

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DEPARTMENT POLICY MA Only This is a Group 2 MA category. MA is available to parents and other caretaker relatives who meet the eligibility factors in this item. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. NONFINANCIAL ELIGIBILITY FACTORS A caretaker relative is a person who meets all of the following requirements:  Except for temporary absences, the person lives with a dependent child. Use “CARETAKER RELATIVE NONFINANCIAL TEMPORARY ABSENCE” below. Dependent child is defined later in this item.  The person is: The parent of the dependent child; or The core relative (other than a parent) who acts as parent for the dependent child. Core relative is defined later in this item. Acts as parent means provides physical care and/or supervision.  The MA eligibility factors in the following items must be met. BEM 220, Residence. BEM 221, Identity. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 256, Spousal/Parental Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status. BEM 270, Pursuit of Benefits. When a dependent child lives with both parents, both parents may be caretaker relatives.

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Occasionally, a core relative (other than a parent) who claims to act as parent for the dependent child and the child's parent both live with the child. The client’s statement regarding who acts as parent must be accepted. If both the parent and other core relative claim to act as parent, assume the parent is the caretaker relative. When only the other core relative claims to act as parent, both the other core relative and the parent(s) may be caretaker relatives. Except as explained in the two preceding paragraphs, a child can have only one caretaker relative. This means that if a person is an Medicaid applicant or beneficiary based on being a caretaker relative, no other person can apply for or receive Medicaid based on being a caretaker relative for the same dependent child. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories. See BAM 115 and 220. FINANCIAL ELIGIBILITY FACTORS

Groups Use the fiscal group policies for Group 2 Medicaid in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Count- able assets are determined using BEM 400 and BEM 401. Divestment Policy in BEM 405 applies because income can be divested. Income Eligibility Income eligibility exists when net income does not exceed the Group 2 needs in BEM 544. Apply the Medicaid policies in BEM 500, 530 and 536 to determine net income. If the net income exceeds Group 2 needs, Medicaid eligibility is still possible. See BEM 545.

BEM 135 3 of 7 GROUP 2 CARETAKER RELATIVES BPB 2015-015 10-1-2015

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DEPENDENT CHILD DEFINED A child is a dependent child when he meets all of the following con- ditions:  The child is born.  The child meets the FIP eligibility factors in the following items: BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 270, Pursuit of Benefits.  The child is a resident using Medicaid policy in BEM 220.  The child meets the following age or age and school attendance requirement: He must be under age 18; or He must be age 18 and a full-time student in a high school or in the equivalent level of vocational or technical training as defined in FIP policy in BEM 245. He must be expected to complete his educational or training program before age 19.  The child is: A FIP recipient. A SSI recipient. A Medicaid applicant. Active Medicaid deductible. A Medicaid beneficiary. A MIChild beneficiary. CARETAKER RELATIVE NONFINANCIAL TEMPORARY ABSENCE Living together or living with others means sharing a home, where family members usually sleep, except for temporary absences. A temporarily absent person is considered in the home. A person’s absence is temporary if:  His location is known; and

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 There is a definite plan for his return; and  He lived with the group before the absence; Note: Newborns and unborn are considered to have lived with the group; and  The absence has lasted, or is expected to last, 30 days or less. Exceptions:  “Joint Custody” below.  A person in a medical hospital is considered in the home.  A person is considered in the home when absent for training or education.  A dependent child (defined above) in a psychiatric hospital is considered in the home for up to 12 calendar months after the admission date. Presume that a placement in a residential facility (other than a med- ical hospital) will last over 30 days. The absence begins with the admission date and ends with a discharge to the person’s home. It is not interrupted by home visits or admission to a medical hospital. Consider the stay temporary only if the facility provides a signed statement that includes an expected discharge within 30 days after the admission. Residential facilities provide 24-hour care, maintenance and super- vision. Examples:  Long-term care facilities.  Homes for the aged.  Licensed child foster care homes.  Child caring institutions.  Mental health facilities. Joint Custody Sometimes a court awards custody of children to both parents jointly. Separated parents may practice joint custody informally in the absence of a court order. A child is considered to be living with only one parent in a joint custody arrangement. This person is the primary caretaker. This is the person who provides the home where the child sleeps more than half of the days in a month, averaged over a twelve month period. The twelve month period begins at the

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time the determination is being made. This is the parent who is responsible for the child’s day-to-day care and supervision. In a joint custody arrangement, one parent must be the primary caretaker. The other parent is considered absent from the home. For purposes of determining a primary caretaker accept the client’s statement unless questionable or disputed by the other parent. When parenting time is disputed or questionable, base your deter- mination on a court order that addresses custody or visitation, if one is available. In the absence of a court order, give each parent an opportunity to present evidence of their claim. See Verification Sources in this item. CORE RELATIVE DEFINED A core relative is any of the following:  Parent.  Aunt or uncle.  Niece or nephew.  Any of the above relationships prefixed by grand, great or great-great.  Stepparent.  Sister or brother.  Stepsister or stepbrother.  First cousin.  First cousin once removed (i.e., a first cousin’s child).  The spouse of any person above, even after marriage is ended by death or divorce. The above includes relationships established by adoption. Note: Termination of parental rights is a court order that ends a parent’s rights and responsibilities to the child.

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A person whose parental rights are terminated by a court is not a core relative. The child’s relationships to other core relatives are not affected. VERIFICATION REQUIREMENTS The client's statements regarding relationship, primary caretaker, presence in the home and school attendance for the dependent child (ren) may be accepted. Verification is required only if the individual's statements are inadequate or inconsistent with other information. Verification requirements for all other eligibility factors are in the appropriate manual items. Verification Sources Relationship  Birth certificate.  Hospital certificate of birth.  Official records containing relationship information. Examples: court, school, church or medical records; marriage certificate; insurance policy.  Newspaper account containing relationship information.  Written statements by at least two persons with direct knowledge of the relationship. Presence in the Home  Home call.  Written statements by at least two persons who do not live with the group but have direct knowledge of the living arrangement.  School contact confirming where and with whom the child lives. DHS-3380, School Enrollment Verification, may be used.  Court, medical or other official records confirming the child’s presence in the home.

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 Written statement from the landlord if the individual has direct knowledge of the living arrangement. Primary Caretaker:  School records indicating who enrolled the child in school, first person called in an emergency, who arranges for the child’s transportation to and from school.  Child care records showing who makes and pays for the child care arrangements and who drops off and picks up the child.  Medical records showing where the child lives and who generally takes the child to medical appointments. LEGAL BASE MA 42 CFR 435.310, .510. Deficit Reduction Act of 2005.

BEM 136 1 of 3 PRESUMPTIVE ELIGIBILITY BPB 2016-001 1-1-2016

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Presumptive Eligibility Medicaid Only Presumptive eligibility is temporary Medicaid eligibility as determined by a trained qualified entity. This allows individuals to receive needed health coverage and providers to receive payment for services provided before a full Medicaid determination is completed. Qualified entities include but are not limited to local health departments, hospitals, and tribal health facilities operated by the Indian Health Services. These entities are trained and authorized by the Michigan Department of Health and Human Services (MDHHS). To be considered a qualified entity, under the regulation at 42 CFR 435.1110(b) (1), the provider must agree to make presumptive eligibility determinations consistent with state policies and procedures. Application A streamlined application is used to determine eligibility. Information on the presumptive eligibility application will be self- attested, without the need for verification. The application consists of a few simple questions such as name, household size and estimated monthly income. Presumptive eligibility is determined based on gross income reported at the time of the application. Eligibility is determined for an individual whose application is filed online, by a trained qualified entity. Eligibility Groups The eligibility groups for which qualified entities determine eligibility presumptively are:  Pregnant Women  Infants and children under age 19  Parents and caretaker relatives  Adult Group age 19-64

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 Former Foster Care Children  Certain individuals needing treatment for breast and cervical cancer. Eligibility Period The presumptive eligibility period begins on the date the determination is made by the qualified entity. The end date of the presumptive period is the earlier of:  The date the eligibility determination for ongoing Medicaid is made, if an application for Medicaid is filed by the last day of the month following the month in which the determination of presumptive eligibility is made: or  The last day of the month following the month in which the determination of presumptive eligibility is made, if no application for Medicaid is filed by that date. The beneficiary must complete a health care coverage application and receive a determination to avoid losing coverage when the temporary eligibility period ends. This must be completed within 60 days of the date of the presumptive eligibility determination. Presumptive eligibility is limited to one period of eligibility during any consecutive 12 month period. Pregnant women are limited to one presumptive eligibility period per pregnancy. Covered Services Presumptive eligibility benefits for infants, children and adults are the same as those provided under the Medicaid category for which the individual is determined to be presumptively eligible. Coverage for a pregnant woman is limited to ambulatory prenatal care services only. Covered services include physician visits for prenatal care, prescription drugs related to pregnancy and prenatal laboratory tests.

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Legal Base The Affordable Care Act of 2010 is the collective term for the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act (P. L. 111-152). 42 CFR 435.1110(b) (1).

BEM 137 1 of 3 HEALTHY MICHIGAN PLAN BPB 2024- wrk001BPB 2024-001 1-1-2024

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OVERVIEW Medicaid (MA) Only The Healthy Michigan Plan (HMP) is based on Modified Adjusted Gross Income (MAGI) methodology. The Healthy Michigan Plan provides health care coverage for a category of eligibility authorized under the Patient Protection and Affordable Care Act and Michigan Public Act 107 of 2013 effective April 1, 2014. Targeted Population The Healthy Michigan Plan (HMP) provides health care coverage for individuals who: • Are 19-64 years of age. • Do not qualify for or are not enrolled in Medicare. • Do not qualify for or are not enrolled in other Medicaid programs. • Are not pregnant at the time of application. • Meet Michigan residency requirements. • Meet Medicaid citizenship requirements. • Have income at or below 133 percent Federal Poverty Level (FPL). Fee for Service Beneficiaries For Healthy Michigan Plan beneficiaries who are exempt from enrollment in managed care plans or who have yet to enroll in a managed care plan, copayments for services may apply. Fee-For- Service (FFS) beneficiaries will not be assigned a MI Health Account. Copayments may be required and due at the point of service for office visits, pharmacy, inpatient hospital stays, outpatient hospital

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visits, and non-emergency visits to the emergency department for beneficiaries age 21 years and older. Health Risk Assessment The Michigan Department of Health and Human Services (MDHHS) has developed a Healthy Michigan Plan Health Risk Assessment that encompasses a broad range of health issues and behaviors including, but not limited to: • Physical activity. • Nutrition. • Alcohol, tobacco, and substance use. • Mental health. • Influenza vaccination. • Chronic conditions. • Recommended cancer or other preventative screenings. The DCH-1315, Health Risk Assessment form, is available through the health plans or at www.michigan.gov/Assistance Programs/Health Care Coverage/ Healthy Michigan Plan. NONFINANCIAL ELIGIBILITY FACTORS The Medicaid eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. Credible Coverage Parents requesting health care coverage for themselves must provide proof that their children have credible coverage, even if not applying for the children.

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Credible coverage is health insurance coverage under any of the following: • Group health plan, individual or student health insurance. • Medicare or Medicaid. • TRICARE/CHAMPUS. • CHIP (MIChild in Michigan). • Federal Employees Health Benefit Program. • Indian Health Service. • Peace Corps. • Public Health Plan (any plan established or maintained by a State, the U.S. government, or a foreign country). • A state health insurance high-risk pool. Assets The Healthy Michigan Plan does not have an asset test. Income Modified adjusted gross income must be at or below 133 percent of the Federal Poverty Level (FPL). REFERENCES Patient Protection and Affordable Care Act 1902(a)(10)(A)(i)(VIII) of the Social Security Act. Michigan Public Act 107 of 2013. Michigan Public Act 208 of 2018.

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DEPARTMENT POLICY Medicaid Only This is a MAGI related Medicaid category. Newborns who meet the eligibility factors in this item are automati- cally eligible for Medicaid from birth to age one. AUTOMATIC ELIGIBILITY A newborn is automatically eligible for MA the month of birth if, for his date of birth, his mother receives Medicaid coverage, regardless of when that coverage is authorized. Eligibility continues through the month of the newborn's first birthday if he meets the MA eligibility factors in all of the following items: • BEM 220, Residence. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. If eligibility was granted based on incorrect or fraudulent information, continuous eligibility may be interrupted. A newborn who meets the above criteria is eligible for MA without an application or eligibility determination. Authorize MA as soon as the minimum information needed to acti- vate the newborn is received. A child born to a MA beneficiary is considered a U.S. citizen. No further documentation is required. Do not delay authorizing MA for newborns. Medical providers may send local offices MSA-2565C, Hospital Newborn Notice, when they are unable to submit notice of the birth through the Michigan Birth Registry system. Consider an MSA-2565-C received for a newborn as a report of the child's birth.

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Use the information on the form to authorize MA for the child. Con- tact the mother if the form has insufficient information to activate the newborn in Bridges. MDHHS AUTHORIZATIONS Medical Services Administration (MSA) within the Michigan Department of Health and Human Services (MDHHS) will authorize MA for a child born to an MA beneficiary when: • The child’s mother is enrolled in a managed care health plan, and • MSA is notified of the birth, and • The child is not already receiving MA. Note: Do not wait for MSA to authorize MA when notified of the birth. Local Office Responsibilities Eligibility specialists are responsible for taking appropriate case action even if MSA has added newborn coverage when changes, such as an address change are reported. RENEWAL Determine eligibility for all other MA categories no later than the month of the child's first birthday. Proof of U.S. citizenship is not required at annual renewal. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1902(e)(4)

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Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3.

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EFFECTIVE May 9, 2016. DEPARTMENT POLICY Medicaid (MA) Only The Flint Water Group is a MAGI-related MA category. Flint Water Group coverage is available to any individual under the age of 21, pregnant women, and children born to pregnant women who were served by the Flint water system from April 1, 2014 through September 30, 2025. An individual was served by the Flint water system if he or she consumed water drawn from the Flint water system and: • resided in a dwelling connected to the Flint water system, • had employment by an entity served by the Flint water system, • received child care or education in a dwelling/structure connected to the Flint water system. Household income cannot exceed 400% of Federal Poverty Level (FPL). MAGI-based income methodologies are used in calculating household income. Individuals in this group cannot be otherwise eligible for or enrolled in any other Medicaid group. There are no premiums associated with the Flint Water Group. All eligibility factors must be met in the calendar month being tested.

Presumptive Eligibility Refer to BEM 136 for presumptive eligibility policy.

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

NONFINANCIAL ELIGIBILITY FACTORS Children must be under age 21 and women must be currently pregnant or within 2 months post-partum. The MA eligibility factors in the following items must be met. BEM 220, Residence. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status. BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS Household Composition Use household group composition policy for MAGI-related children and pregnant women in BEM 211. Assets There is no asset test. Divestment Policy in BEM 405 applies because income can be divested. Income Eligibility Income eligibility exists when net income does not exceed 400% of the federal poverty level. Apply MAGI methodology policies in BEM 500 to determine income.

ONGOING ELIGIBILITY

Once eligible, a beneficiary's eligibility continues until annual renewal unless the individual:

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• Reaches age 21. • Moves out of state. • Is ineligible due to Institutional Status; see BEM 265. • Dies. • Requests voluntary case closure. If eligibility was granted based on incorrect or fraudulent information, continuous eligibility may be interrupted. Note: An ex parte review is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. LEGAL BASE MA Social Security Act, Section 1902(a)(10)(A)(ii)(XX) Social Security Act 1902(hh) 42 CFR 435.218

.

BEM 150 1 of 9 MA FOR SSI RECIPIENTS BPB 2024-001 1-1-2024

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DEPARTMENT POLICY Medicaid (MA) Only Supplemental Security Income (SSI) is a cash benefit for needy individuals who are aged (at least 65), blind or disabled. The Social Security Administration (SSA) determines SSI eligibility. In Michigan, the Michigan Department of Health and Human Services (MDHHS) supplements federal SSI payments based on the client’s living arrangement. Thus, in this item SSI recipient means a Michigan resident who receives the basic federal payment, the state supplement, or both. To be automatically eligible for Medicaid (MA) an SSI recipient must both: • Be a Michigan resident. • Cooperate with third-party resource liability requirements. MDHHS administers MA for SSI recipients, including a continued MA eligibility determination when SSI benefits end. Ongoing MA eligibility begins the first day of the month of SSI enti- tlement. Some clients also qualify for retroactive (retro) MA cover- age for up to three calendar months prior to SSI entitlement; see BAM 115. The following individuals are considered SSI recipients for MA pur- poses even though they do not receive an SSI cash grant: • Individuals appealing termination of SSI because SSA has determined they are no longer disabled or blind. MDHHS local offices are responsible for determining initial and continuing eligibility; see MA while appealing disability termination in this item. • 1619 Recipients - Certain blind or disabled SSI recipients who work and have too much income for an SSI cash grant may be eligible for continued MA coverage. SSA determines eligibility. These recipients are the same as other SSI recipients in Bridges.

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DATA EXCHANGE SYSTEM Central office receives SSI client information daily from SSA through the State Data Exchange (SDX), which lists SSI: • Applications. • Denials. • Appeals. • Openings and re-openings. • Closures. • Address and other changes. This information is available in Bridges through the SDX Individual Inquiry, located under Interfaces in left navigation; see BAM 800, Data Exchanges. MA-SSI OPENINGS/ TRANSFERS

Central Office SDX Actions An automated process tries to match new SSI recipients on the SDX file with persons active in other programs on Bridges. What happens next depends on what type of match is found. • Exact match found: If the individual is receiving MA in Bridges, EDBC is run in mass update to close MA under the current case and open ongoing SSI under a new case number. • Possible match found: The case is reported to the SSI Coordination Unit for manual processing. The SSI Coordination Unit completes the manual SSI opening and transfers the SSI case to the appropriate local office. • No possible match: Bridges opens a new SSI case and assigns it to a specialist in the appropriate local office based on the individual’s residence.

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LOCAL OFFICE TRANSITIONAL SSI OPENINGS An SSI recipient may come to the local office asking for MA cover- age before the SDX process opens SSI in Bridges. Local offices should open AD-Care when: • The SSI recipient is not currently active for full coverage MA, or • The SSI recipient is receiving MA under another Type of Assistance (TOA.) See opening AD-Care in this item. Note: It is the local office responsibility to complete the AD-Care opening. The SSI Coordination Unit is unable to process manual SSI opening requests timely due to the limited resources available. Opening AD-Care Do all of the following before opening AD-Care for an SSI recipient: • Obtain a signed DCH-1426, Application for Health Coverage & Help Paying Cost, with all of the following minimum information: Recipient's name. Recipient's birth date. Recipient's address (unless homeless). Recipient's/authorized representative's signature. Note: Do not require the completion of the entire DCH-1426. Only the DCH-1426 with all of the minimum information listed above is needed. • If there are other family members receiving Medicaid in the SSI recipient’s household and the applicant is a responsible relative (for example, spouse, parent) of the SSI Recipient, change the SSI Recipient’s individual program status to requested to apply for MA on the family’s case. • If the SSI recipient is receiving other programs but not MA, use the program request screen in the existing case to apply for MA.

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• If there are no active cases into which the SSI Recipient’s MA request can be added, register an application for Medicaid in Bridges. • Determine the SSI Recipient’s state of residence. See BEM 220 if the SSI Recipient does not receive a state supplement from Michigan. • Verify current receipt of SSI and/or state supplement and most recent entitlement date. Acceptable verification includes a cur- rent award letter from SSA (showing SSI eligibility for the cur- rent and ongoing month), information on a DHS-3471, DHS/SSA Referral, or contact with SSA. To ensure transfer of AD-Care Medicaid to SSI Medicaid:

Email: SSI-Bridges-Coord@michigan.gov

Note: All communication with SSI Coordination must include: • Client’s name. • Client’s individual ID. • Client’s case number. • Explanation of the issue or problem. • Your name, title, location, and your telephone number or email address. LOCAL OFFICE RESPONSIBILITIES Central office does not automatically update Bridges when SSA reports an address and county code change. You must: • Update Bridges and transfer the case; see BAM 305, or • Notify SSA via DHS-3471 if the address and county code do not agree. You also have the following case responsibilities based on informa- tion you receive from all sources: • Update any address, residence county code, and residence district changes in Bridges. • Send a copy of the current Bridges individual demographics screen and supporting documentation (for example, birth certificate, SSN card) to the SSI Coordination Unit when a name, date of birth or social security number is incorrect.

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• Enter LTC facility (see definition in the glossary) and living arrangement changes for LTC and waiver patients. Transfer the case, if necessary; see BAM 305. • Notify SSA via DHS-3471 of changes or corrections to: Name. Birthdate. Marital status. Address. County code. Living arrangement. SSA Follow-ups If case information you sent to SSA does not appear on the HR- 070 within 45 days, send copies of the DHS-3471 and documentation to the SSI Coordination Unit; see local office transitional SSI openings in this item. Clearly mark your request Follow-up Report of Change. The SSI Coordinator contacts SSA and, after verifying that the information is acted on, responds to you. Redeterminations SSI recipients who are Michigan residents receive MA-SSI in Bridges for the duration of SSI eligibility. You do not have to conduct redeterminations. However, if SSI stops, you may have to determine continued MA eligibility; see SSI terminations in this item. ELIGIBILITY FOR OTHER SERVICES SSI recipients may qualify for food benefits, state emergency relief or other benefits. Make referrals as appropriate. Note: SSI recipients may apply for FAP at SSA or the MDHHS local office. BAM 116 explains joint application processing. Categorically eligible FAP groups automatically meet FAP asset and income limits. See BEM 213 for a definition of categorically eli- gible FAP groups. SSA may refer SSI recipients with prepaid funeral contracts to MDHHS. BAM 805 explains how to certify the contract as irrevocable.

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SSI TERMINATIONS When SSI benefits stop, central office evaluates the reason based on SSA's negative action code, then does one of the following: • SSI Closure. MA-SSI is closed in Bridges if SSI stopped for a reason that prevents continued MA eligibility (for example, death, moved out of state). Bridges sends the recipient a DHS- 1605. • Transfer to MA-Terminated SSI Medicaid. SSI cases not closed due to the policy above are transferred to the MA Termination SSI Medicaid Type of Assistance. A redetermination date is set for the second month after transfer to allow for an ex parte review; see glossary. Local Office Responsibilities for Cases Transferred to SSIT Based on current circumstances, determine whether the client qualifies for MA under: • MA While Appealing Disability Termination in this item, or • Any other MA category; see BEM 105. Note: A redetermination/ex parte review (see glossary and BAM 210) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, a redetermination/ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115, 210 and 220. When an MA Terminated SSI Medicaid EDG is set in Bridges, the new automated process will run. See SSI-Terminated (SSI-T) Redetermination/Ex Parte Review Process job aid for the full breakdown of the automated process and specialist responsibilities.

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MA While Appealing Disability Termination MA eligibility continues for an individual who: • Has been terminated from SSI because he is no longer considered disabled or blind, and Note: See BEM 260 about SSI denial codes. • Has filed an appeal of the termination with SSA within SSA’s 60-day time limit, and Note: See BEM 260 for information about the SSA appeal process and appeal codes. • Is a Michigan resident. Other eligibility factors such as income, assets and third-party resource liability are not an issue. MA eligibility continues until the person: • Exhausts his SSA appeal rights, or • Fails to file an appeal at any step within SSA’s 60-day time limit, or • Is no longer a Michigan resident. When you run EDBC, Bridges will determine whether the individual qualifies under other MA categories (BEM 105) when eligibility ends based on this policy. Administrative Case Closures SSI cases with PAY STAT code N20 on SOLQ are closed due to administrative reasons and might reopen within three weeks. Con- sider this in deciding when to begin evaluating continued MA eligibility and watch for an SSI reopening during the evaluation process.

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SSI Closures E-mail or fax the SSI Coordination Unit to close an SSI case if the client is: • Deceased. • No longer a Michigan resident. When reporting a death, include a copy of the client’s death certifi- cate, obituary or other proof the client is deceased with the e-mail or fax. VERIFICATION REQUIREMENTS Verify current receipt of SSI and/or state supplement and the most recent entitlement date before authorizing AD-Care for an SSI recipient. Verify the following for MA based on the MA While Appealing Dis- ability Termination policy. • SSI was terminated because the person was no longer considered disabled or blind. • Timely appeal filed at SSA. VERIFICATION SOURCES

Current Receipt of SSI • Copy of a current SSI award letter from SSA. • DHS-3471, DHS/SSA Referral. • Contact with SSA. • SOLQ.

Note: See BEM 260 for a list of appropriate codes. SSI Termination Reason • SOLQ.

Note: See BEM 260 for a list of appropriate codes. • Contact with SSA. • Copy of SSI Termination Notice. Timely Appeal at SSA Note: See BEM 260 for a list of appeal codes.

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• SOLQ • Copy of the SSI appeal form (SSA-561 or HA-501). • Correspondence from SSA. • Legal document indicating appeal filed. LEGAL BASE MA 42 CFR 435.120,.230 MCL 400.106

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DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. MA is available to former SSI recipients who receive RSDI benefits and would now be eligible for SSI if RSDI cost-of-living increases paid since SSI eligibility ended were excluded. The reason for SSI ineligibility does not matter. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. 503 individuals eligible for Medicare are covered by the Buy-In Pro- gram (see BAM 810) and are considered eligible for QMB (BEM 165). Nationally, this MA category is referred to as Medicaid under the Pickle Amendment. NONFINANCIAL ELIGIBILITY FACTORS  The person must: Currently receive RSDI benefits, and Have stopped receiving SSI benefits after April 1977, and Have been entitled to RSDI benefits in the last month he was eligible for and received SSI. Note: RSDI benefits paid retroactively can be considered. An SSI recipient who receives retroactive RSDI benefits does not become retroactively ineligible for SSI even when the retroac- tive RSDI monthly benefit was more than his SSI benefit.  The person must be: Age 65 or older (BEM 240), or Blind (BEM 260), or Disabled (BEM 260).  The MA eligibility factors in the following items must be met:

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BEM 220, Residence. BEM 221, Identity. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 256, Spousal/Parental Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status. BEM 270, Pursuit of Benefits. Note: An ex parte reivew (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories. See BAM 115 and 220. FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on the MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies. Income Eligibility Income eligibility exists when net income does not exceed the spe- cial protected income level in RFT 245. Income eligibility cannot be established with a patient-pay amount or by meeting a deductible. Determine countable income according to MA policies in BEM 500 and BEM 530, except as explained in “503 COUNTABLE RSDI” below. Apply the deductions in BEM 540 (for children) or BEM 541 (for adults) to countable income to determine net income.

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503 COUNTABLE RSDI Bridges does this calculation. Enter current RSDI in Bridges. RSDI cost-of-living allowances are called COLAs. For all persons whose income is considered, do not count COLAs received since the 503 individual's last month of concurrent RSDI/SSI. Exception: If the client objects to the amount used, request a COLA history from the SSA district office. Send a DHS-3471, DHS/SSA Referral to the SSA district office with the following request:  Client objects to our determination of Medicaid eligibility under the Pickle Amendment. Please supply each amount of Title II COLA paid since * . *Enter month and year of the last concurrent RSDI/SSI benefit. If a fiscal group contains more than one potential 503 individual and their last month of concurrent RSDI/SSI differs, do separate budgets for each 503 individual. VERIFICATION REQUIREMENTS Verify current RSDI. Verify the last month of concurrent RSDI entitlement and SSI eligibility and receipt. BENDEX has such information. The verification requirements for all other eligibility factors are spec- ified in the appropriate manual items. LEGAL BASE MA 42 CFR 435.135 Deficit Reduction Act (2005), Social Security Act 1903(x) PL 109- 171. JOINT POLICY DEVELOPMENT Medicaid, Adult Medical Program (AMP) also known as Adult Benefit Waiver (ABW), Transi- tional Medical Assistance (TMA/TMA-Plus), and Maternity Outpatient Medical Services (MOMS) policy has been developed jointly by the Department of Community Health (DCH) and the Department of Human Services (DHS).

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DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. MA is available to any person who: 1. Is not entitled to Medicare Part A (hospital insurance), and 2. Receives RSDI benefits some or all of which are early widow(er)'s benefits under section 202(e) or (f) of the Social Security Act, or under any other provision of section 202 if they are also eligible under subsections (e) or (f), and Note: Sections 202(e) and (f) provide the same benefits; (e) is for widows and (f) is for widowers. 3. Was terminated from SSI because of RSDI received under section 202 of the Act, and 4. Received SSI in the month before the month he began receiving RSDI under section 202 of the Act, and 5. Would be eligible for SSI if all RSDI under section 202 of the Act were excluded. The Social Security Administration notifies central office when SSI terminates for a person meeting the criteria in 1-4 above. Notifica- tion is via a code on State Data Exchange (SDX) tapes. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. This category is also referred to as “Kennelly Widows.” NONFINANCIAL ELIGIBILITY FACTORS The person must meet all the following: • Is not entitled to Medicare Part A, Hospital Insurance. • Receives:

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Early widow(er)'s RSDI under section 202(e) or (f) of the Social Security Act, or RSDI under another provision of section 202 but is also eligible under section 202(e) or (f) • Was terminated from SSI because of RSDI received under section 202 of the Act. • Received SSI in the month before the month he began receiving RSDI under section 202 of the Act. • Is blind or disabled (BEM 260).Receipt of RSDI will not always verify blindness or disability. A widow(er) who is at least age 60 may be entitled to RSDI without being blind or disabled. • Meets the MA eligibility factors in the following items: BEM 220, Residence. BEM 221, Identity. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 256, Spousal/Parental Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status. BEM 270, Pursuit of Benefits. IDENTIFICATION Persons receiving early widow(er)'s RSDI have a social security claim number suffix of W, W1-W9, WB, WC, WF, WG, WJ, WR or WT. In addition, the SSI termination notice indicate potential MA eligibil- ity; see EXHIBIT. FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211.

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Assets Countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on the MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies. Income Eligibility Income eligibility exists when net income does not exceed the spe- cial protected income level in RFT 245. Income eligibility cannot be established with a patient-pay amount or by meeting the deductible. Determine countable income according to MA policies in BEM 500 and 530 except as explained in COUNTABLE RSDI below. Apply the deductions in BEM 541 to countable income to determine net income. COUNTABLE RSDI Exclude all RSDI benefits for the early widow(er). For all other persons, countable RSDI is the person's gross RSDI for the month being tested. Gross RSDI means the amount before any deductions such as Medicare. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. VERIFICATION REQUIREMENTS Verification of the following factors unique to this category is required at application, redetermination and whenever there is a change in RSDI benefits: • Receipt of (or eligibility for) benefits under section 202(e) or (f) of the Social Security Act. • Not entitled to Medicare Part A.

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Verification policies for other eligibility factors are in the appropriate manual items. Verification Sources Receipt of (or eligibility for) RSDI benefits under section 202(e) or (f) of the Social Security Act: • Social security claim number suffix from BENDEX, SOLQ, or other Social Security Administration document; see Identification. • Memo or other communication from central office. • Social Security Administration.Medicare Part A eligibility: • BENDEX. • SOLQ. • SSA-1610-U2. • Social Security Administration. EXHIBIT - SSI NOTICE This is the information about Medicaid which appears on SSI denial/termination notices when SSI ineligibility resulted from early widow(er)'s RSDI benefits. You may be receiving Medicaid from your state. If you are, you may be able to keep Medicaid even though your SSI payments are stop- ping. You may receive Medicaid under special rules if all the follow- ing are true. • You are a widow (widower) age 50 through 64; • You no longer receive SSI because of Social Security payments; • You do not have hospital insurance under Medicare; AND • You meet the other state rules for Medicaid. If these are not true about you, you may still be able to receive Medicaid under other state rules.

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To apply for Medicaid, call or visit the Department of Human Ser- vices. If you visit, please bring this letter. If you call, tell them you received a widow's or widower's Medicaid letter. That will help them answer your questions. LEGAL BASE MA Social Security Act, Section 1634(d) Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109- 171

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DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. MA is available to a person receiving disabled adult children's (DAC) (also called Childhood Disability Beneficiaries' or CDBs') RSDI benefits under section 202(d) of the Social Security Act if he or she: 1. Is age 18 or older; and 2. Received SSI; and 3. Ceased to be eligible for SSI on or after July 1, 1987, because he became entitled to DAC RSDI benefits under section 202(d) of the Act or an increase in such RSDI benefits; and 4. Is currently receiving DAC RSDI benefits under section 202(d) of the Act; and Note: To receive DAC RSDI a person must have a disability or blindness that began before age 22. 5. Would be eligible for SSI without such RSDI benefits. The Social Security Administration notifies central office when SSI terminates for a person meeting the criteria in 1-4 above. Notifica- tion is via a code on State Data Exchange (SDX) tapes. Central office sends a memo (see EXHIBIT I) to the appropriate local office. See SSI TERMINATIONS in BEM 150. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. DAC MA recipients eligible for Medicare are covered by the Buy-In Program (see BAM 810) and are considered eligible for QMB (BEM 165). NONFINANCIAL ELIGIBILITY FACTORS 1. The person must be age 18 or older.

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2. The person must have: • Received SSI; and • Ceased to be eligible for SSI on or after July 1, 1987, because the person became entitled to DAC RSDI benefits under section 202(d) of the Act or an increase in such benefits. Note: DAC RSDI is also called Childhood Disability Benefits (CDB). 3. The person is currently receiving DAC RSDI benefits. Note: When SSA employees say someone is a “DAC” they mean he receives DAC RSDI. 4. The MA eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on the MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies.

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Income Eligibility Income eligibility exists when net income does not exceed the spe- cial protected income level in RFT 245. Income eligibility cannot be established with a patient-pay amount or by meeting a deductible. Determine countable income according to MA policies in BEM 500 and 530 except as explained in COUNTABLE RSDI below. Apply the deductions in BEM 541 to countable income to determine net income. COUNTABLE RSDI Exclude all DAC related RSDI benefits for the person whose DAC eligibility is being determined. Count any RSDI benefits that are not related to DAC. For all other persons, countable RSDI is the person's gross RSDI for the month being tested. Gross RSDI means the amount before any deductions such as Medicare. IDENTIFYING DACS An individual may be receiving DAC RSDI benefits if one of the fol- lowing descriptions applies: • He has been identified as a DAC by central office or an SSI letter and his social security claim number suffix contains the letter C. The C may be followed by another letter or number (CA, CB, C1, etc.). • He is more than 19 years 2 months old and his social security claim number suffix contains the letter C. The C may be followed by another letter or number (CA, CB, C1, etc.). • He is age 18 or older, not a full-time student in elementary or secondary school and his social security claim number contains the letter C. The C may be followed by another letter or number (CA, CB, C1, etc.). Note: When an individual meets a bullet listed you must request a screening for DAC eligibility from central office unless a determination has already been completed by central office. After you receive verification of DAC RSDI from central office you still need to determine all other factors for MA eligibility (income and asset etc., listed on page 1 of this item) are met. You should retain

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the copy of the verification from central office as you only need to verify DAC eligibility once. Requests must be made through your management or central spe- cialized staff (include titles). Send requests to: MDHHS-DAC-Determination-Mailbox@michigan.gov and include the beneficiary’s name, case number, SSN, SS claim number and any other information pertaining to the request. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories. See BAM 115 and 220. VERIFICATION REQUIREMENTS Verification of the following factors unique to DAC eligibility is required prior to authorizing DAC MA eligibility: • Receipt of SSI on the basis of blindness or a disability. • Termination of SSI on or after July 1, 1987 because of entitlement to DAC RSDI benefits or an increase in such benefits. Verification of receipt of DAC RSDI benefits under section 202(d) of the Act is required prior to authorizing DAC MA eligibility and at redetermination. Verification policies for other eligibility factors are in the appropriate manual items. Verification Sources Receipt of SSI on the basis of blindness or a disability. • Memo or other communication from central office. • SSI letter. • Social Security Administration. Termination of SSI on or after July 1, 1987 because of entitlement to DAC RSDI benefits or an increase in such benefits:

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• Memo or other communication from central office. • SSI letter. • Social Security Administration. Current receipt of DAC RSDI benefits: • Social security claim number suffix from BENDEX, SOLQ or other Social Security Administration document. See “Identifying DACs.” • SSI letter. • Social Security Administration.

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EXHIBIT I - CENTRAL OFFICE MEMO

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LEGAL BASE MA Social Security Act, Section 1634(c) Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109- 171 JOINT POLICY DEVELOPMENT Medicaid, Adult Medical Program (AMP), Transitional Medical Assistance (TMA/TMA-Plus), and Maternity Outpatient Medical Services (MOMS) policy has been developed jointly by the Department of Community Health (DCH) and the Department of Human Services (DHS).

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DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. Consider eligibility under this category only if eligibility does not exist under BEM 154 through 158. Use this category before using Extended-Care (BEM 164) or any Group 2 MA category. This category is available to persons who are aged or disabled (AD).Net income cannot exceed 100% of the poverty level. All eligibility factors in this item must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. NONFINANCIAL ELIGIBILITY FACTORS 1. The person must not be eligible for MA under BEM 154 through 158. 2. The person must be aged (BEM 240, Age) or disabled (BEM 260, MA Disability/Blindness). Note: Blindness is not a basis of eligibility. However, a blind person who is also aged or disabled meets this eligibility factor. 3. The MA eligibility factors in the following items must be met.  BEM 220, Residence.  BEM 221, Identity.  BEM 223, Social Security Numbers  BEM 225, Citizenship/Alien Status  BEM 255, Child Support.  BEM 256, Spousal/Parental Support.  BEM 257, Third Party Resource Liability.  BEM 265, Institutional Status.  BEM 270, Pursuit of Benefits.

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FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Count- able assets are determined based on MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies. Income Eligibility Net income cannot exceed one hundred percent of the federal poverty level. The net income limit can be determined by subtracting twenty dollars from the income limits listed in table one of RFT 242. Income eligibility cannot be established with a patient- pay amount or by meeting a deductible. Determine countable income according to SSI-related MA policies in BEM 500, 501, 502, 503, 504 and 530 except as explained in COUNTABLE RSDI in this item. Apply the deductions in BEM 540 (for children) or 541 (for adults) to countable income to determine net income. COUNTABLE RSDI Gross amount means the amount of RSDI before any deduction such as Medicare. Countable RSDI for fiscal group members is the gross amount for the previous December when the month being tested is January, February or March. Federal law requires that the cost-of-living increase received in January be disregarded for these three months. For all other months, countable RSDI is the gross amount for the month being tested.

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For all other persons whose income must be considered, countable RSDI is always the gross amount for the month being tested. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items. LEGAL BASE MA Social Security Act, Section 1902(m), 1902(r)(2) Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109- 171

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DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. Consider eligibility under this category only if eligibility does not exist under BEM 154 through 163. Use this category before using a Group 2 category. Consider Medicare Savings Program eligibility in addition to this category; see BEM 165. This category is available only to L/H and waiver clients who are aged (65 or older), blind or disabled. See Bridges Glossary for the definition of L/H patients. See BEM 106 for the definition of waiver clients. Gross income cannot exceed 300 percent of the SSI federal benefit rate; see RFT 248. All eligibility factors in this item must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, see BEM 546 to determine the post-eligibility patient-pay amount. NONFINANCIAL ELIGIBILITY FACTORS • The person must not be eligible for MA under BEM 154 through 163 but may be eligible for a Medicare Savings Program under BEM 165. • The person must be an L/H or waiver client. • The person must be aged, blind or disabled; see BEM 240, Age, or BEM 260, MA Disability/Blindness. The MA eligibility factors in the following items must be met: BEM 220, Residence. BEM 221, Identity. BEM 223, Social Security Numbers. BEM 225, Citizenship/Alien Status. BEM 255, Child Support. BEM 256, Spousal/Parental Support. BEM 257, Third Party Resource Liability. BEM 265, Institutional Status.

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BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related MA groups in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies. Income Eligibility Income eligibility exists when gross countable income does not exceed 300 percent of the SSI benefit rate. Apply the MA policies in BEM 500, 501, 502, 503, 504 and 530 to determine gross income. Do not apply the deductions in BEM 540 and 541. Income eligibility cannot be established with a patient-pay amount or by meeting a deductible. Third Party Liability Complete MSA-1354 for clients with other insurance including long term care/nursing home insurance and submit with a copy of insur- ance card if available. Patient Pay Offsets If an LTC applicant requests an offset of their patient pay to cover old medical bills, see Pre-Eligibility Medical Expense (PEME) in glossary and BEM 546.

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VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items. LEGAL BASE MA 42 CFR 435.217 and .236 Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109- 171

BEM 165 1 of 10 MEDICARE SAVINGS PROGRAMS BPB 2024-018 7-1-2024

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DEPARTMENT POLICY MA Only Medicare Savings Programs (MSP) are SSI-related MA categories. They are neither Group 1 nor Group 2. This item describes the categories that make up the Medicare Savings Programs. The categories are: 1. Qualified Medicare Beneficiaries (QMB).

This is also called full-coverage QMB and just QMB. Program group type is QMB. 2. Specified Low-Income Medicare Beneficiaries (SLMB).

This is also called limited-coverage QMB and SLMB. Program group type is SLMB. 3. QI Additional Low-Income Medicare Beneficiaries (ALMB).

This is also referred to as ALMB and as just Q1. Program group type is ALMB. 4. Non-Categorically Eligible Michigan Beneficiaries (NMB). There are both similarities and differences between eligibility poli- cies for the categories. Benefits among the categories also differ. Income is the major determiner of category. QMB Net income cannot exceed 100% of poverty. SLMB Net income is over 100% of poverty, but not over 120% of poverty. ALMB (QI) Net income is over 120% of poverty, but not over 135% of poverty. NMB Income and assets above allowed ALMB limits but have full coverage Medicaid with Medicare part A/B entitlement.

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A person who is eligible for one of these categories cannot choose to receive a different Medicare Savings Program category. For example, a person eligible for QMB cannot choose SLMB instead. All eligibility factors must be met in the calendar month being tested. MEDICARE SAVINGS PROGRAMS BENEFITS

QMB Benefits QMB pays: • Medicare premiums, and Note: QMB pays Medicare Part B premiums and Part A premiums for those few people that have them. • Medicare coinsurances, and • Medicare deductibles. SLMB Benefits SLMB pays Medicare Part B premiums. ALMB Benefits ALMB pays Medicare Part B premiums provided funding is avail- able. NMB Benefits NMB pays the Medicare Part B premiums (and the part A premiums for the few who have them) for full coverage Medicaid beneficiaries not otherwise eligible for MSP. MEDICARE AND BUY-IN INFORMATION See BAM 810 for general information about Medicare and informa- tion about the Buy-In program.

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WHEN TO DO MEDICARE SAVINGS PROGRAMS DETERMINATIONS

Separate Medicare Savings Programs Determination Some Medicaid programs do not have automatic MSP coverage. Complete a Medicare Savings Program determination for any individual entitled to Medicare Part A. This includes individuals who are also eligible for Medicaid in the following categories: • Medicare Savings Programs-only. • Group 2 MA (MAGI-related and SSI-related). • Extended Care (BEM 164). • Healthy Kids. • Any other full coverage Medicaid program under MAGI or SSI- Related categories. Note: The individual who is eligible for MA under any of these categories does not have to request a determination of MSP eligibility or re-apply for MA in order to be reviewed for MSP eligibility by the department. Automatic QMB Person’s receiving MA under the following categories and entitled to Medicare Part A are considered QMB eligible without a separate QMB determination: • BEM 150, SSI Recipients. • BEM 155, 503 Individuals. • BEM 158, DAC. • BEM 163, AD-Care. • BEM 110, LIF. • BEM 111, TMA. MSP Determinations When Requested by CMS The Centers for Medicare and Medicaid Services (CMS) may ask MDHHS to review eligibility for, and addition of, MSP coverage for a timeframe when there was no Medicare Cost Share approved. The

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central office Buy-In Unit at MSA will contact the field office to ask that a determination of the recipient's eligibility for MSP during that timeframe be completed and to update the case record to add the MSP coverage if the recipient is eligible. MEDICARE SAVINGS PROGRAMS COVERAGE BEGIN DATES

QMB Begin Date Begin QMB coverage the calendar month after the processing month. The processing month is the month during which an eligibility determination is made. QMB is not available for past months or the processing month. SLMB Begin Date SLMB coverage is available for retro MA months and later months. Note: SLMB is only available for months income exceeds the QMB limit. A person cannot choose SLMB in place of QMB in order for coverage to start sooner (example, to get retro MA). ALMB Begin Date ALMB coverage is available for retro MA months and later months; however, not for time in a previous calendar year. ALMB and Previous Year Limit Do not approve ALMB for any month that is in a previous calendar year, even if application was made in the previous calendar year. Application was made December 27, 2015. Eligibility was determined on January 3, 2016. ALMB cannot be approved for any time before January 1, 2016. NMB Begin Date NMB coverage is available for retro MA months and later months.

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MEDICARE SAVINGS PROGRAMS INQUIRY A person may wish to know whether MA will pay Medicare premi- ums before enrolling in Medicare. The person may even contact the department before reaching age 65 (example, during the three months before the person’s 65th birthday). Advise persons listed under Automatic QMB above that MA will pay their Medicare premium. Do a determination of eligibility for all other persons. In doing this determination: • Explain the nonfinancial eligibility factors. Assume they will be met. • Use current information to determine financial eligibility. Do not ask for verification. • Explain that changes may affect the actual determination of eligibility. Be sure to discuss asset policy thoroughly if the person’s assets exceed the limit. • There is no need for a person to make a separate application or a re-application for an MSP determination. A Health Care Coverage application is used for an MSP only determination. NONFINANCIAL ELIGIBILITY FACTORS

Entitled to Medicare Part A The person must be entitled to Medicare Part A. That means some- thing different for QMB than it does for SLMB and ALMB. Entitled to Medicare Part A for QMB For QMB, entitled to Medicare Part A means the person meets con- dition 1, 2 or 3: 1. Is receiving Medicare Part A with no premium being charged.

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Note: A premium is being charged even when it is being paid by the Buy-In program.

BENDEX and State Online Query (SOLQ) indicate whether a Medicare Part A premium is being charged. 2. Refused premium-free Medicare Part A.

Suffix. Claim number suffix is always M1. 3. Is eligible for, or receiving, Premium HI (Hospital Insurance).

Premium HI is what the Social Security Administration calls Medicare Part A when it is not free of charge.

Suffix. Claim number suffix is M. Exception: Medicare Part A under section 1818A of the Social Security Act does not meet this eligibility factor; see Part A Identification in this item. Entitled to Medicare Part A for SLMB and ALMB For SLMB and ALMB, entitled to Medicare Part A means the person is receiving Medicare Part A with no premium being charged. BENDEX and SOLQ indicate whether a Medicare Part A premium is being charged. A premium is being charged even when it is being paid by the Buy- In program. Exception: Medicare Part A under section 1818A of the Social Security Act does not meet this eligibility factor; see Part A Identification in this item. ALMB and Other MA A person is not eligible for ALMB if the person is eligible for and receiving MA under another category. However, for deductible clients: • Persons in active deductible status are not considered eligible for another MA category, and

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• Persons identified as ALMB eligible at the time they report meeting their deductible remain ALMB eligible. • Persons who change to a nursing home status, Freedom to Work, or a waiver are not eligible for ALMB. Persons who are eligible for MA benefits under another category, but do not want such assistance can be eligible for ALMB. Persons can receive QMB or SLMB and full Medicaid benefits under another category. Other Nonfinancial Factors The MA eligibility factors in the following items must be met: • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. Part A Identification Absent evidence to the contrary (example, SSA document), use the following guidelines to distinguish between Medicare for Medicare Savings Programs and Medicare under section 1818A of the Social Security Act. • There is no charge for the person’s Medicare Part A - Medicare Savings Program. • The person is at least age 65 - Medicare Savings Programs • The person is under age 65 and there is a premium charged for Medicare Part A -not Medicare Savings Programs; see BEM 169, Qualified Disabled Working Individuals. Note: BENDEX and SOLQ indicate whether a Medicare Part A premium is being charged. Even if the BENDEX or SOLQ only indicate there may be entitlement for part A, a determination of

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MSP eligibility should be completed; see Part B Eligibility in this item. Part B Eligibility Individuals who receive Medicare part A (free or with a premium) but do not show receipt of part B, may not show part B coverage in Bridges because they refused it. Note: Because it is advantageous for the state to enroll every person who is entitled to Medicare part B (even if they have refused the coverage) into the MSP program, a determination of eligibility should be made even if a person shows only entitlement for Medicare part A. FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211. Assets Countable assets cannot exceed the limit in BEM 400. Countable assets are determined based on MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies to MSP because there could be a Medi- care coinsurance or deductible for LTC or home and community- based services. Income Eligibility Income eligibility exists when net income is within the limits in RFT 242 or 247. Income eligibility cannot be established with a patient- pay amount or by meeting a deductible. Determine countable income according to the SSI-related MA poli- cies in BEM 500, 501, 502, 503, 504 and 530, except as explained in COUNTABLE RSDI in this item. Apply the deductions in BEM 540 (for children) and 541 (for adults) to countable income to determine net income.

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COUNTABLE RSDI Federal law requires that for January, February and March: • The RSDI cost-of-living increase received starting in January be disregarded for fiscal group members, and • The income limits for the preceding December be used. For all other months, countable RSDI means the countable amount for the month being tested. For all other persons whose income must be considered, the RSDI cost-of-living increase is not disregarded. Countable RSDI Enter countable RSDI for the month being tested. When the month being tested is January, February or March Bridges will automati- cally: • Compute and deduct the RSDI cost-of-living increase for fiscal group members, and • Use the limits for the preceding December. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items. Annual Redetermination A redetermination of ALMB eligibility must be completed before the end of each calendar year. Set the ALMB redetermination date as September, October, November or December. ALMB cannot have a 24-month certification.

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MEDICARE PART A Answer the Medicare Part A question on SSI-related MA in Bridges based on the following: • 1- Receiving Medicare Part A with no premium being charged. • 2- Refused premium-free Medicare Part A. Claim number suffix is M1. • 3- Entitled to buy Medicare Part A. The Social Security Administration calls this Premium HI. Claim number suffix is M. Enter countable RSDI for the month being tested. The RSDI cost- of-living increase for fiscal group members will be deducted automatically if the month being tested is January, February or March. Enter the person’s claim number on the Recipient Information Screen when it is requested. It will then be printed on any memo generated for the Buy-In coordinator. APPLICATION FOR MEDICARE Verification of application for Medicare is by self-attestation. NOTIFICATION Email the beneficiary information to the Buy-in Coordinator at Buyinunit@michigan.gov when retro buy-in has been approved and indicate retro buy-in in the subject line. LEGAL BASE Social Security Act sections: • 1902(a)(10)(E)(i) for QMB. • 1902(a)(10)(E)(iii) for SLMB. • 1902(a)(10)(E)(iv) for ALMB. • 1902(r)(2). • 1905(a) for retro MA. • 1933 for ALMB funding.

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DEPARTMENT POLICY MA Only This is an SSI-related Group 2 MA category. Consider eligibility under this category only when eligibility does not exist under BEM 155 through 164, 170 or 171. Consider Medicare Savings Program eligibility (BEM 165) in addi- tion to Group 2 MA. MA is available to a person who is aged (65 or older), blind or dis- abled. All eligibility factors must be met in the calendar month being tested. If the month being tested is an L/H month and eligibility exists, go to BEM 546 to determine the post-eligibility patient-pay amount. NONFINANCIAL ELIGIBILITY FACTORS 1. The person must not be eligible for MA under BEM 155 through 164, 170 or 171, but may be eligible for a Medicare Savings Program under BEM 165. 2. The person must be aged, blind or disabled (BEM 240, Age, or BEM 260, MA Disability/Blindness). The MA eligibility factors in the following items must be met.  BEM 220, Residence.  BEM 221, Identity.  BEM 223, Social Security Numbers.  BEM 225, Citizenship/Alien Status.  BEM 255, Child Support.  BEM 256, Spousal/Parental Support.  BEM 257, Third Party Resource Liability.  BEM 265, Institutional Status.  BEM 270, Pursuit of Benefits.

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FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211. Assets Countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on MA policies in BEM 400, 401 and 402. Divestment Policy in BEM 405 applies. Income Eligibility Income eligibility exists when net income does not exceed the Group 2 needs in BEM 544. Apply the MA policies in BEM 500, 530, 540 (for children) or 541 (for adults), and 544 to determine net income. If the net income exceeds Group 2 needs, MA eligibility is still possible per BEM 545. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte reivew should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories. See BAM 115 and 220. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items.

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LEGAL BASE MA 42 CFR 435.320, .322 and .324 MCL 400.106 Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109- 171

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DEPARTMENT POLICY MA Only The Program of All Inclusive Care for the Elderly (PACE) is a man- aged care program designed for the frail, elderly population. PACE enrollment is always prospective. The Medicaid Services Administration (MSA) administers the program through contracts with PACE organizations. The PACE organization receives referrals from medical providers in the community who believe a person meets both the PACE program and Medicaid eligibility factors in this item as well as the nursing facility level of care criteria. PACE is currently operating in several counties in southern Michigan. The PACE program is not a Medicaid category, but there are spe- cial eligibility rules for clients approved for PACE services. TARGETED GROUP The person must meet all the following: • Be medically qualified. • Be 55 years of age or older. • Live within an approved geographic area of the PACE provider. • Not reside in a nursing facility at the time of enrollment. • Not enrolled in the MIChoice Waiver. • Not enrolled in an HMO. NONFINANCIAL ELIGIBILITY FACTORS The eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits.

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FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211. A PACE participant is a group of one even when living with a spouse. Individuals covered under the Extended Care eligibility group can be enrolled in PACE. Assets Countable assets cannot exceed the asset limit for SSI-related MA categories in BEM 400. Countable assets are determined based on MA policies in BEM 400, 401, and 402. Initial Asset Assessment (IAA) Date The special MA asset rules in BEM 402 apply when completing the initial asset assessment. The date of the medical assessment and approval for PACE enrollment is completed by the PACE agency is the first day of continuous care for the purpose of determining the IAA; unless there is a previous period of care which meets the definition of a first day of continuous care found in BEM 402. Approval means the participant expects to receive appropriate waiver services for at least 30 consecutive days. Divestment

The MA divestment policy in BEM 405 apply to PACE waiver applicants and participants.

Income Income eligibility exists when gross income does not exceed 300 percent of the federal benefit rate. Income eligibility cannot be established with a patient-pay amount or by meeting a deductible.

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Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. PATIENT-PAY AMOUNT A patient-pay amount will be calculated if a PACE enrollee is admit- ted to a nursing facility or hospital. The PACE organization is responsible for collecting the patient-pay amount. Notice of the start, effective date, and any changes to the amount must be sent to the PACE organization. NOTICES PACE organizations have received federal and state approval for administering the program. Therefore, the following information may be shared without a signed release from the client: • A copy of the DHS-3503, Verification Checklist. • A copy of the DHS-4598, Medical Program Eligibility Notice, or the system equivalent. • A copy of the DHS-1606, MA Determination Notice. The original DHS-3503, DHS-4598, DHS-1606 must be sent to the client or the guardian, court or agency who is legally responsible for the client. PACE PROVIDERS CareResources 1471 Grace St. S.E. Grand Rapids, MI 49506 616-913-2006 or 1-800-610-6299

LifeCircles- PACE Muskegon 560 Seminole Rd. Muskegon, MI 49444 231-733-8686 or 1-888-204-8626

LifeCircles-PACE Holland 12330 James St.

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Holland, MI 48424 616-582-3100

CentraCare 200 West Michigan Ave. Battle Creek, MI 49017 269-441-9300 or 877-284-4071 CentraCare 445 W. Michigan Ave. Kalamazoo, MI 49001 269-488-5460 or 1-800-488-5860

PACE of Southwest Michigan 2900 Lakeview Ave. St. Joseph, MI 49085 855-483-8876

PACE Southeast Michigan 24463 W. 10 Mile Southfield, MI 48033 855-445-4554

PACE Southeast Michigan Dearborn Center 15401 N. Commerce Dr. Dearborn, MI 48120 855-445-4554

PACE Southeast Michigan Thome Rivertown PACE Center 250 McDougall St. Detroit, MI 48207 855-455-4554

PACE Southeast Michigan Warren 30713 Schoenherr Warren, MI 48088 855-455-4554

Thome PACE 2282 Springport Rd. Jackson, MI 49202 517-768-9791

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Huron Valley PACE 2940 Ellsworth Rd. Ypsilanti, MI 48197 855-483-7223

Genesys PACE of Genesee County 412 E. First Street Flint, MI 48502 810-236-7500

Great Lakes PACE 3378 Fashion Square Blvd. Saginaw, MI 48603 989-272-7610

VOANS Senior Community Care of Michigan 1321 E. Miller Road Lansing, MI 48911 517-319-0700

Community at PACE, Inc. 231 West Pine Lake Drive Newaygo, MI 49337 1-800-689-6675 LEGAL BASE MA Title XIX of the Social Security Act. 42 CFR 460.

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POLICY Please see historical policy for MI Health Link (MHL) information. MI Health Link enrollees will transition automatically to MICH with no break in coverage. The MI Coordinated Health (MICH) program is a Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) launching on January 1, 2026. It replaces the MI Health Link program and is designed to provide integrated care for individuals eligible for both Medicare and Medicaid. The goals of the program are to improve coordination of support and services offered through Medicare and Medicaid, enhance quality of life, improve quality of care, and align financial incentives. This category is available to waiver clients who are aged (65 or older), blind or disabled. See BEM 106 for the definition of waiver clients. Gross income cannot exceed 300 percent of the SSI federal benefit rate; see RFT 248. All eligibility factors in this item must be met in the calendar month being tested INTERGRATED CARE ORGANIZATIONS (ICO) MDHHS and the Center for Medicaid and Medicare Services (CMS) contracts with managed care entities called MI Coordinated Health (MICH) to provide Medicare and Medicaid covered acute and primary health care, pharmacy, dental and Long Term Supports and Services (nursing facility and home and community-based services). In addition to all Medicare Parts A, B, and D, and Medicaid State-plan services (except those covered through contracts between the State and the Michigan Pre-Paid Inpatient Health Plans), Mich is required to provide supplemental benefits and other supports and services as defined in the approved 1915(b) and 1915(c) waivers and other supporting documentation, or rules, provided by CMS or MDHHS. See Exhibit I in this item for a list of MICH names and service areas.

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The PIHPs are responsible for managing Medicaid Specialty Services and Supports in specified geographic regions, under contract with the Michigan Department of Health and Human Services (MDHHS) consistent with the Michigan Mental Health Code (MMHC). The MICH and PIHPs coordinate and manage care for jointly served enrollees. ELIGIBILITY MI Coordinated Health (MICH) is a Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) for Michigan residents that: • Age 21 or older at the time of enrollment including individuals age 21 and older served by the Children’s Specialized Health Care Services (CSHCS) program. • Are enrolled in both Medicare and Medicaid. Entitled to Medicare Part A, Medicare Part B, and Medicare Part D. • Receiving full Medicaid benefits (this includes individuals who are eligible for Medicaid through expanded financial eligibility limits under a 1915(c) waiver or who reside in a Nursing Facility, including those who have a monthly Patient Pay Amount). • Do not live in a state-operated veteran’s home. • Are not currently enrolled in hospice care. • Live in Michigan in the following regions/counties: Region 1: Upper Peninsula (except Chippewa, Gogebic, and Menominee). Region 8: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren. Region 10: Macomb. Region 12: Wayne. • It is allowable for an Enrollee residing in a MI Coordinated Health region to be admitted to a Nursing Facility outside the HIDE-SNP region for a service that cannot be obtained in the HIDE-SNP region (and replacement is not based on the family

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or social situation of the Enrollee). This is allowable for up to 6 consecutive months. INELIGIBLE POPULATION Populations ineligible for the MI Coordinated Health Program are: • Individuals under the age of 21. • Individuals previously disenrolled due to special disenrollment from Medicaid managed care as defined in 42 C.F.R. § 438.56. • Individuals not living in a HIDE SNP Service Area. • Individuals who are eligible for partial Medicaid coverage through the following eligibility groups: Additional Low Income Medicare Beneficiary (ALMB), Qualified Individual (QI), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Disabled and Working Individuals (QDWI). • Individuals without full Medicaid coverage (including those with spenddowns or deductibles). • Individuals with Medicaid who reside in a State psychiatric hospital. • Individuals with other comprehensive health coverage including commercial HMO coverage. • Individuals who elected hospice services prior to HIDE SNP enrollment: • If an existing HIDE SNP Enrollee elects to receive hospice services, the Enrollee may remain enrolled in the HIDE SNP and will only be disenrolled at the Enrollee’s request. • Individuals who are incarcerated. • Individuals with presumptive eligibility. • Individuals not eligible for Medicaid due to divestment. • Individuals residing in designated State sanction Veterans’ Homes.

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Note: Individuals enrolled in MI Choice, PACE, MI Care Team, Independence at Home, and CSHCS are eligible but must leave their programs before joining MI Coordinated Health. MI Coordinated Health members cannot be simultaneously enrolled in MI Choice, PACE, or Home Help; see ASM 126 for information on Home Help referrals from MI Coordinated Health. MICH ENROLLMENT PROCESS Enrollment in the MI Coordinated Health program occurs through voluntary enrollment. Voluntary Enrollment All enrollments must be voluntary. There are several ways to enroll in MICH. Enrolling, Disenrolling, or Cancelling Automatic Enrollment HIDE-SNPs will manage enrollment processes with the allowance of agents and brokers. Beneficiaries may enroll in HIDE-SNPs by: 1. Contacting the plan, they want to enroll in. 2. Contacting an insurance agent or Broker. 3. Contacting 1-800-MEDICARE (1-800-633-4227, TTY: 1-800- 486-2048). 4. Using Medicare’s online official Plan Finder tool. There are no open enrollment periods. Eligible individuals can enroll, disenroll, and change plans at any time. Note: Enrollment and disenrollment elections will be active the first day of the month following the date the request is processed. MICH COORDINATED INFORMATION AND SUPPORT To learn more about MI Coordinated Health, individuals should contact the following:

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• The MI Options Program: MI Options Program provides resources to help individuals navigate Medicare options. To contact MMAP, individuals may call 1-800-803-7174. Office hours vary by location. Open Monday through Friday. Individuals actively enrolled in MI Coordinated Health with questions or concerns related to their care may contact the following: • The MI Community, Home, and Health Ombudsman (MI CHHO): MI CHHO is an independent program that serves as an advocate and problem-solver for beneficiaries enrolled in MI Coordinated Health. All services are free and confidential. To contact MI CHHO, members may call toll-free at 1-888-746- 6456 Monday through Friday 8 AM to 5 PM. Written correspondence can go through email at: MI-CHHO@meji.org or mailed to 15851 S. US 27, Suite 73 Lansing, MI 48906. MICH 1915 (B) AND (C) WAIVERS The Behavioral and Physical Health and Aging Services Administration (BPHASA) MI Coordinated Health Program offers comprehensive Medicare and Medicaid managed care, as well as a Home and Community Based Services (HCBS) Waiver through a single managed care organization called Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP). The MI Coordinated Health 1915(b) Waiver program allows Michigan to passively (automatically) enroll individuals eligible for both full Medicare and full Medicaid into a contracted HIDE on a monthly basis. MDHHS contracts with several Plans throughout the state of Michigan, known as Health Delivery Entities (HDEs). Individuals enrolled in an HDE who are eligible for 1915(c) Home and Community Based Services (HCBS) can access them through their HDE without being disenrolled from MI Coordinated Health. Individuals receiving HCBS in MI Coordinated Health’s 1915(c) waiver would, absent the waiver, require services in a nursing facility. This means an individual enrolled in MI Coordinated Health is receiving comprehensive managed care and HCBS concurrently through their HDE.

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Note: The MI Coordinated Health Waiver is not an MA category, but there are special eligibility rules for people approved for the waiver; see Financial Eligibility Factors in this item. 1915 (C) WAIVER ADMINISTRATION MI Coordinated Health administers the HCBS Waiver through contracts with Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP). 1915 (C) Waiver Eligibility To be eligible for the MI Coordinated Health HCBS waiver, an individual must do all of the following: • Be enrolled in the MI Coordinated Health program. • Meet nursing facility level of care as determined by Michigan's Medicaid Nursing Facility Level of Care Determination tool. • Have a need for one or more of the Waiver services listed in the MI Coordinated Health waiver application. Enrollees must receive at least one waiver service each month to remain enrolled in the MI Health Link HCBS Waiver. 1915(C) Waiver Enrollment Process The HCBS waiver enrollment process includes: Assessment HDE and/or the HDE’s contracted vendor are responsible for completing an assessment to verify a member’s medical and functional eligibility for the Waiver. Once all Waiver enrollment materials are complete, the HDE must enter the HCBS Waiver enrollment in CHAMPS and upload an enrollment packet for MDHHS to review. Additionally, HDEs must complete new Waiver assessments and submit to MDHHS at least annually. The MDHHS local office is still responsible for financial eligibility determination.

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Plan of Service A written plan of services, also known as an “Individualized Care Plan (ICP)” is developed by the HDE and the Waiver participant if the assessment confirms medical and functional eligibility for the HCBS Waiver. The participant may choose to receive home and community-based services from the HDE. At a minimum, the plan of services includes all of the following: • Types of services to be furnished. • The amount, frequency, and duration of each service. • The type of provider to furnish each service. • Participant goals, preferences, and outcomes. • Participant approval of the plan. • The signature of the care coordinator assisting with developing the plan. Care Coordination Through care coordination, a person employed by the HDE, (known as a care coordinator) or a team, (known as an integrated care team), assists MICH enrollees in accessing Medicare and Medicaid services, including medical services and supplies, behavioral health, substance use disorder and/or intellectual developmental disabilities, pharmacy, and Long Term Supports and Services (LTSS), to promote quality, effectiveness, and integration of care. The Enrollee’s HDE is responsible for arranging for planned services to be provided. In addition to coordinating with MDHHS- contracted PIHPs for the delivery of Medicaid behavioral health services, HDEs may contract with downstream providers for delivery of covered services. APPROVED FOR THE 1915 (C) WAIVER Approved for the HCBS waiver means all of the following: • The HDE conducted the assessment. • A person-centered plan of service has been developed. • The participant has been approved for an available Waiver slot.

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• The participant has at least one ongoing service need per month and is receiving at least one service from the ICO per month to remain on the waiver. • The HDE submitted an assessment, a care plan, and other required documentation to MDHHS. • The HDE reviewed documentation and determined medical and functional Waiver eligibility and enrolled into the HCBS Waiver. The participant’s Waiver documentation has not been deemed incomplete or deficient through ongoing MDHHS monitoring and auditing processes. Approval and Termination Dates The HDE determines the Waiver effective date and termination date based on the participants’ needs. The HDE is responsible for advising the appropriate local Michigan Department of Health and Human Services (MDHHS) office of these dates by entering the information into CHAMPS. Waiver enrollment automatically terminates when the participant enters a Long-Term Care (LTC) facility; see BEM 547 for instructions. Note: An HCBS Waiver Notice is sent from CHAMPS to Bridges to notify caseworkers when an individual is newly enrolled in the waiver, which qualifies them for expanded financial eligibility. The HCBS Waiver Notice appears as an Admission/Discharge Notice in Bridges and is sometimes misinterpreted as a Nursing Facility Admission. Page one of the notice specifies in the SMA Approval Type field that the individual is in an HDE, meets Nursing Facility Level of Care Determination, and is in the community (formerly LOC 03 now HDE-HCBS or HDE-HOSW). MDHHS LOCAL OFFICE RESPONSIBILITIES The local MDHHS office is responsible for completing an initial asset assessment (IAA) and determining MA eligibility for potential waiver participants.

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Waiver Participant Defined A waiver participant is a person who is approved to receive or receives waiver services based on medical and functional and financial eligibility. Waiver Month Defined A waiver month is a calendar month containing at least one day that the participant is (or was) receiving Waiver services. HDEs enter Waiver enrollment into CHAMPS for either the current or the following month, dependent on service start date. The enrollment would be effective the first of the month. For purposes of MA eligibility, a month remains a waiver month even if the Waiver participant enters an LTC facility and/or hospital (L/H) in the same calendar month. A waiver month does not become an L/H month; Example: A member is approved for the waiver and becomes a waiver participant in June. That same month, the member enters an LTC facility and/or hospital. June would still be considered a waiver month and not an L/H month because the member was approved for the waiver for at least one day of the calendar month. See Bridges Glossary for the definitions of Waiver Month and L/H Month. NOTE: MHL HCBS Waiver months start on the first day of the month and end on the last day of the month. There is no mid-month start date or end date other than upon admission or discharge to/from a Nursing Facility. NONFINANCIAL ELIGIBILTY FACTORS The eligibility factors in the following items must be met. • BEM 220, Residence. • BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Non-Citizen Status. • BEM 255, Child Support. • BEM 256, Spousal/Parental Support. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits.

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FINANCIAL ELIGIBILITY FACTORS Use special MA policies in the MA eligibility determination: • A waiver participant is a group of one even when he/she lives with a spouse; see BEM 211. • The Special MA Asset Rules in BEM 402 apply when completing the Initial Asset Assessment; see special initial asset assessment rules for waiver applicants in this item for rules on determining the first period of continuous care. • The extended-care category is available to waiver participants; see BEM 164. • Gross income must be at or below 300 percent of the SSI Federal Benefit Rate. An individual cannot spenddown income to waiver eligibility; see BEM 500. A waiver participant may no longer qualify for waiver services; however, they may still qualify for MA. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. Initial Asset Assessment for 1915 (C) Waiver Applicants An Initial Asset Assessment (IAA) may be needed for potential Waiver participants with a spouse. The IAA is used to protect a certain amount of the couple’s combined resources for the community spouse. It does not determine the start of Medicaid eligibility. Use policy in BEM 402 to determine if an IAA is appropriate. An IAA uses a first day of continuous care; see BEM 402 for definition. The first period of continuous care is a period of at least

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30 consecutive days where the institutionalized spouse/applicant has been or is expected to be: • In a hospital and/or LTC facility; and/or • Approved for the Waiver. Note: The period is no longer continuous when none of the above is true for 30 or more consecutive days; see BEM 402 for examples. The first period or continuous care may have occurred in the past; however, the applicant must be currently receiving services to complete an IAA. If there is no past period of continuous care, then the IAA date must start on the first day that meets the definition of continuous care in BEM 402. Notices MI Coordinated Care waiver activities are performed by HDEs who meet the federal definition of administering the MA program. Therefore, you can share the following information with the HDE without a signed release from the participant: • A copy of the DHS-3503, Verification Checklist. • A copy of the DHS-4588, Initial Asset Assessment Notice. The original DHS-3503, and DHS-4588 must be sent to the participant or the guardian, court or agency that is legally responsible for the participant. Do not enter HDEs in Bridges as a third-party type. Only the participant's legal guardian, court or agency legally responsible for the participant can be entered as a third-party type. HOSPICE SERVICES In MI Coordinated Health, HCBS Waiver participants may receive hospice services and waiver services simultaneously. However, individuals with elected hospice services prior to enrolling in MI Coordinated Health are ineligible for the program. If an existing MICH participant elects hospice services, the participant may remain enrolled in the program and obtain the hospice service through the Medicare FFS benefit.

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MICH COVERED SERVICES The MI Health Link program offers an array of services to dually eligible individuals enrolled in the program. Covered services include all health care services covered by Medicare and Medicaid: • Dental and vision services. • Diagnostic testing and lab services. • Emergency and urgent care. • Equipment and medical supplies. • Home health services. • Hospitalizations and surgeries. • Medications (without co-payments). • Nursing home services. • Hospice (if elected while enrolled). • Primary care and specialty services. • Transportation for medical emergencies and medical appointments. • Care Coordination. Services for long-term support and services include: • Adult day program. • Chore services. • Community transition services. • Equipment to help with activities of daily living. • Fiscal intermediary services. • Home delivered meals. • Home modifications. • Non-medical transportation. • Nursing home care. • Personal care. • Personal Emergency Response System (PERS). • Preventive nursing services.

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• Private duty nursing. • Respite. Home and Community Based services available through the MICH1915(c) Waiver include: • Adaptive Medical Equipment and Supplies. • Adult Day Program. • Assistive Technology. • Care Coordination. • Chore Services. • Environmental Modifications. • Expanded Community Living Supports. • Fiscal Intermediary. • Home Delivered Meals. • Non-Medical Transportation. • Personal Emergency Response Systems (PERS). • Preventative Nursing Services. • Private Duty Nursing. • Respite. MICH MDHHS LOCAL OFFICE RESPONSIBILITIES Caseworkers must check for Medicare enrollment or eligibility at time of MA application and redetermination/renewal to avoid placement in the Healthy Michigan Plan (HMP) when the individual could be eligible for MICH through a HDE. At the time of MA application and redetermination/renewal, the caseworker should review the State Online Query (SOLQ) and Consolidated Inquiry to ensure the individual is not enrolled in Medicare. If the individual is enrolled in Medicare, they are not eligible for HMP, but may qualify for MI Coordinated Health/HDE; see BAM 801, SSA Data Exchanges. DEEMING PERIOD FOR MI COORDINATED HEALTH The deeming period is a temporary grace period that allows individuals enrolled in MI Coordinated Health (MICH) to continue receiving Medicaid-covered services while their Medicaid eligibility is being re-evaluated through the redetermination process.

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Purpose of Deeming Deeming ensures continuity of care for beneficiaries who may experience delays in completing or processing their Medicaid redetermination paperwork. During this period, members retain access to: • Medicare services through their MICH plan. • Most Medicaid services, including long-term supports and behavioral health care. Eligibility for Deeming A member may enter the deeming period if: • They are currently enrolled in MICH. • Their Medicaid redetermination paperwork is not submitted or processed by the due date. Duration of Deeming • The deeming period lasts for three, four, five or six months, depending on deeming period elected by the plan, following the missed redetermination deadline. • During this time, the members remain enrolled in MICH and continues to receive services. Member Notification • Members will receive a written notice from their MICH health plan indicating they are in the deeming period. • The notice will include instructions for submitting or correcting redetermination paperwork. End of Deeming • If full Medicaid eligibility is reconfirmed during the deeming period, the member continues uninterrupted enrollment in MICH. • If eligibility is not re-established, the member will be disenrolled from MICH and will:

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Receive Medicare services through traditional Medicare or a Medicare Advantage plan. Lose access to Medicaid-covered services. VERIFICATION REQUIREMENTS Home and Community based services listed in this item are used to determine the first day of continuous care for the IAA must be verified. VERIFICATION SOURCES Review SMA screen in Bridges for enrollment dates.

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EXHIBIT I MICH INTEGRATED CARE ORGANIZATIONS

HDE Name COUNTIES SERVED Aetna Better Health of Michigan, Inc. 855-676-5772 www.aetna.com/medicare-dsnp/michigan Region 8: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren Region 10: Macomb Region 12: Wayne AmeriHealth Caritas VIP Care 844-964-4433 www.amerihealthcaritasvipcare.com/mi Region 10: Macomb Region 12: Wayne HAP CareSource To enroll: 855-524-6993 Current members: 833-230-2057 www.caresource.com/mi/plans/mich/ Region 10: Macomb Region 12: Wayne

Humana Dual Integrated 855-281-6070 www.provider.humana.com/medicaid/michigandsnp Region 10: Macomb Region 12: Wayne

Meridian Complete 888-437-0606 www.mmp.mimeridian.com

Region 8: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren Region 10: Macomb Region 12: Wayne Molina Healthcare, Inc. 855-735-5604 www.MolinaHealthcare.com/Medicare Region 8: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Van Buren excluding St. Joseph Region 10: Macomb Region 12: Wayne Priority Health Choice, Inc. 844-836-4123 www.priorityhealth.com/medicare/dsnp Region 8: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren Region 10: Macomb Region 12: Wayne United Healthcare Community Plan, Inc. 855-645-2501 www.uhc.com/communityplan/call?cid=sp:dsnp- bng-uhc-bp-dsnp Region 8: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren Region 10: Macomb Region 12: Wayne Upper Peninsula Health Plan 877-349-9324 www.uphp.com/medicare Region 1: All counties in the Upper Peninsula Except Chippewa, Menominee and Gogebic

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LEGAL MA Social Security Act, Section 1915 42 CFR Part 435.217, 441.350,.400, 438, 422.

BEM 169 1 of 4 QUALIFIED DISABLED WORKING INDIVIDUALS BPB 2016-006 4-1-2016

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DEPARTMENT POLICY MA Only This is an SSI-related MA category. It is neither a Group 1 nor a Group 2 MA category. MA pays only the recipient's Medicare Part A premium. A person eligible under this category is called a Qualified Disabled Working Individual (QDWI). A QDWI is a person who:  Receives, or is eligible to enroll in, Medicare Part A under section 1818A of the Social Security Act, and  Is not eligible for MA under any other category, and  Meets the eligibility factors specified in this item. All eligibility factors must be met in the calendar month being tested. BEM 546, Post-Eligibility Patient-Pay Amounts, does not apply. INQUIRY A person may wish to know whether MA will pay Medicare Part A premiums before enrolling. If the person is not an MA, FIP or SSI recipient, do a determination of QDWI eligibility. Advise the person whether he might be eligible. In doing this determination:  Explain the nonfinancial eligibility factors. Assume they will be met.  Determine financial eligibility using current information. Verification is not required.  Explain that changes may affect the actual determination of eligibility. Be sure to discuss asset policies thoroughly if the person's current assets exceed the limit. NONFINANCIAL ELIGIBILITY FACTORS 1. The person must receive or be eligible to enroll in Medicare Part A under section 1818A of the Social Security Act (Act). See "1818A Identification" below.

BEM 169 2 of 4 QUALIFIED DISABLED WORKING INDIVIDUALS BPB 2016-006 4-1-2016

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

2. The MA eligibility factors in the following items must be met.  BEM 220, Residence.  BEM 223, Social Security Numbers.  BEM 265, Institutional Status. 3. The person must not be eligible for any other MA category.

Presume a person eligible for Medicare Part A under section 1818A of the Social Security Act is not disabled for purposes of BEM 260 unless the person reports a change and claims he is again unable to perform a substantial gainful activity. 1818A Identification BAM 810 describes eligibility factors for Medicare Part A under sec- tion 1818A of the Act. The Social Security Administration is respon- sible for determining eligibility for Medicare and authorizing Medicare coverage. Assume a person who is eligible for Medicare Part A is eligible under section 1818A if he is:  Under age 65, and  Charged a premium for his Medicare Part A, Hospital Insurance.

BENDEX, Wire Third Party and TPQY indicate whether a Medi- care Part A, Hospital Insurance, premium is being charged. Other sources of identification include correspondence from, or contact with, the Social Security Administration. FINANCIAL ELIGIBILITY FACTORS

Groups Use fiscal and asset group policies for SSI-related groups in BEM 211.

BEM 169 3 of 4 QUALIFIED DISABLED WORKING INDIVIDUALS BPB 2016-006 4-1-2016

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

Assets Countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on the MA policies in BEM 400 and 401. Divestment Do not apply policy in BEM 405. Income Eligibility Income eligibility exists when net income does not exceed the income limit in RFT 246. Income eligibility cannot be established with a patient-pay amount or by spending-down. Apply the MA policies in BEM 500, 530, 540 (for children) and 541 (for adults) to determine net income. COVERAGE The only MA benefit is payment of Medicare Part A premiums. The mi health card, is not issued. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories. See BAM 115 and 220. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items. Verification of Medicare Part A eligibility and premium is required. The following are accepted as verification of Medicare Part A or Hospital Insurance premiums being charged:  SOLQ.  Correspondence from SSA.  Contact with SSA.

BEM 169 4 of 4 QUALIFIED DISABLED WORKING INDIVIDUALS BPB 2016-006 4-1-2016

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LEGAL BASE MA Social Security Act, Sections 1902(a)(10)(E), 1905(p)(3), 1905(s)

BEM 170 1 of 4 HOME CARE CHILDREN BPB 2017-017 10-1-2017

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

DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. MA is available to a child who requires institutional care but can be cared for at home for less cost. The child must be under age 18, unmarried and disabled. The income and assets of the child's parents are not considered when determining the child's eligibility. Children's Special Health Care Services (CSHCS) and the local MDHHS office share responsibility for determining eligibility for Home Care Children. All eligibility factors must be met in the calendar month being tested. NONFINANCIAL ELIGIBILITY FACTORS

CSHCS Responsibilities CSHCS determines if medical eligibility exists. That is:  The child requires a level of care provided in a medical institution (for example the hospital, skilled nursing facility or an intermediate care facility); and  It is appropriate to provide such care for the child at home; and  The estimated MA cost of caring for the child at home does not exceed the estimated MA cost for the child's care in a medical institution. CSHCS also obtains necessary information to determine whether the child is disabled and forwards it to the Disability Determination Service DDS. If the criterion in BEM 260 are met, disability will be certified on a DHS-49-A, Medical-Social Eligibility Certification, by DDS.

BEM 170 2 of 4 HOME CARE CHILDREN BPB 2017-017 10-1-2017

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

Communication to the Local Office If the child is disabled and requirements above are met, CSHCS sends a MSA-1785, Policy Decision, and the medical packet to the appropriate MDHHS local office. The MSA-1785 certifies that the medical requirements in CSHCS Responsibilities in this item are met. CSHCS will also notify the MDHHS local office when this category can no longer be used for a child. Pursue eligibility for other MA categories when a child is no longer eligible for this category. A child determined medically eligible for this category does not need a determination of Medicaid eligibility under a MAGI category first. Local Office Responsibilities Do not authorize MA under this category without a MSA-1785 certifying medical eligibility for this category. Use this category when the child is not an SSI or FIP recipient. Use this category before using a Group 2 category. If a MSA -1785 is received for a child who is not an MA applicant or recipient, treat the MSA -1785 as a request for assistance. Contact the child's parents concerning an MA application for the child. Determine if the child meets the MA eligibility factors in the following items:  BEM 220, Residence.  BEM 223, Social Security Numbers.  BEM 225, Citizenship/Alien Status.  BEM 257, Third Party Resource Liability.  BEM 270, Pursuit of Benefits. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220.

BEM 170 3 of 4 HOME CARE CHILDREN BPB 2017-017 10-1-2017

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INQUIRIES Inquiries from medical providers or parents concerning medical eligibility (requirements in CSHCS Responsibilities in this item) under this category should be directed to a nurse consultant at:

Michigan Department of Health and Human Services

Public Health Administration

Bureau of Family, Maternal & Child Health, Children’s Special Health Care Services

Lewis Cass Building, 6th Floor

320 S. Walnut Street

Lansing, MI 48913

Phone: 1-800-359-3722 FINANCIAL ELIGIBILITY FACTORS Financial eligibility is determined by the MDHHS local office. Only the child's own income and assets are counted. Do not deem income and assets from the child's parents to the child. Groups The child is a fiscal and asset group of one. Assets The child's countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on MA policies in BEM 400 and BEM 401. Divestment Do not apply policy in BEM 405. Income Eligibility Apply the MA policies in BEM 500, 501, 502, 503, 504, and 530 to determine net income. Income eligibility exists when the child's net income is equal to or less than 100 percent of the SSI federal benefit rate; see RFT 248: VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items.

BEM 170 4 of 4 HOME CARE CHILDREN BPB 2017-017 10-1-2017

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

LEGAL BASE MA Tax Equity and Fiscal Responsibility Act of 1982 (P.L. 97-248), Section 134

BEM 171 1 of 4 CHILDREN'S WAIVER BPB 2026-007 4-1-2026

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

DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. MA is available to a child who requires care in an Intermediate Care Facility for Individuals with Intellectual Disability (ICF/ID) but can be cared for at home for less cost. The child must be under age 18, unmarried and disabled. The income and assets of the child's parents are not considered when determining the child's eligibility. MDHHS is responsible for determining eligibility for the Children’s Waiver. All eligibility factors must be met in the calendar month being tested. NONFINANCIAL ELIGIBILITY FACTORS

MDHHS Responsibilities MDHHS determines if medical eligibility exists. That is: • The child requires a level of care provided in an ICF/ID, and • It is appropriate to provide such care for the child at home, and • The average estimated MA cost of caring for the child at home does not exceed the average estimated MA cost for the child's care in an ICF/ID. The Bureau of Children's Coordinated Health Policy and Supports is responsible for the following at application and medical review: • Obtaining medical evidence of the disability. • Certifying disability on the DHS-49-A, Medical-Social Eligibility Certification. MDHHS certifies that the requirements above are met on an MSA- 1785, Policy Decision. If the child is not receiving MA, MDHHS will send the family: • A copy of the MSA-1785 and

BEM 171 2 of 4 CHILDREN'S WAIVER BPB 2026-007 4-1-2026

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

• A DCH-1426 with the address of the local office to mail the completed application. Communication to the Local Office MDHHS will send the MSA-1785 and the DHS-49A to the local MDHHS office when: • A child is an MA recipient, or • A child is not an MA recipient. DCH will also notify the local MDHHS office when this category can no longer be used for a child. Pursue eligibility for other MA categories when a child is no longer eligible for this category. Local Office Responsibilities Do not authorize MA under this category without a DHS-49-A and MSA-1785 authorizing MA in this category. Use this cate- gory when the child is not an SSI or FIP recipient. Use this category before using a Group 2 category. Treat the MSA-1785 as a request for assistance, if it is received for a child who is not an MA applicant or recipient. Determine if the child meets the MA eligibility factors in the following items: • BEM 220, Residence. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 257, Third Party Resource Liability. • BEM 260, MA Disability/Blindness. • BEM 270, Pursuit of Benefits. Note: MDHHS is responsible for obtaining medical evidence and certifying disability on the DHS-49-A; see MDHHS Responsibilities. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see Bridges Administrative Manual (BAM) 115 and 220.

BEM 171 3 of 4 CHILDREN'S WAIVER BPB 2026-007 4-1-2026

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INQUIRIES Inquiries from medical providers or parents concerning medical eligibility (requirements (a) through (c) above) under this category should be directed to your local Community Mental Health Services Program, Developmental Disabilities Division. FINANCIAL ELIGIBILITY FACTORS Financial eligibility is determined by the MDHHS local office. Count only the child's own income and assets. Do not deem income and assets from the child's parents to the child. Groups The child is a fiscal and asset group of one. Assets The child's countable assets cannot exceed the asset limit in Bridges Eligibility Manual (BEM) 400. Countable assets are determined based on MA policies in BEM 400 and 401. Divestment Do not apply policy in BEM 405. Income Eligibility Income eligibility exists when the child's gross income is equal to or less than 300% of the federal SSI benefit rate; see RFT 248. Gross income is the amount determined after applying the MA poli- cies in BEM 500, 501, 502, 503, 504 and 530. Do not apply the deductions in BEM 540 and 541. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items.

BEM 171 4 of 4 CHILDREN'S WAIVER BPB 2026-007 4-1-2026

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LEGAL BASE MA Social Security Act, Section 1915 (c)

BEM 172 1 of 4 CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE (SED) WAIVER BPB 2024-023 10-1-2024

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

DEPARTMENT POLICY Medicaid (MA) ONLY This is an SSI-related Group 1 MA category. MA is available to a child who meets the criteria for admission to a state psychiatric hospital and/or who are at risk of hospitalization without wavier services. The child must be under age 18 when approved for the waiver, unmarried, a current patient in a psychiatric hospital or at risk of such placement; must demonstrate serious functional limitations that impair ability to function in the community; and must have a completed MichiCANS Comprehensive that indicates SED waiver eligibility and meets Medicaid Provider manual eligibility criteria as determined by the local Community Mental Health Services Pro- gram (CMHSP). If a child on the SEDW turns 18, continues to meet all non-age-related eligibility criteria (see below in this item), and continues to need waiver services, the child can remain on the waiver up to their 21st birthday. The income and assets of the child’s parents are not considered when determining the child’s eligibility. The Bureau of Children's Coordinated Health Policy and Supports (BCCHPS) and local MDHHS office share responsibility for determining eligibility for the SED Waiver. BCCHPS, in cooperation with the local CMHSP, has responsibility for determining non- financial eligibility factors for the SED Waiver. Financial eligibility is determined by MDHHS. All eligibility factors must be met in the calendar month being tested. NONFINANCIAL ELIGIBILITY FACTORS

BHDDA Responsibilities BCCHPS determines that clinical eligibility exists. That is: • The child meets the criteria for admission to a state inpatient psychiatric hospital; and

BEM 172 2 of 4 CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE (SED) WAIVER BPB 2024-023 10-1-2024

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

• It is appropriate to provide such care for the child in the community; and • The average estimated cost to Medicaid of caring for the child in the community does not exceed the average estimated cost to Medicaid for the child’s care in the state psychiatric hospital. Mental Health Services to Children and Families within BCCHPS is responsible for the following at application and medical review: • Obtaining and reviewing clinical evidence of the child’s serious emotional disturbance and functional limitations from the local CMHSP, and • Certifying disability on the DHS-49-A, Medical-Social Eligibility Certification. The Behavioral and Physical Health and Aging Services Administration (BPHASA) certifies on the MSA-1785, Policy Decision, that the requirements in BCCHPS Responsibilities in this item are met. If the child is not receiving MA, BPHASA will send the family: • A copy of the MSA-1785, and • A DCH- 1426, Assistance Application, with the address of the local office to mail the completed application. Communication to the Local Office BPHASA will send the MSA-1785 and the DHS-49-A to the local MDHHS and CMHSP offices whether or not a child is an MA recipient. BPHASA will send a letter of termination when a child is no longer eligible for this category. Pursue eligibility for other MA categories when a child is no longer eligible for the waiver. Local Office Responsibilities Do not authorize MA under this category without a MSA-1785 and DHS-49-A authorizing MA in this category. Use this cate- gory when the child is not an SSI or FIP recipient. Use this category before using a Group 2 category. Treat the receipt of the MSA-1785 as a request for assistance if it is received for a child who is not an MA applicant or recipient.

BEM 172 3 of 4 CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE (SED) WAIVER BPB 2024-023 10-1-2024

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

Determine if the child meets the MA eligibility factors in the following items: • BEM 220, Residence. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 257, Third Party Resource Liability. • BEM 260, MA Disability/Blindness. • BEM 270, Pursuit of Benefits. Note: The State Hospital Administration (SHA) is responsible for obtaining clinical evidence and for certifying disability on the DHS-49-A; see BCCHPS Responsibilities in this item. If a child on the SEDW turns 18 and continues to meet all the non- age related eligibility criteria, and continues to need waiver services, the child can remain on the waiver up to their 21st birthday. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. INQUIRIES Inquiries from medical providers or parents concerning clinical eligi- bility under this category should be directed to the local CMHSP. FINANCIAL ELIGIBILITY FACTORS Financial eligibility is determined by the local office. Count only the child’s own income and assets. Do not deem income and assets from the child’s parents to the child. Groups The child is a fiscal and asset group of one.

BEM 172 4 of 4 CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE (SED) WAIVER BPB 2024-023 10-1-2024

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

Assets The child’s countable assets cannot exceed the asset limit in BEM 400. Countable assets are determined based on MA policies in BEM 400 and 401. Divestment Do not apply policy in BEM 405. Income Eligibility Income eligibility exists when the child’s gross income is equal to or less than 300 percent of the federal SSI benefit rate, see RFT 248. Gross income is the amount determined after applying MA policies in BEM 500 and 530. Do not apply the deductions in BEM 540 and 541. VERIFICATION REQUIREMENTS Verification requirements for all eligibility factors are in the appropri- ate manual items. LEGAL BASE MA Social Security Act, Section 1915 (c)

BEM 173 1 of 5 BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT PROGRAM BPB 2016-014 10-1-2016

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

DEPARTMENT POLICY MA The Breast and Cervical Cancer Prevention and Treatment Program (BCCPTP) is a Group 1 Medicaid category for women. The Department of Health Health and Human Services/ Medical Services Administration (MSA)is responsible for establishing Medicaid under this category. This category is not included on the priority lists in BEM 105 because MDHHS does not determine eligibility. Eligibility is related to screening through a health department program called the Breast and Cervical Cancer Control Program. Breast and Cervical Cancer Control Program The Breast and Cervical Cancer Control Program is a health department program.The program may be more commonly known as the breast and cervical screening program. People seeking screening should refer to the name Breast and Cervical Cancer Control Program or the Breast and Cervical Screening Program. Do not use the Medicaid category name to refer to the health department program, even though this program provides complete Medicaid coverage to the client. Not all local heath departments participate and there are sites enrolled in the program that are not local health departments. A woman may request screening from a participating agency if her local health department does not participate. More information about the health department program through the MDHHS website. Use the link on the MDHHS Authorized Internet Sites on the MDHHS-Net, or:  Go to www.michigan.gov/mdch.  Type bcccp in the Search box.  That will give you a link to the BCCCP page. Scroll down on that page for a link to the agency list.

BEM 173 2 of 5 BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT PROGRAM BPB 2016-014 10-1-2016

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

The health department program has its own financial test for BCCCP. Income cannot exceed 250 percent of the federal poverty level. However, that determination is not an MDHHS responsibility. BCCPTP APPLICATION AND ELIGIBILITY DETERMINATION A simplified application form (DCH-1088, Medicaid Breast and Cer- vical Cancer Prevention and Treatment Program) has been created for this Medicaid category. It will be completed by a health department program coordinator or case manager and sent to MSA. MSA will register the application. MSA will determine Medicaid eligibility for this Medicaid category at application (including any retro Medicaid eligibility), redetermination and when a change is reported. BCCPTP is the only Medicaid category considered when the DCH- 1088 is used. BCCPTP AND OTHER MEDICAL ASSISTANCE A woman who is already receiving Medicaid will not be approved for BCCPTP. If a woman receiving BCCPTP is found eligible for FIP, notify MSA by calling the BCCPTP coordinator, Michele Barton at 517- 241- 8164. If a woman found eligible under BCCPTP is in Medicaid deductible status, MSA will end the Medicaid deductible status, open BCCPTP and notify the local office. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte reivew should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all Medicaid categories; see BAM 115 and 220.

BEM 173 3 of 5 BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT PROGRAM BPB 2016-014 10-1-2016

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BCCPTP REPORTS RECEIVED AT LOCAL OFFICE The MDHHS local office in the county of residence will receive system generated reports (example, RD-093) which include BCCPTP recipients. The local office may also happen to receive change of address information for these recipients (example, woman is also receiving Food Assistance Program). Send reports (or copies) for unit 78/specialist 88 and address changes to MSA.

Department of Health and Human Services

BCCPTP Coordinator

P.O. Box 30479

Lansing, MI 48909-7979

Telephone: 517- 241-8164

Fax: 517- 373-9305 BCCPTP HEARINGS All hearing requests for BCCPTP applicants and recipients will be handled by MSA. If received by MDHHS, such hearing requests must be faxed, then mailed, to MSA’s Administrative Tribunal; see Role of MDHHS Staff in BAM 600,Hearings. BCCPTP NONFINANCIAL ELIGIBILITY FACTORS MSA determines eligibility. The person must:  Be female, and  Be age 18 through 64, and  Have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention’s Breast and Cervical Cancer Early Detection program established under Title XV of the Public Health Services Act, and

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Note: This is a health department program called the Breast and Cervical Cancer Control Program.  Have been diagnosed with breast or cervical cancer or a precancerous condition through that health department screening program, and Note: A finding by a woman’s doctor that she has breast or cervical cancer is not a substitute for a diagnosis through the screening program.  Not have credible health insurance coverage [as the term is used under 42 U.S.C. 300gg(c)] that covers breast or cervical cancer or precancerous conditions.

Examples of credible health insurance are Medicare, Armed Forces insurance, group health plan, state health risk pool, medical care under a hospital or medical services policy or cer- tificate, hospital or medical service plan or contract, and health maintenance organization contract.

Being in MA deductible status is not credible coverage. How- ever, someone already receiving MA (coverage F or E) is not eligible under the BCCPTP category.

A woman who has Medicare cannot receive MA under BCCPTP because Medicare is credible health insurance. Therefore, a woman eligible under BEM 165, Medicare Savings Programs, cannot be BCCPTP eligible. The woman must also meet the eligibility requirements in the following items:  BEM 220, Residence.  BEM 221, Identity.  BEM 223, Social Security Number.  BEM 225, Citizenship/Alien Status.  BEM 257, Third Party Resource Liability.  BEM 265, Institutional Status. FINANCIAL ELIGIBILITY FACTORS There are no financial eligibility factors for the BCCPTP Medicaid category.

BEM 173 5 of 5 BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT PROGRAM BPB 2016-014 10-1-2016

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Note: There is a financial test for the health department’s Breast and Cervical Cancer Control Program. Income cannot exceed 250 percent of the federal poverty level. However, that determination is not an MDHHS responsibility. LEGAL BASE Social Security Act, Sections 1902(a)(10)(ii)(XVIII) and 1902(aa) DCH Appropriations Act. Deficit Reduction Act 2005, Social Security Act 1903 (x), PL 109- 171

BEM 174 1 of 4 FREEDOM TO WORK (FTW) BPB 2026-016 7-1-2026

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

DEPARTMENT POLICY MA Only This is an SSI-related Group 1 MA category. FTW is available to an individual with disabilities aged 16 through 64 who has earned income. Eligibility begins the first day of the calendar month in which all eligibility criteria are met. All eligibility factors must be met in the calendar month being tested. Note: SSI recipients whose SSI eligibility has ended due to financial factors are among those who should be considered for this program. NON-FINANCIAL ELIGIBILITY FACTORS 1. The individual must be disabled according to the disability standards of the Social Security Administration, except employment, earnings, and substantial gainful activity (SGA) cannot be considered in the disability determination. Note: FTW applicants who do not already have a disability established with Social Security Administration require a disability determination from Disability Determination Service (DDS). The medical packet must clearly indicate the individual is applying for FTW by checking the other Program box and writing “Freedom to Work” or “FTW” on the cover sheet. 2. The individual must be employed. FTW coverage is retained when a participant is relocated due to employment. Note: An individual may have temporary breaks in employment up to 24 months if the break is the result of an involuntary layoff, or is determined to be medically necessary, and retain FTW eligibility. Use individual statements to verify. Note: Employment includes self-employment. There is no set number of minimum hours of employment required. 3. The MA eligibility factors in the following items must be met: • BEM 220, Residence.

BEM 174 2 of 4 FREEDOM TO WORK (FTW) BPB 2026-016 7-1-2026

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• BEM 221, Identity. • BEM 223, Social Security Numbers. • BEM 225, Citizenship/Alien Status. • BEM 257, Third Party Resource Liability. • BEM 265, Institutional Status. • BEM 270, Pursuit of Benefits. FINANCIAL ELIGIBILITY FACTORS

Groups An individual eligible under the FTW category is a fiscal and asset group of one. Assets Initial Eligibility The asset limit for the initial eligibility determination is set to the Medicare Savings Program asset limit for an individual in that calendar year. Ongoing Eligibility Once eligibility for FTW is established, countable assets cannot exceed the asset limit for FTW in BEM 400. Accumulated assets that are excluded (not countable) while the participant is enrolled in the FTW program will continue to be excluded if the beneficiary loses eligibility for the FTW program and has a determination of eligibility in another SSI-related Medicaid category. Example: Additions made to a 401(k) account while the participant is working and in the FTW program are excluded from the ongoing FTW asset test and from the eligibility determination for any SSI related MA category such as AD Care, if eligibility for the FTW program is lost. See BEM 400 for jointly owned assets. Divestment Do not apply policy in BEM 405.

BEM 174 3 of 4 FREEDOM TO WORK (FTW) BPB 2026-016 7-1-2026

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

Income Eligibility Initial and Ongoing Eligibility Initial income eligibility exists when the individual’s countable income (earned and unearned) does not exceed 250 percent of the Federal Poverty Level (FPL). Ongoing eligibility exists when the individual's unearned income does not exceed 250 percent of the FPL. Determine countable earned and unearned income according to SSI-related MA policies in BEM 500, 501, 502, 503, 504, and 530. Determine income deductions using BEM 540 (for children) or 541 (for adults). Unemployment compensation benefits are not count- able income for FTW. PREMIUM PAYMENT There are no premiums for individuals with MAGI (Modified Adjusted Gross Income) income less than 138 percent of the federal poverty level (FPL). • A premium of 2.5 percent of their income will be charged for an individual with MAGI income between 138 percent of the FPL and $75,000 annually. • A premium of 100 percent of the average FTW participant cost will be assessed for an enrolled individual with MAGI income over $75,000. Bridges will automatically notify the premium coordinator when premiums for a FTW participant start/change/end. The premium coordinator has final determination over actual premium begin or amount change dates, as well as premium exclusions. Note: Nonpayment of premium is automatically sent to Bridges and mass update will close the Freedom to Work category. If the individual has questions regarding the premiums, you may direct them to call the Beneficiary Help Line 1-800-642-3195, TTY 1-866-501-5656. Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case

BEM 174 4 of 4 FREEDOM TO WORK (FTW) BPB 2026-016 7-1-2026

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closure. The review includes consideration of all MA categories; see BAM 115 and 220. MEDICARE SAVINGS PROGRAM (MSP) MSP and FTW have different group composition, income and asset limits. A separate determination (for MA and MSP) must be done for the spouse. Reminder: An individual eligible for MA under FTW is not eligible for ALMB. LEGAL BASE MA Title XIX of the Social Security Act Public Act 32 of 2003 Public Act 518 of 2014

BEM 200 1 of 5 FAMILY INDEPENDENCE SPECIALIST PHILOSOPHY AND FAMILY CONTRACT BPB 2019-006 4-1-2019

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PHILOSOPHY OF FIP PROGRAM FIP The department goal is to assist families towards self-sufficiency. Self-sufficiency is best accomplished by: • Adults being employed, • Securing court-ordered child support for each child where appropriate, • Providing life skills training for those needing it including minor and teen parents, and • Ensuring that all children have access to medical care. As families become self-sufficient, we will meet the legal mandates such as work participation rates, reducing subsequent out of wed- lock pregnancies, ensuring that teens are completing secondary education, and ensuring that minor parents are living in appropriate settings. Role of the FIS The Family Independence Specialist (FIS) uses a Strength Based Solution Focused Approach and will: • Identify goals with the client and develop plans for self- sufficiency, expressed in the client’s own words, when possible. This will occur through the interactive solution focused process. When setting goals with the client, keep in mind that the goals should be clear, simple, specific, measurable, realistic, positive and important to the client. Clients must see their role in these goals for themselves to change concrete behavior. Monitor progress toward meeting the goals identified in the Family Self Sufficiency Plan (FSSP). • Modify or add to the plan, when there is a change in circumstances; or upon discovery of a challenge or concern. • Determine eligibility for financial and medical programs. • Identify and or authorize support services to help families carry out their plan.

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• Provide direct services such as counseling and problem solving when needed. This is especially helpful for clients who are in noncompliance. • Identify resources and initiate referrals for community services, including employment and training, and domestic violence counseling. • Explore options and authorize child care. Case managers should focus on building a trusting relationship with families using the solution-focused interviewing skills. This is best accomplished by doing an interview. Building trust requires accepting clients for who they are, and understanding they are key in identifying their own needs and strengths in moving toward self- sufficiency. Case managers will help clients discover their needs and build on their strengths, recognizing that open and frequent communication is necessary to build the family's trust. Use all available means in facilitating communications and trust. Such contact and communication are effective in developing and monitoring plans/contracts while reducing negative consequences. However, consequences will be used to reinforce the concept that clients are responsible for their own lives. Whenever possible, dis- cretion has been left to staff to work with families. Discretion includes the frequency and types of contact beyond mandatory cli- ent contacts. As the relationship with the client begins to build, the client may begin to disclose other barriers to self-sufficiency, such as domestic violence. The Michigan Department of Health and Human Services (MDHHS) believes all individuals have a right to be safe from violence. Domestic violence is a critical issue for many people. Victims of domestic violence need services that enhance their safety and self-sufficiency. If there is a disclosure of domestic violence, and the client is not receiving services, the FIS must refer the family to the appropriate community services. Determine if domestic violence presents a barrier to cooperation with agency requirements, such as pursuit of child support (BEM 255), participation in employment and training activities (BEM 230A), and third-party liability (BEM 257).

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Interviews Interviews provide the best opportunity to interact with a client. Interviews help establish a trusting relationship which will open the door to an increased level of participation and willingness to discuss the family concerns. While doing the interview, you can celebrate successes and identify challenges the family faces. Review and monitor the FSSP goals and activities and help the clients make a plan for removing any obstacles they perceive. Topics for Discussion When talking with a client, there are numerous topics for you to discuss, such as: • The successes each adult has had since the previous contact for example, a plan for employment and, if they are employed, what progress have they made toward a raise, promotion, increased hours, or the results of any evaluations? This discussion will also give you an opportunity to make sure the correct earned income is in the benefit budgets. • Any concerns or challenges that have come up which slowed down or hindered the family’s movement to self-sufficiency. To meet those challenges, develop a plan. Compliment the family on any successes they had in dealing with the challenges or concerns. If a challenge or concern continues to exist, discuss and create a plan using the Solution Focused Approach to help the family meet these challenges. • Discuss goals that the adults have for themselves which they believe will lead to self-sufficiency, what steps they need to take to achieve these goals, and how confident and motivated they are in achieving these goals (scaling questions). • Involve the family in a discussion of the children and the importance of education. Ask the adult and the children, if present, how each child is doing in school, what their interests are and what extra-curricular activities they are participating in. Together with the family, talk about resources or opportunities for the children in their areas of interest.

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This discussion will provide an opportunity for you to provide positive feedback and compliments. It will increase participation and involve the entire family in the plan to support each other. Inform them of the Tuition Incentive Program and other educational opportunities that are available for children to attend college if applicable. • Ask what personal and community resources they know of that may be available to help the family remove their challenges and concerns, meet their goals, and move toward self- sufficiency. If the client does not know about community resources, help them develop a plan that will teach them to find these resources. • Discuss child care arrangements that the parent has made for care of the children while the parent is employed, child care arrangements during school breaks, and back-up plans for child care if the provider is ill or otherwise unable to care for the children. • Explain the Federal Earned Income Tax Credit and how receiving this credit throughout the year can increase monthly income. Help them find out how to apply for the credit. • Discuss how to access the advanced education and training opportunities that are available for persons meeting the participation requirements. • Discuss support services that are available while persons are participating in employment-related activities. • Discuss the children and their adjustment to having the parent employed or otherwise out of the home and participating in employment-related activities. • The children and their relationship to a stepparent or other adult living in the home can also be a topic of discussion and planning with the parent. • Let clients know there are family and/or community support groups that are available in cases of emergencies. For ineligible grantee cases, the focus of the interview should be a discussion about the children and resources that may be available to the family and/or the ineligible grantee, for example,

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support groups that are available to grandparents who are raising grandchildren. In absent parent situations, discuss the importance of parenting time and the involvement of both parents in a child’s life. Discuss the relationship between the absent parent and child. Include steps in the plan to make it better. This discussion is also important for ineligible grantee cases. Does the child visit the parent? Are there custody issues? Is the relative interested in securing guardianship of the child, if appropriate? In all interviews, including ineligible grantee situations, be alert to key indicators that signal problems in the home which may indicate a need for preventive services or require intervention by protective services. Be alert to situations of domestic violence, substance abuse by any family member, and behavioral problems of children or conflicts between family members. Ask for the client’s explanation of events but if you believe that the home environment requires preventive or protective services involvement, a referral must be made.

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DEPARTMENT PHILOSOPHY Minor parents and their children should live under adult supervision to ensure that they are in a safe, nurturing environment. Adult par- ents should act as the caretakers of their minor children and provide maintenance, physical care, and guidance, even after a minor child has become a parent. When living with a parent, stepparent, or legal guardian is not possible, the minor parent and child should live in another adult-supervised living arrangement. DEPARTMENT POLICY FIP All minor parents must live in an adult-supervised living arrangement as a condition of eligibility. A minor parent and the dependent child in his or her care must live with the minor parent's parent, stepparent, or legal guardian or have good cause to live elsewhere. A minor parent who has good cause for not living with a parent, stepparent, or legal guardian must live in an acceptable adult-supervised living arrangement. A minor parent living in a parent's or stepparent's home may not receive assistance on his/her own behalf, but must be treated as the dependent child of the parent or stepparent. A minor parent living in an adult relative's or legal guardian's home must be included as a dependent child in the relative's/legal guardian's group if the relative/legal guardian also receives benefits under the Family Independence Program (FIP); see BEM 210, Multi- Generation and Combined Groups. DEFINITIONS Minor Parent: a person under age 18 who is not emancipated and is either the parent of a dependent child living with him/her or is pregnant. A person under age 18 is emancipated if: • Ever validly married. • Emancipated by court order. • On active duty with the Armed Forces of the United States. Acceptable Adult-Supervised Living Arrangement: a Michigan Department of Health and Human Services (MDHHS) -approved

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living arrangement, other than the home of the parent, stepparent, or legal guardian, in which the minor parent and child live with an adult who acts as a parent to the minor parent. See Acceptable Living Arrangements in this item for specific criteria. Adult Relative: a person age 18 or over who is related to the minor parent as grandparent (including great and great-great), aunt or uncle (including great and great-great), sibling or stepsibling, nephew or niece, first cousin, first cousin once removed, or the par- ent of the putative (alleged) father. Supervising Adult: a person who accepts responsibility for the supervision of a minor parent, and is an adult relative of the minor parent or is an unrelated person age 21 or over. INFORMING CLIENTS When a minor parent applies for assistance, inform them of all of the following: • The requirement to live under adult supervision. • The circumstances under which there is good cause for permitting the minor parent to live in an adult-supervised setting other than the home of a parent, stepparent, or legal guardian. • The requirement to attend school if the minor parent has not completed high school. When a minor parent who is not living with a parent, stepparent, or legal guardian applies for assistance, inform him/her that MDHHS will determine good cause. Do not approve assistance, except for MA and FAP. REFERRALS Record information about the minor parent’s circumstances in Bridges. Bridges will generate a task/reminder when a CPS referral is needed. See the Administrative Policy Manual Human Resources (APR) - Mandated Reporters Child, for information regarding how to report suspected child abuse and neglect.

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Protective Services Complaint A complaint to Children's Protective Services (CPS) is required if any of the following are true: • There is reason to suspect that either the minor parent or the child is endangered, abused, or neglected. • The financial needs, safety, and security of the minor parent and child cannot be assured during the period of eligibility determination for FIP. • The minor parent became pregnant when she was under the age of 12. • The parent, stepparent, or legal guardian will not allow the minor parent to live in his/her home. Law Enforcement A referral to local law enforcement is required if: The minor parent became pregnant when she was between the ages of 12 and 16. The purpose of this referral is so local law enforcement can determine if the situation should be investigated or referred to the prosecuting attorney if the minor parent is a victim of criminal sexual conduct. Local offices must develop guidelines for such referrals with the local prosecuting attorney. Use the DHS- 1266, Law Enforcement Referral, form to initiate this referral. Minor Parent Coordinator Local offices must designate a minor parent coordinator to coordi- nate the delivery of services to minor parents. Refer all minor par- ents who refuse to comply with the requirements of this policy or withdraw their request for assistance to the minor parent coordina- tor. The department offers services to minor parents whether eligible for assistance benefits or not.

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GOOD CAUSE REASONS - LIVING ARRANGEMENT The good cause reasons for not requiring a minor parent and his/her child to live with a parent, stepparent, or legal guardian are: • The minor parent is living with another adult relative with parental consent. • The minor parent has no living parent, stepparent, or legal guardian whose whereabouts is known. At a minimum, do a Bridges Individual Inquiry on the parent's/stepparent's/legal guardian's name(s) to attempt to locate them. • The parent, stepparent, or legal guardian will not allow the minor parent to live in his/her home. A CPS complaint is required because of neglect. Do not delay other actions or the eligibility determination awaiting the CPS determination. • The physical or emotional health or safety of the minor parent or dependent child would be jeopardized if they lived with the minor parent's parent, stepparent, or legal guardian because: An investigated CPS complaint (confirmed or unconfirmed) indicates that the minor parent or other children in the household did not receive adequate food, clothing, medical care or other necessities or were physically, emotionally, or sexually abused. An unconfirmed complaint must have indicated that there was risk to the children although the allegations could not be substantiated. The return of the minor parent and child to the parent's, stepparent's, or legal guardian's home would result in violation of the terms of a lease or violation of local health or safety standards. Law enforcement officers have verbally verified that there is probable cause to believe that the home of the parent, stepparent, or legal guardian is the scene of illegal activity. • The minor parent is participating in a licensed substance abuse treatment program which would no longer be available if he/she returned to the parent's, stepparent's or legal guardian's home.

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• The minor parent's parent, stepparent or legal guardian lives in another state. Reevaluate good cause if it is discovered that circumstances regarding the good cause reason have changed. Local Office Exception The local office director may grant an exception to this policy and allow the minor parent to live independently when all of the following are true: • Attending school full-time. • Participating in a MDHHS or Teen Parent services plan. • Moving would require the minor parent to change schools. • The independent living arrangement will provide adequate structure and safety for the minor parent and child. Follow local office procedure for requesting such exceptions. Local offices must maintain a record of these exceptions for annual reporting to the legislature. DETERMINING GOOD CAUSE - LIVING ARRANGEMENT The standard of promptness is 30 calendar days to determine if the minor parent has good cause for not living in the home of the parent, stepparent, or legal guardian. The client must move into the home of the parent, stepparent, or legal guardian unless he/she has good cause for refusing. Document good cause determinations in the case record. At local office discretion, determinations of good cause and evalua- tions and supervision of acceptable living arrangements may be assigned to children's services staff instead of the specialist. No Good Cause If the minor parent does not have good cause, do all of the following: • Record the fact that there is no good cause in Bridges. • Run EDBC and certify the FIP denial in Bridges.

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• Offer services to assist the minor parent to return home. • Make a referral to a teen parent contractor or other community services to work with the minor parent, if appropriate. • Make a referral to the local office minor parent coordinator if the client refuses to comply with the requirements. Good Cause Granted If the minor parent has good cause: • Inform the minor parent that: He/she must live in an adult-supervised living arrangement approved by the department. The department will assist him/her in locating an acceptable adult-supervised arrangement if necessary. FIP cannot be opened until the minor parent is living in an acceptable adult-supervised living arrangement. • Determine if the minor parent's current living arrangement is acceptable. • Help the minor parent to select an acceptable living arrangement, if necessary. Minor parents age 16 and over have primary responsibility for find- ing and selecting an acceptable adult-supervised living arrange- ment. Assist the minor parent if necessary. Notify your area service center if the minor parent, with the depart- ment's assistance, is unable to locate an acceptable adult-super- vised living arrangement within 30 calendar days. ACCEPTABLE LIVING ARRANGEMENTS A minor parent cannot live with the child's other parent, regardless of the other parent's age, unless both reside in an acceptable adult- supervised living arrangement. The child's adult parent may not function as the supervising adult to the minor parent. Acceptable adult-supervised living arrangements are:

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• The home of an adult relative. • The home of an unrelated adult age 21 or over. These arrangements include private homes and cooperative and congregate living facilities. • A licensed foster family home or foster family group home.

Supervision of a minor parent in family foster care may be pur- chased from a licensed private child placing agency. • A child welfare-licensed residential facility. If placement in a foster home or residential facility is selected, a DHS-3813, Voluntary Placement Agreement, must be signed by the minor parent's parent or legal guardian. If the only acceptable living arrangement is in a foster home or residential facility and if the par- ent/legal guardian refuses to sign an agreement, make a referral to CPS for a petition for court jurisdiction. DETERMINING ACCEPTABLE LIVING ARRANGEMENT Determine if the minor parent's living arrangement is acceptable. The living arrangement must be one of those described in ACCEPTABLE LIVING ARRANGEMENTS in this item and must do all of the following: • Support the minor parent's efforts to complete a high school education or participate in employment and training opportunities. • Support the minor parent's efforts to learn parenting skills and enhance decision-making skills. • Provide a safe environment which supports the minor parent's responsibilities to provide food, clothing, and medical care to the child. Use the guidelines under Safety Assessment and Supportive Environment Assessment in this item to determine if the living arrangement meets the above criteria.

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Safety Assessment The living arrangement must not include individuals (other than par- ents, stepparents, or legal guardians when reunification is appropri- ate) who are listed as perpetrators on the CPS Central Registry. Request a check of all individuals over age 18 in the home against the CPS Central Registry. If it is suspected at any time that either the minor parent or the child is endangered, abused, or neglected, make an immediate referral to CPS. Some indications that a CPS referral should be made are: • The child or minor parent has marks or bruises which appear suspicious. • The child is fearful of the parent or other people living in or having access to the home. • The living conditions are hazardous or present a public health threat. • The minor parent or child appear malnourished. • The minor parent or another person living in or having access to the home exhibits violent behavior. • The minor parent describes or acts toward the child in predominately negative terms or has unrealistic expectations, or the supervising adult or another person in the household exhibits similar behavior to the minor parent. • Family members or household members refuse access to the minor parent or child, or there is reason to believe that the minor parent is about to flee, or the minor parent's child's whereabouts cannot be ascertained. • The minor parent is unwilling or unable to meet his/her own or the child's needs for food, clothing, shelter, or medical care. • The minor parent's use of alcohol or drugs seriously affects his/her ability to supervise, protect, or care for the child. • The minor parent fails to protect himself/herself or the child from physical harm or threatened physical harm, neglect, or sexual abuse by other family or household members or others having access to the child.

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• The minor parent does not provide the supervision needed to protect the child from potential harm: The minor parent does not attend to the child to the extent that the child's need for care goes unnoticed or unmet (for example, allows the child to wander outdoors alone, play with dangerous objects, or be exposed to other serious hazards). The minor parent leaves the child alone in the home. The minor parent makes inadequate/inappropriate child care arrangements or demonstrates very poor planning for the child's care. • The minor parent has experienced incidents of domestic violence. Supportive Environment Assessment Determine if the living arrangement is a supportive environment for the minor parent. A supportive environment is one in which: • The minor parent has a support person, such as the supervising adult, family members, neighbors, or other people in the community who are available to support and help the minor parent. • The supervising adult discusses issues of concern with the minor parent and solutions are identified and pursued. • The supervising adult does not take over parenting of the minor parent's child but demonstrates and discusses appropriate parenting techniques and skills. • The supervising adult establishes reasonable house rules regarding visitors, curfews, phone usage, and care of the minor parent's child. • The supervising adult is available to the minor parent when the minor parent experiences a problem. • The minor parent has child care and transportation resources to enable attendance at school or work.

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RESPONSIBILITIES OF THE SUPERVISING ADULT By agreeing to be the supervising adult, a person assumes certain responsibilities. These must be explained to and accepted by the supervising adult. These responsibilities include: • The supervising adult agrees to be the protective payee of the minor parent's FIP grant. As protective payee, the supervising adult must manage the minor parent's grant and help the minor parent learn to manage money. • The supervising adult agrees to report any suspicion of abuse or neglect of the minor parent or his/her child to CPS. • The supervising adult agrees to assist and facilitate the minor parent's school attendance and participation in other activities required by MDHHS. At a minimum, the supervising adult will not place any expectations on the minor parent which will impede attendance at school or negatively affect the minor par- ent's ability to care for his/her child. • The supervising adult must acknowledge that the MDHHS is not responsible for any payments or expenses beyond those specifically included in the minor parent's FIP grant. • The supervising adult has the authority and responsibility to set reasonable house rules regarding visitors, curfews, phone usage, and other issues necessary to maintain a safe and stable home. If the minor parent refuses to comply with the rules or if other disputes arise, the supervising adult or the minor parent may request the intervention of the specialist. If they are unable to resolve the issue, the supervising adult may request the minor parent to move to another appropriate setting. • The supervising adult is not responsible for providing child care. The minor parent may be eligible for child care payments according to policies of the Child Development and Care program. Obtain a signed, written agreement specifying the responsibilities and expectations for the minor parent, the supervising adult, and the department.

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PAYMENTS The minor parent's FIP grant must be paid to a protective payee. The supervising adult should be the protective payee; see BAM 420. SCHOOL ATTENDANCE As a condition of eligibility, a minor parent must attend high school full-time. See BEM 245 for the definition of high school and full- time. Minor parents who have graduated from high school must partici- pate in Partnership. Accountability. Training. Hope. (PATH). Failure to meet the above requirements causes ineligibility for the minor parent and his/her child. This requirement applies to all minor parents, including those who are living with a parent, stepparent, legal guardian, or other adult relative and are not the grantee. If an applicant minor parent will not agree to attend school deny or close the FIP Eligibility Determination Group (EDG). A minor parent whose FIP is closed for this reason must reapply and enroll in school before assistance can be granted; see BEM 245, Regaining FIP Eligibility After Previously Failing Student Enrollment/Atten- dance Requirement. VERIFICATION REQUIREMENTS Verify good cause for living arrangement reasons as needed. Verify school enrollment and attendance at application, redetermination, and at each birthday. VERIFICATION SOURCES • DHS-3380, Verification of Student Information. • Telephone contact with the school. School Attendance See BEM 245.

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LEGAL BASE FIP

42 USC 608(a)(4) 42 USC 608(a)(5) MCL 380.10 MCL 380.1561 MCL 400.57 et seq. Mich Admin Code, R400.3112 45 CFR 233.107

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DEPARTMENT POLICY FIP Only Each eligible child under age six must receive all immunizations recommended by the Michigan Department of Health and Human Services (MDHHS). The group is in compliance when immunizations have begun for all children subject to this requirement. The group's payment standard is reduced by $25 for each month in which the following apply: • One or more eligible children under age six are not immunized, and • The group has no unresolved barriers to immunizations. Consider a child to be age six for the full month in which he/she reaches age six. Child Development and Care (CDC) Only Each non-exempt, eligible child for whom CDC is requested must receive all immunizations recommended by the Michigan Department of Health and Human Services (MDHHS), as verified by self-certification. The child is in compliance when immunizations have begun. Note: A licensed child care provider may require documentation related to immunizations, and may allow less time to comply with immunization requirements than the CDC program. These licensing requirements do not impact a child’s eligibility for the CDC benefit. Clients (parents) should discuss these requirements with their licensed provider. EXEMPTIONS FIP and CDC A child is exempt from the immunization requirement if: • He/she is under two months of age. • Immunizations are medically inappropriate for the child. • Immunizations are contrary to the family's religious beliefs.

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GRACE PERIOD CDC Only A child who has not met the immunization requirement will have a grace period that extends until the next eligibility determination. If the child fails to meet the immunization requirement at the next eligibility determination, the child will not be eligible to receive the CDC benefit. IMMUNIZATION PENALTY FIP Only At redetermination, Bridges reduces the group's payment standard by $25 for each month in which: • One or more non-exempt eligible children under age six are not immunized, and • The group has no unresolved barriers to immunization. The penalty is not initiated at case opening. Related FAP The unreduced FIP payment standard is budgeted in related FAP cases when an immunization penalty is imposed on the FIP group. CDC Only At redetermination, CDC eligibility will end for a child who does not meet the immunization requirement and did not meet the immunization requirement at or since the previous eligibility determination, according to the grantee’s self-certification. At reapplication/member add, CDC will be denied for a child who does not meet the immunization requirement and did not meet the immunization requirement at or since the most recent application or redetermination eligibility period, according to the grantee’s self- certification. A denial will only impact the child who has not met the requirement.

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Compliance FIP Only The group is in compliance when immunizations have begun for all non-exempt children. When the group begins immunizations, enter the date the group begins as the Circumstances Start Change Date and Cooperation Begin Date on the Immunizations screen. Do not: • Wait until immunizations are complete, or • Require written verification. The group is in compliance for the whole month in which immuniza- tions are begun. Bridges will remove the penalty and issue a supplement to affect the full month of compliance when the regular monthly issuance cannot be affected. CDC Only The child is in compliance when immunizations have begun. If the child begins immunizations after being out of compliance, enter the date the child begins as the Circumstance Start Change Date on the Immunization screen. Do not do either of the following: • Wait until immunizations are complete. • Require written verification. Bridges will allow CDC eligibility to be approved for the child. Assisting Clients FIP Only Assist clients to resolve problems which hinder compliance with the immunization requirement prior to imposing the penalty. This might include: • Assistance with transportation; see BAM 825, and • Referral to the group's health provider or to the local health department. Document these efforts in the physical case record or in Case Comments on Bridges.

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APPLICATION PROCEDURES FIP Only At application, do the following: • Inform the FIP group with a non-exempt child under the age of six of the following: Immunization requirement. Penalty for failure to immunize, which might be initiated at redetermination. • Review the information titled Immunize Your Children (FIP only) from the Cash Assistance section of the MDHHS-1171- INFO, Information Booklet, with the client to ensure full understanding of this requirement. • Refer the group to its health provider or to the local Health Department for more information on immunizations, as needed. CDC Only At application, do the following: • Inform the CDC client with a non-exempt child for whom CDC has been requested of the following: Immunization requirement. Penalty for failure to immunize, which might be initiated at redetermination. • Refer the group to its health provider or to the local Health Department for more information on immunizations, as needed. Reapplication FIP Only At reapplication, ask if a formerly penalized group is now willing to comply. The penalty continues at reopening if the: • FIP EDG closed while being penalized, or because the penalty was initiated, and

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• Group is unwilling to comply at reopening, and • Group has no unresolved barriers to immunization. CDC Only At reapplication, CDC will be denied for a child who does not meet the immunization requirement and did not meet the immunization requirement at the most recent eligibility determination, according to the grantee’s self-certification. A denial will only impact the child who has not met the requirement. REDETERMINATION PROCEDURES FIP Only At redetermination, ask the client if there are any children under age six who are not up-to-date on their immunizations (shots) in the FIP EDG. If any non-exempt eligible child is not up-to-date on immunizations, the group might be subject to the penalty. Ask why the child has not been immunized. If a problem such as lack of transportation hinders compliance, do all of the following: • Assist the client to resolve the problem through appropriate referrals or other actions. • Document all actions in the physical case record or in Case Comments in Bridges. • Follow up with the group at the next annual redetermination. Do not enter a non-cooperation date on the Immunizations - Details screen in Bridges if a group has an unresolved problem that hinders compliance. If the client is uncertain whether immunizations are up to date for a child under six, treat that as a problem which hinders compliance. Refer the group to its health provider or to the local health department and document your actions in the physical case record or in Case Comments in Bridges. If the group is not cooperating, use the date the group became non- compliant as the Circumstances Start/Change Date and the Non- Cooperation Date on the Bridges Immunization - Details screen.

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Bridges will give the group timely notice of this action and affect the next possible month. If imposing the penalty results in a grant amount under $10, the FIP EDG will close. CDC Only At redetermination, eligibility will end for a child who does not meet the immunization requirement and did not meet the immunization requirement within the previous grace period, according to the grantee’s self-certification. A denial will only impact the child who has not met the requirement. VERIFICATION REQUIREMENTS FIP and CDC Accept the client's statement, or declaration on an application, redetermination or change document that one of the following applies: • All children in the FIP group, or children(ren) for whom CDC has been requested, have met the immunization requirement. • Immunizations are contrary to the family's religious beliefs. • Immunizations are medically inappropriate for a child. Use the client's response on the current or most recent application, redetermination, change document, or the client's verbal statement. Do not require written verification. Document verbal statements and resulting eligibility decisions in the case record or in Case Comments in Bridges. Document all actions taken to assist the group with compliance prior to imposing the penalty in the case record or Case Comments in Bridges. LEGAL BASE FIP 42 USC 608(b)(2)(A)(ii) MCL 400.57g Mich Admin Code, R 400.3115

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FAP 7 USC 2017(d) CDC The Child Care and Development Block Grant (CCDBG) Act (42 USC § 9858 et seq.), as amended by the CCDBG Act of 2014 (Pub. L. 113-186). 45 CFR Parts 98 and 99. Social Security Act, as amended 2016.

BEM 203 1 of 8 CRIMINAL JUSTICE DISQUALIFICATIONS BPB 2026-009 4-1-2026

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

POLICY Family Independence Program (FIP), Refugee Cash Assistance (RCA) State Disability Assistance (SDA) and Food Assistance Program (FAP) People who have been convicted of certain crimes and probation or parole violators are not eligible for assistance. Policy to establish intentional program violations (IPV) disqualifications and overpayments is found in Bridges Administrative Manual (BAM) 700, Benefit Overpayments and BAM 720, Intentional Program Violation. DUPLICATE RECEIPT OF ASSISTANCE FIP, SDA, and FAP An individual shall be disqualified for a period of 10 years if found to have committed an intentional program violation either through an administrative disqualification hearing, court conviction, or by signing a disqualification consent agreement, based on having made a fraudulent statement or representation regarding their identity or residence to receive benefits using more than one set of personal identifiers, or address at the same time, resulting in duplicate benefits being issued by one or more states (including within the same state), under the following program(s): • State programs funded under Title IV-A of the Social Security Act (known as Temporary Assistance for Needy Families (TANF) in the Social Security Act; known as FIP in Michigan. • State programs funded under Michigan's Social Welfare Act of 1939 (Public Act 280) known as State Disability Assistance (SDA). • State programs funded under the Supplemental Nutrition Assistance Program (SNAP) in the Food and Nutrition Act of 2008 (known as Food Assistance Program (FAP) or the Disaster Food Assistance Program (DFAP).

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PROBATION AND PAROLE VIOLATORS FIP, RCA, SDA A person who is violating a condition of probation or parole imposed under a federal or state law is disqualified. The person is disqualified as long as the violation occurs. A person is considered to be violating probation or parole if the Michigan Department of Health and Human Services (MDHHS) is made aware through a quarterly data match with the Michigan Department of Corrections that the individual is in violation of a condition of probation or parole imposed under federal or state law. FAP A person is disqualified because of a probation or parole violation if all the following conditions are met: • MDHHS verifies with law enforcement, the courts or the MDOC that the individual is found to be violating a condition of probation or parole imposed under federal or state law. • The individual is absconding from supervision; see BPG Glossary for definition of absconding. • Federal, state, or local law enforcement, or Michigan Department of Corrections authorities are actively seeking the individual to enforce the conditions of the probation or parole. Actively seeking means one of the following: • A Federal State, or local law enforcement agency informs MDHHS that it intends to enforce an outstanding felony warrant or to arrest an individual for a probation or parole violation within 20 days of submitting a request for information about the individual to MDHHS. • A Federal, State or local law enforcement agency presents a felony arrest warrant or to arrest an individual for a probation or parole violation within 20 days. • A Federal, state, or local law enforcement agency states that it intends to arrest an individual for a probation or

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parole violation within 30 days of the date of a request from MDHHS about a specific probation or parole violation. If the law enforcement agency indicates it does intend to arrest the individual for the probation or parole violation within 20 days of the contact with MDHHS or 30 days of the date of the MDHH's request for information, MDHHS will postpone taking any action on the case until the appropriate 20 or 30-day period has expired. Once the 20 or 30-day period has expired, MDHHS shall verify with the law enforcement agency whether it has attempted to arrest the probation or parole violator. If it has, MDHHS shall take appropriate action to deny an applicant or terminate an individual who has been determined to be a probation or parole violator. If the law enforcement agency has not taken any action within 20 or 30 days, MDHHS will not consider the individual a probation or parole violator. The person is disqualified as long as the violation occurs and until the Michigan Department of Corrections notifies MDHHS the individual is no longer absconding or until Federal, State or local law enforcement is no longer actively seeking the individual. Central office staff enters any disqualification. FLEEING FELONS FIP SDA and FAP A fleeing felon is an individual who is intentionally fleeing to evade prosecution, custody, or confinement for a felony and is actively being pursued by federal, state or local law enforcement. For FIP, SDA, and FAP purposes, an individual can only be considered a fleeing felon if they meet all of the criteria below and have been determined to be a fleeing felon by Office of Inspector General (OIG) and MDHHS central office review. An individual's fleeing felon status must be evaluated only when the following occurs for an individual receiving or applying for FIP/SDA and/or FAP: • A federal, state or local law enforcement officer acting in their official capacity, presents to MDHHS an outstanding felony arrest warrant that conforms to one of the following offense descriptors and/or their corresponding Uniform Offense

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Classification Codes, as published by the National Crime Information Center (NCIC), to obtain information on the location of and other information about the individual named in the warrant: Escape (4901); Flight to Avoid (prosecution, confinement, etc.) (4902); or Flight-Escape (4999). If a felony warrant is presented, notify a supervisor, and send the following to: MDHHS-Policy-Criminal-Justice@michigan.gov: • Local office requestor's name, telephone number and job title. • Individual or geo group email address where a response should be sent. • Law enforcement requestor's name, email, telephone number and job title and law enforcement agency (for example, ___ City Policy Department, ___ County Sheriff's Department). • MDHHS case name and number. • Name of individual who may be a fleeing felon. • Above individual's ID, date of birth, race, sex and SSN. • How the individual was reported to the department as a fleeing felon. • Scanned copy of warrant. • Written documentation that law enforcement: Initiated the presentment of the warrant, and Requested location information regarding the individual. • Date the felony warrant was presented to MDHHS. MDHHS central office will log and forward to OIG to evaluate the individual's information and determine if they meet the department's definition of fleeing felon. Benefits must be processed as normal during the evaluation period. Benefit determination must not be delayed while waiting for OIG's determination.

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OIG Process Referrals received from MDHHS central office will be loaded, processed, and tracked in MIGS. OIG will screen the referral and assign the status determination. The agent will review the warrant to verify if the warrant is a felony and whether it conforms to the above NCIC codes or comparable MCL. After confirming, the agent will verify that the individual on the warrant matches the individual in Bridges. When both the felony warrant and individual are confirmed, OIG must contact the law enforcement agency to inquire whether law enforcement intends to enforce the warrant within 20 days of OIG’s contact. If law enforcement intends to enforce the warrant, OIG will recontact after 20 days to determine whether or not the law enforcement agency has attempted to arrest the individual. An individual is able to be disqualified as a fleeing felon if OIG is able to: • Verify the individual is the person with the warrant. • Verify that the law enforcement agency intends to enforce the warrant in the next 20 days from OIG’s initial contact. • Verify that law enforcement unsuccessfully attempted to enforce the warrant within 20 days from OIG’s initial contact. • Verify that the warrant is still outstanding after the 20 days from OIG’s contact. • Verify the warrant conforms to offense descriptors and/or their corresponding Uniform Offense Classification Codes, as published by the NCIC. If OIG is unable to verify any of the items listed above, the individual cannot be disqualified as a fleeing felon. After the above review, the OIG agent is to contact policy (MDHHS- Policy-Criminal-Justice@michigan.gov) indicating whether or not the individual is to be disqualified due to fleeing felon status.

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Adding a Fleeing Felon Disqualification to Bridges If the individual is not considered a fleeing felon, central office staff will update Bridges case comments and notify the local office via email. If the individual is considered a fleeing felon, central office staff will complete a manual budget to remove the individual from the group, add an override, add case comments in Bridges, send the DHS- 1605 to the group and notify the local office via email. Removing a Fleeing Felon Disqualification A fleeing felon disqualification must be removed at application, redetermination, or if the individual reports that the warrant is resolved or that law enforcement is no longer actively seeking them. Removing a Fleeing Felon Disqualification from Bridges At application, redetermination or reported change, immediately send the following to: MDHHS-Policy-Criminal- Justice@michigan.gov: • Local office requestor's name, telephone number and job title. • Individual or geo group email address where a response should be sent. • Case name and number. • Individual's name and individual ID that must have a fleeing felon disqualification removed. • Reason for removal (application, redetermination or reported change). Central Office staff will update Bridges, add case comments, and notify the local office via email of the disqualification removal. Evaluating a Disqualification When a group with a disqualified fleeing felon is receiving FAP and applies for FIP or SDA or is receiving FIP or SDA and applies for FAP, the fleeing felon disqualification must be reevaluated. Notify a supervisor, and send the following to: MDHHS-Policy-Criminal- Justice@michigan.gov:

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• Local office requestor's name, telephone number and job title. • Individual or geo group email address where a response should be sent. • MDHHS case name and number. • Name of individual who needs to be reevaluated for fleeing felon disqualification. • Above individual's ID, date of birth, race, sex and SSN. • Reason for reevaluation. Releasing Information Do not release information to law enforcement unless and until central office approves the release; see BAM 310, Confidentiality and Public Access to Case Records. INTENTIONAL PROGRAM VIOLATION FIP and FAP A person is disqualified from receiving benefits for the duration of their penalty period when any of the following have occurred: • An administrative hearing decision has determined the person was found to have committed an IPV. • A disqualification agreement has been signed agreeing to an IPV disqualification. • A court decision has found the person to be guilty of an IPV. See, BAM 700, Benefit Overpayments and BAM 720, Intentional Program Violation, for definitions (including trafficking) and for standard and non-standard disqualification penalty periods. LEGAL BASE FIP 42 USC 608 (a)(8) and (9) PA 280 of 1939, as amended PA 109 of 1997

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21 USC 862a(1) Section 619 of the Michigan Appropriations Act SDA MDHHS Annual Appropriations Act Mich Admin Code, R 400.3151 – 400.3180 FAP Food and Nutrition Act of 2008, as amended PA 294 of 1998, sect. 621 7 CFR 273.11 (c)(1), (n)(1), (2) and (3) 7 CFR 273.16 (b)(5) 21 USC 862a(1) Section 619 of the Michigan Appropriations Act

BEM 205 1 of 3 CDC GROUP COMPOSITION BPB 2024- wrk022BPB 2024-025 10-1-2024

BRIDGES ELIGIBILITY MANUAL MICHIGAN DEPARTMENT OF LIFELONG EDUCATION, ADVANCEMENT AND POTENTIAL CHILD DEVELOPMENT AND CARE

DEPARTMENT POLICY CDC Group composition is the determination of which persons living together are included in the Child Development and Care (CDC) program group. Use the definitions in this item to determine CDC group composition. DEFINITIONS Program group means those persons living together whose income and assets must be counted in determining eligibility; see BEM 703, Eligibility Groups. Living together means sharing a home except for temporary absences. Temporary absence: A person’s absence is temporary if: • The person’s location is known. • The person plans to return. • The person lived with the group before the absence. Note: A person in the U.S. Military whose absence exists solely due to military service is considered to be living in the home. A temporarily absent person is considered to be living in the home. See BEM 702 for required verifications. DETERMINING THE PROGRAM GROUP When CDC is requested for a child, each of the following persons who live together must be in the program group: • Each child for whom care is requested. • Each child’s legal and/or biological parent(s) or stepparent. • Each child’s unmarried, under age 18, sibling(s), stepsiblings or half sibling(s).

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• The parent(s) or stepparent of any of the above sibling(s). • Any other unmarried child(ren) under age 18 whose parent, stepparent or legal guardian is a member of the program group. Note: In some circumstances, when you determine who is in the program group, the applicant is not included; see Applicant in this item. For example, if a legal guardian requests care for a child, the legal guardian is not included in the program group if there are no other children for whom care is requested. APPLICANT The applicant/client is the person who signs the application and who serves as primary contact with the Michigan Department of Health and Human Services (MDHHS). This person must live with the child(ren) for whom care is requested, and be one of the following in relation to the child(ren) needing care: • Parent, stepparent or foster parent of the child. • Another related person acting as caretaker to the child. • Legal guardian of the child. • An unrelated adult who is at least age 21 and whose petition for legal guardianship of the child is pending. • An unrelated adult with whom MDHHS Children’s Services has placed a child, subsequent to a court order identifying MDHHS as responsible for the child’s care and supervision. • The FIP grantee for the child. A minor parent (unmarried and under age 18) may be the applicant only if his/her parent or legal guardian does not live in the home. If the minor parent’s parent or legal guardian lives in the home, he/she must be the applicant. Exception: If the child needing care receives FIP, the FIP grantee must be the applicant. When an application is received and it is determined that another CDC household member must be the applicant, send or give a new

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application to that person. If the signed, completed application is returned within 10 calendar days of the date the specialist requested the new application, use the date of the original application as the receipt date. The original application must be filed and kept in the correct applicant’s case record. SHARED/JOINT CUSTODY If a child’s parents do not live together but have shared/joint custody of the child, authorize care only for the time periods when the parent who is applying has physical custody of the child. The parent's statement of shared/joint custody is acceptable. LEGAL BASE

The Child Care and Development Block Grant (CCDBG) Act (42 USC § 9858 et seq.), as amended by the CCDBG Act of 2014 (Pub. L. 113-186). 45 CFR Parts 98 and 99. Social Security Act, as amended 2016.

BEM 209 1 of 5 CASH ASSISTANCE GENERAL REQUIREMENTS BPB 2022-001 1-1-2022

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

DEPARTMENT POLICY FIP, RCA and SDA The Family Independence Program (FIP), Refugee Cash Assis- tance (RCA) and State Disability Assistance (SDA) are cash assis- tance programs designed to help individuals and families become self-sufficient. When an individual applies for cash assistance, Bridges determines group composition and builds an eligibility determination group (EDG) for these programs in the following order: FIP, RCA and SDA. Cash assistance is available to eligibility determination groups who meet all of the non-financial and financial requirements that are needed to determine eligibility and calculate benefit amounts. FIP GROUP COMPOSITION In order to evaluate FIP eligibility, a FIP EDG must exist, based on the rules in BEM 210, FIP Group Composition. FIP NON-FINANCIAL ELIGIBILITY FACTORS Non-financial eligibility factors in the following Bridges Eligibility Manual (BEM) items must be met: • 201, Minor Parents • 202, Immunizations • 203, Criminal Justice Disqualifications • 220, Residence • 221, Identity • 222, Concurrent Receipt of Benefits • 223, Social Security Numbers • 225, Citizenship/Non-Citizenship Status • 227, Strikers

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• 228, Family Automated Screening Tool and Family Self- Sufficiency Plan • 229, Orientation • 230A, Employment and/or Self-Sufficiency-related Activities • 233A, Failure to Meet Employment and/or Self-Sufficiency- Related Requirements • 234, FIP Time Limits • 240, Age • 245, School Attendance and Student Status • 255, Child Support • 256, Spousal/Parental Support • 257, Third Party Resource Liability • 265, Institutional Status • 270, Pursuit of Benefits FIP FINANCIAL ELIGIBILITY FACTORS Financial eligibility factors in the following BEM items must be met: • 400, Assets • 500, Income Overview • 501, Income From Employment • 502, Income From Self-Employment • 503, Income, Unearned • 504, Income From Rental/Room and Board • 505, Prospective Budgeting/Income Change Processing • 515, FIP/RCA/SDA Needs Budgeting • 518, FIP/RCA/SDA Income Budgeting • 520, Computing the FIP/RCA/SDA Budget RCA GROUP COMPOSITION In order to evaluate RCA eligibility, a RCA EDG must exist, based on the rules in BEM 215, RCA Group Composition.

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RCA NON- FINANCIAL ELIGIBILITY FACTORS Non-financial eligibility factors in the following items must be met. • 203, Criminal Justice Disqualifications • 220, Residence • 221, Identity • 222, Concurrent Receipt of Benefits • 223, Social Security Numbers • 225, Citizenship/Non-Citizenship Status • 228, Family Automated Screening Tool and Family Self- Sufficiency Plan • 230C, Employment and/or Self-Sufficiency-related Activities: RCA • 233C, Failure to Meet Employment and/or Self-Sufficiency- Related Requirements: RCA • 240, Age • 245, School Attendance and Student Status • 256, Spousal/Parental Support • 265, Institutional Status • 270, Pursuit of Benefits • 630, Refugee Assistance Program RCA FINANCIAL ELIGIBILITY FACTORS Financial eligibility factors in the following items must be met: • 400, Assets • 500, Income Overview

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• 501, Income From Employment • 502, Income From Self-Employment • 503, Income, Unearned • 504, Income From Rental/Room and Board • 505, Prospective Budgeting/Income Change Processing • 515, FIP/RCA/SDA Needs Budgeting • 518, FIP/RCA/SDA Income Budgeting • 520, Computing the FIP/RCA/SDA Budget SDA GROUP COMPOSITION In order to evaluate SDA eligibility, an SDA EDG must exist, based on the rules in BEM 214, SDA/AMP Group Composition. SDA NON- FINANCIAL ELIGIBILITY FACTORS Non-financial eligibility factors in the following items must be met: • 203, Criminal Justice Disqualifications • 220, Residence • 221, Identity • 222, Concurrent Receipt of Benefits • 223, Social Security Numbers • 225, Citizenship/Non-Citizenship Status or 225A Special Immigration Status • 240, Age • 256, Spousal/Parental Support • 261, Disability - SDA • 265, Institutional Status • 270, Pursuit of Benefits • 271, SSI Referral, Application, Denial and Appeal • 272, SDA Repay Agreements SDA FINANCIAL ELIGIBILITY FACTORS Financial eligibility factors in the following items must be met: • 400, Assets • 500, Income Overview • 501, Income From Employment • 502, Income From Self-Employment

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• 503, Income, Unearned • 504, Income From Rental/Room and Board • 505, Prospective Budgeting/Income Change Processing • 515, FIP/RCA/SDA Needs Budgeting • 518, FIP/RCA/SDA Income Budgeting • 520, Computing the FIP/RCA/SDA Budget LEGAL BASE FIP 42 USC 603 - 608 MCL 400.57 - 400.57(z) Mich Admin Code, R 400.3101 - 400.3131

RCA

45 CFR 400 45 CFR 401

SDA

Annual MDHHS Appropriations Act Mich Admin Code, R 400.3151 - 400.3180

BEM 210 1 of 20 FIP GROUP COMPOSITION BPB 2026-002 1-1-2026

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

DEPARTMENT PHILOSOPHY The Michigan Department of Health and Human Services (MDHHS) believes that children are best served by living in supportive family settings. The mutual responsibility of family members for each other and their commitment to caring for each other are key to building strong families. Parents are responsible for the care and support of their minor children. In the absence of parents, children may be cared for by other adults having specific relationships to the children. Spouses are responsible for each other. All needy family members living together are expected to share income, assets, and expenses. The limited nature of the Family Independence Program is essential to meeting the goals of the program. DEPARTMENT POLICY FIP Group composition is the determination of which individuals living together are included in the FIP eligibility determination group/pro- gram group and the FIP certified group. To be eligible for FIP both of the following must be true: • The group must include a dependent child who lives with a legal parent, stepparent or other qualifying caretaker. • The group cannot include an adult who has accumulated more than 60 TANF funded months, beginning October 1, 1996 or any other time limits in the Family Independence Program; see BEM 234. DEFINITIONS

Caretaker A caretaker is a legal parent or stepparent living in the home, or when no legal parent or stepparent lives in the home, another adult who acts as a parent to a dependent child by providing physical care and supervision. See Who May Be a FIP Caretaker? in this item.

BEM 210 2 of 20 FIP GROUP COMPOSITION BPB 2026-002 1-1-2026

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Certified Group The certified group means those individuals in the FIP EDG who meet all non-financial FIP eligibility factors. Countable income and assets of certified group members are considered in determining FIP eligibility. Certified group members have a FIP EDG participa- tion status of Eligible Child or Eligible Adult. Dependent Child A dependent child is an unemancipated child who lives with a care- taker and is one of the following: • Under age 18. • Age 18 and a full-time high school student. See BEM 245, for definition of high school. Note: See definition of Emancipated, later in this item. Eligibility Determination Group (EDG)/ Program Group The EDG means those individuals living together whose information is needed to determine FIP eligibility. Based on data entry, and rules programmed into the system, Bridges assigns an EDG participation status to each member of the household. EDG Participation Status The FIP EDG participation status explains the role the individual plays in the FIP eligibility determination. Individuals having a FIP EDG participation status other than Excluded Adult or Excluded Child, are included in the FIP EDG. The countable income and assets of individuals having an Eligible or Disqualified FIP EDG participation status are considered in determining FIP eligibility. Note: The FIP payment standard is based on the grantee’s EDG participation status and the FIP certified group size; see RFT 210. Emancipated A child is emancipated if any of the following: • Ever validly married.

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• Emancipated by court order. • On active duty with the armed forces of the United States. Joint Physical Custody Joint physical custody occurs when parents or other caretakers alternate taking responsibility for the child’s day-to-day care and supervision in separate homes. It may be included in a court order or may be an informal arrangement between parents or other care- takers. Living Together Living together means sharing a home where family members usu- ally sleep except for temporary absences. Primary Caretaker The primary caretaker is the caretaker who is primarily responsible for the child’s day-to-day care and supervision in the home where the child sleeps more than half of the days in a month, when aver- aged over a twelve-month period. The twelve-month period begins at the time the determination is being made. Absent Caretaker Once a caretaker is determined to be the primary caretaker, the child’s other caretakers are considered absent caretakers. Temporary Absence A temporarily absent person is considered to be living in the home when all of the following are true: • Individual’s location is known. • There is a definite plan to return. • The individual lived with the FIP EDG before the absence (newborns are considered to have lived with the FIP EDG). • The absence has lasted or is expected to last 30 days or less. Exception: An individual is still considered to be living in the home, even after 30 days if the absence reason is any of the following:

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In the hospital (including a psychiatric hospital).

In a residential substance abuse treatment center.

Absent for school or training.

Absent due solely to active duty in the uniformed services of the U.S.

A child who is living apart from a parent due solely to the parent residing in a domestic violence shelter. Note: A dependent child who is temporarily absent, can be considered living with only one caretaker. When a child sleeps in the home of multiple caretakers who do not live together, Bridges makes a primary caretaker determination; see Determining Primary Caretaker in this item. Exception: A court ward is under the care and supervision of the court. Even if they meet the temporary absence requirements above, the child is not considered to be living in the parent’s home. FAILURE TO REPORT CHILD’S ABSENCE A parent or other FIP caretaker, must notify the department of a child’s absence from the home within five days of the date it becomes clear to the caretaker that the child will be absent for 30 days or more. If the child’s absence does not meet temporary absence requirements to be considered in the home, the caretaker who fails to notify the department within five days is disqualified for one month. WHO IS IN THE FIP EDG? The FIP EDG includes all household members whose information is needed to determine FIP eligibility. Based on data entered in the system, Bridges determines all of the following: • Each household member’s FIP EDG participation status. • Which individuals’ income and assets are considered. • Which individuals’ needs are considered. • Which individuals’ relationship(s) to other members are considered.

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These determinations are made based on the individual’s: • Age. • School attendance. • Relationship(s) to other household members. • Program Request status. • Receipt of other program benefits such as SSI, child foster care payments or Independent Living Stipend. • Criminal justice disqualifications. • FIP time limit. Mandatory FIP EDG Members When cash assistance is requested for a dependent child, or a dependent child is a mandatory FIP EDG member, all of the follow- ing individuals who live together are in the FIP EDG: • Dependent child. • Child's legal parent(s). • Child's legal siblings who meet the definition of a dependent child (siblings have at least one legal parent in common). • Legal parent(s) of the child’s siblings. • Child's legal stepparent, even after death of or divorce from the parent. • Child's legal stepsiblings, who meet the definition of a dependent child, even after death of or divorce from the parent. • Child's child. Example: Sally is 18 and attends high school full-time. Sally and her one-year-old daughter live with her mother and 13-year-old brother. Sally applies for cash assistance for herself and her daughter. Everyone in the household is a mandatory FIP EDG member because Sally has requested cash for her dependent child, making Sally a mandatory EDG member; and Sally meets the

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definition of a dependent child, making her brother and mother mandatory FIP EDG members. Exception: The client has the option to exclude a new spouse from the FIP Certified Group for up to 18 months after the month the marriage took place. See the marriage exemption section of this policy item. Refusal of any FIP EDG member to provide information needed to determine FIP eligibility causes ineligibility for the entire FIP EDG. Exception: Failure to cooperate with the following eligibility requirements have specific penalties, not always FIP denial or closure: • Employment and/or family self-sufficiency requirements. • Social Security Numbers. • Child Support. • Third Party Liability. • Caretaker’s failure to report a child’s absence timely. • School attendance. • Criminal justice requirements. See Failure to Report Child’s Absence in this item and BEM 223, 228, 230A-233B, 255 and 257 for penalties for failure to meet these requirements. There are circumstances in which a FIP certified group contains no dependent child; see FIP Certified Groups with No Child in this item. Who May be a FIP Caretaker? A legal parent or stepparent living with a dependent child is always the child’s caretaker, unless the parent is a minor. See Multi-Gener- ation and Combined Groups in this item for exceptions regarding minor parents. A person other than a legal parent or stepparent may be a caretaker only when the dependent child has no legal parent or stepparent in the home. A caretaker in the child’s home, other than a parent or stepparent must be one of the following: 1. A relative who is at least age 18 and legally related to the child by blood, marriage or adoption, as any of the following:

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• Grandparent (including great or great-great). • Aunt or uncle (including great or great-great). • Sibling. • Stepsibling. • Nephew or niece. • First cousin or first cousin once removed. • The spouse of any of the above, even after the marriage is ended by death or divorce. • The parent of the child's putative (alleged) father. Note: When a court order has terminated parental rights, the parent and child are no longer legally related. However, the child’s relationship to other relatives is not affected. 2. The child’s legal guardian(s). 3. An adult(s) who is at least age 21 and whose petition for legal guardianship of the child is pending. 4. An adult, having none of the qualifying relationships above, with whom MDHHS children’s services has placed a child, subsequent to a court order identifying MDHHS as responsible for the child’s care and supervision. This relationship is known as unrelated caregiver, formerly fictive kin. Occasionally, a child is included in a FIP EDG when there is not a qualifying relationship to the caretaker due to mandatory EDG member policy. Example: Anthony applies for cash assistance for his son Tony and Tony’s half-sister Angela. Anthony was never married to Tony’s mother and she is not in the home. Because Tony and Angela are half siblings, Angela is a mandatory FIP EDG member, even though there is no qualifying relationship between Angela and Anthony. Receipt of Other Program Benefits Receipt of the following types of other program benefits or services affects an individual’s FIP EDG participation status.

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• Children’s Services Independent Living Stipend. • SSI. • Child foster care payments. • MDHHS children’s services for a child in an out-of-home foster care placement due to abuse or neglect, when there is a plan to return the child to the parent’s home. Independent Living Stipend A FIP EDG member who is a recipient of an Independent Living Sti- pend has an EDG participation status of Other Adult. The income, assets and needs of this individual are not considered in determin- ing eligibility for FIP, however, their relationship to other FIP EDG members is considered. Example: Linda, a foster child, lives independently and receives an Independent Living Stipend. Linda has a baby daughter in the home. There is no allowance for the child in the Independent Living Stipend. Even though Linda cannot receive FIP for herself, she can receive ineligible grantee FIP for the child because she is the dependent child’s caretaker. SSI Recipients A FIP EDG member, who receives SSI, has a FIP EDG participation status of Other Adult or Other Child. The income, assets and needs of an SSI recipient are not considered in determining eligibility for the FIP EDG. However, their relationships to other EDG members are considered. Example: An unmarried couple has one child in common. Paternity has been established. The child receives SSI. The child’s relationship to the parents forms a valid FIP EDG, even though the SSI recipient cannot be in the FIP certified group. The SSI recipient’s relationship to the parents makes them mandatory FIP EDG members. Example: SSI recipient has one child. The SSI recipient cannot be in the FIP certified group; however, the SSI parent’s relationship to the dependent child forms a valid FIP EDG. Note: Request cash assistance for the SSI child, even though the child will not be in the FIP certified group.

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Children’s Foster Care Payment Recipient A recipient of children’s foster care payments has a FIP EDG participation status of Excluded Child. The income, assets, needs and relationships to other household members are not considered. This child has no effect on FIP eligibility determination. Parent of Child in Out-of-Home Foster Care Placement The legal parent and/or stepparent of a child in an out-of-home fos- ter care placement due to abuse or neglect forms a valid FIP EDG, as long as there is a plan to return the child to the parent/steppar- ent’s home up to twelve months from the date of removal. When there is no basis for FIP eligibility except for the parent’s relationship to the child in out-of-home foster care placement, the child has a FIP EDG participation status of Other Child on the parent's case. If the foster care plan is to return the child to the parents' home, the parent/stepparent may be eligible for FIP based on the relationship to the child in foster care; see FIP Certified Groups with No Child in this item. Note: Request cash assistance for the foster care child on the parent's case even though the child will not be in the FIP certified group. OPTIONAL CERTIFIED GROUP MEMBERS A needy caretaker other than a parent or stepparent may request cash assistance and be included in the FIP certified group. The caretaker's spouse and dependent children living in the home must also be included in the FIP certified group when the caretaker is included. When FIP eligibility is based solely on the presence of a child placed in the home by children’s services, the adult is in the FIP EDG for relationship purposes, but cannot be in the FIP certified group. FIP for court-ordered unrelated caregivers is limited to the ineligible grantee payment standard. If there are other children in the home who have different relationships to this caretaker; see Multi-Generation and Combined Groups in this item.

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Marriage Exemption The marriage exemption option applies to all marriages that occur on or after 1/1/2020. The client has the option to exclude a new spouse from the FIP certified group for up to 18 months after the month of the marriage when all the following non-financial and financial criteria are met: • The group is already active FIP. • Marriage occurred on or after 1/1/2020. • The new spouse was not already a FIP Group member. • The new spouse meets all other non-financial eligibility criteria. • The total assets of the program group, including the new members as a result of the marriage, are equal to or less than double the FIP asset limits; see BEM 400. • The budgetable income (result of the qualifying issuance test) of the Program Group, including the new members as a result of the marriage, is less than twice the FIP Monthly Payment Standard for the group size; see RFT 210. Note: If a group qualifies for the marriage exemption and chooses to include the new spouse in the FIP group, the marriage exemption would no longer be an option for that spouse. Additionally, if a family uses the exemption, a child or sibling/half- sibling to an active member would be considered a mandatory group member. Any child that joined the group only as a result of the marriage, would not be part of the mandatory group. Example 1: Leighton and her daughter Lizzy receive FIP. Leighton marries Luke in January 2020 and Luke moves into the home. Luke and Leighton's total liquid assets equal $4,000. The only income for the family is $1,100 per month of earned income. ($1,100 earned income - $200 earned income disregard - $180 additional 20% of the remaining earnings = $720) The budgetable income (after the qualifying income deductions) is $720 per month. Twice the payment standard for the FIP group of 3 is $1,166 per month. Leighton has the option to exclude Luke from

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the FIP group. If the family chooses to use the exemption, Luke's assets and income will not count in the FIP budget for up to 18 months. The group is potentially eligible for the exemption through July 2021. Luke becomes a mandatory group member effective August 2021. (January 2020 + 18 months = July 2021) Example 2: Brook and her son Chase receive FIP. Brook marries John and John moves into the home. Brook and John's total liquid assets equal $4,000. The only income for the family is $4,300 per month of unearned income. The budgetable income is $4,300 per month, the household did not qualify for any of the income deductions. Twice the payment standard for the FIP group of 3 is $1,166 per month. Brook and John do not qualify for the exemption. John is a mandatory group member. John's assets and income will count in the FIP budget. Example 3: Bill and his son Matt receive FIP. Jane marries Bill and moves into the home. Jane also has a child that moves into the home. If the family qualifies for the exemption and chooses to use the exemption, Jane and her child will remain out of the FIP certified group. Example 4: Amy and her son Mike receive FIP. Tom lives with his son Jack at a different address. Amy is Jack's mother. Tom and Amy get married and all four of them move in together. The family qualifies for the exemption and chooses to use the exemption. The FIP certified group consists of Amy, Mike, and Jack. Tom is excluded. Complete the DHS-1172-M, FIP Marriage Exemption Worksheet, for all groups that meet the non-financial requirements of the marriage exemption. Required verifications must be received prior to determining if the group meets the financial requirements of the exemption. If the group does not meet the exemption requirements, proceed with regular case processing. If the group does meet the exemption requirements, once all information has been verified and scanned into the electronic case file, submit the DHS-1172-M to Policy-FIP-SDA@michigan.gov for final approval. The specialist will be notified of the results via email. Upon approval policy will complete the exception override in Bridges. The override can only be modified by the Cash Policy unit.

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Note: Notify the Cash Policy unit of all changes that may impact eligibility results. Email the following to Policy-FIP- SDA@michigan.gov: case name, case number, and details of the change. Example 5: Kenton and his son Zack are receiving FIP. Kenton marries Kristin in February of 2020 and reports that Kristin is in the home. The group qualified and chose to use the marriage exemption. Kristin is not in the FIP group. The Cash Policy unit has completed the override, only Kenton and Zack are included in the FIP group. May 2020, Kenton reports the only income for the household is $5,000 per month of earned income. ($5,000 earned income - $200 earned income disregard - $960 additional 20% of the remaining earnings = $3,840) The budgetable income (after the qualifying income deductions) is $3840 per month. Twice the payment standard for the FIP group is $1,166 per month. Kenton and Kristin no longer qualify for the exemption. Kristin is now a mandatory group member. Kristin's assets and income will now count in the FIP budget. Determining Primary Caretaker The primary caretaker is the person who is primarily responsible for the child’s day-to-day care and supervision in the home where the child sleeps more than half the days in a month, when averaged over a twelve-month period. The twelve-month period begins at the time the determination is being made. When a child spends time in the home of multiple caretakers who do not live together (such as joint physical custody or parent/grandparent), Bridges determines the primary caretaker based on the number of days per month a child sleeps in the home. Accept the client’s statement regarding number of days the child sleeps in the caretaker’s home unless questionable or disputed by another caretaker. Child’s Normal Sleep Time When a caretaker works during a child’s normal sleep hours, include the nights the child sleeps away from home when due

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solely to the caretaker’s employment, as nights slept in the home of the caretaker. Vacations/Other Absences Vacations or other time a child spends away from the primary care- taker does not change the result of the primary caretaker determination, unless the child is away, or expected to be away from the home for more than 30 consecutive days. Once a caretaker is established as primary, the child’s other caretakers are considered absent caretakers. Only the primary caretaker can receive FIP for a child. Absent Caretakers Exception: If otherwise eligible, an absent caretaker may receive FIP for a child when both of the following are true: • The child lives with the absent caretaker for more than 30 consecutive days. • The child does not meet temporary absent requirements to be considered living with the primary caretaker. Caretaking Time Shared Equally If the child sleeps in the home of multiple caretakers an equal num- ber of days in a month, when averaged over a twelve-month period, such as every other week, the caretaker who applies and is certified eligible first is the primary caretaker for that program. Note: It is possible to have a different primary caretaker for different programs Caretaking Time Disputed When the number of days per month a child sleeps in the home of multiple caretakers is questionable or disputed, give each caretaker the opportunity to provide evidence of their claim. Base primary caretaker determination upon best available information and evi- dence supplied by the caretakers; see Verification Sources in this item.

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Example 1: Joey is seven years old and lives with Mom during the school year. He spends eight weeks each summer with Dad. Joey returns to Mom’s home two days per week during this time with Dad. Joey sleeps in Mom’s home more than half the days in a month, when averaged over the next twelve months. Mom is the primary caretaker and continues to receive assistance for Joey through the summer. Note: If Joey does not return to Mom’s home at least once every 30 days, he is no longer considered to be living with Mom. If Joey is in Dad’s home for more than 30 consecutive days, Dad could apply and receive assistance for Joey. Example 2: Eric is ten years old. His mom works during the week. Eric’s mom drops him off at his grandmother’s house on Sunday evening and picks him up on Friday evening. Eric’s grandmother is primarily responsible for his care and supervision in the home where he sleeps more than half the days in a month when averaged over the next twelve months. Eric’s grandmother is the primary caretaker. His mom is an absent caretaker. Note: If Mom works during Eric’s normal sleep hours, and he is only at Grandma’s to sleep while mom works, he is not there all week. Mom is the primary caretaker. Grandma is providing child care. Changes in Primary Caretaker Re-evaluate primary caretaker status when any of the following occur: • There is a change in the number of days per month the child sleeps in a caretaker’s home. • A second caretaker disputes the first caretaker’s claim of the number of days the child sleeps in his/her home. • A second caretaker applies for assistance for the same child. Example 1: Tommy has lived in his Mom’s home except for weekends for the past several years. He is now fourteen and has become a discipline problem. Mom and Dad agree that it would be better for Tommy to live with Dad except weekends. Dad is now the primary caretaker. Mom is now an absent caretaker.

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Example 2: Mom is receiving FIP for her six-year-old son, Austin. At application, Austin sleeps in her home more than half the days in a month, when averaged over the next twelve months. Dad is con- tacted by Friend of the Court regarding his ability to pay child sup- port. Dad states that Austin sleeps in his home all week and spends weekends only with Mom. Determine the number of days per month Austin stays in each parent’s home based on best available information and evidence supplied by both parents. Legal Guardian Whenever a FIP Eligible Child has a legal guardian, the legal guardian must be the protective payee for the FIP grant; see BAM 420. This applies whether or not the guardian resides with the FIP group and continues until guardianship is terminated. Verify termination of legal guardianship prior to terminating the protective payee; see Verification Sources in this item. Note: When a legal guardian is receiving FIP for a child, and the parent of the only eligible child returns to the home, enter the parent’s data on the legal guardian’s Bridges case and run eligibility. The legal guardian’s FIP will be terminated. If the parent applies and is found eligible for FIP, the legal guardian must be made the protective payee for the parent’s FIP. MULTI-GENERATION AND COMBINED GROUPS When an unemancipated minor parent and the parent’s child (see BEM 201) live with a legal parent(s) or stepparent, all three genera- tions compose the group. The unemancipated minor parent may not be the grantee for FIP when living with a parent(s) or stepparent; the unemancipated minor parent is the dependent child of the parent(s) or stepparent. When a minor parent lives with a qualifying FIP caretaker other than a parent or stepparent, and the caretaker requests cash assistance for themselves, the minor parent is a dependent child. If the minor parent’s non-parent caretaker does not request cash assistance, or is ineligible for FIP, the minor parent may apply, be treated as an adult and be the FIP grantee; see BEM 201. When a person is caring for two or more dependent children who are not legally related to each other as siblings or stepsiblings, all children for whom the caretaker requests cash assistance are in a

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single FIP EDG and certified group. The caretaker, however, is not required to request assistance for all children who are not related to each other as siblings or stepsiblings. FIP Certified Groups with No Child A FIP certified group may be composed of only adults under speci- fied circumstances. Groups with no eligible child may consist of the following: • A pregnant woman and if married, her spouse. Note: If the pregnant woman is not a member of the certified group, such as an SSI recipient, there is no FIP eligibility based on the pregnancy. • The caretaker(s) of a dependent child who would be eligible for FIP except for the child's receipt of SSI. • A legal parent(s) and/or stepparent of a dependent child in an out-of-home foster care placement due to abuse and/or neglect when there is a plan to return the child to the parent's home. Eligibility based on this policy is allowed for up to 12 months from the date the child(ren) were removed. Children’s services or the Services Inquiry screens will verify that there is a plan for reunification with the parent, at application and redetermination; see Verification Sources in this item. DETERMINING THE FIP CERTIFIED GROUP Bridges determines which members of the FIP EDG are included in the FIP certified group. A FIP EDG member, who does not meet a nonfinancial eligibility factor or is disqualified for any reason, is not in the FIP certified group. Note: An immunization penalty is not a disqualification. VERIFICATION REQUIREMENTS

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Relationship Relationship must be verified for each dependent child on the FIP EDG. Verification must establish the relationship of each dependent child to the child's legal parent, stepparent or other qualifying caretaker. When a child lives with the natural father, but paternity has not been legally established, the father may voluntarily complete the DHC-0682, Affidavit of Parentage; see BEM 255, Child Support, Voluntary Paternity Acknowledgement. Marriage Exemption Verification of date of marriage is required when applying the marriage exemption. Primary Caretaker Accept the client’s statement regarding the number of days per month a child sleeps in the home. If questionable or disputed by another caretaker, request verification from both caretakers. Pregnancy Verification of pregnancy is required when FIP eligibility is based solely on the pregnancy. Guardianship Termination Verify termination of legal guardianship before terminating the pro- tective payee. Reunification Plan Verify at reported change, application and redetermination, that there is a plan for a child in foster care to be returned to a parent’s home. Unrelated Caregiver Placement Verify that a court has ordered MDHHS responsible for the care and supervision of a child(ren), and that MDHHS children’s services

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staff have placed the child(ren) with an unrelated caregiver at application and redetermination. Emancipated Verify emancipation of a child under age 18. VERIFICATION SOURCES

Relationship • Birth certificates. • Michigan Birth Registry. • Adoption records. • Marriage license/certificate. • School records. • Separation records. • Divorce records. • Hospital birth records. • Affidavit of Parentage. • Child support records. • Court orders. • Baptismal records. • Immigration records. • Any legal document that traces the child's relationship to the parent, stepparent or other qualifying caretaker. • Other government or local agency records, newspaper records, or local histories that specify the relationship. • Consecutively numbered I-94 cards do not prove relationship of a caregiver to a child.

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Marriage • Marriage License/Certificate. Primary Caretaker When caretaking time of a dependent child is disputed or question- able, examples of proof to consider include, but are not limited to: • The most recent court order that addresses custody and/or visitation. • School contact or records indicating who enrolled the child in school, first person called in case of emergency, and/or who arranges for the child’s transportation to and from school. • Child care provider contact or records showing who makes and pays for child care arrangements, and who drops off and picks up the child. • Medical providers contact or records showing where the child lives and who usually brings the child to medical appointments. • Other documents or collateral contacts that support/contradicts the caretaker’s claim. Pregnancy Statement, including expected date of delivery, from one of the fol- lowing: • Doctor of Medicine (MD). • Doctor of Osteopathy (DO). • Physician's Assistant (PA). • Ob-gyn Nurse Practitioner (NP). • Ob-gyn Clinical Nurse Specialist (NS). • Certified Nurse-Midwife. • Registered Nurse (RN). • DHS-49, Medical Examination Report; DHS-54A, Medical Needs; DHS-54E, Medical Needs-PATH or other written statement may be used. Guardianship Termination Guardianship or other documents showing legal guardianship has been terminated.

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Reunification Plan Any document or collateral contact that verifies the services plan is to return the child to the parent’s home. When a child in out-of-home foster care placement is active Chil- dren’s Protective Services only, assume there is a plan to return the child to the parent’s home when the field on the Services Inquiry screen Petition Filed for Termination of Parental Rights is not yes. When the child in out-of-home foster care placement is active Chil- dren’s Foster Care, there is a plan to return the child to a parent’s home when the Services Inquiry screen shows ‘MI goal of return home’ and the ‘parent cooperation’ switch is not ‘no’. Unrelated Placement Verify that a court has ordered MDHHS responsible for the care and supervision of a child(ren), and that the child has been placed with the unrelated caregiver by MDHHS children’s services staff with one of the following: • A DHS-498, Caregiver Assistance Application Cover Letter, completed by MDHHS children’s services staff. • A copy of court documents. • Contact with or statement from the MDHHS children’s services staff that provides the same information. Emancipated • Marriage certificate. • Court order. • Armed forces documentation. LEGAL BASE FIP 42 USC 608 42 USC 619 Mich Admin Code, R 400.3112, .3114, .3122 MCL 400.57 et seq. MCL 400.6(3) and (4) 2018 P.A. 574

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DEPARTMENT POLICY MAGI-Related Group composition for MAGI-related categories follows tax filer and tax dependent rules. The MAGI related groups are: • Children (U19). The income limit for children birth to age 1 is 195 percent of the federal poverty level (FPL). The income limit for a child age 1-19 is 160 percent FPL. • Pregnant Women (PW). The income limit for pregnant women of any age is 195 percent FPL. • Parents and caretakers (PCR). The income limit for parents and caretakers is 54 percent FPL. • Healthy Michigan Plan (HMP). The income limit for adults age 19-64 is 133 percent FPL. • Former foster children (FCTM). There is no income test for individuals aged 18-26 who were in foster care in Michigan at age 18. • MOMS. The income limit for pregnant women of any age is 195 percent FPL. • MIChild. The income limit for children birth to age 19 is 212 percent FPL. • Plan First. The income limit is 195 percent FPL. More information regarding income limits is available at www.medicaid.gov. FAMILY SIZE The size of the household will be determined by the principles of tax dependency in the majority of cases. Parents, children and siblings are included in the same household. Parents and stepparents are treated the same. Individual family members may be eligible under different categories.

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TAX FILERS AND NON- TAX FILERS The household for a tax filer, who is not claimed as a tax dependent, consists of: • Individual. • Individual’s spouse. • Tax dependents. The household for a non-tax filer who is not claimed as a tax dependent, consists of the individual and, if living with the individual: • Individual’s spouse. • The individual's natural, adopted and stepchildren under the age of 19 or under the age of 21 if a full-time student. • If the individual is under the age of 19 (or under 21 if a full-time student), the group consists of individual's natural, adopted and stepparents and natural, adoptive and step siblings under the age of 19 (or under 21 if a full time student). The household for an individual who is a tax dependent of someone else, consists of: • The household of the tax filer claiming the individual as a tax dependent, except that the individual’s group must be considered as non-filer/non-dependent if: • The individual is not the spouse or a biological, adopted, or stepchild of the taxpayer claiming them; or • The individual is under the age of 19 (or under 21 if a full-time student) and expects to be claimed by one parent as a tax dependent and are living with both parents but the parents do not expect to file a joint tax return; or • The individual is under the age of 19 (or under 21 if a full-time student) and expects to be claimed as a tax dependent by a non-custodial parent, • The individual’s group consists of the parent who has a court order or binding separation, divorce, or custody agreement establishing physical custody controls, or

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• If there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights. Core Relative Core relatives include any of the following: • Parent. • Aunt or uncle. • Niece or nephew. • Any of the above relationships prefixed by grand, great or great-great. • Stepparent. • Sister or brother. • Stepsister or stepbrother. • First cousin. • First cousin once removed (for example, a first cousin’s child). A core relative may also include the spouse of any individual above, even after the marriage is ended by death or divorce. Core relatives include relationships established by adoption. The individual’s statement regarding relationship, presence in the home and tax dependency is acceptable. HOUSEHOLD COMPOSITION EXAMPLES Kayla is a grandmother who claims her 20 year old daughter, Samantha and 2 year old granddaughter, Joy as tax dependents. Samantha is a full-time student. Kayla is the tax filer. • Tax rules apply to all. • Kayla's group is 3. Kayla, Samantha and Joy. • Samantha's group is 3. Samantha, Kayla and Joy. • Joy’s group is 2, Samantha and Joy.

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Bob and Mary are married. Mary is the mother of Jane, age 22. Jane attends college in Ohio. Bob is the tax filer and claims Mary and Jane as tax dependents. • Tax rules apply to all. • Group is 3 for all individuals. SSI-Related Medicaid (MA), Group 2 Pregnant Women, Group 2 Persons Under Age 21, Group 2 Caretaker Relative Use fiscal groups and, for SSI-related MA, Group 2 Persons Under Age 21 and Group 2 Caretaker Relative, asset groups to determine the financial eligibility of a person who requests Medicaid and meets all the nonfinancial eligibility factors for an Medicaid category. Individual family members may be eligible under different Medicaid categories. All categories of Medicaid must be explored for each person who requests Medicaid; see choice of category in BEM 105. REFUSING INFORMATION SSI-Related MA, Group 2 Pregnant Women, Group 2 Persons Under Age 21, Group 2 Caretaker Relative A person about whom information necessary to determine eligibility is refused and that person's spouse and children, if living with the person, are not eligible for MA. Therefore, no fiscal or asset group is set up for them. Failure to cooperate with SSN, support or third party resource liabil- ity requirements (BEM 223, 255, 256 and 257) may result in MA ineligibility for a person, but is not refusing information necessary to determine eligibility. DEFINITIONS SSI-Related MA, Group 2 Pregnant Women, Group 2 Persons Under Age 21, Group 2 Caretaker Relative Child means an unmarried person under age 18. Adult means a person who is married or age 18 or older.

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RULES FOR GROUPS SSI-Related MA, Group 2 Pregnant Women, Group 2 Persons Under Age 21, Group 2 Caretaker Relative Determine the fiscal and asset groups separately for each person requesting MA. When referring to the group listings, remember: • Only persons living with one another can be in the same group; see living with in this item. • Certain persons cannot be fiscal or asset group members in SSI-related MA; see excluded persons in this item. • There is no asset test for Group 2 Pregnant Women. For all Group 2 MA categories, when a child lives with both parents who do not live with each other (for example, child lives with his mother two weeks each month and his father the other two weeks), only one parent, the primary caretaker, is in the fiscal group. Determine a primary caretaker. The primary caretaker is the parent who is primarily responsible for the child’s day-to-day care and supervision in the home where the child sleeps more than half the days in a month, when averaged over a twelve month period. The twelve month period begins at the time the determination is being made. Vacations and visitation with the absent parent do not interrupt primary caretaker status. Joint physical custody occurs when parents alternate taking responsibility for the child’s day-to-day care and supervision. It may be included in a court order or may be an informal arrangement between parents. A child is considered to be living with only one parent in a joint custody arrangement. This parent is the primary caretaker. Pregnancy Count a pregnant woman as at least two members. If multiples are expected count the woman as three, etc.

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LIVING WITH SSI-Related MA, Group 2 Pregnant Women, Group 2 Persons Under Age 21, Group 2 Caretaker Relative Living with others means sharing a home where family members usually sleep, except for temporary absences. A temporarily absent person is considered in the home. Temporary Absence SSI-Related MA, Group 2 Pregnant Women, Group 2 Persons Under Age 21, Group 2 Caretaker Relative A person's absence is temporary if for the month being tested: • His/her location is known; and • There is a definite plan for him/her to return home; and • He/she lived with the group before the absence (Note: newborns and unborns are considered to have lived with their mothers); and • The absence did not last, or is not expected to last, the entire month being tested unless the absence is for education, training, or active duty in the uniformed services of the U.S. Exception: An absence is never temporary when: • The month being tested is an L/H month (see BPG) for the absent person; or • The absent person is in one of the following on the last day of a past month or on the processing date for current and future months: Long-term care (LTC) facility. Adult foster care facility. Home for the aged. Licensed child foster care home. Child caring institution. Therefore, the above persons (including spouses residing in the same facility) are never considered to be living with others. A child who has resided in a hospital for 30 or more days is not considered

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to be living with others and is a fiscal group of one. Certify for 12 months before re-determining eligibility for the child. RULES FOR DEPENDENT CHILDREN A dependent child can be temporarily absent from only one home. When a child spends time with two parents who do not live together, a primary caretaker must be determined. Scheduled vacations and visitation do not interrupt primary caretaker status. EXCLUDED PERSONS FOR SSI- RELATED SSI-Related MA The following cannot be fiscal or asset group members: • FIP recipients. • SSI recipients. • Title IV-E recipients. • Department wards. • A person about whom information necessary to determine eligibility is refused. SSI-RELATED FISCAL GROUPS SSI-Related MA Determine the fiscal group for each person who is requesting MA. The fiscal group must be determined separately for each person. SSI-Related Child SSI-Related MA A child is a fiscal and asset group of one. For a child living with his parent(s), BEM 400 and 540 explain whether the parent(s) must deem assets or income to the child. Also, see BEM 540 to determine budgetable income for the fiscal group.

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SSI-Related Adult SSI-Related MA Example: When an adult is applying for any Medicaid program (including the Medicare Savings Program) and is Waiver, Program of All Inclusive Care for the Elderly (PACE), or Freedom to Work (FTW), and is living with a spouse, the fiscal and asset group is only the adult applicant. When an adult is applying for any Medicaid program (including the Medicare Savings Program) and is not Waiver, PACE, or FTW, is living with a spouse, the fiscal and asset group is the adult applicant and the spouse. When an adult is applying for any Medicaid program (including the Medicare Savings Program) the fiscal and asset group is only the adult applicant when their spouse is L/H. The adult’s fiscal determination for Medicaid (including Medicare Savings Program) would include any income, such as the Community Spouse Income Allowance (CSIA) they receive from the L/H spouse. See BEM 400 to determine the asset group’s countable assets and BEM 541 to determine budgetable income for each person in the fiscal group. See the glossary for the definition of L/H. Exception: When BEM 402 instructs you to determine a couple's countable assets for an INITIAL ASSET ASSESSMENT or Initial Eligibility, the L/H or waiver patient and the community spouse are considered an asset group. Note: Transfers of income and/or assets are allowed between spouses regardless of each’s eligibility for program benefits. Transfers between spouses may cause program ineligibility for one or both spouses. This includes transfers of income from an L/H spouse to the spouse in the home who may be a waiver client. Group 2 Fiscal Groups Determine the fiscal and asset groups separately for each person requesting Medicaid. The fiscal group must be determined separately for each person. In determining a person's eligibility, the only income that may be considered is the person's own income and the income of the following persons who live with the individual:

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• The individual's spouse, and • The individual's parent(s) if the individual is a child. Group 2 Under Age 21 A child's fiscal group is the child and the child's parents. Group 2 Caretaker Relative An adult's fiscal group is the adult and the adult's spouse. VERIFICATION REQUIREMENTS Group 2 Medicaid Verify the primary caretaker when questioned or disputed. Verification Sources Primary Caretaker Court order that addresses custody or visitation. School records indicating who enrolled the child and who is called in an emergency situation. Medical records stating where the child lives, who is responsible for the child’s medical care. Child care records showing where the child lives and who makes and pays for the child care arrangements. LEGAL BASE MA Social Security Act, Sections 1902(a) (10), (17) MCL 400.106 The Affordable Care Act (Pub. L. 111-148) and the Health Care and Education Reconciliation Act (Pub. L. 111-152).

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DEPARTMENT POLICY Bridges will help determine who must be included in the Food Assistance Program (FAP) group prior to evaluating the non- financial and financial eligibility of everyone in the group. Food Assistance Program group composition is established by determining all of the following: 1. Who lives together. 2. The relationship(s) of the people who live together. 3. Whether the people living together purchase and prepare food together or separately. 4. Whether the person(s) resides in an eligible living situation; see Living Situations in this item. RELATIONSHIPS The relationship(s) of the people who live together affects whether they must be included or excluded from the group. First, determine if they must be included in the group. If they are not mandatory group members, then determine if they purchase and prepare food together or separately. Spouses Spouses who are legally married and live together must be in the same group. Parents and Children Children include natural, step and adopted children. Parents and their children under 22 years of age who live together must be in the same group regardless of whether the child(ren) have their own spouse or child who lives with the group. Note: For ongoing and intake applications where the child(ren) are not yet 22, they are potentially eligible for their own case, the month after turning 22.

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Primary Caretaker The primary caretaker is the person who is primarily responsible for the child’s day-to-day care and supervision in the home where the child sleeps more than half of the days in a calendar month, on average, in a twelve-month period. Caretaker A caretaker is a related or unrelated person who provides care or supervision to a child(ren) under 18 who lives with the caretaker but who is not a natural, step or adopted child. This policy does not apply to foster children (see below). A person acting as a parent and the child(ren) for whom they act as a parent who live with them must be in the same group. Example: Emma's grandson Pete (age 15) lives with them and they receive FIP for Pete as an ineligible grantee. They provide for Pete's care by giving them a place to live, clothing, etc. Emma and Pete must be in the same group. Example: Polly's niece Peggy (age 17) lives with them. Peggy has a full-time job, pays room rent and buys their own food. Polly states that they have just provided a place to live in exchange for the room rent; they do not supervise Peggy's activities. Polly and Peggy are separate groups. Either may apply with separate group status. Foster Children The FAP group may choose to include or exclude a foster child whose foster parent is a group member. If excluded, the foster child is not eligible for FAP as a separate group, and the foster care pay- ment is not income to the group. Foster Adults The FAP group may choose to include or exclude a foster adult who lives with the group. If excluded, the foster adult is not eligible for FAP as a separate group, and the foster care payment is not income to the group. Exception: This policy does not apply to residents of Adult Foster Care (AFC)/Community Living Facility (CLF) homes which are nonprofit and licensed for 16 or fewer residents. Policy in Bridges Eligibility Manual (BEM) 615, Group Living Facilities and BEM 617, FAP in Nonprofit Group Living Facilities applies to these residents.

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LIVING WITH Living with means sharing a home where family members usually sleep and share any common living quarters such as a kitchen, bathroom, bedroom or living room. Persons who share only an access area such as an entrance or hallway or non-living area such as a laundry room are not considered living together. For policy regarding persons in other group living situations; see BEM 617. Temporary Absence A person who is temporarily absent from the group is considered living with the group. A person's absence is temporary if all of the following are true: • The person’s location is known. • The person lived with the group before an absence (newborns are considered to have lived with the group). • There is a definite plan for return. • The absence has lasted or is expected to last 30 days or less. Exception: The absence may last longer than 30 days if the absent person is in a hospital and there is a plan for them to return to the home. DETERMINING PRIMARY CARETAKER When a child spends time with multiple caretakers who do not live together such as joint physical custody, parent/grandparent, etc., determine a primary caretaker. Only one person can be the primary caretaker and the other caretaker(s) is considered the absent care- taker(s). The child is always in the FAP group of the primary care- taker. If the child’s parent(s) is living in the home, they must be included in the FAP group. Exception: If otherwise eligible, the absent caretaker may receive FAP benefits for the child when the child is visiting the absent

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caretaker for more than 30 days (not temporarily absent from the primary caretaker’s home.) Determine primary caretaker by using a twelve-month period. The twelve-month period begins when a primary caretaker determination is made. To determine the primary caretaker: • Ask the client how many days the child sleeps at their home in a calendar month. • Accept the client’s statement unless questionable or disputed by another caretaker. Note: When a caretaker works during a child’s normal sleep hours, include the nights the child sleeps away from home when due solely to the caretaker’s employment as nights slept in the home of the caretaker; see Example 3. • If primary caretaker status is questionable or disputed, verification is needed. • Allow both caretakers to provide evidence supporting their claim. Base your determination on the evidence provided by the caretakers; see Verification Sources in this item. • Document who the primary caretaker is in the case. If the child spends virtually half of the days in each month, averaged over a twelve-month period with each caretaker, the caretaker who applies and is found eligible first, is the primary caretaker. The other caretaker(s) is considered the absent caretaker(s). Example 1: Patty normally lives with Mom and they receive FAP benefits. Dad has scheduled visitation every other weekend, two weeks at Christmas, two weeks at Easter and eight weeks in the summer. When Patty is gone for the eight weeks in the summer, Dad (absent caretaker) could apply and receive FAP benefits with Patty in his group, if otherwise eligible. Patty would have to be removed from Mom’s case because they no longer meet the defini- tion of temporary absence. Note: If in the example above, Patty returns every other weekend to visit with Mom during the summer visitation with Dad, Peggy remains on Mom’s case (they are temporarily absent).

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Example 2: Eric is ten years old. Their mom works during the week, drops them off at their grandmother’s house on Sunday evening and picks them up on Friday evening. Eric’s grandmother is primarily responsible for their care and supervision in the home where they sleep more than half the days in a month when averaged over the next twelve months. Eric’s grandmother is the primary caretaker. Their mom is considered an absent caretaker. Example 3: Mom works during Eric’s normal sleep hours, and Eric is only at Grandma’s house to sleep while mom works (they are not there all week). Mom is the primary caretaker. Grandma is providing child care. Changes in Primary Caretaker Re-evaluate primary caretaker status when any of the following occur: • A new or revised court order changing custody or visitation is provided. • There is a change in the number of days the child sleeps in another caretaker’s home and the change is expected to continue, on average, for the next twelve months. • A second caretaker disputes the first caretaker’s claim that the child(ren) sleeps in their home more than half the nights in a month, when averaged over the next 12 months. • A second caretaker applies for assistance for the same child. Example: Martin has lived in Mom’s home more than half the days in a month on average over the past several years. He is now a teenager and becoming a problem for Mom. There is a change in the custody arrangement. Mom and Dad agree that it would be better for Martin to live with Dad. They now expect them to stay at Dad’s home more than half the days in a month, when averaged over the next twelve months. Dad is now the primary caretaker. Mom is considered the absent caretaker. FOOD PURCHASE AND PREPARATION The phrase, purchase and prepare together, is meant to describe persons who usually share food in common.

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Persons usually share food in common if any of the following conditions exist: • They each contribute to the purchase of food. • They share the preparation of food, regardless of who paid for it. • They eat from the same food supply, regardless of who paid for it. In general, persons who live together and purchase and prepare food together are members of the FAP group. Example: Sue, age 26 and their sister Mary, age 29 live in the same home. They purchase and prepare their food together. They are one FAP group. Example: Betty and their two children move in with Sara, Betty's friend. Sara purchases and prepares food separately from Betty and their two children. They are two groups for FAP purposes. Persons who normally purchase and prepare separately maintain that distinction even when they are temporarily sharing food with others. Persons are temporarily sharing food if both of the following are true: • They had previously purchased and prepared separately. • Others are sharing their food until the person: Is approved for FAP. Qualifies for other cash assistance. Secures some other source of income. The purchase and prepare question on the MDHHS-1171, Assistance Application, is addressed as buy and fix food together. Senior Impaired Group A person at least 60 years old, their spouse and their children under 22 years of age may choose to be a separate group from those they live with, even if they purchase and prepare together if both of the following are true:

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• The person cannot purchase and prepare meals due to a permanent disability as determined by Social Security Administration (SSA) or a non-disease-related permanent, severe disability. • The countable income of all the other people the senior impaired group lives with does not exceed 165 percent of the poverty level; see Reference Tables Manuals (RFT) 250. LIVING SITUATIONS The following policies describe living situations which create ineligi- bility for FAP or which must meet specific requirements to allow eli- gibility. Boarder A boarder is a person residing in either of the following: • In a commercial boarding house. • With the FAP group and paying reasonable monthly compensation for meals. A commercial boarding house is an establishment which provides room and board for compensation. It may or may not be licensed; it is not IRS tax exempt. Persons residing in a commercial boarding house are not eligible for FAP. Reasonable monthly compensation is: • The amount of the maximum monthly FAP benefits for the number of persons making the board payment if the payment is for at least three meals a day. • Two-thirds of the maximum monthly FAP benefits for the number of persons making the board payment if the payment is for less than three meals per day. Note: Spouses, parents and children, and children under parental control of a person acting as a parent living together are never boarders, regardless of any payments made to one another. The group providing the board in a noncommercial board situation may choose to include or exclude the boarder(s) from the group. If excluded, the boarder is not eligible for FAP.

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Persons paying less than reasonable monthly compensation for board must be included in the group providing the board. Residents of Institutions A person is a resident of an institution when the institution provides the majority of their meals as part of its normal services. Residents of institutions are not eligible for FAP unless one of the following is true: • The facility is authorized by the Food and Nutrition Service (FNS) to accept FAP benefits. • The facility is an eligible group living facility; see BEM 615, Group Living Facilities. • The facility is a medical hospital and there is a plan for the person's return home; see Temporary Absence in this item. DISQUALIFIED PERSONS A disqualified person is one who is ineligible for FAP because the person refuses or fails to cooperate in meeting an eligibility factor. Disqualified members are determined based on questions in Bridges. Individuals are disqualified for the following reasons: • Failure to meet citizenship/non-citizen status; see BEM 225, Citizen/Non-citizen. • Failure to provide a social security number; see BEM 223, Social Security Numbers. • Failure to comply with employment-related activities; see BEM 233B, Intentional Program Violation. • Intentional program violation; see Bridges Administrative Manual (BAM) 720. • Voluntary quit; see BEM 233B, Failure to Meet Employment Requirements: FAP.

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• Failure to comply with a Quality Control review; see BAM 105, Rights and Responsibilities. • Traffickers; see BEM 203, Criminal Justice Disqualifications. • Parole and Probation Violators; see BEM 203. • Divestment; see BEM 406, FAP Divestment. • Time Limited; see BEM 620, Time Limited Food Assistance. • Fleeing Felons; see BEM 203. MEMBER ADDS/ DELETES A member add that increases benefits is effective the month after it is reported or, if the new member left another group, the month after the member delete. See BAM 220, Case Actions, All Other Reported Changes. In determining the potential FAP benefit increase, Bridges assumes the FIP/SDA supplement and new grant amount have been authorized. When a member leaves a group to apply on their own or to join another group, a member delete should be completed in the month the local office learns of the application/member add. Initiate recoupment if necessary. If the member delete decreases benefits, adequate notice is allowed. NON-GROUP MEMBERS Persons might live with the FAP group or applicant group who are not group members. Do not consider their income and assets (for non-categorically eligible groups) when determining the group's eligibility. Furloughed Prisoner A furloughed prisoner is a person on leave from a correctional insti- tution. The Department of Corrections provides meals or meal money to such persons. A furloughed prisoner is not eligible.

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Ineligible Student A person who is in student status and does not meet the criteria in BEM 245, School Attendance and Student Status is a non-group member. Live-in Attendant A live-in attendant lives in the group's home to provide housekeep- ing, medical or child care, or similar personal services. Persons who take someone into their own home to provide such services are not live-in attendants. The live-in attendant may apply for FAP as a separate group. Note: Spouses, parents and children, and persons acting as a parent and the children they care for cannot be live-in attendants for one another, regardless of the actual situation. Roomer A roomer is a person to whom the group furnishes lodging, but not meals, for compensation. The roomer(s) may apply for FAP as a separate group. Persons Who Have Already Received FAP Benefits A person must not participate as a member of more than one FAP group in any given month; see BEM 222, Concurrent Receipt of Benefits. Exception: Residents of shelters for victims of domestic violence; see BEM 617. If the person is a mandatory group member, action must be taken as soon as possible to remove them from their former group and add them to the new group. CATEGORICALLY ELIGIBLE GROUP After determining who is in the FAP group, Bridges determines if this group is categorically eligible for FAP benefits; see BEM 213, Food Assistance Program Group Compensation.

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VERIFICATION REQUIREMENTS Verify group composition factors if the information given is questionable. Such factors might include boarder status, age or senior members, and inability to purchase and prepare meals separately. Primary Caretaker Accept the client’s statement regarding the number of days per month (on average) a child sleeps in their home. Verify only if ques- tionable or disputed by the other parent. Senior Impaired Status A person's impaired status must be verified if it is not obvious and it affects the FAP group composition. VERIFICATION SOURCES Verify the factors below using one of the listed sources. Boarder Status Written statement from the board provider that indicates the amount paid for board. Impaired (Disability Considered Permanent Under SSA) The following is a partial list of disabilities considered permanent under the SSA: • Permanent loss of the use of both hands, both feet, or one hand and one foot. • Amputation of a leg at the hip. • Amputation of a leg or foot because of diabetes mellitus or a peripheral vascular disease. • Total deafness, not correctable by surgery or a hearing aid.

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• Statutory (legal) blindness, except if due to cataracts or a detached retina. • IQ of 59 or less, established after age 16. • Paraplegia or quadriplegia. • Multiple sclerosis that is severe, recurring, and includes muscle weakness, paralysis, or interference of vision or speech. • Muscular dystrophy with a significant effect on the use of the arms or legs. • Chronic renal disease (documented by persistent, adverse objective findings) resulting in severely reduced kidney function. Age Birth Certificate. Hospital certificate of birth. Other official records containing birth information such as school records, medical records, baptismal record, marriage certificate, or insurance policy. Identification containing birth information such as driver's license or state-issued ID. Newspaper clipping containing the date of birth. Written statements from two or more individuals who know the per- son's age. Inability to Purchase and Prepare Meals Statement from physician or psychologist. Primary Caretaker When primary caretaker status is questionable or disputed, base the determination on the evidence provided by the caretakers. Give each caretaker the opportunity to provide evidence supporting their claim. Suggested verifications include:

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• The most recent court order that addresses custody and/or visitation. • School records indicating who enrolled the child in school, first person contacted in case of emergency, and/or who arranges for child’s transportation to and from school. • Child care records showing who makes and pays for child care arrangements, and who drops off and picks up the child(ren). • Medical providers’ records showing where the child lives and who generally takes the child to medical appointments. LEGAL 7 CFR 273.1 7 CFR 273.8(h) Mich Admin Code, R 400.3006

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DEPARTMENT POLICY Food Assistance Program (FAP) Only Categorically eligible groups automatically meet the asset and income limits for the Food Assistance Program (FAP). Categorically eligibility applies to groups, not individuals. Bridges determines group composition prior to determining categorical eligibility. Categorially Eligible Groups FAP groups are categorically eligible based on enhanced authorization for Domestic Violence Prevention Services (DVPS). If their gross income is at or below 200 percent of the federal poverty level, they are also categorically eligible. Determination of categorical eligibility will be made at application, reported change and redetermination. Note: Categorical eligibility does not mean applicants automatically receive FAP as clients must still meet all of the other program requirements. Exception: All FAP groups are required to report and must close if they receive a single lottery or gambling winning of $4,500 or more. All FAP groups that close for lottery or gambling winnings, will be required to verify assets if they reapply. Non-Categorically Eligible Groups The following groups are not categorically eligible but are authorized to receive DVPS. They must meet income, asset and all other program requirements to receive FAP benefits. Senior/Disabled/Disabled Veteran (SDV) Groups which contain an SDV member and whose gross income is above 200 percent are not categorically eligible. They may still be eligible for benefits if their net income is below 100 percent of the poverty level, and they meet the asset limit; see Bridges Eligibility Manual (BEM) 400, Assets, and BEM 550, FAP Income Budgeting.

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Disqualified Member A group is not categorically eligible for FAP if any member of the group is FAP disqualified for: • Intentional program violation (IPV). • Fleeing Felon. • Employment-related activity only when the disqualified person is the head of household. Excess Income Denial Categorically Eligible and Non-Categorically Eligible Groups Excess Income Denial FAP groups must verify all countable income before an application or redetermination can be denied for exceeding the income limit. A VCL must be sent giving the group 10 calendar days to provide the income verification. If the group does not provide income verification by the VCL due date, the application or redetermination must be denied for failure to provide verification. If income verification is provided, the application or redetermination can be denied for exceeding the income limit, if applicable. APPLICATION PROCESSING

Verification If questionable, verify that the group: • Meets all the group composition requirements; see BEM 212, Food Assistance Program Group Composition. • Includes all persons who purchase and prepare food together in one FAP group, and • Includes no persons who have been FAP disqualified for IPV, and/or fleeing felon, and/or employment-related activity (only when the disqualified person is the head of household). If categorically eligible, do not verify for FAP purposes:

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• That the group's income is within the gross income limit (130 percent) and net income limit (100 percent); see RFT 250, FAP Income Limits. • Social Security numbers. • Sponsored alien information. • Residency. Note: Although the above eligibility factors are not verified for categorically eligible households, they must be verified if they are not verified by another program. Postponing Denial Postpone the denial of benefits for a potential categorically eligible group until the 30th day if it is likely that the group will be categorically eligible. ISSUING BENEFITS Bridges will compute net income for all categorically eligible groups. One and two member categorical FAP groups that exceed the gross and/or 100 percent net income limit, but whose gross income is at or below 200 percent of the poverty level, and all other FAP eligibility requirements are automatically eligible for the minimum benefit amount. Three or more member categorical FAP groups that exceed the gross and/or 100 percent net income limit, but whose gross income is at or below 200 percent of the poverty level and who meet all other FAP eligibility requirements may be eligible for benefits as low as $1 as determined by RFT 260, Food Assistance Issuance Table. Exception: Benefits are prorated in the initial month of application and benefits will not be issued if the issuance is less than $10. A case with zero benefits will not be opened in Bridges. Therefore, categorically eligible FAP groups with three or more members will be denied or closed if net income results in a zero benefit amount based on the Food Assistance Issuance Table.

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TERMINATION OF CATEGORICAL ELIGIBILITY When the group is no longer categorically eligible due to imposing a FAP disqualification for IPV, and/or fleeing felon, and/or employment-related activity (only when the disqualified person is the head or household), all FAP eligibility requirements are reviewed to determine whether the group remains eligible. Bridges will send a DHS-1605 to inform the client of any change in eligibility or benefit level. LEGAL BASE FAP 7 CFR 273.2(j) 7 CFR 273.8 Food and Nutrition Act of 2008, as amended

BEM 214 1 of 3 SDA GROUP COMPOSITION BPB 2019-006 4-1-2019

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

DEPARTMENT PHILOSOPHY Spouses are responsible for each other. Needy spouses living together are expected to share income, assets, and expenses. DEPARTMENT POLICY SDA SDA is a cash program for individuals who are not eligible for FIP and are disabled or the caretaker of a disabled person. An SDA eli- gibility determination group (EDG) consists of either a single adult or adult and spouses living together. See BEM 261 for disability criteria. DEFINITIONS

Adult An individual is considered an adult for SDA when he or she is age 18 or older or has been emancipated. Emancipated An individual under the age of 18 is emancipated if any of the following: • Ever validly married. • Emancipated by court order. • On active duty with the armed forces of the United States. An emancipated individual is considered an adult. Eligibility Determination Group The eligibility determination group (EDG) means those adults living together whose information is needed to determine SDA Eligibility. Only an adult individual and his or her spouse who live together are included in an SDA EDG.

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Certified Group The certified group (CG) means those persons in the EDG who meet all non-financial SDA eligibility factors. Countable income and assets of CG members are always considered in determining SDA eligibility. Living Together Living together means sharing a home except for temporary absences. Temporary Absence A temporarily absent person is considered to be living in the home when all of the following are true: • His location is known. • He plans to return. • He lived with the group before the absence. • The absence has lasted or is expected to last 30 days or less. Exception: A person is considered living in the home, even after 30 days, when absence is due to hospitalization, education or training. DETERMINING THE ELIGIBILITY DETERMINATION GROUP SDA The EDG consists of both: • The individual. The individual’s spouse who lives with the individual and does not receive FIP, Refugee Cash Assistance, or a refugee matching grant. Bridges determines the members of the SDA EDG based on infor- mation reported by the individual and entered in the system.

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DETERMINING THE CERTIFIED GROUP The CG includes only the eligible members of the SDA EDG. A spouse in the home may fail eligibility and be excluded from the CG but remains a mandatory EDG member. A spouse who fails to meet a nonfinancial eligibility factor or is disqualified for any reason is excluded from the CG. Bridges determines the members of the SDA CG based on informa- tion reported by the individual and entered in the system. LEGAL BASE SDA Annual Appropriations Act Michigan Administrative Code R 400.3151 - 400.3180

BEM 215 1 of 4 RCA GROUP COMPOSITION BPB 2013-012 7-1-2013

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DEPARTMENT PHILOSOPHY Refugee Cash Assistance (RCA) is a federal program that helps refugees become self-sufficient after their arrival in the U.S. RCA is a cash program for refugees who are not eligible for FIP. DEPARTMENT POLICY RCA Group composition is the determination of which individuals living together are included in the eligibility determination group (EDG) and certified group (CG). Spouses are responsible for each other. Needy spouses living together are expected to share income, assets, and expenses. To be considered for RCA all of the following must apply:  An individual must be a refugee as defined in the REFUGEES section in BEM 630 or 225A.  The months for which eligibility is being determined must be within the RCA eligibility period as defined in BEM 630 and BEM 225A.  When there is potential FIP eligibility, the group must take all actions available to obtain FIP. Failure to do so results in group RCA ineligibility. DEFINITIONS

Adult An individual is considered an adult for RCA when the individual is 18 years of age or older or has been legally emancipated. Exception: An individual who meets the definition of a dependent child is not considered an adult for RCA eligibility purposes; see BEM 210. Certified Group The RCA certified group means those individuals in the RCA EDG who meet all non-financial eligibility factors. Countable income and assets of CG members are always considered in determining eligi-

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bility. CG members have a RCA EDG participation status of eligible adult. Note: The RCA payment standard is based on the CG size. EDG Participation Status The RCA EDG participation status explains the role the individual plays in the RCA eligibility determination. The countable income and assets of individuals having an eligible or disqualified RCA EDG participation status are considered in determining RCA eligibility. Eligibility Determination Group The RCA EDG means those individuals living together whose infor- mation is needed to determine eligibility for RCA. Note: Individuals with an EDG participation status of disqualified adult remain in the RCA EDG. Disqualified individuals must meet all program requirements. Bridges considers their income and assets. Emancipated An individual under the age of 18 is emancipated if any of the fol- lowing apply:  Ever validly married.  Emancipated by court order.  On active duty with the armed forces of the United States. Living Together Living together means sharing a home, where individuals usually sleep, except for temporary absences. Refugee A refugee is an individual who meets the criteria under the REFU- GEES section in BEM 630 or BEM 225A. Temporary Absence A temporarily absent individual is considered to be living in the home when all of the following are true:

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 Individual’s location is known.  There is a definite plan to return.  The absence has lasted or is expected to last 30 days or less.  The individual lived with the RCA EDG before the absence. Exception: An individual is considered living in the home, even after 30 days, when absence is due to any of the following:  In-patient hospitalization (including a psychiatric hospital).  Absence for training or education.  Absence due solely to active duty in the armed forces of the U.S. GROUP COMPOSITION RCA Based on data entered in the system, Bridges determines all of the following:  Each household member’s RCA EDG participation status.  Which individuals’ income and assets are considered.  Which individuals needs are considered.  Which individuals relationship(s) to other members are considered. These determinations are made based on the individual’s:  Age.  Relationship(s) to other household members.  Receipt of other program benefits such as SSI or Refugee Matching Grant payments. Mandatory RCA EDG Members RCA The following individuals who live together are mandatory RCA EDG members:  The individual.  The individual’s spouse who lives with the individual. Exception: A special living arrangement (SLA) resident’s spouse has an EDG participation status of excluded even if they would otherwise live together; see BEM 616 for SLA policy.

BEM 215 4 of 4 RCA GROUP COMPOSITION BPB 2013-012 7-1-2013

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Excluded RCA EDG Members The following individuals have an EDG participation status of other adult. They have no effect on the eligibility determination:  SSI Recipients.  Refugee matching grant recipients. Refusal of a RCA EDG member to provide information needed to determine eligibility causes group ineligibility. LEGAL BASE RCA 45 CFR 400 P.L. 106-386 of 2000, Section 107

BEM 216 1 of 6 RMA GROUP COMPOSITION BPB 2015-010 7-1-2015

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

DEPARTMENT PHILOSOPHY Refugee Medical Assistance (RMA) is a federal program that helps refugees become self-sufficient after their arrival in the U.S. RMA is a medical assistance program for refugees who are not eligible for other Medical Assistance (MA) or MIChild programs. Eligibility for these categories must be determined prior to making an RMA eligibility determination. DEPARTMENT POLICY Group Composition is the determination of which individuals living together are included in the eligibility determination group (EDG). Use fiscal groups and asset groups to determine the financial eligibility of an individual who requests MA and meets all the nonfinancial eligibility factors for a MA category. Individual family members may be eligible under different MA categories. Explore all categories for each individual who requests MA; see CHOICE OF CATEGORY in BEM 105. Example: A refugee family, consisting of a mother and father and two children, is approved LIF for all members. After initial MA approval, the father begins employment and the income exceeds the income limit for LIF. The two children are approved for Children under 19 and the parents are approved for RMA. Example: A refugee family, consisting of a mother and father and two children, is approved LIF for all members. The mother and father begin employment and the income exceeds the income limit for LIF and for all full-coverage MA. The children are determined ineligible for MI Child. The family of 4 are approved RMA. DEFINITIONS Child means an unmarried person under age 18. Adult means a person who is married or age 18 or older.

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REFUSING INFORMATION Refusal of any information needed to determine eligibility for an individual causes ineligibility for the individual’s spouse and/or child living in the home. There is no fiscal or asset group for them. Failure to cooperate with social security number, support or third party resource liability requirements (BEM 223, 255, 256 and 257) may result in MA ineligibility for an individual, but it is not considered refusing information necessary to determine eligibility for the individual. RULES FOR GROUPS Determine the fiscal and asset groups separately for each individual requesting MA. When referring to the EDG, remember:  Only individuals living with one another can be in the same EDG; see Living With in this item.  Count a pregnant woman as at least two members. If twins are verified, count the woman as three, etc. LIVING WITH Living with others means sharing a home where family members usually sleep, except for temporary absences. A temporarily absent individual is considered in the home; see Temporary Absence in this item. When a child lives with both parents who do not live with each other (for example, child lives with his mother two weeks each month and his father the other two weeks), only one parent, the primary caretaker, is in the fiscal group. Make a determination of the primary caretaker. The primary caretaker is the parent who is primarily responsible for the child’s day-to-day care and supervision in the home where the child sleeps more than half the days in a month, when averaged over a 12 month period. The 12 month period begins at the time the determination is being made. Vacations and visitation with the absent parent do not interrupt primary caretaker status. See rules in BEM 255 concerning support from the other parent.

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Joint physical custody occurs when parents alternate taking responsibility for the child’s day-to-day care and supervision. Joint custody may be outlined in a court order or may be an informal arrangement between parents. For RMA purposes, a child is considered to be living with only one parent in a joint custody arrangement. This parent is the primary caretaker. TEMPORARY ABSENCE An individual’s absence is temporary for the month being tested if:  The individual’s location is known; and  There is a definite plan for the individual to return home; and  The individual lived with the group before the absence; and Note: newborns and unborns are considered to have lived with their mothers  The absence did not last, or is not expected to last, the entire month being tested unless the absence is for education, training, or active duty in the uniformed services of the U.S. Exception: An absence is never temporary when:  The month being tested is an L/H month (see BPG manual) for the absent individual; or  The absent individual is in one of the following on the last day of a past month or on the processing date for current and future months: Long-term care (LTC) facility. Adult foster care facility. Home for the aged. Licensed child foster care home. Child caring institution. The above individuals (including spouses residing in the same facility) are never considered to be living with others. A child who has resided in a hospital for 30 or more days is not considered to be living with others and is a fiscal group of one. Certify for 12 months before redetermining eligibility for the child.

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RULES FOR CHILDREN A child can be temporarily absent from only one home. When a child spends time with two parents who do not live together, a determination of primary caretaker must be made; see Living With in this item. Example: Amanda normally lives with mom. Dad has scheduled visitation every other weekend, two weeks at Christmas, two weeks at Easter and two weeks in the summer. Mom is the primary caretaker. Example: Emily’s mother works during the week. She drops Emily off at her grandmother’s house on Sunday evening and picks her up on Friday evening. Emily’s grandmother is primarily responsible for her care and supervision in the home where she sleeps more than half the days in a month when averaged over the next twelve months. Emily’s grandmother is the primary caretaker. Example: Emily’s mother works during Emily’s normal sleep hours. Emily is only at her grandmother's to sleep while mom works and is not there all week. Mom is the primary caretaker. Grandmother is considered to be providing child care. FISCAL GROUP Determine the fiscal group for each individual who is requesting MA. The fiscal group must be determined separately for each individual. In determining an individual’s eligibility, the only income that is considered is the individuals own income and the income of the following persons who live with the individual:  The individual’s spouse, and  The individual’s parent(s) if the individual is a child. For example:  A child's income cannot be used to determine a parent’s eligibility.  A stepparent’s income cannot be used to determine a stepchild’s eligibility.

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 A grandparent’s income cannot be used to determine a grandchild’s eligibility.  A parent’s income is considered in determining his/her child’s eligibility.  Each spouse’s income is considered in determining the other spouse’s eligibility. In addition to establishing a fiscal group for each individual requesting MA, use policy in BEM 536 to prorate an individual’s income among the individual’s dependents and him/herself. Child Fiscal Group A child's fiscal group is:  The child, and  The child's parents. See BEM 400 to determine the asset group’s countable assets. See BEM 536 to determine budgetable income of the fiscal group. Adult Fiscal Group An adult's fiscal group is:  The adult, and  The adult's spouse. See BEM 400 to determine the asset group’s countable assets. See BEM 536 to determine budgetable income of the fiscal group.

VERIFICATION REQUIREMENTS

Pregnancy and Number of Unborns Verify the number of unborns when:  A pregnant woman claims to be expecting more than one child, and

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 Multiple unborns are necessary to establish income eligibility. Primary Caretaker Verify the primary caretaker when questioned or disputed. VERIFICATION SOURCES

Pregnancy and Number of Unborns DHS-49, Medical Examination Report, DHS-54A, Medical Needs. Written statement from any of the following:  M.D.  D.O.  Physician's assistant (PA).  Ob-gyn nurse practitioner (NP).  Ob-gyn clinical nurse specialist (NS).  Certified nurse midwife.  Registered nurse (RN).

Primary Caretaker Court order that addresses custody or visitation. School records indicating who enrolled the child and who is called in an emergency situation. Medical records stating where the child lives, who is responsible for the child’s medical care. Child care records showing where the child lives and who makes and pays for the child care arrangements. LEGAL BASE Social Security Act, Sections 1902(a)(10),(17) MCL 400.106 45 CFR 400.90 - 104

BEM 220 1 of 9 RESIDENCE BPB 2026-010 4-1-2026

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

POLICY Family Independence Program (FIP), State Disability Assistance (SDA), Refugee Cash Assistance (RCA), Medicaid (MA), Child Development and Care (CDC), Food Assistance (FAP), and State SSI Payment (SSP) To be eligible, a person must be a Michigan resident. Bridges uses the requirements in the Residence section in this item to determine if a person is a Michigan resident. See BAM 110, Application Filing and Registration, Where to Apply/Process Applications. Medicaid Only Bridges uses the requirements in the Institutionalized Persons section in this item when the fiscal group consists of only a person in, or expected to be in, an institution the entire calendar month being evaluated and certified. In all other situations, it uses the requirements in the Residence section in this item, based on circumstances for the calendar month being evaluated and certified. RESIDENCE

FIP, SDA A person is a resident if all of the following apply: • Is not receiving assistance from another state. • Is living in Michigan, except for a temporary absence. • Intends to remain in the state permanently or indefinitely. CDC and FAP A person is considered a resident while living in Michigan for any purpose other than a vacation, even if there is no intent to remain in the state permanently or indefinitely. Eligible persons may include: • Persons who entered the state with a job commitment or to seek employment; and • Students (for FAP only, this includes students living at home during a school break.)

BEM 220 2 of 9 RESIDENCE BPB 2026-010 4-1-2026

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Medicaid A Michigan resident is an individual who is living in Michigan except for a temporary absence. Residency continues for an individual who is temporarily absent from Michigan or intends to return to Michigan when the purpose of the absence has been accomplished. Example: Individuals who spend the winter months in a warmer climate and return to their home in the spring. They remain MI residents during the winter months. Example: College students who attend school out of state but return home during semester breaks or for the summer can remain MI residents. State SSI Payment (SSP) Interface coding received from the Social Security Administration (SSA) validates Michigan residency on a month-by-month basis. HOMELESS PERSONS

FIP, SDA, RCA, MA, and FAP A homeless person is an individual who lacks a fixed and regular night-time dwelling or whose temporary night time dwelling is one of the following: • Supervised private or public shelter for the homeless. • Halfway house or similar facility to accommodate persons released from institutions. • Home of another person. • Place not designed or ordinarily used as a dwelling (for example, a building entrance or hallway, bus station, park, campsite, vehicle).

Lack of a permanent dwelling or fixed mailing address does not affect an individual’s state residence status. Assistance cannot be denied solely because the individual has no permanent dwelling or fixed address.

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

All Programs Use the local office address or another location agreeable to the individual as the mailing address in Bridges. Do not designate a temporary mailing address as the individual’s physical address. Note: The local office mailing address is for MDHHS mail only and if not collected, should be shredded after 90 days. Any mail or packages not for or from the department should be immediately returned to the sender. Attempted package deliveries should be refused. CDC Only Homeless policy can be found in BEM 703, CDC Program Requirements. INSTITUTONALIZED PERSONS

FIP, SDA, and Medicaid An institution is an establishment that furnishes food, shelter and some treatment or services to more than three people unrelated to the proprietor. For SDA clients, this also includes group living facilities; see BEM 615, Group Living Facilities. Medicaid Only In this section only, institution includes an out-of-state foster care home licensed by that state that provides food, shelter and support- ive services to at least one person unrelated to the proprietor. OUT-OF-STATE PLACEMENTS

FIP and SDA Incompetent adults and dependent children are sometimes placed in another state by a person or agency legally responsible for their care. The individual remains a Michigan resident unless the move is to establish a permanent out-of-state home. Note: An incompetent adult or dependent child placed in Michigan from another state is not a Michigan resident unless the move is to establish a permanent home in Michigan.

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Medicaid Only An individual is a Michigan resident if placed in an out-of-state insti- tution by a Michigan agency (for example, MDHHS, juvenile court). An individual is not a Michigan resident if placed in a Michigan institution by another state's agency. DETERMINATION OF CAPABILITY

Medicaid Only If the individual is institutionalized, first determine whether they are capable or incapable of indicating their intent to remain in the state. Exception: This does not apply to out-of-state placements (see above) or to unmarried persons under age 18. Consider an individual capable of indicating intent unless one of the following factors is documented: • IQ under 50. • Mental age under 8. • Judgment of incompetence by a court. • In a psychiatric facility by court order. • Determined incapable by the medical review team. CAPABLE PERSONS AT LEAST AGE 18 OR MARRIED

Medicaid Only An institutionalized, capable individual at least age 18 or married has Michigan residence if the individual lives in Michigan and intends to remain in the state permanently or indefinitely. Exception: An individual remains a Michigan resident if the individual: • Is currently in an out-of-state LTC facility, and • Was a Michigan resident immediately prior to entering the LTC facility. Note: A Michigan resident who voluntarily enters an out-of-state long-term care facility on or after October 1, 2007 is not considered a Michigan resident for Medicaid purposes.

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UNDER AGE 18 AND UNMARRIED; OR INCAPABLE BEFORE AGE 21

Medicaid Only An individual who (1) is under age 18 and unmarried, or (2) became incapable of indicating intent before age 21, has Michigan resi- dence in any of the following circumstances: • One of their legal parents lives in Michigan or did so at the time of the institutional placement. • Parental rights of the parents were terminated; the court appointed a legal guardian for the individual; and the guardian lives in Michigan or did so at the time of the institutional placement. • They were abandoned by their parents and do not have a court-appointed legal guardian, but an individual who lives in Michigan completed the most recent application for them. INCAPABLE AT OR AFTER AGE 21

Medicaid Only An institutionalized individual who became incapable at or after age 21 has Michigan residence if physically present in Michigan and not placed by an out-of-state agency. Note: A Michigan resident who voluntarily enters an out-of-state long-term care facility on or after October 1, 2007 is not considered a Michigan resident for Medicaid purposes. VERIFICATION REQUIREMENTS Record the verification source in Bridges for all items below that have a verification source field. Bridges will list them on a DHS- 3503, Verification Checklist, if they are not verified or if the verifica- tion source is not valid for the program(s) on the case.

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Assistance from Another State FIP and SDA only Verify receipt of assistance from another state; see BEM 222, Concurrent Receipt of Benefits. Address FIP, SDA, CDC Verify the individual's address, unless homeless. FAP only Verify that the individual lives in the area your office serves. However, do not deny benefits to an individual with no permanent address (such as a new arrival, migrant, homeless) solely for lack of a verified address. The lack of this verification and reason for it must be documented. Intent to Remain in Michigan FIP and SDA Accept an individual’s statement of intent to remain in Michigan unless the statement is inconsistent or conflicts with known facts. Intent to Return to Michigan FIP and SDA If an individual is temporarily absent from Michigan, verify the intent to return; see verification sources in this item. Job Commitment/ Seeking Employment CDC only Accept an individual’s statement of entering the state with a job commitment or to seek employment unless it is inconsistent or conflicts with known facts.

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Incapability to Indicate Intent Medicaid Only Verify an institutionalized individual’s incapability to indicate intent unless they are: • An out-of-state placement, as defined in this item, or • Under age 18 and unmarried. VERIFICATION SOURCES

Address FIP, SDA, FAP and CDC • Driver's license. • Other ID which provides a name and address. • Mortgage or rent receipt. • Lease agreement. • Homeowner/rental insurance. • Property taxes. • Utility bill/internet bill/trash bill. • The DHS-4578, Child Care Education Verification, form or the DHS-3380, Verification of Student Information, completed by the school. • Collateral contact with a person who knows the individual’s living arrangement. FAP only Exception: Verification of residence is not needed for categorically eligible groups; see BEM 213, Categorical Eligibility. Medicaid Only Verification of residence is not needed. State SSI Payment (SSP)

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SDX interface as well as SOLQ, display the State Code under the heading State and County Jurisdiction. The code for the State of Michigan is 23. Intent to Return to Michigan FIP and SDA • Evidence that rent, property taxes, utilities or house payments in Michigan are being paid. • Evidence that a local job is being held for the individual. • Evidence that the reason for the absence implies intent to remain a Michigan resident. Incapability to Indicate Intent Medicaid Only • Medical evidence of an IQ under 50 or mental age under 8. Use a DHS-49D, Psychiatric Examination Report, or other professional medical certification. • Legal evidence of a court judgment of incompetence or court- ordered placement in a psychiatric facility. Use copies of court documents or other official legal evidence. • Follow the procedures in BAM 815, Medical Determination and Disability Determination Service (DDS), to obtain medical evidence or make a referral to the medical review team. LEGAL BASE FIP 42 USC 602(a) (1) (A) (i) MCL 400.32 Annual Appropriations Act MA 42 CFR 435.403 Section 11005 of P.L. 99-570 Social Security Act, Sections 1902(a) (48), 1902(b)(2) MCL 400.32

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The Patient Protection and Affordable Care Act (Pub. L. 111-148) and the Health Care and Education Reconciliation Act (Pub. L. 111- 152). FAP 7 CFR 273.2 (f)(1)(vi), .3 7 CFR 271.2 7 U.S.C. 2012(m) SDA DHS Annual Appropriations Act Mich Admin Code, R 400.3151 – 400.3180 CDC The Child Care and Development Block Grant (CCDBG) Act (42 USC § 9858 et seq.), as amended by the CCDBG Act of 2014 (Pub. L. 113-186). 45 CFR Parts 98 and 99. Social Security Act, as amended 2016.

BEM 221 1 of 5 IDENTITY BPB 2020-010 4-1-2020

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DEPARTMENT POLICY Family Independence Program (FIP), State Disability Assistance (SDA), Refugee Cash Assistance (RCA), Child Development and Care (CDC) and Food Assistance Program (FAP) Identity of head of household (grantee) must be verified. If an authorized representative (AR) applies on behalf of a group, the AR must verify his own and the identity of the head of house- hold. Failure of the head of household (grantee) to verify identity results in group ineligibility. Failure or inability to verify identity when required results in member disqualification of the individual for whom acceptable verification is not provided. FIP, SDA, RCA If an individual presents identification issued by another state, verify that person is not receiving benefits from that state; see Bridges Eligibility Manual (BEM) 220 and BEM 222. Medicaid Applicants and beneficiaries of Medicaid are not required to verify identity. FIP, SDA, RCA Non-U.S. citizens are not required to verify identity unless question- able. Note: The Secretary of State will waive the fees on state IDs for individuals who receive FIP or SDA. The individual must present a DHS- 1605, Notice of Case Action, from MDHHS indicating the applicant is currently eligible to receive FIP or SDA. The notice must contain the approved benefit period for FIP or SDA. VERIFICATION REQUIREMENTS Record the verification source for identity in Bridges. If an individ- ual’s verification source is not valid for the individual’s program(s),

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Bridges will list the verification of identity needed on a DHS-3503, Verification Checklist, for each individual whose identity must be verified. VERIFICATION SOURCES FIP, SDA, and FAP The data match with Social Security Administration (SSA) is sufficient to verify identity. Examples of acceptable verification of identity include but are not limited to: • Driver's license. • State-issued identification. • School-issued identification. • Federal or local government issued identification card. • Document indicating an individual’s receipt of benefits under a program that requires verification of identity (for example, Supplemental Security Income (SSI), Retirement Survivors and Disability Insurance (RSDI). • Identification for health benefits. • Voter registration card. • Wage stub. • Birth certificate/record. • Cross match with SSA that validates the Social Security number. Documents listed under CDC are also acceptable for FIP, SDA, and FAP. Any documents which reasonably establish the applicant’s identity must be accepted. If documentary evidence is not readily available, use a collateral contact to verify identity. CDC The data match with SSA is sufficient to verify identity and should be completed prior to requesting verification from a recipient; see BAM 130. Other acceptable verifications include:

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

• Current, valid driver's license with a photograph of the individual. • Federal, state, or local government issued identification card with the same information included on a driver’s license. • School-issued identification with a photograph. • U.S. military card or draft record. • Benefit award letter or other document indicating an individual’s receipt of benefits under a program that requires verification of identity (for example, SSI, RSDI). • A cross match with a federal or state governmental, public assistance, law enforcement, or correction agency’s data system (for example, the SSA cross match in Bridges). • A U.S. passport. • A Certification of Naturalization (Department of Homeland Security, (DHS) Forms N-550 or N-570). • A Certificate of U.S. Citizenship (DHS Forms N-560 or N-561). • Military dependent’s identification card. • Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native tribal document. • U.S. Coast Guard Merchant Mariner card. • School records, such as report cards, are acceptable for children age 16-18. • Three or more corroborating documents such as marriage licenses, divorce decrees, high school diplomas, college degrees, or employer ID cards. This option is only available to individuals who submitted second or third tier proof of U.S. citizenship, not fourth tier; see BEM 225 for citizenship tiers. When this is used for proof of identity, choose other acceptable as the verification source on citizenship/residency screen in the individual demographics logical unit of work (LUW). • Disabled individuals in residential care facilities may have their identity attested to by the facility director or administrator when

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the individual does not have or cannot get any document from the preceding list. The affidavit is signed under penalty of perjury but does not need to be notarized. Note: Recently expired (30 days) identity documents are acceptable as long as there is no reason to believe the document does not match the individual. FIP, SDA, RAP, CDC Examples of acceptable verification of identity when questionable for non-US citizens include: • Immigration document. • Refugee resettlement agency document. • Passport/VISA. LEGAL BASE FIP P.A. 280 of 1939, as amended, MCL 400.1 et seq.R 400.3116 (MAC) SDA MDHHS Annual Appropriations Act Michigan Administrative Code; R 400.3151 – 400.3180 RCA 45 CFR 400.53(a)(2) CDC Child Care and Development Block Grant Act of 1990 45 CFR Parts 98 and 99 Social Security Act, as amended R 400.5001 - 400.5020 MA MCL 400.105 Subsection 1903(x) of the Social Security Act Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3.

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The Patient Protection and Affordable Care Act (Publication L. 111- 148) and the Health Care and Education Reconciliation Act (Publication L. 111-152). FAP 7CFR 273.2(f)(1)(vii)

BEM 222 1 of 5 CONCURRENT RECEIPT OF BENEFITS BPB 2018-016 10-1-2018

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

DEPARTMENT POLICY All Programs Concurrent receipt of benefits means assistance received from multiple programs to cover a person's needs for the same time period. Certain restrictions apply, as specified in this item. Benefit duplication means assistance received from the same (or same type of) program to cover a person's needs for the same month. For example, FIP from Michigan and similar benefits from another state's cash assistance program. Benefit duplication is prohibited except for Medicaid and FAP in limited circumstances (see Medicaid Benefits and FAP Benefits in this item). See BEM 203, Criminal Justice Disqualifications, for penalties for individuals found to have received duplicate assistance. Bridges is programmed to apply the requirements in this item. Cash Assistance Benefits Family Independence Program (FIP), Refugee Assistance Pro- gram Cash (RCA) and State Disability Assistance (SDA) Only A recipient of cash assistance from another state is not eligible for FIP, RCA or SDA in Michigan for the same month. A recipient of FIP in Michigan is not eligible for SDA or RCA for the same month. A recipient of SDA in Michigan is not eligible for FIP or RCA for the same month. A recipient of RCA in Michigan is not eligible for FIP or SDA for the same month. To prevent benefit duplication, send an DHS-3782, Out-of-State Inquiry, to another state's agency when either of the following: • The individual arrived from that state within 30 days before FIP/SDA/RCA application. • Any evidence suggests receipt of assistance from that state for the current month. • The individual presents current out-of-state identification.

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If the applicant arrived here from a state other than his home state, you might have to contact both states. Pending the other state's response, authorize FIP/SDA/RCA for an otherwise eligible individual if no evidence suggests benefit duplication. If such evidence does exist, wait for the response before certifying eligibility in Bridges. When the other state’s response indicates benefit duplication, benefits should only continue in the state where the client resides. Enter out-of-state benefits in Bridges, run EDBC and an Over Payment (OP) referral will be generated if you approved benefits pending the other state’s response. Refugee Matching Grant FIP, RCA and SDA Only A person cannot receive both Refugee Matching Grant and FIP, RCA or SDA for the same month. SSI Benefits FIP and RCA Only A person cannot receive both SSI and FIP or RCA for the same month. Children's Foster Care Payments FIP and RCA Only Children's foster care payments are cash payments for the care of a minor child, that are paid to a relative or a licensed foster care provider. A child for whom foster care payments are received, is not eligible for FIP or RCA for the same month. Medicaid Benefits Medicaid Assume an Medicaid applicant is not receiving medical benefits from another state unless evidence suggests otherwise. Do not delay the Medicaid determination. Upon approval, notify the other state's agency of the effective date of the client's medical coverage in Michigan.

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FAP Benefits FAP Only A person cannot be a member of more than one FAP Certified Group (CG) in any month. A person cannot receive FAP in more than one state for any month. Exception: A resident of a shelter for victims of domestic violence may temporarily be a member of two FAP groups; see BEM 617. Nutrition Assistance Program (NAP) NAP benefits from Puerto Rico, American Samoa and the Northern Marianna Islands are not counted when determining eligibility and benefits. Food Distribution Program Benefits FAP Only A person cannot receive both FAP and Indian Tribal Food Distribu- tion benefits for the same month. To prevent benefit duplication, check the lists of food distribution participants provided by the tribes. If duplication has occurred, the recoupment policy in BAM 700, 705 and 720 applies. VERIFICATION REQUIREMENTS FIP, RCA, SDA and FAP Make an out-of-state inquiry when an applicant arrived from another state within 30 days before application and/or presents current identification from another state. Use a DHS-3782, Out-of- State Inquiry. FIP, SDA and RCA Only Verify the receipt and/or termination of SSI benefits and Refugee Matching Grant from another state.

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VERIFICATION SOURCES

Out-of-State Benefits FIP, RCA, SDA and FAP Out-of-state benefit receipt or termination may be verified by one of the following: • DHS-3782, Out-of-State Inquiry. • Letter or document from other state. • Collateral contact with the state. Receipt or Termination of SSI FIP, SDA and RCA Only Receipt or termination of SSI can be verified by one of the following: • Current SSI check. • SSI award letter. • SSA-1610-U2, Public Assistance Agency Information Request; see BAM 800. • SOLQ (State Online Query) response; see BAM 800. • Recent SSA correspondence which clearly indicates the client's SSI status. Receipt or Termination of Refugee Matching Grant FIP, SDA and RCA Only Verify receipt or termination of Refugee Matching Grant by contact with the refugee resettlement agency administering the grant.

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LEGAL BASE FIP Mich Admin Code, R 400.3122 MCL 400.57a(12)(a) & (b) SDA Mich Admin Code, R 400.3174 FAP 7 CFR 273.3; 7 CFR 281.1

BEM 223 1 of 12 SOCIAL SECURITY NUMBERS BPB 2023-006 4-1-2023

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DEPARTMENT POLICY All Programs Family Independence Program (FIP), Refugee Cash Assistance (RCA), State Disability Assistance (SDA), Child Development and Care (CDC), Medicaid (MA), Food Assistance (FAP) SSN refers to a Social Security number. SSA refers to the Social Security Administration. As a condition of eligibility, individuals, including individuals being added to an active case, must: • Supply their SSN. • Cooperate in obtaining an SSN. • Be excused from supplying and obtaining an SSN. See excused from providing and obtaining an SSN. Note: This condition of eligibility does not apply to individuals who are only applying for benefits on behalf of someone else (example, parents who want MA just for their children). Exception: For FAP only, expedited service recipients must cooperate in providing or obtaining an SSN before the first issuance after the expedited benefit. Exception: For CDC only, obtain the Social Security number (SSN) of the CDC grantee. Do not deny eligibility solely when unable to obtain the SSN. Verification of an SSN is not initially required. Therefore, do not delay processing an application for verification of an SSN. SSNs are checked with SSA for accuracy. If SSA is unable to con- firm the SSN, a Bridges enumeration task will be generated; see Enumeration Tasks in this item. The client must cooperate in resolving any errors.

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FAILURE TO COMPLY All Programs Except CDC Disqualify family members for whom the grantee refuses to supply an SSN, cooperate in obtaining an SSN or cooperate in resolving any errors. Note: Providing an SSN is not a condition of eligibility for CDC clients. Note: This condition of eligibility does not apply to individuals who are only applying for benefits on behalf of someone else (example, parents who want MA just for their children). SUPPLYING AN SSN All Programs The requirement to supply an SSN is met by any of the following: • Previously verified SSN. Bridges displays a check in the protected Validated by SSA field on the individual information screen. Note: Use the validated SSN already on Bridges even if the individual provides a different SSN. • Providing an SSN. Note: See MORE THAN ONE SSN if the client has more than one SSN. COOPERATE IN OBTAINING AN SSN All Programs Except CDC The requirement to cooperate in obtaining an SSN is met by any of the following: • Completing an SS-5, Application for a Social Security Card. See APPLYING FOR A SOCIAL SECURITY CARD VIA SS-5. • A refugee or, for FAP only, any individual provides an SSA- 5028, Receipt for Application for a Social Security number, to verify his SSN application at SSA.

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• A newborn is assigned an SSN via the Enumeration At Birth process, and the parent provides any of the following documents: • A DHS-4557, Information About Your Baby’s Social Security Card. • SSA-2853, Information About When You Will Receive Your Baby’s Social Security Card. • A copy of a signed State of Michigan Certificate of Live Birth indicating that a Social Security card was requested. • A modified birth document, indicating a Social Security card was requested. See Verification Sources in this item. Note: Inform clients who provide an SSA-5028 or proof of Enumeration at Birth that they must report the SSN upon receipt. SSNs issued through these processes are not tape matched onto Bridges. Failure to report these SSNs within six months of receipt or by the next redetermination, whichever is later, results in an overissuance. EXCUSED FROM PROVIDING AND OBTAINING AN SSN All Programs An individual excused by court order is excused from providing and obtaining an SSN. FAP and MA Only An individual is excused from providing and obtaining an SSN based on religious grounds. If an SSN already exists, it may be used. MA Only The following individuals are excused from providing and obtaining an SSN: • Newborns automatically eligible per BEM 145. • Deceased individuals. • Safe Delivery babies.

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Specialists are not responsible for the enumeration of individuals receiving foster care MA (such as department wards or title IV-E recipients whose MA eligibility is determined in MISACWIS). MA Only The following non-citizens whose medical coverage is limited to emergency services are excused from providing and obtaining an SSN: • Illegally present in the U.S. • Nonimmigrant status (for example, non-citizen with a student visa). Note: This does not include parolees, permanent residents and other legal non-citizens whose medical coverage is limited to emergency services; see BEM 225. APPLYING FOR A SOCIAL SECURITY CARD VIA SS-5 All Programs A client meets the requirement of applying for an SSN by completing an SS-5, Application for a Social Security Card, at the local office. Help the client complete the form and the client must sign it. Assist and advise the client, as needed, to provide verification of age, identity and citizenship/non-citizen status required by SSA. Inform the client that SSA determines whether the submitted documents are acceptable. See the verification requirements on the SS-5. SS-5 Instructions All Programs An SS-5 must be completed, signed and dated for each individual who needs a Social Security number. Place a photocopy of the SS- 5 in the case record to document that the client has applied for an SSN. Mail or deliver the original SS-5 to the local SSA office. Attach age, identity and citizenship documents unless any of the following are true:

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• The client will be interviewed in person at the SSA office. Note: Non-Citizens and individuals 18 or older who have never had a Social Security number must be interviewed in person at the SSA office. • The document(s) cannot be obtained before the application is otherwise ready for processing. • The client should not, or chooses not, to give up possession of the document(s), for example a driver's license. Note: SSA requires original documents or copies certified by the issuing agency. In these situations, tell the client to go to the SSA office and give him a photocopy of the SS-5 to take along so that SSA has the Bridges case number. Tell the client to comply with SSA requirements. SS-5 Follow-Up All Programs Follow up at each redetermination for each client whose SSN is not on Bridges: • If the client received an SSN, he must provide his SSN. • If the client did not receive an SSN, a current SS-5 is required, and the SS-5 Instructions above must be followed. Exception: Wait until the next redetermination to have a duplicate SS-5 processed if it is for a child under six months old and the SSN was applied for via birth certificate. MORE THAN ONE SSN All Programs Client Presents Multiple SSNs If a client presents multiple SSNs do all of the following: • Enter one of them on the Bridges in the SSN field on the individual information screen.

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• Refer the client to the local SSA office. • Send a letter of explanation to that office. See the sample letter in Exhibit of this item. SSA will notify the client which SSN to use and cross reference the multiple numbers in the SSA files. The client must provide the SSN he/she is instructed to use. Enter that number on the Individual Information screen. Enter the origi- nally recorded SSN, if different, in the reported SSN field on the Individual Information screen. SSA Verifies Multiple SSNs If SSA verifies multiple SSNs for the same individual, Bridges will generate an enumeration task: SSA has assigned multiple SSNs to client. Refer client to SSA to verify number client is to use. It may be necessary to request verification of the client’s SSN in this situation. BRIDGES INSTRUCTIONS All Programs Bridges receives all SSN-related input by specialists. It also per- forms some SSN tape match functions and generates enumeration error tasks. Bridges performs some SSN tape match functions and generates the DHS-4639, Important Notice About Social Security Numbers. Where to Input SSN Information All Programs Social Security numbers are entered and verified on the Individual Information screen. Information about an individual’s application for an SSN is recorded in Bridges on the Individual Demographics - SSN Application/Armed Services screen. The information includes: • SS-5 completion date.

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• Verification of SSN application. • Willingness to apply for an SSN. • Reason unwilling to apply for an SSN. DHS-4639, Important Notice About Social Security Numbers All Programs Bridges generate form letter DHS-4639, Important Notice About Social Security numbers, every three months until a SSN is entered in Bridges. The letter asks the grantee to write the SSN on the letter for the recipients indicated and to return the letter to you. Enumeration Tasks All Programs Bridges produces an enumeration task when: • Bridges and SSA records differ on the name, sex or birthdate of the individual. • The individual has more than one SSN. Note: Request verification of the individual’s SSN when the individual has more than one SSN. Erroneous SSN on Bridges All Programs Use the Individual Information screen to correct any SSN discov- ered to be erroneous. A duplicate SSN error message means another individual on the system is using the SSN. Complete an Individual Inquiry on the SSN to determine if your client and the client using the SSN are the same individual. • Same Individual. If both clients are the same individual, do the following: Explore the possibility of fraud if the client is active in another case.

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Request deletion of the duplicate individual ID if the client is inactive in another case. • Different Individuals. If your client and the client using the SSN are different individuals, do the following: Request verification of the SSN from your client. If the SSN verified by your client is still the same SSN, blank out your client’s SSN. Have your client complete an SS-5 using procedures in this item. A check in the Validated by SSA box on Bridges means SSA has verified that SSN for that individual. Contact the Bridges Application Support Unit at (517) 241-9700 for resolution if the verified SSN conflicts with the SSN verified by the client. VERIFICATION REQUIREMENTS Record the SSN verification source in Bridges for each SSN for which the Validated by SSA box is not checked. If an individual’s SSN is not verified or the source is not valid for the individual’s pro- gram(s), Bridges will list verification of SSN is needed on a DHS- 3503, Verification Checklist, for each individual whose SSN must be verified. All Programs Verify cooperation in obtaining an SSN at application and member add. File a photocopy of the client's verification of SSN application or SS-5 in the physical case record. Verification of an SSN may be needed to resolve an enumeration task or when two people claim the same SSN. Verification Sources MA Only The following may be used in place of an SSN application: • A valid Social Security card.

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• A FDSH (federal data source) validation. All Programs The following sources in the SSN Application Verification field in Bridges are valid verification of an SSN application. • SS-5, Application for a Social Security Card. • SSA-5028, Receipt for Application for a Social Security number (allowed only for refugees for FIP, SDA, RAP, or MA; allowed for all individuals for FAP). • DHS-4557, Information About Your Baby's Social Security Card. • SSA-2853, Enumeration at Birth (EAB) Receipt. • Michigan birth certificate with box 10b marked that an SSN and card were requested. • Modified birth document that includes the minimum required information. The minimum required information on a modified birth document is: • Child's name. • Child's date of birth. • Parent(s) name(s). • Name of hospital where child was born. • Signature of hospital representative. • Dated and check-marked annotation that SSN was requested.

EXHIBIT - MULTIPLE SSNS FOR THE SAME CLIENT Use this letter as a guide when drafting a letter to the Social Security Administration to resolve multiple SSNs for a client.

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Note: Address the letter to the SSA district or branch office serving the area of the client’s residence. That address is in the telephone directory or available by entering the client’s zip code in the online Social Security Office Locator located within the Social Security online Web site.

January 01, 2006

Social Security Administration 5210 Perry Robinson Lansing, MI 48911

Re: John S. Doe, Our Client ID #33434343

SSN 373-40-0001 & SSN 363-40-8088 Dear Sir or Madam: We have received verification which indicates that our client, John Sylvester Doe, born 8/31/42, has been assigned two different Social Security numbers (SSN). Attached are copies of our verification documents for each SSN. In order to update our records correctly, we need to know which SSN Mr. Doe should use. Please advise both Mr. Doe and the specialist named below of your decision. Thank you for your assistance in this matter. Sincerely, _________________, Eligibility Specialist Ingham County Department of Human Services 5303 South Cedar Lansing, MI 48910 Telephone (517) 887-9400

cc: Mr. John S. Doe

2120 W. Willow

Lansing, MI 48917

Attachments

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LEGAL BASE FIP Social Security Act, Sections 409(a)(4) and 1137(a)(1),(b),(f) SDA DHS Annual Appropriations Act

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Mich Admin Code,;\ R 400.3151 – 400.3180 MA 42 CFR 435.910 FAP 7 CFR 273.6 RAP 45 CFR 400.62 45 CFR 401 CDC 45 CFR 98.71

BEM 225 1 of 46 CITIZENSHIP/NON-CITIZEN STATUS BPB 2026-017 7-1-2026

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DEPARTMENT POLICY In this item: • INA refers to the Immigration and Nationality Act. • USCIS refers to the U.S. Citizenship and Immigration Services, formerly the Bureau of Citizenship and Immigration or Immigration and Naturalization Service. • SSA refers to the Social Security Administration. All Programs Determine the status of each non-citizen requesting benefits at application, member addition, redetermination and when a change is reported. Note: For Child Development & Care (CDC), only determine the non-citizen status of each child for whom care is requested, not other family members. Exception: RSDI and SSI recipients, Medicare recipients; see Bridges Eligibility Manual (BEM) 145, Newborns, safe delivery babies, and children receiving Title IV-B services or Title IV-E adoption assistance, or foster care payments are not required to verify U.S. citizenship. Citizenship/non-citizen eligibility for the Refugee Assistance Program can be found in BEM 630. FIP, SDA, CDC and SNAP If a group member is identified on the application as a U.S. citizen, do not require verification unless the statement about citizenship is inconsistent, in conflict with known facts or is questionable. The fol- lowing are not sufficient reasons to question citizenship: • General appearance of the applicant. • Accent. • English is not first language. • Employment as a migrant farmworker. • Unique sounding name. A person must be a U.S. citizen or have an acceptable non-citizen status for the designated programs; see Citizenship/Non-

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Citizenship Status in this item. Persons who do not meet this requirement, or who refuse to indicate their status, are disqualified. Others living with a person disqualified by this requirement can qualify for program benefits. However, the disqualified person's assets and income might have to be considered based on the program(s) requested; see BEM 210, MA Group Composition, BEM 212, Food Assistance Program Group Composition,-and BEM 550, FAP Income Budgeting. Example: Fred and Sadie complete an MDHHS-1171, Assistance Application, to request FIP and SNAP for only their two children born in the United States. Fred and Sadie are not applying for benefits for themselves and refuse to indicate their status, so they are disqualified. Do not require the parents to provide proof of their status or Social Security numbers. Fred and Sadie have no assets; however, since they are both working, they must provide proof of their income to determine eligibility for the children. Non-immigrants (for example, students, tourists, etc.) and undocu- mented non-citizens are not eligible. A non-immigrant temporarily enters the U.S. for a specific purpose such as business, study, tem- porary employment, or pleasure. When a person is admitted to the United States, a USCIS official will assign a non-immigrant category according to the purpose of the visit. CDC Each child receiving child care paid through CDC must be a U.S. citizen or have an acceptable non-citizen status; see Citizenship/Non-citizenship Status in this item. Exclude a child’s day care need if that child fails the requirement. Deny the application or close the case if all children needing care on the case fail the requirement. MA Citizenship/non-citizen status is not an eligibility factor for emergency services only (ESO) MA. However, the person must meet all other eligibility factors, including residency; see BEM 220, Residence. To be eligible for full MA coverage a person must be a U.S. citizen, or a non-citizen admitted to the U.S. under a specific immigration status.

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U.S. citizenship must be verified with an acceptable document to continue to receive Medicaid; see Bridges Administrative Manual (BAM) 130, Verification and Collateral Contacts. A person claiming U.S. citizenship is not eligible for ESO coverage. The status of each non-citizen must be verified to be eligible for full MA coverage; see Citizenship/Non-citizenship Status in this item. A child born to a woman receiving Medicaid is considered a U.S. citizen. No further documentation of the child’s citizenship is required. Exception: RSDI and SSI recipients, Medicare recipients; see BEM 145, newborns, safe delivery babies, and children receiving Title IV-B services or Title IV-E adoption assistance, or foster care payments are not required to verify U.S. citizenship. MA coverage is limited to emergency services for any: • Persons with certain non-citizen statuses or U.S. entry dates as specified in policy; see Citizenship/Non-citizenship Status in this item. • Persons refusing to provide citizenship/non-citizen status information on the application. • Persons unable or refusing to provide satisfactory verification of non-citizen information. All other eligibility requirements including residency must be met even when MA coverage is limited to emergency services; see BEM 220. CITIZENSHIP/ NON- CITIZENSHIP STATUS All Programs Persons listed under the program designations in Acceptable Status meet the requirement of citizenship/non-citizen status. Eligibility may depend on whether the person meets the definition of Qualified Non-citizen. Note: U.S. Nationals are considered citizens.

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QUALIFIED NON- CITIZEN All Programs The definition of qualified non-citizen includes specific non-citizen statuses, but not all non-citizen statuses. This definition is used in several of the acceptable non-citizen statuses, in conjunction with other criteria. Not all acceptable non-citizen statuses require that the person be a qualified non-citizen FIP, SDA, MA and CDC Qualified non-citizen means a non-citizen who is: • Lawfully admitted for permanent residence under the INA. • Granted asylum under Section 208 of the INA. • A refugee who is admitted to the U.S. under Section 207 of the INA; this includes Iraqi and Afghan special immigrants. • Paroled into the U.S. under Section 212(d)(5) of the INA for a period of at least one year. • A non-citizen whose deportation is being withheld under Section 241(b)(3) or 243(h) of the INA. • Granted conditional entry pursuant to Section 203(a)(7) of the INA. • A Cuban/Haitian entrant. • A non-citizen who has been battered or subjected to extreme cruelty in the U.S. by a U.S. citizen or legal permanent resident spouse or parent, or by a member of the spouse's or parent’s family living in the same household or is the parent or child of a battered person. SNAP Only Qualified non-citizen means a non-citizen who is: • Lawfully admitted for permanent residence under the INA (Identified as I-551 or I-151). • A Cuban/Haitian entrant.

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FIP, SDA, MA, CDC and SNAP • A Compact of Free Association (COFA) citizens of Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau entrant. ACCEPTABLE STATUS FIP and SNAP • U.S. citizen (including persons born in Puerto Rico). • Children of U.S. citizens born abroad must meet the following criteria: • Two U.S. citizen parents in wedlock: One of the parents MUST have resided in the U.S. prior to the child’s birth. • Child of one U.S. citizen and one non-citizen parent in wedlock: the U.S. citizen was physically present in the U.S. for time period required by law at the time of the child’s birth: Birth on or after 11/14/1986: U.S. citizen’s required time period is five years; two of the years must be after the age of 14. Birth between 12/24/1952 and 11/13/1986: U.S. citizen’s required time period is 10 years; five of the years must be after the age of 14. • Child of only U.S. citizen father out of wedlock must meet each of the following criteria: A blood relationship between the applicant and the father is established by clear and convincing evidence. The father had the nationality of the U.S. at the time of the applicant’s birth. The father (unless deceased) had agreed in writing to provide financial support for the person until the applicant reached the age of 18. While the person is under the age of 18:

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Applicants are legitimated under the law of their residence or domicile.

Father acknowledges paternity of the person in writing under oath.

The paternity of the applicant is established by adjudication court. • Child of U.S. citizen mother out of wedlock: the mother was a U.S. citizen at the time of the child’s birth, and the mother had previously been physically present in the U.S. or one of its outlying possessions for a continuous period of one year. • FIP, SDA, MA and CDC U.S. citizens (including persons born in Puerto Rico). Note: See Exhibit IV, HOW TO BECOME A UNITED STATES CITIZEN, in this item. • Persons born in Canada who are at least 50 percent American Indian. • Member of a federally acknowledged American Indian tribe. • Qualified military non-citizen--a qualified non-citizen on active duty in, or veteran honorably discharged from, the U.S. armed forces. Active duty must not be for training, such as two weeks of active-duty training for National Guard. Discharge must not have been due to non-citizen status. Veteran means a person who either: • Served in the active military, naval or air service for the shorter of 24 months of continuous active duty or the full period for which he or she was called to active duty. • Died while in the active military, naval or air service. • Served in the military forces of the Commonwealth of the Philippines while such forces were in the service of the armed forces of the U.S. during the period from July 26, 1941, through June 30, 1946.

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• Served in the Philippine Scouts under Section 14 of the Armed Forces Voluntary Recruitment Act of 1945. • A qualified non-citizen spouse and unmarried qualified non- citizen dependent child of a qualified military non-citizen. Note: Dependent child is a child claimed as a dependent on the qualified military non-citizen's federal tax return and under 18, or under age 22 and a student regularly attending school. Spouse includes the unremarried surviving spouse of a deceased qualified military non-citizen. The marriage must fulfill one of the following: • The spouse was married to the veteran for one year or more. • A child was born to the spouse and veteran during or before the marriage. • The spouse was married to the veteran within the 15-year period following the end of the period of service in which an injury or disease causing the death of the veteran was incurred or aggravated. • Holder of one of the following immigration statuses: Lawful permanent resident (LPR) with class code RE, AS, SI or SQ on the I-551 (former refugee or asylee). Note: For SNAP, clients who enter the U.S. with one of the following categories are eligible for the first seven years. If they adjust to another category which requires them to meet the five-year requirement, they are still eligible for the first seven years. Refugee admitted under INA Section 207. Granted asylum under INA Section 208. Cuban/Haitian entrant. Amerasian under P.L. 100-202 (class code AM on the I- 551). Victim of trafficking under P.L. 106-386 of 2000; see VICTIMS OF TRAFFICKING in this item.

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Non-citizen whose deportation (removal) is being withheld under INA Sections 241(b)(3) or 243(h). For FIP, eligibility is limited to five years following the date of the withholding order unless the non-citizen is a qualified military non-citizen or the spouse or dependent child of a qualified military non-citizen. SNAP Only • U.S. citizens (including persons born in Puerto Rico). NOTE: See Exhibit IV, HOW TO BECOME A UNITED STATES CITIZEN, in this item. • Member of a federally acknowledged American Indian tribe. • Qualified military non-citizen--a qualified non-citizen on active duty in, or veteran honorably discharged from, the U.S. armed forces. Active duty must not be for training, such as two weeks of active-duty training for National Guard. Discharge must not have been due to non-citizen status. Veteran means a person who either: • Served in the active military, naval or air service for the shorter of 24 months of continuous active duty or the full period for which he or she was called to active duty. • Died while in the active military, naval or air service. • Served in the military forces of the Commonwealth of the Philippines while such forces were in the service of the armed forces of the U.S. during the period from July 26, 1941, through June 30, 1946. • Served in the Philippine Scouts under Section 14 of the Armed Forces Voluntary Recruitment Act of 1945. • A qualified non-citizen spouse and unmarried qualified non- citizen dependent child of a qualified military non-citizen. Note: Dependent child is a child claimed as a dependent on the qualified military non-citizen's federal tax return and under 18, or under age 22 and a student regularly attending school.

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Spouse includes the unremarried surviving spouse of a deceased qualified military non-citizen. The marriage must fulfill one of the following: • The spouse was married to the veteran for one year or more. • A child was born to the spouse and veteran during or before the marriage. • The spouse was married to the veteran within the 15-year period following the end of the period of service in which an injury or disease causing the death of the veteran was incurred or aggravated. • Holder of one of the following immigration statuses: • Lawful permanent resident with class code RE, AS, SI or SQ on the I-551 (former refugee or asylee). Note: For SNAP, clients who enter the U.S. with one of the following categories are eligible for the first seven years. If they adjust to another category which requires them to meet the five-year requirement, they are still eligible for the first seven years. • Lawful Permanent Resident with a class code on the I-551 other than RE, AM or AS is disqualified for the first five years in the U.S. Exception: A non-citizen admitted into the U.S. on or after August 22, 1996, with one of these statuses is eligible immediately: • Non-citizen is a qualified military non-citizen or the spouse or dependent child of a qualified military non-citizen. • Permanent resident has at least 40 Social Security Credits. • Lawfully residing in U.S. on 8/22/96 and age 65 or older on 8/22/96; or a Hmong or Highland Laotian tribe member that rendered assistance to U.S. personnel by taking part in a military or rescue operation during Vietnam era (August 5, 1964 - May 7, 1975) lawfully residing in U.S., their spouse, unmarried dependent child under age 18 now, or unremarried surviving spouse. • Lawfully residing in the U.S. and blind or disabled now.

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• Under age 18 now. • Non-citizen deportation withheld, persons born in Canada who are at least 50% American Indian and certain Afghan nationals granted parole between July 31, 2021 and September 30, 2023, and certain Ukrainian nationals granted parole between February 24, 2022, and September 30, 2024. • Cuban/Haitian entrant. • Amerasian under P.L. 100-202 (class code AM on the I- 551). • Victim of Trafficking. FIP, SDA, MA, CDC and SNAP • Compact of Free Association (COFA) citizens of the Federated States of Micronesia, the Republic of Marshall Islands and the Republic of Palau entrant. FIP, SDA and MA • Non-citizen admitted into the U.S. with one of the following immigration statuses: Lawful Permanent Resident with a class code on the I-551 other than RE, AM or AS. Non-citizen paroled into the U.S. for at least one year under INA Section 212(d)(5). Exception (both statuses above): The eligibility of a non- citizen admitted into the U.S. on or after August 22, 1996, with one of these statuses is restricted as follows unless the non- citizen is a qualified military non-citizen or the spouse or dependent child of a qualified military non-citizen: For FIP, an individual is disqualified for the first five years in the U.S. For SDA, an individual is disqualified. For MA an individual is limited to emergency services for the first five years in the U.S.

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• Non-citizen granted conditional entry under INA section 203(a)(7). • Lawful Permanent Resident with an I-151, Alien Registration Receipt Card. (not acceptable for MA verification) FIP, MA • A non-citizen who has been battered or subjected to extreme cruelty in the United States or whose child or parent has been battered or subjected to extreme cruelty in the United States. Exception: The eligibility of a battered alien admitted into the U.S. on or after August 22, 1996, is restricted as follows: For FIP, clients are disqualified for the first five years in the U.S. For MA, clients are limited to emergency services for the first five years in the U.S. A non-citizen is considered a battered alien if all the following conditions are met: The USCIS or the Executive Office of Immigration Review (EOIR) has granted a petition or found that a pending peti- tion sets forth a prima facie case that the non-citizen is eligible for legal permanent resident status (LPR) by way of being one of the following: - A spouse or child of a U.S. citizen or LPR. - The widow or widower or a U.S. citizen to whom the non-citizen had been married for at least two years before the citizen’s death. - A battered alien, or the non-citizen parent of a battered child, or the non-citizen child of a battered parent. The abuse was committed by the non-citizen’s spouse or parent, or by a member of the spouse or parent’s family residing in the same household as the non-citizen, and the spouse or parent consented to such battery or cruelty (and if the victim was the non-citizen’s child, the non-citizen did not participate in or condone the abuse).

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There is a substantial connection between the battery or extreme cruelty and the need for assistance. The battered alien, child or parent no longer lives in the same household as the abuser. CDC • Lawful Permanent Resident (regardless of class code). • Non-citizen paroled into the U.S. under INA Section 212(d)(5)8USC for at least one year. • Non-citizen granted conditional entry under INA Section 203(a)(7). MA • Non-citizen paroled into the U.S. for less than one year under INA Section 212(d)(5). Coverage is limited to emergency services only. • Non-immigrant--a non-citizen temporarily in the U.S. for a specific purpose (for example, student, tourist). The non-citizen must not have exceeded the time period authorized by USCIS. For MA, coverage is limited to emergency services only. • Person who does not meet any of the MA citizenship/non- citizen statuses above--limited to coverage of emergency services only. This includes, for example, undocumented non- citizens and non-immigrants who have stayed beyond the period authorized by USCIS. SDA and SNAP • Lawful Permanent Resident (regardless of class code) meeting the Social Security Credits (SSC) requirement; see Social Security Credits in this item. Note: A qualified military non-citizen, spouse or dependent child, regardless of date of entry or class code, need not meet the SSC requirement. Note: For SNAP, a qualified non-citizen who has been in the U.S. for five years need not meet the SSC requirement.

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SDA • A qualified non-citizen who was receiving SSI on August 22, 1996. • A qualified non-citizen who was lawfully residing in the U.S. (see below) on August 22,1996 and is now blind or disabled according to SSI standards. SNAP • U.S. citizens (including persons born in Puerto Rico). • NOTE: See Exhibit IV, HOW TO BECOME A UNITED STATES CITIZEN, in this item. • Member of a federally acknowledged American Indian tribe. • Qualified military non-citizen--a qualified non-citizen on active duty in, or veteran honorably discharged from, the U.S. armed forces. Active duty must not be for training, such as two weeks of active-duty training for National Guard. Discharge must not have been due to non-citizen status. Veteran means a person who either: • Served in the active military, naval or air service for the shorter of 24 months of continuous active duty or the full period for which he or she was called to active duty. • Died while in the active military, naval or air service. • Served in the military forces of the Commonwealth of the Philippines while such forces were in the service of the armed forces of the U.S. during the period from July 26, 1941, through June 30, 1946. • Served in the Philippine Scouts under Section 14 of the Armed Forces Voluntary Recruitment Act of 1945. • A qualified non-citizen spouse and unmarried qualified non- citizen dependent child of a qualified military non-citizen. Note: Dependent child is a child claimed as a dependent on the qualified military non-citizen's federal tax return and under 18, or under age 22 and a student regularly attending school.

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Spouse includes the unremarried surviving spouse of a deceased qualified military non-citizen. The marriage must fulfill one of the following: • The spouse was married to the veteran for one year or more. • A child was born to the spouse and veteran during or before the marriage. • The spouse was married to the veteran within the 15-year period following the end of the period of service in which an injury or disease causing the death of the veteran was incurred or aggravated. • Holder of one of the following immigration statuses: Lawful permanent resident with class code RE, AS, SI or SQ on the I-551 (former refugee or asylee). Note: For Supplemental Nutrition Assistance Program (SNAP), clients who enter the U.S. with one of the following categories are eligible for the first seven years. If they adjust to another category which requires them to meet the five-year requirement, they are still eligible for the first seven years. Lawful Permanent Resident with a class code on the I-551 other than RE, AM or AS is disqualified for the first five years in the U.S. Exception: A non-citizen admitted into the U.S. on or after August 22, 1996, with one of these statuses is eligible immediately: • Non-citizen is a qualified military non-citizen or the spouse or dependent child of a qualified military non-citizen. • Permanent resident has at least 40 Social Security Credits. • A qualified non-citizen who was lawfully residing in the U.S. on August 22, 1996, and was 65 years of age or older on August 22, 1996 • A person who is lawfully residing in the U.S. and was a member of a Hmong or Highland Laotian tribe at the time that the tribe assisted U.S. personnel by taking part in a military or rescue operation during the Vietnam era

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beginning August 5, 1964, and ending May 7, 1975, or is either: The unmarried dependent child of such Hmong or Highland Laotian who is under the age of 18 or if a full-time student under the age of 22; an unmarried child under the age of 18 or if a full-time student under the age of 22 of such a deceased Hmong or Highland Laotian provided the child was dependent upon them at the time of their death; or an unmarried disabled child age 18 or older if the child was disabled and dependent on the person prior to the child’s 18th birthday. The spouse or surviving spouse of such a person who is deceased. • A person lawfully residing in the U.S. and disabled now. Disabled means: Receives SSI, RSDI, MA, or Railroad Retirement benefits based on disability or blindness. Is a veteran with a disability rated or paid as total by the Veterans Administration (VA). Is a veteran or the surviving spouse of a veteran and considered by the VA to be in need of regular aid and attendance or permanently housebound. Is a surviving child of a veteran and considered by the VA to be permanently incapable of self-support. Is a surviving spouse or child of a veteran and considered by the VA to be entitled to compensation for a service-connected death or pension benefits for a non-service-connected death and has a permanent disability • A qualified non-citizen who is under 18 years of age. • Non-citizen deportation withheld, persons born in Canada who are at least 50% American Indian, certain Afghan nationals granted parole between July 31, 2021 and September 30,2023, and certain Ukrainian nationals granted parole between February 24, 2022, and September 30, 2024.

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• Cuban/Haitian entrant. • Amerasian under P.L. 100-202 (class code AM on the I- 551). • Victim of Trafficking.

LAWFULLY RESIDING IN THE U.S. A person is (or was) lawfully residing in the U.S. if they meet (or have met) one of the following criteria: • Is a qualified non-citizen. • Has been inspected and admitted to the U.S. and has not violated the terms of the status under which the individual was admitted or to which he or she has changed after admission. • Has been paroled into the U.S. pursuant to Section 212(d)(5) of the INA for at least one year or was either: Paroled for deferred inspection or pending exclusion proceedings under 236(a) of the INA. Paroled into the U.S. for prosecution under 8 CFR 212.5(a)(3). • Is in temporary resident status under Section 210 or 245A of the INA. • Is under temporary protected status under Section 244A of the INA. • Is a family unity beneficiary under Section 301 of P.L. 101-649, as amended. • Is under deferred enforced departure pursuant to a decision made by the president of the United States. • Is in deferred action status pursuant to service operations instructions at OI 242.1(a)(22).

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• Is the spouse or child of a U.S. citizen whose visa petition has been approved and who has a pending application for adjustment of status. • Is an applicant for asylum under Section 208(a) of the INA. • Is an applicant for withholding of deportation under Section 243(h) of the INA who has been granted employment authorization. • Is an applicant for asylum or withholding of deportation who is under the age of 14 and has had an application pending for at least 180 days. NOTIFICATION TO USCIS FIP and SNAP The local office must complete a USCIS referral after determining that a member of the applicant or recipient group is ineligible because their presence in the U.S. is unlawful. A person is in the U.S. unlawfully only if either: • A final order of deportation is presented during the eligibility or redetermination process. • A determination of ineligibility based on immigration status was made and the action by MDHHS was upheld in an administrative hearing, and the hearing determination of unlawful presence is supported by a determination by the USCIS or the executive office of immigration review, such as a formal order of deportation. Note: The absence of proof of legal residence, a determination of a person’s ineligibility, or a group member’s statement regarding illegal residence does not meet the conditions of unlawful residence in the U.S. and does not require notification to USCIS. The USCIS referral must contain: • The information which led to the referral, and • The person's: Full name. Date of birth. Place of birth.

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Current residence. Place of employment (if any). USCIS file number (if known). Place of entry into the U.S. (if known). Do not release any other information to USCIS. Send referrals to: US Citizenship and Immigration Services (USCIS) Detroit District 333 Mt. Elliott Street Detroit, MI 48207 Document the basis for the USCIS referral in the case record. VICTIMS OF TRAFFICKING All Programs The Office of Refugee Resettlement (ORR) within the U.S. Depart- ment of Health and Human Services issues letters of certification to persons it determines are victims of trafficking. Children under age 18 are issued eligibility letters instead of certification letters. Per- sons with the original certification and/or eligibility letters are not required to provide any other immigration documents to receive benefits. When a victim of trafficking applies for assistance: • Accept the original certification and/or eligibility letter. Copy the letter for the case record and return the original to the client. • Telephone the ORR trafficking verification line at 1-866-401- 5510 to confirm the validity of the certification and/or eligibility letter and inform ORR of the benefits for which the person has applied. Document the phone call in the case record. See sample ORR letters in BEM 630, Refugee Assistance Program, Exhibits II and III. Note: Victims of trafficking are sometimes issued T visas and eligible relatives of the trafficking victims are entitled to visas designated as T-2, T-3, T-4 or T-5 (collectively referred to as Derivative T Visas). The eligible relative(s) with a Derivative T Visa is eligible for the same program(s) as the victim of trafficking,

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providing they meet other eligibility criteria (for example, asset or income limits). SOCIAL SECURITY CREDITS (SSC) SDA and SNAP Social Security credits (SSC) are earned by working at a job cov- ered by Social Security and/or Medicare. The Social Security Administration (SSA) decides how many SSCs a person has earned. A person can earn up to four SSCs per year, depending on the amount of their gross earned income. SSCs do not represent earnings in a particular calendar quarter. However, SSA attributes SSCs to calendar quarters to assist in determining non-citizen program eligibility. SSCs are posted to the earner's Social Security earnings file by September of the taxable year following the year in which they were earned. For example, SSCs earned in 1996 are posted by Septem- ber 1997. SSCs which have been earned but not yet posted are lag SSCs; see Lag SSCs in this section. SSC Requirement Some lawful permanent residents must meet the SSC requirement to be eligible; see Citizenship/Non-citizen Status and EXHIBIT II in this item. To meet the SSC requirement, a lawful permanent resident must have at least 40 countable SSCs; see Determining Countable SSCs in this section. A non-citizen must meet this requirement only once. Each lawful permanent resident whose eligibility depends upon SSCs must complete and sign a DHS-4784, Permanent Resident Alien Declaration, at application (including member addition) unless there is proof that the SSC requirement has already been met. Review at redetermination the eligibility of any group members dis- qualified for failing the SSC requirement.

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Whose SSCs to Count Count towards the non-citizen's SSC requirement all SSCs earned by: • The lawful permanent resident. • The non-citizen's spouse and one or more deceased spouses, while married to the non-citizen. Note: Do not count any SSCs of a non-citizen’s ex-spouse. Determine the non-citizen's eligibility without the ex-spouse’s quarters at the next redetermination following the report of a divorce. • The non-citizen's parent(s) while the non-citizen was under age 18 (including SSCs earned prior to the non-citizen's birth). • The non-citizen's stepparent(s) while the non-citizen was under age 18 (including SSCs earned prior to the non-citizen's birth), provided the step relationship has not terminated by divorce. Exception: SSCs earned after December 31, 1996, might not be countable; see Uncountable SSCs in this section. SSCs of Nongroup Members Obtain a completed and signed DHS-4757, Social Security Credits Release, from each living nongroup member whose SSCs are used in the eligibility determination. The completed form must be on file before inquiring with SSA about the person’s SSCs. Note: No release is required to inquire about a deceased person’s SSCs. If a nongroup member cannot be located or refuses to provide the completed and signed release, document the circumstances in the case record. Determine that person’s countable SSCs using avail- able information; see Determining Countable SSCs. Determining Countable SSCs Determine countable SSCs using the numbered steps below. Some SSCs might be uncountable; see Uncountable SSCs in this section.

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Before the determination, examine the non-citizen's DHS-4784. If at least seven years of U.S. employment are declared on line 4, complete the Wire Third Party 40 quarters process in Bridges for each person whose work contributed to that total; see SSCs of Nongroup Members about restrictions. Refer to the Wire Third Party 40 quarters report, if applicable, and the DHS-4784 in the following steps. Note: Each person can earn a maximum of only four SSCs per year. However, more than four SSCs per year might be countable towards the non-citizen's SSC requirement (for example, four from each parent). 1. Determine the number of countable SSCs, including lag SSCs earned by the non-citizen; see Lag SSCs in this item. If 40 or more, the SSC requirement is met. If fewer than 40, go to step 2. 2. Determine the number of countable SSCs, including Lag SSCs, earned by the non-citizen's spouse since their marriage. Include in your calculation the SSC attributed to the calendar quarter containing the date of marriage. Add these SSCs to those from step 1. If the total is 40 or more, the SSC requirement is met. If the total is less than 40, go to step 3. 3. Determine the number of countable SSCs, including Lag SSCs, earned by the (step)parent(s) while the non-citizen was under age 18. Include in your calculation the SSC attributed to the calendar quarter containing the 18th birthday. Add these SSCs to the total from step 2. If the total is 40 or more, the SSC requirement is met. If the total is less than 40, the non-citizen fails the requirement. Lag SSCs Due to the lag in SSA's posting process, SSCs earned this year and last year might not be posted to a person's earnings file until September of the year after they were earned. These lag SSCs are counted toward a non-citizen's eligibility if they meet all other requirements in this item. Lag SSCs might exist when the non-citizen enters current year or last year gross earnings for the non-citizen, spouse and/or

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(step)parent(s) on the DHS-4784. Determine the number of lag SSCs earned by an individual using the following steps: • Determine that current year and last year wages are covered by Social Security or Medicare. Wages are covered if FICA or Medicare was withheld. • Total the gross covered wages earned by each person in each calendar year. • Divide each person's yearly total by the minimum amount needed to earn an SSC in that year. Those minimums are: $1,360 for 2019. $1,320 for 2018. $1,300 for 2017. $1,260 for 2016. $1,220 for 2015. $1,200 for 2014. $1,160 for 2013. $1,130 for 2012. $1,120 for 2010 and 2011. $1,090 for 2009. $1,050 for 2008. $1,000 for 2007. $970 for 2006. $920 for 2005. $900 for 2004. $890 for 2003. $870 for 2002. $830 for 2001. $780 for 2000. $744 for 1999. $700 for 1998. $670 for 1997. $640 for 1996. Round the answer down to the nearest whole number. That number, up to a maximum of four, is the number of lag SSCs earned by the person in that calendar year. Uncountable SSCs Special restrictions apply to SSCs earned starting January 1, 1997. An SSC attributed by SSA to a particular calendar quarter is uncountable if any time during that quarter either the non-citizen or

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the person earning the SSC (if other than the non-citizen) received any of the following benefits anywhere in the U.S.: • Aid to Families with Dependent Children, or its equivalent (called Family Independence Program, or FIP, in Michigan). • Supplemental Nutrition Assistance Program (SNAP) benefits. • Medical Assistance (but not MA for emergency services only). • Supplemental Security Income (SSI). Exception: Because lag SSCs have not been attributed by SSA to a particular calendar quarter, a different determination is used. One lag SSC earned during a calendar year becomes uncountable for each calendar quarter (January 1 - March 31, April 1 - June 30, etc.) during that year in which either the non-citizen or the person earning the SSC (if other than the non-citizen) received the above benefits anywhere in the U.S; see Lag SSCs in this section. Eligibility While Disputing Earnings File Your inquiry to SSA on non-citizen’s earnings files might verify fewer SSCs than they claimed on Line 1 of the DHS-4784 (for example, they believe their SSA earnings files are in error); see Verification Sources in this item. Non-citizens who believe they have earned at least 40 countable SSCs (including lag SSCs) are eligible while disputing their earnings file with SSA if all the following conditions exist: • The non-citizen's signed DHS-4784 claims that they have worked at least 10 years in the U.S. (estimated 40 SSCs). • It is determined that at least 40 of the non-citizen's estimated SSCs claimed on the DHS-4784 are countable; see Uncountable SSCs in this section. • The non-citizen’s request SSA to review their earnings file and provides proof of this request; see SSA Referral in this section. Note: SSA will not accept a request to review lag credits. Eligibility based on disputed earnings ends six months after the date of the Wire Third Party 40 quarters process, which verified

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fewer SSCs than the non-citizen claimed. File a follow-up to review the non-citizen's SSC requirement at that time. Redetermine the non-citizen's countable SSCs using clarified earnings file information from SSA, if available. If the SSC requirement is not met, disqualify the non-citizen and recoup any benefits issued while the earnings file was being disputed. SSA Referral Refer a non-citizen to SSA with a copy of each person's Wire Third Party 40 quarters report from Bridges when one of the following occurs: • The non-citizen believes there is an error in the SSA earnings file of: The non-citizen. The non-citizen’s deceased spouse or (step)parent(s). • Questionable SSCs needed to meet the non-citizen's requirement appear on the Wire Third Party 40 quarters report from Bridges for both: The non-citizen. The non-citizen’s deceased spouse or (step)parent(s). Inform the non-citizen that the earnings file or questionable SSCs of a living spouse or (step)parent must be clarified with SSA by the spouse or (step)parent. Give the non-citizen a copy of each person's Wire Third Party 40 quarters report from Bridges to assist in the SSA clarification process. VERIFICATION REQUIREMENTS

U.S. Citizenship FIP, SDA, SNAP and CDC Do not request verification from a person claiming U.S. citizenship unless the client’s statements are questionable. MA U.S. citizenship must be verified.

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Non-Citizen Status All Programs The non-citizen status of each non-citizen requesting benefits MUST be verified. Exception: See MA Emergency Services Only in this item. For victims of trafficking, verify the validity of the ORR certification and/or eligibility letter; see Verification Sources in this item. Verify each of the following dates if they affect a non-citizen's eligibility: • Date of entry into the U.S. or LPR adjusted date. • Date asylum was granted under INA Section 208. • Date deportation (removal) was withheld under INA Section 241(b)(3) or 243(h). • ORR certification/eligibility date for victims of trafficking. Note: The client’s statement about a date is verification in certain circumstances; see Dates Affecting Non-Citizen Eligibility in this item. FIP, SDA, and SNAP Disqualify a person who is unable to obtain verification or refuses to cooperate in obtaining it. MA Emergency Services Only The coverage of a person who is unable to obtain verification of non-citizen status or refuses to cooperate in obtaining it is limited to emergency services until verification is obtained. A person claiming to be a U.S. citizen is not eligible for ESO coverage. Verify all other eligibility requirements, including residency, before authorizing emergency services coverage; see BEM 220. Exception: As of August 1, 2024, any pregnant individual or individual under the age of 21 that is legally residing in the United

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States in any immigration status is eligible to receive full coverage. In the case of a pregnant individual, full coverage should continue through the end of the pregnancy and postpartum period. For individuals under 21, full coverage should continue until they reach age 21. Note: Pregnant individuals need to either apply or report their pregnancy while they are currently pregnant or within two calendar months of it ending in order to be assessed for a full coverage Medicaid group. Below are some examples of immigration statuses that pregnant individuals or individuals under age 21 may have that would allow them to receive full coverage. Please note that this is not an exhaustive list. • A qualified alien as defined in section 431 of PRWORA (8 U.S.C. §1641). • An alien in nonimmigrant status who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission (example: work or student visas, etc.). • An alien who has been paroled into the United States pursuant to section 212(d)(5) of the Immigration and Nationality Act (INA) (8 U.S.C. §1182(d)(5)) for less than 1 year, except for an alien paroled for prosecution, for deferred inspection or pending removal proceedings. • An alien who belongs to one of the following classes: Aliens currently in temporary resident status pursuant to section 210 or 245A of the INA (8 U.S.C. §§1160 or 1255a, respectively). Aliens currently under Temporary Protected Status (TPS) pursuant to section 244 of the INA (8 U.S.C. §1254a), and pending applicants for TPS who have been granted employment authorization. Aliens who have been granted employment authorization under 8 CFR 274a.12(c)(9), (10), (16), (18), (20), (22), or (24). Family Unity beneficiaries pursuant to section 301 of Pub. L. 101-649, as amended.

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Aliens currently under Deferred Enforced Departure (DED) pursuant to a decision made by the President. Aliens currently in deferred action status. Aliens whose visa petition has been approved and who have a pending application for adjustment of status. • A pending applicant for asylum under section 208(a) of the INA (8 U.S.C. § 1158) or for withholding of removal under section 241(b)(3) of the INA (8 U.S.C. § 1231) or under the Convention Against Torture who has been granted employment authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days. • An alien who has been granted withholding of removal under the Convention Against Torture. • A child who has a pending application for Special Immigrant Juvenile status as described in section 101(a)(27)(J) of the INA (8 U.S.C. § 1101(a)(27)(J)). • An alien who is lawfully present in the Commonwealth of the Northern Mariana Islands under 48 U.S.C. § 1806(e). • An alien who is lawfully present in American Samoa under the immigration laws of American Samoa. Social Security Credits SDA and SNAP Verify Social Security credits when the non-citizen does one of the following: • Requests verification. • Disputes your SSC determination. • Declares a total of seven or more years of U.S. employment on line 4 of the DHS-4784. Verify the following elements of the SSC requirement: • The non-citizens relationship to the spouse or (step)parent(s), but only when it is questionable. • Covered wages used to calculate lag SSCs.

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• The non-citizen's statement that SSA is reviewing their disputed earnings file. • Clarified SSA earnings file information used to redetermine the non-citizen's countable SSCs when eligibility based on disputed earnings ends. Accept the non-citizen's written statement on DHS-4784, regarding receipt of benefits unless it conflicts with other information (such as SSI receipt on SOLQ). File copies of all SSC-related verification documents in the case record. VERIFICATION SOURCES

Citizenship All Programs Primary evidence of citizenship is documentary evidence of the highest reliability that conclusively establishes that the person is a U.S. citizen. In general, obtain primary evidence of citizenship before using secondary evidence. The data match with the SSA is sufficient to verify citizenship and should be completed prior to requesting verification from a recipient; see BAM 130. See EXHIBIT III in this item for document titles and descriptions. • Birth certificate or other birth record. • U.S. passport. • Voter registration card. • Naturalization papers or USCIS identification card. SNAP A client might offer good reasons why none of the verifications above can be obtained. In that situation, accept a U.S. citizen's signed statement under penalty of perjury that the person in ques- tion is a U.S. citizen. See EXHIBIT I in this item for information required on the statement.

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Primary Evidence Primary evidence of citizenship is: • A U.S. passport. • A U.S. passport card. • A Certificate of Naturalization (N-550 or N-570). • A Certificate of Citizenship (N-560 or N-561). Secondary Evidence Secondary evidence of citizenship is documentary evidence of satisfactory reliability that is used when primary evidence is not available. Secondary evidence is: • A U.S. public birth record showing birth in one of the 50 States, District of Columbia, American Samoa, Swain’s Island Puerto Rico (if born on or after January 13,1941), Virgin Island of the U.S. (if born on or after January 17, 1917), Northern Mariana Islands (if born on or after November 4, 1986) or Guam (if born on or after April 10, 1899). • A Michigan enhanced driver’s license or enhanced state ID. • Certification of Report of Birth (DS-1350). The Department of State issues a DS-1350 to U.S. citizens in the U.S. who were born outside the U.S. and acquired U.S. citizenship at birth based on the information shown on the FS-240. • Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240). Children born outside the U.S. to U.S. military personnel usually have one of these. • Certification of Birth Abroad (FS-545). Before November 1, 1990, Department of State consulates also issued Form FS- 545 along with prior version of the FS-240. In 1990, U.S. consulates ceased to issue Form FS-545. Treat an FS-545 the same as the DS-1350. • United States Citizen Identification Card (I-197 or I-179). INS issued Form I-179 and I-197 to naturalized U.S. citizens living near the Canadian or Mexican borders who needed it for frequent border crossings. Although neither form is currently issued, either form that was previously issued is still valid. • American Indian Card (I-872). The Department of Homeland Security issues this card to identify a member of the Texas

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Band of Kickapoos living near the U.S./Mexican border. A classification code KIC and a statement on the back denote U.S. citizenship. • Northern Mariana Card (I-873). INS issued this form to a collectively naturalized citizen of the U.S. who was born in the Northern Mariana Islands before November 4, 1986. The card is no longer issued, but those previously issued are still valid. • Final adoption decree. The decree must show the child’s name and U.S. place of birth. In situations in which an adoption is not finalized and the state in which the child was born will not release a birth certificate prior to final adoption, a statement from a state-approved adoption agency that shows the child’s name and U.S. place of birth is acceptable. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate. • Evidence of civil service employment by the U.S. government. The document must show employment by the U.S. government prior to June 1, 1976. • Official military record of service. The document must show a U.S. place of birth, (a DD-214 or similar official document showing a U.S. place of birth). • A verification with the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) database. • Evidence of meeting the automatic criteria for U.S. citizenship outlined in the Child Citizenship Act of 2000. The Child Citizenship Act of 2000 allows certain foreign-born, bio- logical and adopted children of American citizens to acquire Ameri- can citizenship at birth, but they are granted citizenship when they enter the United States as lawful permanent residents. The child must meet all the following requirements: • Have at least one American citizen parent by birth or naturalization. • Be under 18 years of age. • Live in the legal and physical custody of the American citizen parent.

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• Be admitted as an immigrant for lawful permanent residence. If the child is adopted, the adoption must be full and final. Third Level Evidence Third level evidence of U.S. citizenship is documentary evidence that is used when neither primary nor secondary evidence is avail- able. Third level evidence may be used only when primary evidence cannot be obtained within a reasonable length of time, secondary evidence does not exist or cannot be obtained, and the applicant or recipient alleges being born in the U.S. Third level evidence is usually a non-government document established for a reason other than to establish U.S. citizenship and showing a U.S. place of birth. The place of birth on the non-government document and the application must agree. Third level evidence is: • An extract of a hospital record on hospital letterhead, established at the time of birth that was created at least five years before the initial application date (or near the time of birth for children) that indicates a U.S. place of birth. Do not accept a souvenir birth certificate. • Life, health or other insurance record showing a U.S. place of birth that was created at least five years before the initial application date. • Religious record recorded in the U.S. within three months of birth showing the birth occurred in the U.S. and showing either the date of the birth or the individual’s age at the time the record was made. The record must be an official record recorded with the religious organization. Entries in a family bible are not considered religious records. • Early school record showing a U.S. place of birth. The school record must show the name of the child, the date of admission to the school, the date of birth, a U.S. place of birth, and the name(s) and place(s) of birth of the applicant’s parents. Fourth Level Evidence Fourth level evidence should only be used in the rarest of circum- stances and includes:

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• Federal or state census record showing U.S. citizenship or a U.S. place of birth, generally for persons born 1900 through 1950. The census record must show the person’s age. To secure this information the applicant, recipient or state should complete a Form BC-600, Application for Search of Census Records for Proof of Age. Add in the remarks section "U.S. citizenship data requested". Also indicate that the purpose is for Medicaid eligibility. This form requires a fee. • Seneca Indian tribal census record. • Bureau of Indian Affairs tribal census records of the Navajo Indians. • Bureau of Indian Affairs Roll of Alaskan Natives. • U.S. State Vital Statistics official notification of birth that is amended more than five years after the person’s birth. • Statement signed by the physician or midwife who was in attendance at the time of birth. • Institutional admission papers from a nursing facility or other institution or medical records from a hospital, doctor or clinic that was created at least five years before the initial application date and indicates a U.S. place of birth. Admission papers generally show biographical information including a place of birth. An immunization record is not considered a medical record for purposes of establishing U.S. citizenship. • A written affidavit should only be used in rare circumstances. It must be completed by the applicant or recipient and at least two additional individuals of whom one is not related to the applicant/recipient and who have personal knowledge of the event(s) establishing the person’s claim of citizenship. Individuals making the affidavit must be able to provide proof of their own citizenship and identity. The affidavit is signed under penalty of perjury by the person making the affidavit but need not be notarized. The affidavit should include information explaining why other documentary evidence establishing the applicant’s claim of citizenship does not exist or cannot be obtained.

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Non-Citizen Status All Programs See EXHIBIT III in this item for document titles and descriptions. • Lawful permanent resident status is indicated on one of the following: I-151 issued before June 1978 or I-551(I-151 is not acceptable for MA, must be replaced with I-551). I-327 (unexpired). I-94 stamped “Processed for I-551.” Passport stamped “Processed for I-551 Temporary Evidence of Lawful Admission for Permanent Residence.” • American Indian who enters the U.S. from Canada is indicated on one of the following: I-151 issued before June 1978 or I-551. (I-151 is not acceptable for MA, must be replaced with I-551). I-181. Other USCIS documentation. Birth record or affidavit from a tribal official indicating the person is at least 50 percent American Indian. Note: Such persons are not required to register with USCIS. • Refugee, asylee or parolee status is indicated on an I-94 annotated with INA section 203(a)(7) (prior to April 1, 1980), 207, 208 or 212(d)(5). • Derivative Asylee. I-730 Asylee Relative Petition. • Parolee. I-94 annotated with INA section 212(d)(5) which has a parole end date (duration) at least one year later than the date of entry.

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• Afghan aliens admitted under Section 101(a)(27) of the INA is indicated on either: Passport with Visa IV category SI or SQ. An I-94 with date of entry. I-551 with category SI or SQ. • Iraqi aliens admitted under Section 101(a)(27) of the INA is indicated on either: Passport with Visa IV category SI or SQ. An I-94 with date of entry. I-551 with category SI or SQ. • Amerasian status is indicated on one of the following documents annotated with class code AM: I-94. I-327 (unexpired). I-551. U.S. or Vietnamese passport. Vietnamese Exit Visa (“Laissez Passer”). • Cuban/Haitian entrant status is indicated on one of the following: I-94 indicating admission into the U.S. from Cuba or Haiti, annotated with “Cuban/Haitian entrant (Status Pending),” “parole,” including public interest or humanitarian, “212(d)(5)” or “Form I-589 Filed.” I-94 indicating admission into the U.S. from Cuba or Haiti and letter or notice from USCIS indicating ongoing (not final) deportation, exclusion or removal proceedings. I-551 with adjustment code CH6 or CU6. I-766 with A4 or C11. I-688B annotated with 274a.12(a)(4), 274a.12(c)(11), or 274a.12(c)(8). A national of Cuba or Haiti who is the subject of removal, deportation, or exclusion proceedings under the INA and with respect to whom a final, non-appealable, and legally enforceable order of removal, deportation, or exclusion has not been entered.

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DHS form I-221, Order to Show Cause and Notice of Hearing. DHS form I-862, Notice to Appear. DHS form I-220A, Order of release on Recognizance. DHS form I-122, Notice to Applicant Detained for a Hearing Before an Immigration Judge. DHS form I-221S, Order to Show Cause, Notice of Hearing and Warrant for Arrest. DHS form I-589 date stamped by the Executive Office for Immigration Review (EOIR), Application for Asylum and Withholding of Removal Subject of Removal, Deportation or Exclusion Proceedings. DHS form I-485 date stamped by EOIR, Application to Register Permanent Residence or to Adjust Status; Individual is Subject of Removal, Exclusion or Deportation Proceedings. EOIR-26, Notice of Appeal, date stamped by the Office of the Immigration Judge. I-766 Employment Authorization Document with the code C10. I-688B, Employment Authorization Document with the provision of law 274a.12(c)(10). Other documentation pertaining to an applicant's removal, exclusion or deportation proceedings. A national of Cuba or Haiti who has an application for asylum pending and with respect to whom a final, non- appealable, and legally enforceable order of removal, deportation or exclusion has not been entered. Department of Homeland Security receipt for filing form I-589. I-766, Employment Authorization Document with C08. I-688B, Employment Authorization Document with the provision of law 274a.12(c)(8).

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Note: Contact the EIOR Hotline at 1-800-898-7180 to verify if a Cuban or Haitian Entrant has a final, non-appealable, and legally enforceable order of removal, deportation, or exclusion, entered. Client confidentiality must be maintained when contacting this number and MDHHS case information should not be shared with the EIOR hotline, other than what is needed for confirmation of their status. • Status as a non-citizen whose deportation (removal) is withheld is indicated on a court order or letter from an immigration judge stating that deportation (removal) is withheld per INA section 241(b)(3) or 243(h). • Victim of trafficking status is confirmed with both: Original ORR certification and/or eligibility letter, or for victims under age 18, an original eligibility letter from ORR (See EXIBITS II and III). Telephone contact with the ORR trafficking verification line (1-866-401-5510) to verify the validity of the letters. Note: Victims of trafficking may also be identified with adjustment code ST6 on the I-551. • Any non-citizen status: G-641 annotated at the bottom by a USCIS representative. Information from the USCIS Records Section, 333 Mt. Elliott, Detroit, Michigan 48207. FIP, SDA, MA, CDC and SNAP • Compact of Free Association (COFA) citizens of the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau entrant. MA • Nonimmigrant status: I-94, visa, passport or other USCIS correspondence granting non-immigrant status. Form I-20 ID (Student) Copy with a future D/S date verifies unexpired non-immigrant student status.

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Dates Affecting Non-Citizen Eligibility All Programs Verify date of entry as required, using the sources listed below. • Refugees under Section 207, date of entry is on an I-94 which has been endorsed with INA Section 207. • Former refugees (class code RE on the I-551), accept the client's statement regarding date of entry if the stated date: Is at least one year earlier than the Date of Adjustment/Admission on the I-551; Does not conflict with other information. • Lawful permanent residents with class codes other than RE, AM, AS, SI or SQ date of entry is the Date of Adjustment/Admission on the I-551. Exception: If the client disputes this date, accept the client's statement regarding date of entry if the stated date is earlier than the date of adjustment admission on the I-551, and does not conflict with other information. Note: Date of entry is not an eligibility factor for Lawful permanent residents presenting an I-151. (I-151 is not acceptable for MA, must be replaced with I-551). • For parolees under Section 212(d)(5), date of entry is on an I- 94 which has been endorsed with INA section number 212(d)(5). The end date (duration) of parole is also on the I-94. For Cuban Parolees, the date of entry is the date of grant of parole, or first parole if more than one parole was granted. • For Cuban/Haitian entrants, date of entry is the date they first entered Cuban/Haitian Entrant status. For entrants in possession of an I-94, date of entry is on a properly endorsed I-94. • For Cuban/Haitian entrants, date of entry is on a properly endorsed I-94; see Non-Citizen Status in this section.

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• For victims of trafficking, date of entry is the date of certification on the ORR certification/eligibility letter; see EXHIBITS II and III in BEM 630. For asylees, the date of entry is the date asylum was granted. Verify date asylum was granted, as required, using the sources listed below. • For asylees under Section 208, the date asylum was granted appears on an I-94 which has also been endorsed with INA Section 208. • For former asylees (class code AS on the I-551), accept the client’s statement regarding the date asylum was granted if the stated date: Is at least one year earlier than the date of adjustment/admission on the I-551) and does not conflict with other information. Verify date deportation (removal) was withheld under section 241(b)(3) or 243(h) using the court order or letter from an immigra- tion judge granting the withholding of deportation (removal). Social Security Credits SDA and SNAP Use 40 Quarters functionality in Bridges Inquiry. For lag SSCs, use the following documents showing FICA or Medi- care withholding to verify covered earnings: • Employer-prepared wage statements. • Forms W-2 and/or W-2c. • Copy of the earner's tax return. Disputed Earnings File SDA and SNAP An SSA document stating that the clients have requested a review of their earnings file is verification that they have requested this review.

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Non-Citizens Limited to Emergency MA Coverage During a Five-Year Bar MA A non-citizen limited to emergency services only (ESO) coverage during the five-year bar means a non-citizen whose immigration status does not entitle them to full Medicaid coverage without first lawfully residing in the United States for five years. For example, a lawful permanent resident with an I-551 with a class code other than RE, AM, AS, SI, or SQ will receive ESO coverage for the first five years they reside in the United States after their date of entry or the date on which they switched to this immigration status. Exception: As of August 1, 2024, children under age 21 and pregnant individuals (including through the entirety of their postpartum period) are no longer subject to the five-year bar. They should be approved for full coverage even if their immigration status would normally require them to first reside in the United States lawfully for five years. When a pregnant individual's postpartum period ends, or an individual reaches age 21, they will revert to ESO coverage if they have not met the five-year bar and are still in an immigration status that is subject to it. Note: Pregnant individuals need to either apply or report their pregnancy while they are currently pregnant or within two calendar months of it ending in order to be assessed for a full coverage Medicaid group. See MA Emergency Services Only above for more information about coverage for pregnant women and children under age 21 residing in the United States legally in any immigration status. EXHIBIT I - CITIZENSHIP STATEMENT

Citizenship Statement Case Name: Case Number:

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Citizenship Statement County/Workload No: I certify that I am a United States citizen and that (insert name) is a United States citizen. I understand that if I intentionally give false information to help (insert name) get SNAP benefits, I may be prosecuted and may be fined, imprisoned, or both. Signature Date

EXHIBIT II - CITIZENSHIP/NON-CITIZEN STATUS TABLE

FIP SDA CDC SNAP MA U.S. Citizen (include person born in Puerto Rico) Yes Yes Yes Yes Yes Person born in Canada, at least 50% American Indian Yes Yes Yes No Yes Member of American Indian tribe Yes Yes Yes Yes Yes Qualified Military Non-Citizen Yes Yes Yes Yes Yes Spouse or Dependent Child of Qualified Military Non- Citizen Yes Yes Yes Yes Yes Refugee under Section 207; including Iraqi and Afghan special immigrants. Yes Yes Yes No Yes Asylee under Section 208 Yes Yes Yes No Yes Cuban/Haitian Entrant Yes Yes Yes Yes Yes Compact of Free Association (COFA) citizens* Yes Yes Yes Yes Yes Amerasian (I-551 has class code AM) Yes Yes Yes Yes Yes Victim of Trafficking Yes Yes Yes No Yes Lawful Permanent Resident (LPR), I-551 has class code RE, AM, AS, SI or SQ Yes Yes Yes Yes Yes Lawful Permanent Resident, I-551 class code is OTHER THAN RE, AM, AS, SI or SQ • U.S. entry before 8/22/96 Yes Yes Yes Yes Yes • U.S. entry on or after 8/22/96 First five years in U.S. or (SNAP only) from date of LPR. No a No a,b,d Yes No E a

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FIP SDA CDC SNAP MA a,b,c, f, g, i More than five years in U.S. or (SNAP only) from date of LPR. Yes No a,b,d Yes Yes Yes Lawful Permanent Resident, has I-151 Yes Yes Yes Yes No Deportation (Removal) Withheld under Section 241(b)(3) or 243(h) • First five years after withholding order Yes Yes Yes No Yes • Sixth and seventh years after withholding order No Yes Yes No Yes • More than seven years after withholding order No a Yes Yes No Yes Granted Conditional Entry under Section 203(a)(7) Yes Yes Yes No Yes Paroled under Section 212(d)(5) for at least one year • U.S. entry before 8/22/96 Yes Yes Yes No Yes • U.S. entry on or after 8/22/96 First five years in U.S. No a No a,d Yes No E a More than five years in U.S. Yes No a,d Yes No Yes Battered Aliens • U.S. entry before 8/22/96 Yes No a,d No No Yes • U.S. entry on or after 8/22/96 First five years in U.S. No No a,d No No E a More than five years in U.S. Yes No a,d No No Yes Paroled under Section 212(d)(5) for less than one year No No No No E Non-immigrant (student, tourist) No No No No E

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FIP SDA CDC SNAP MA Pregnant individual or individual under age 21 that is legally residing in the US in any immigration status N/A N/A N/A N/A Yes h Non-Citizens not described above undocumented non- citizens) No No No No E a Unless a qualified military non-citizen, or the spouse or dependent child of a qualified military non-citizen. b Unless permanent resident has at least 40 countable Social Security Credits. c Unless lawfully residing in U.S. on 8/22/96 and age 65 or older on 8/22/96; or a Hmong or Highland Laotian tribe member that rendered assistance to U.S. personnel by taking part in a military or rescue operation during Vietnam era (August 5, 1964 - May 7, 1975) lawfully residing in U.S., their spouse, unmarried dependent child under age 18 now, or unremarried surviving spouse. d Unless lawfully residing in the U.S. now and was receiving SSI on 8/22/96 or was lawfully residing in the U.S. on 8/22/96 and is blind or disabled now. e Means medical coverage is limited to emergency services. f Unless lawfully residing in the U.S. and blind or disabled now. g Unless under age 18 now. h Full coverage continues through pregnancy and postpartum period or until individual reaches age 21. i Unless non-citizen deportation withheld, persons born in Canada who are at least 50% American Indian, victim of trafficking, certain Afghan nationals granted parole between July 31, 2021 and September 30, 2023, and certain Ukrainian nationals granted parole between February 24, 2022, and September 30, 2024. *Citizens of the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau.

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EXHIBIT III - DOCUMENTS

U.S. STATE DEPARTMENT U.S. State Department documents regarding citizenship include: • United States passport. It is issued to U.S. citizens and nationals. The expiration date is on the document face. A U.S. passport does not have to be currently valid to be accepted as evidence of citizenship, as long as it was originally issued without limitation. • United States passport card. This card cannot be used for air travel; otherwise, it carries the same rights and privileges of the U.S. passport book. • DS-1350, Certification of Report of Birth or FS-545, Certification of Birth Abroad. Issued to U.S. citizens born in another country. The FS-545 was last issued in 1990. • FS-240, Consular Report of Birth Abroad of a Citizen of the U.S. It is issued to U.S. citizens born in another country, often children of U.S. military personnel. U.S. CITIZENSHIP AND IMMIGRATION SERVICES (USCIS) USCIS documents regarding citizenship/non-citizen status include, but are not limited to: Note: Information about forms and fees is available on the USCIS website. Some forms may be filled out online and some are available for electronic filing. The website is http://www.uscis.gov/portal/site/uscis. • G-641, Application for Verification of Information from U.S. Citizenship and Immigration Services Records. • I-20 ID (Student) Copy is issued to non-immigrant students authorized to study in the U.S. The D/S date (duration of status) indicates expiration of student status. • I-94, Arrival-Departure Record. It is usually attached to the unexpired foreign passport of non-immigrant non-citizens. The expiration date is on the document face. As of 5/1/13, the I-94 will begin to be automated at certain airports in the U.S. Some of the I-94 information will be stamped on the unexpired foreign passport. Refugees, derivative asylees and parolees will continue to receive a paper I-94. • I-151, Alien Registration Receipt Card. It was issued prior to June 1978 to lawful permanent residents and is commonly referred to as a green card. The I-151 became obsolete on 3/20/96, and individuals should have requested the I-551 replacement. (Cannot use the I-151 card as verification for MA eligibility, must have replaced with the I- 551). • I-327, Permit to Reenter the United States. It is issued to lawful permanent residents before leaving the U.S. for one to two years. The expiration is on page 2.

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• I-485, Application to Register Permanent Residence or to Adjust Status. • I-539 Application to Extend/Change Non-immigrant Status. • I-551, Permanent Resident Card (PRC). It is a revised edition of the I-151, issued for a renewable 10-year period to lawful permanent residents. The expiration date is on the document face. • I-551, Permanent Resident Card (Conditional Permanent Resident). It is issued for a two- year period (expiration date on the back) to conditional permanent residents such as non- citizen spouses of U.S. citizens/permanent residents. • I-571, Refugee Travel Document. It is issued to non-citizens granted refugee status who intend to travel abroad. The date of expiration is on page 4. • I-698, Application to Adjust Status From Temporary to Permanent Resident. • I-765, Application for Employment Authorization. • I-766, Employment Authorization Document. • I-797, Notice of Action. It is issued to applicants/petitioners to acknowledge receipt of applications, convey statuses, etc. It verifies lawful permanent resident status when it acknowledges both receipt of application for a replacement I-551 and receipt of the old I- 551. • N-550 or N-570, Certificate of Naturalization. It is issued to naturalized U.S. citizens. • N-560, Certificate of United States Citizenship. It is issued to persons with citizenship acquired through naturalization of a parent, birth by a U.S. citizen in another country, or application by adoptive parents. USCIS NON-IMMIGRANT CLASSIFICATIONS These classifications indicate temporary or time-limited status. They include but are not limited to the following: A. Foreign government representatives on official business and their families and servants (A1-3). B. Visitors for business or pleasure, including exchange visitors (B1, 2). C. Non-Citizens in travel status while traveling directly through the U.S. (C1-4). D. Crewman on shore leave (D1,2). E. Treaty traders and investors and their families (E1,2).

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F. Foreign students (F1,2). G. International organization representation and personnel and their families and servants (G1-5). H. Temporary workers including agricultural contract workers (H1-4). I. Members of foreign press, radio, film or other information media and their families (I). EXHIBIT IV - HOW TO BECOME A UNITED STATES CITIZEN Most people become U.S. citizens in one of two ways: by birth, either within the territory of the United States or to U.S. citizen parents, or by naturalization. For information about becoming a U.S. citizen go to the U.S. Citizenship and Immigration Services (USCIS) website at http://www.uscis.gov/portal/site/uscis. Click on the Learn about U.S. Citizenship button on the left navigation. LEGAL BASE All Programs Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) P.L. 104-193 of 1996, as amended P.L. 106-386 of 2000, Victims of Trafficking and Violence Protection Act of 2000 P.L. 110-457 of 2008, William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 P.L. 114.22, Justice for Victims of Trafficking Act of 2015 65 FR 58301

CDC

The Child Care and Development Block Grant (CCDBG) Act (42 USC § 9858 et seq.), as amended by the CCDBG Act of 2014 (Pub. L. 113-186). 45 CFR Parts 98 and 99 Social Security Act, as amended 2016

FIP P.A. 280 of 1939, as amended, MCL 400.1 et seq. INA: Act 301- Sec. 301(8 U.S.C. 1401)(g)

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MA 42 CFR 435.403, 406, 407, Public Law 109-171 Deficit Reduction Act 2005, Social Security Act 1903(x), PL 109- 171 Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3. SDA Annual Appropriations Act Mich Admin Code, R 400.3151 – 400.3180 SNAP Supplemental Nutrition Assistance Program 7 U.S.C. 2011-2036 7 CFR 273.2(b)(1)(iii) 7 CFR 273.2(f)(1)(ii) 7 CFR 273.4(a)(4), (5), (6) and (b) 38 U.S.C 5303(b) 38 U.S.C 107 INA: Act 301- Sec. 301(8 U.S.C. 1401) (g Public Law 119-21 section 10108

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DEPARTMENT POLICY The Michigan Department of Health and Human Services (MDHHS) routinely utilizes data exchanges for verification of certain eligibility factors. Information provided with MDHHS and the Michigan Department of Lifelong Education, Advancement and Potential (MiLEAP) applications (MDHHS-1171, MDHHS-1010, DHS-4574, DHS-4574B, and DCH 1426) informs individuals of the data exchange process. OVERVIEW The Systematic Alien Verification for Entitlements (SAVE) Program enables federal, state, local government agencies and licensing bureaus to obtain immigration status information needed to determine a noncitizen applicant's eligibility for many public benefits. The SAVE Program is an intergovernmental information- sharing initiative designed to aid specialists in determining a noncitizen applicant's immigration status. This will ensure that only eligible noncitizen applicants receive federal, state, or local public benefits. The SAVE Program is an information service which benefits issuing agencies, institutions, licensing bureaus, and other entities. The SAVE Program does not make a determination on noncitizen applicant's eligibility for a specific benefit or license. All Programs Determine the status of noncitizens according to policy outlined in BEM 225. Apply the SAVE process at intake, add a member, and if a change in immigration status occurs. When the SAVE box is not checked, additional screens are required to complete the SAVE process. PROCESS The SAVE process is prompted in Bridges when the specialist completes the Alien Details screen. Record all non-citizen details in Bridges that are reported by the individual and/or are supported by documentation. The data that is required is determined by the selection of the status, document type, and verification; see Verification Sources in BEM 225. Benefits may be approved while SAVE is pending. However, if the final response from SAVE does not validate the individual’s status

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as reported, the specialist must contact the individual to clarify the discrepancy. SAVE Response The SAVE response screen begins with the display of the Individual information as entered on the Alien-Details screen. Validation of the information is obtained from SAVE at three levels. The Level 1 process should resolve ninety percent of all requests within 3-5 seconds. The Level 2 process may be required when further information is needed and may take 3-5 federal working days. Few inquiries require the Level 3 process which takes 10-20 federal working days to resolve. The three levels of SAVE are enabled as needed in the process. Level 1 The specialist must submit initial verification at Level 1. Within 3-5 seconds the SAVE response fills the data fields to com- plete Level 1. See table for possible responses and necessary action: RESPONSE to LEVEL 1 ACTION Eligibility status is confirmed SAVE indicator is checked. No further action needed by specialist. Submitted verification requires correction Correct document, number or additional verification and submit corrected verification. Institute Additional Verification Proceed to Level 2. Note: When the Class of Admission code found for the noncitizen indicates a student or exchange visitor the individual alien type/document is automatically changed to non-immigrant and SAVE is not applied. Level 2 When the initial verification cannot conclusively determine the non- citizen status electronically, the secondary verification prompts SAVE to perform a manual search of the individual’s status. The specialist must request secondary verification when indicated by the Level 1 response. See table for possible responses and necessary action:

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RESPONSE to LEVEL 2 ACTION Eligibility status is confirmed with major code other than 15. SAVE indicator is checked. No further action needed by specialist. Major code is 15.

Task/reminder is generated for specialist to proceed to Level 3. Level 3 When Level 2 verification cannot conclusively determine the indi- vidual’s non-citizen status, the Level 3 process is required. The specialist must submit the Level 3 verification when indicated by the Level 2 response. See table for possible responses and necessary action: RESPONSE to LEVEL 3 ACTION Eligibility status is confirmed with major code 1, 2, 4, 5, 6, 7, 8, 9, 11, 19, or 20. SAVE indicator is checked. No further action needed by specialist. Major code is anything other than 1, 2, 4, 5, 6, 7, 8, 9, 11, 19, or 20. Task/reminder is generated for specialist to review the SAVE response and change the alien type to undocumented alien. Complete verification.

SAVE Completion The process may be complete at any level of the SAVE process. Once complete, one of the following will occur: • The individual’s status is confirmed, the SAVE indicator is checked and eligibility status is sustained. • The specialist changes the individual’s alien status to undocumented alien and proceeds with case processing. • The SAVE response indicates non-immigrant status and SAVE is not applicable.

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LEGAL BASE Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Pub. L. No. 104-193, 100 Stat. 2105, as amended. Immigration Reform and Control Act of 1986, Pub. L. No 99-603, 100 Stat 3359 as amended (see, e.g., 8USC 1101). Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRAIRA), P.L. 104-208, 110 Stat. 3009-546. 7 CFR 272.11

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DEPARTMENT POLICY FAP Only This item applies only to non-categorically eligible FAP groups that have a member who is FAP disqualified, see BEM 213. Definitions Indigent Alien A sponsored alien who is unable to obtain food and shelter because the sum of the sponsored alien’s income and that of the sponsor’s income and contributions are less than 130 percent of the poverty income guideline for the household size; see “Determining Deemed Amounts” in this item. INA The Immigration and Nationality Act. USCIS refers to the U.S. Citizenship and Immigration Services, for- merly Bureau of Citizenship and Immigration Services (BCIS) or Immigration and Naturalization Service (INS). A sponsor is a person and the person’s spouse who has executed USCIS form I-864, I-864A or I-864EZ on or after December 19, 1997, agreeing to financially support an non-citizen as a condition of the non-citizen's entry into the U.S. for permanent residence. A sponsored alien is an non-citizen for whom the above agreement of financial support is made. Date of entry, established by USCIS, is the date the sponsored alien was admitted into the U.S. for permanent residence. Deemed income means a financial resource that is considered available to the sponsored alien without proof of an actual contribu- tion. Note: Sponsors’ assets will be deemed only to non-categorically eligible households. Overview The income and assets of both the sponsor and their spouse must be considered in determining eligibility and benefit level until:

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• The non-citizen gains U.S. citizenship. • Has earned 40 qualifying work quarters. • A portion of the sponsor's income might be deemed available to the non-citizen; see Determining Deemed Amounts in this item. Consider the deemed amounts available to the sponsored alien even if the sponsor: • Does not make an actual contribution to the non-citizen. • Gives up sponsorship responsibilities. Exception: Indigent Aliens; see Income Test. If the non-citizen changes sponsors, evaluate the new sponsor's income and assets. Deeming ceases for the earlier sponsor. The names of all non-citizens a sponsor is responsible for must be provided at application and redetermination. If the sponsored aliens are in separate FAP groups, divide the total deemable income equally among the groups. If no other names are provided, attribute the total deemable amounts to the non-citizen applicant. Exempt Aliens The income and assets of the non-citizen sponsor must be evaluated for all sponsored aliens except the following: • Any non-citizen who is under age 18. • Battered alien spouse or alien parent of a battered child for 12 months after battery is determined by USCIS or the state agency. The battered alien must not live with the batterer. • Non-citizens admitted into the U.S. as refugees under INA section 212(d)(5) or 207. • Non-citizens granted political asylum under INA section 208. • Non-citizens granted withholding of deportation per INA section 243(h). • Non-citizens admitted as conditional entrant refugees before April 1, 1980 under INA section 203(a)(7).

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• Non-citizens granted permanent resident status under INA section 245A or 210 (class code S16, S26, W16, W26 or W36 on the I-551). • An indigent alien. • Non-citizens whose sponsor signed the agreement of support before December 19, 1997. • Non-citizens who are a member of their sponsor’s FAP household. • Disqualified sponsored alien. Determining Deemed Amounts Evaluate the income and assets of the sponsor and their spouse if they live together. This applies even if they were not married when the agreement was signed. Use a DHS-2411, Statement of Sponsor's Resources, to obtain information about a sponsor. To determine deemed income, see BEM 550. Deeming ceases if the sponsor dies, regardless of a surviving spouse and/or estate. Income Test The sponsor's income deemed to be available to the sponsored alien is counted as income to the non-citizen's group. If the sponsored alien has been determined to be indigent; see Definitions, deem only that amount of income that is actually provided. Continue to deem this amount for 12 months. Determine indigence every 12 months. Send indigence determinations to the U.S. Attorney General’s Office at: U.S. Department of Justice 950 Pennsylvania Ave. NW Washington, D.C. 20530-0001 Provide the sponsor’s name and the sponsored alien’s name. Note: The sponsored alien must provide written consent before any information is released to the Attorney General or the non-

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citizen's sponsor. However, the specialist must notify the sponsored alien of the consequences of refusing to provide consent; see Refusing Information below. Reporting Changes All sponsored aliens must report sponsor information at the follow- ing times: • At application and redetermination. • At a change in sponsor. • When income of the sponsor or sponsor's spouse changes, including loss of employment. • Upon death of the sponsor or sponsor's spouse. Refusing Information If requested information about a sponsor is not provided, one of the following applies: • If the sponsored alien is cooperating, treat him as disqualified. • If the sponsored alien is not cooperating, another adult group member must cooperate. If none do, all group members are ineligible, even if they are U.S. citizens. Overissuance The sponsor and non-citizen are jointly responsible for a benefit overissuance due to inaccurate or incomplete information regarding the sponsor's income or assets. Exception: The non-citizen is solely responsible if the sponsor had good cause or was without fault. BAM 715 explains recoupment procedures for active and closed cases. Initiate recoupment from the group which received the overissu- ance. However, repayment can be made by the group, the sponsor, or both. If both parties repay and the total exceeds the overissuance, the excess must be refunded in proportion to the amount paid by each party.

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VERIFICATION REQUIREMENTS The sponsored alien must provide, or assure that the sponsor pro- vides, necessary information and verification. The non-citizen must report any change in the sponsor's circumstances. Verify a sponsor's claim of sponsoring aliens in different FAP groups. Record the non-citizen's place of birth and alien registration number in the case. LEGAL BASE FAP 7 CFR 273.4(c) 7 CFR 273.11(h) 7 USC 2014

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DEPARTMENT POLICY

Family Independence Program (FIP) and Food Assistance Program (FAP) Only A striker is a person involved in an employee strike, concerted stoppage, slowdown or interruption of work activities or employment operations. This includes a stoppage when a collective bargaining agreement expires. Persons are not considered strikers if they: • Are locked out of the workplace by the employer, or • Are not part of the bargaining unit on strike, or • Are non-strikers who fear reprisal if they cross a picket line, or • For FAP only, they were exempt from employment-related activities on the day before the strike for any reason other than being employed. FIP Only Exclude from the group a person on strike on the last day of a cal- endar month. Also exclude: • The striker's spouse, if they live together, and • The striker's children living with them APPLICATION FIP Only At application, assume a striker will be on strike on the last day of the month unless it is verified that they will not be. FAP Only FAP groups with strikers are eligible only if they were eligible for or receiving FAP before the strike and continue to be eligible. If pre- strike ineligibility is established, you do not have to determine cur- rent eligibility. Pre- and post-strike eligibility is determined as follows:

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• Evaluate the FAP group's nonfinancial eligibility on the day before the strike. If those factors were met, evaluate current nonfinancial eligibility. • Calculate the FAP group's countable pre-strike income. If the group was income eligible, combine The striker's pre-strike or current countable income, whichever is higher, plus Current countable income of other FAP group members. See Bridges Eligibility Manul (BEM) 550, FAP Income Budgeting. The FAP group is eligible if it meets all the above conditions. Both pre-strike and current circumstances must be verified. Document the case record including both the pre-strike and current circumstances. Use of Union or Company Facilities FAP Only Do not complete FAP certifications using services or facilities of organizations or individuals involved in a strike/lockout. However, you may use union or company officials to verify applicant informa- tion. ONGOING FIP Only If a group member was on strike on the last day of the report month, remove the striker from the group for two pay periods or until the strike ends, whichever is longer. Remove their spouse, if they live together, and their natural/adopted children who live with them. FAP Only Refer to the Application section in this item to determine whether a FAP group with a striker continues to be eligible.

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LEGAL BASE FIP R400.3117 FAP 7 CFR 273.1 (e) 7 CFR 273.9 7 CFR 273.10 Food and Nutrition Act of 2008, as amended

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DEPARTMENTAL PHILOSOPHY The Family Independence Program (FIP) is a temporary cash assistance program to support a family’s movement to self- sufficiency. The Family Self-Sufficiency Plan (FSSP) was created to allow Michigan Department of Health and Human Services (MDHHS) and other MDHHS client service providers to document and share information about mutual participants for optimal case management. The department’s goal of assisting families to achieve self-sufficiency whenever possible can only be achieved if barriers are properly identified and overcome. Use the Family Automated Screening Tool (FAST) and the FSSP described below to serve the FIP assistance recipients. DEPARTMENTAL POLICY Federal and state laws require each family receiving FIP to develop a plan and participate in activities that will strengthen the family and/or help them reach self-sufficiency. Users of the FSSP include MDHHS and the Partnership. Accountability. Training. Hope. (PATH)/one-stop service centers. Note: Recipients of Refugee Cash Assistance (RCA) are not required to complete the FAST or FSSP issued from Bridges. These individuals are required to complete a Refugee Family Self- Sufficiency Plan (RFSSP) with the refugee contractor (RC). Michigan’s success in meeting federal work participation requirements is measured by the participant’s actual hours of participation in work related activities as documented on the FSSP. The FSSP identifies compliance goals and responsibilities to be met by members of the FIP group, MDHHS, and PATH. The FSSP plan reflects the individual needs and abilities of the particular family, and includes the following: • The obligation of each adult to participate (an adult who is not working 40 hours a week) in PATH and to meet federal guidelines for work participation unless verified as deferred. • The obligation of each minor parent who has not completed secondary school to attend school.

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• The obligation to cooperate in the establishment of paternity and to assign child and spousal support to MDHHS and to cooperate in the procurement of child support. • The obligation of the recipient who fails to comply with compliance goals due to substance abuse to participate in substance abuse treatment and submit to any periodic drug testing required by the treatment program. • Notification to the recipient of the individual 60-month lifetime cumulative total for receiving FIP assistance. • Notification to recipient regarding employment and self- sufficiency related noncompliance that may be imposed. • Prohibition against use of FIP to purchase lottery tickets, alcohol, or tobacco. Cash assistance grants cannot be used for gambling, illegal activities, massage parlors, spas, tattoo shops, bail-bond agencies, adult entertainment, cruise ships or other nonessential items. • The Family Automated Screening Tool (FAST) is a Web-based initial screening to identify the strengths and needs of FIP families. Completing a FAST is one of the FIP participant’s first required work related activities and establishes a foundation for the development of a successful FSSP. All Work Eligible Individuals (WEIs) and non WEI’s as defined below are required to complete the FAST within 30 days and participate in the development of the FSSP within 90 days of the FAST/FSSP notice. Compliance with the FSSP is a required activity for all WEIs. These requirements apply to FIP participants who are referred to PATH as well as those who are temporarily deferred. Non-compliance with the FSSP without good cause may result in penalties outlined in BEM 233A, 233B and 233C. Exception: RCA recipients have a requirement to complete a Refugee Family Self-Sufficiency Plan (RFSSP) with the refugee contractor (RC). WHEN TO COMPLETE Explain the purpose of the FAST and FSSP during the initial in-per- son or phone interview and determine whether the participant

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needs a paper copy of the DHS-595, FAST, or additional help to complete the FAST. A FAST/FSSP notice, DHS-1535 or 1536 is automatically sent to applicants the night after the first run of eligibility (EDBC) for FIP. All participants listed on the notice are required to complete the FAST within 30 days and the FSSP within 90 days of the notice. The DHS-1535 is for deferred WEIs and the DHS-1536 is for referred WEIs. The completion of the FAST is required once for each episode of FIP assistance. The FSSP is complete when the participant, department and other service providers have agreed to the activities and the agreement date is entered in the Contract Agreement under the Contracts tab of the FSSP. The FAST is required for the determination of good cause. When a participant is noncompliant with work related activities and a FAST has not been completed during the same episode of assistance, a FAST must also be completed, in order to determine good cause. Send a DHS-2442, Notice of Employment-Related Appointment/Assignment or Home call, to the participant after the submission of the FAST and before the 90th day from the date the FAST/FSSP notice to arrange for the development of an FSSP for those not served by PATH. Note: The completion of the FSSP requires action by all agencies involved in the case management of the participant. The participant cannot be considered noncompliant for the FSSP, if the agency fails to complete the FSSP mapping process. WHO MUST COMPLETE All FIP WEIs and non-WEIs must complete a FAST and develop a FSSP. Work Eligible Individuals (WEIs) Work Eligible Individuals (WEIs) are FIP participants who count in the state and/or federal work participation rate. All WEIs are required to participate in work related activities (core or non-core) for a minimum number of hours based on case circumstances unless reasonable accommodations are required and other activities are planned; see BEM 230A. WEIs include all FIP applicants and participants, except those listed under Non-Work

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Eligible Individuals, below. For more information about the work participation role, see Exhibit I. Non-Work Eligible Individuals Non-WEIs are FIP recipients who do not count in the state and/or federal work participation rate. Non-WEIs are not required to partici- pate in work related activities for a minimum number of hours but may volunteer for core or non-core activities. Instead, non-WEIs engage in other activities to strengthen the family or improve self- sufficiency skills. For more information about PATH, see Exhibit I. Non-WEIs include all the following: • An adult FIP client who is disqualified due to being a non- citizen. Note: All other disqualified adults are WEIs. • Ineligible Grantees.The person who acts as grantee but who is not an eligible group member. • An adult FIP participant providing care for a spouse who is disabled and living in the home. Note: Verification of the disability and that the care is needed on a full time basis must be supported by medical documentation; see BEM 230A, Care of a Disabled Spouse or Disabled Child. • An adult FIP participant providing care for a child who is disabled and living in the home. Note: Verification of the disability and that the care is needed must be supported by medical documentation; see BEM 230A, Care of a Disabled Spouse or Disabled Child. The following types of dependent children are not WEIs and are the only individuals who do not have to complete a FAST or FSSP. • Dependent children who are either: Under age 16. Age 16 through 18 who are full-time students in high school.

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See BEM 245 for a definition of high school and an explanation of full time enrollment and attendance. FAMILY AUTOMATED SCREENING TOOL The Family Automated Screening Tool (FAST) is a 50-question, Web-based survey designed to identify an individual's strengths, needs and barriers to family functioning and/or successful employ- ment. The framework of information about the family that is gathered from the FAST will pre-fill various sections of the FSSP. Participants complete the FAST from any computer with Internet access. This could occur in the participant's home, through public Internet access, at the local PATH office, or from a PC available in the local MDHHS office. The address to the FAST is www.michigan.gov/fast. The client recipient ID, the name of the service county and the last four digits of the participant’s Social Security number are entered to complete a FAST. (Instruct participant to enter four zeros when participant has no Social Security number.) Completion of the FAST will take approximately 30 minutes depending on the individual's reading and computer skills. The participant must select an answer to every question even if it is skip. When the participant submits final answers to complete the FAST, the participant will be given a confirmation number to print or write down as verification that the FAST was completed. Individuals with disabilities, no Internet access or literacy skills that prevent successful completion of the FAST may complete the DHS- 595, Family Screening Tool. MDHHS specialists and PATH case managers must assist. The participant's answers from the paper FAST must be entered on the electronic FAST to pre-fill information on the participant's FSSP. MDHHS staff may enter this information for deferred participants. FAMILY SELF- SUFFICIENCY PLAN The Family Self-Sufficiency Plan (FSSP) is a Web-based service plan developed by the department, employment service provider and, most importantly, the participant. It allows agencies to share information about mutual participants to eliminate the participant's need to comply with multiple plans. It is used to collect, document,

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and report participant activities that promote self-sufficiency and meet federal reporting requirements. Information is entered on the FSSP from the following sources: • As a result of FAST completion. • Directly by MDHHS specialist. Directly by the PATH case manager. MDHHS specialists access the FSSP from Bridges. The one-stop service center case workers access the FSSP (read only) from OSMIS. Create or Update FSSP Open the FSSP at the in-person interview (new episode) or when completing a changeto enter strengths and/or barriers that are identified during the interview. Enter the case number of a pending or active FIP case in Bridges to view the FSSP. GENERAL INFORMATION ABOUT THE FSSP Each summary page in the FSSP displays a header that includes identifying information about the specific participant for quick reference: Name, client ID, case number. Required and planned hours are displayed for the benefit of serving FIP recipients. The sources of information are automatically entered on the FSSP. The sources may be the FAST (participant), FSSP, or OSMIS. Access information for various sections of the FSSP by clicking the edit pencil box to the far right of a goal, activity, strength, etc page. Enter comments by clicking the comment icon at the top of a barrier, strength, etc page. Click save and continue prior to leaving a section to save your entry. Add case comments to clarify and changes or errors. Previously saved comments cannot be deleted. Items entered and comments saved for those items from the FAST cannot be deleted.

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CLIENT INFORMATION Information in these sections are either pre-filled by systems or saved by the case manager. Information saved by the case man- ager will remain on this FSSP despite the status of the FIP assis- tance. There are six sections under this tab: • Client Information- Contact- The page will be auto populated by the information found on the Data collection pages in Bridges. . • Employment Information- The Employment pages will auto populate by the information found on the Data Collection pages (Employment-Details and Employment-Summary). • Skills Information- The Specialist will evaluate and measure individual skill levels and enter information on the Skills page. • Education Information- The Specialist will evaluate and measure individual education level and educational goals and enter information on the Education page. • Testing Information- The Specialist will evaluate and measure the need for testing and enter testing information on the Testing page. Family Strengths Information- Individual or Family goals will appear on the Strengths page. Participation These fields are automatically pre-filled and are read only. Required Hours are the minimum of hours per week, on average, that a participate must participate in work related activities to meet the federal work participant requirement. Planned Hours are the hours per week, on average, that a partici- pant will participate in work-related or other activities which are doc- umented under the Goals and Activities tab. Activities assigned by the PATH in the OSMIS system are included in this calculation.

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STRENGTHS AND ABILITIES. Start with this section when you interview the participant to complete the FSSP. Compliment the participant on strengths identified at application, interviews or by completion of the FAST. A confident participant will be a more active participant in developing the FSSP. Strengths are identified by type: employment, education and training or family strengthening for quick reference by the worker assigned from each agency. Some strengths will be pre-filled based on how the participant answered the FAST questions. Comments may be entered for items collected from the FAST; however, the item cannot be deleted. Enter comments to strength when necessary as you discuss them with the participant. Help the participant identify resources the participant already has available to move toward success without MDHHS. The following technique is recommended: Tell me about a success you have had in the past. Which of your qualities contributed to your success? Have you always had this quality or did you have to learn it? Often concerns can translate to strengths. For instance: • Children who have no history of truancy or expulsion from school.. • An individual successfully completed inpatient or outpatient rehabilitation.. • Successfully completed Employment and Training programs under the Job Training Parternership Act (JTPA). • An individul who have litte ornever worked, however very knowledgeable in life experiences, andbonded with their children. BARRIERS & RESOURCES

Barriers Identify, document and address barriers to self-sufficiency in this section as in the Strengths and Abilities section.

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Based on how the participant answered the FAST, explore the need to address specific potential barriers. Discuss these items with the individual and document results discussion in the comments section associated when necessary. When the FAST results suggest a barrier that the participant has already addressed or does not recognize, document this in the comments and focus on addressing barriers which the participant recognizes and is ready to work on. Consider activities that could be planned that will address the barriers the participant is willing and able to address. Resources After discussing strengths and abilities, complete the resource sec- tion. FAST results in this section will report needs for which the par- ticipant specifically requested help or services. Participants are more likely to be successful in activities related to these items because they are self-identified. Help the participant choose activi- ties related to these items. Add potential referrals to this section for needs that are identified but an activity cannot be entered to address that need, or the participant does not yet recognize the need. GOALS & ACTIVITIES Enter goal and activity information agreed upon with the participant in these sections. Remember to ask about and enter activities in which the participant is already participating. Goal Help the participant identify family goals. Use the miracle question to allow him/her to dream or create an alternative future. When using the miracle question, ask the participant: “When you wake up tomorrow morning and your world is exactly how you want it to be, what would be different from today?” If the participant’s goals are too vague, broad, or far in the future, assist by asking for more detail so the participant will be motivated toward short term goals and a plan can be developed. To be meaningful, the goals must be achievable, clear, simple, and measurable. Participant complaints about their current situation can be rephrased as goals to change something in their lives. For example, if the participant complains that s/he does not have enough money, the goal could be to get more money. Get details on what s/he would buy with the money to make the goal more

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concrete. Compliment the participant as s/he works through this process. Activities Activities are specific actions the participant will take to reach the goal(s) and meet PATH requirements. Activities are divided into three categories: core, non-core and other. Note: PATH workers enter activities in OSMIS when the WEI is referred there. Necessary comments that pertain to PATH activities must be entered in OSMIS. Core Activities Core activities are recorded by PATH for the WEI referred to the PATH. They include the following activities: • Unsubsidized employment. • Subsidized private and public sector employment. • Work experience. • On-the-job training. • Job search/job readiness. • Community service programs. • Vocational educational training, including condensed vocational training. • Providing child care for a community service participant. Unless a WEI is planning to participate in a minimum of 20-hour core activities and the remaining required hours in non-core activi- ties, none of the hours will meet federal participation requirements and thereby reduce the state’s participation rate. Fair Labor Standards Act (FLSA) As a core activity, when a participant is assigned to or participating in unpaid work activity that includes community service or work experience, the total number of required hours of participation in the unpaid work cannot exceed the FIP grant amount divided by state minimum wage per month.

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Combined FIP/FAP Waiver In order to comply federal FLSA requirements, a participant must engage in another core activity if the maximum unpaid work hours are not enough to meet the minimum federal participation require- ments. With the combined FIP/FAP waiver, the FIP and FAP grants are combined and divided by the state minimum wage, in most cases, allowing the participant increased hours for which they can participate in community service and/or unpaid work experience to meet federal work participation requirements. Furthermore, if a par- ticipant is assigned the maximum hours allowed by the FLSA calcu- lation, but this maximum is not enough to meet their core hour requirement, the remaining core hours may be “deemed.” Deeming gives the participant credit for completing core (for community ser- vice or unpaid work experience only) hours when they have not actually met their required hours, due to the FLSA restriction. By deeming, the participant meets WPR requirements for the month. Note: Bridges interfaces to OSMIS the combined FIP/FAP grant amount on a monthly basis. Example: FIP and FAP grant amount combined for a family of two (consisting of one adult and one child) is $803. Divide $803 by state minimum wage ($9.25). The total of 86.81 hours per month is rounded to the lower whole number. 86 hours per month is the maximum number of community service/unpaid work hours that may be required of the participant. This participant has a 30 hour per week minimum federal requirement, multiplied by four weeks, totaling 120 hours per month. In this example, there is a shortfall of 34 required hours, as the FIP and FAP combined grant amounts limits the participant to 86 hours maximum in community service and/or unpaid work experience. The participant will be deemed as meeting his/her entire work requirement for that month. A participant with a 30 hour requirement must complete their 20 required hours in the core activities and may complete the additional 10 required hours in non-core activities. If the participant is able to deem their 20 hour requirement based on the combined FIP/FAP waiver, but does not meet their additional 10 hour non- core requirement, that participant will not meet their work participation requirement for the month.

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Non-Core Activities Non-core activities are only countable when the minimum number of core activities have been met. Non-core activities include the following: • Job skills training directly related to employment. • Education directly related to employment. • High school completion/GED. Other Activities Other activities are family strengthening activities that may support efforts made toward self-sufficiency and are not counted toward federal participation requirements. These include self-improvement or other activities that will assist the participant to overcome barriers so they may participate in employment services or otherwise strengthen the family. Other activities include but are not limited to the following: • Parenting programs or classes. • Counseling, including mental health, substance abuse, marital, family. • Life skills programs or classes . • Conflict resolution programs or classes. • Arranging child care or home care for a family member with disabilities. • Attendance in a support group. • Any other activity that would assist the participant in achieving self-sufficiency. Any activities that are part of the FSSP must be appropriate to the individual’s and family’s needs and circumstances, including disability-related needs or limitations. Note: Counseling contractors are paid directly from the DSS allocation. Contractors that serve your county are listed in the MDHHS-Net by selecting the Department Site, Central Office, Financial and Administrative Service, Logistics and Rate Setting, Counseling Contracts. Select the county and type of counseling desired.

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REQUIRED HOURS OF PARTICIPATION FOR WEIS Required hours are the minimum number of hours per week on average the WEI is to participate in work-related activities to meet the federal work participation requirement. Required hours will appear in the Required Hours field on the FSSP and OSMIS for every WEI. Required hours are automatically determined by the group composition when the FSSP is opened/edited as follows: Single Parent Households 20-Hour Requirement A FIP group containing only one WEI when the youngest child in the group is less than six years old. Exception: A WEI who is temporarily deferred from a referral to employment services due to being a caregiver of a child less than two months old or a caretaker of a child less than six years old is temporarily disregarded from participation when appropriate, adequate or affordable child care is not available and unavailability is verified in writing by the Great Start Connect contractor. (Required hours are zero). 30-Hour Requirement A FIP group containing only one WEI parent when the youngest child in the group is six years old or greater. Note 1: A FIP household containing two parents, where only one parent is a FIP group member/WEI due to the marriage exemption, will follow the single parent household hour requirements. Note 2: A FIP household containing two parents has a 30 hour requirement, regardless of the age of the youngest child, when only one parent is a FIP group member/WEI due to receipt of SSI by the second parent. Two-Parent Households In a two-parent family, the required hours apply to the couple as opposed to the individual; however, the entire required hours

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appear only on the grantee’s FSSP. The second adult will show zero required hours. Exception: A two-parent household is considered a single-parent household when one parent: • Receives SSI. • Is needed in the home to care for a child/spouse who is disabled. • Is disqualified due to being a non-citizen. Combined 35-Hour Requirement A FIP group containing two WEIs when the group is not active for the Child Development and Care (CDC) Program or CDC payment has not been authorized. One WEI can complete combined 35 hour requirement. Combined 55-Hour Requirement A FIP group containing two WEIs when the group is active for the CDC Program and CDC payment has been authorized. Both WEIs must complete combined 55 hour requirement. 18 And 19 Year Old Adults 18 and 19 year old adults who are active at the one-stop service center may be deemed as meeting their required hours if they are participating in high school completion or GED to satisfactory atten- dance as determined by the educational institution. This deeming is determined by the PATH case manager. REQUIRED HOURS OF PARTICIPATION FOR NON-WEIS Non-WEIs are not required to participate in work related activities for a minimum number of hours. Instead, they should be encouraged to engage in activities to strengthen the family or improve self-sufficiency skills. Notice the difference in verification requirements for the WEI and non-WEI.

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DRAWING ACTIVITIES FROM YOUR CLIENT Employment service providers take the lead in planning activities when the participant is referred for employment services. MDHHS must plan and monitor other activities appropriate to the needs, strengths and circumstances of a family when the participant is referred to the employment service provider for a reduced number of hours due to a partial deferral, accommodation for disabilities or special needs and/or limitations. MDHHS takes the lead in planning activities when the participant is not referred to an employment service provider. Explore situations from the participant’s past to find success. Ask, “Was there ever a time in the past when you were in a similar situa- tion? Do you know of anyone who has been in a similar situation? How was that handled?” Get details. Allow the participant time to think. Compliment the participant as s/he thinks of solutions. Write down all options the participant comes up with, then discuss the possible consequences after a few options have been listed. Do not offer solutions. Let the participant suggest his/her own ideas. Help the participant identify the activities s/he needs to take, the date to start the activities, and the expected result. Ask the partici- pant, “What is the very first small step? Before that? Before that? What else?” until the participant identifies specific activities s/he can begin now. Ask, “How will you do that?” “How will you know when you achieve it?” and “What would you like to see happen as a result?” Consider the participant’s circumstances and local resources in helping them choose the best activity. Keep these suggestions in mind when assisting the participant to identify options they can choose to meet goals. Avoid using phrases such as “you should,” “why don’t you?” or “you must.” Ineligible grantees are more likely to engage in activities that pro- mote family strengthening such as volunteering at their childrens’ school or visiting the library on a regular basis.

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Entering Goals/ Activities on the FSSP Click Add to enter the participant's long and/or short-term goal statements or an activity. Select the type from education & training, employment, or family strengthening for a goal. The activity selected determines the fields used to describe specifics about the activity. You may enter other details about the activity in the Description area. Statuses include • Planned: The participant has agreed to participate in the goal/activity. • In Progress: The participant is currently participating in the goal/activity. • Complete: The participant completed the goal/activity. Enter an end date. This goal/activity will be stored in the History section of the activities screen. A completed goal will also appear as a strength. • Abandoned: The participant is no longer participating in this goal/activity. This activity will automatically move to the History section of that screen for future consideration. Other Fields Other fields that may appear in a goal/activity are as follows: • Begin Date: Enter the expected begin date or actual begin date. There are time limits on some activities so it is most advantageous to begin an activity early in the week that starts with Sunday. • Target Date: The target date for a GOAL is the anticipated date of completion. The target date for an ACTIVITY is the next date the actual hours must be entered on the FSSP. • End Date: Enter the last date the participant participated in the goal or activity. • Planned Hours/wk: Enter the average number of hours per week the participant expects to participate in the activity. This must be a whole number.

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• Actual Hours/wk: The Status of an activity must be saved as In Progress to enter Actual Hours/wk. Enter the number of hours per Verifications later in this item. Note: Actual hours must be entered for all WEIs for their participation in work related activities to be counted in the federal participation rate.

Verification of wage earning activities must be entered in the Actual Hours at least every six months. Project the actual hours by taking the average from at least two consecutive pay stubs that represent hours worked. Actual hours may be projected for up to six months or one week at a time.

Verification of unpaid activities must be entered in the Actual Hours of that activity aweekly for the WEI. The DHS-630, Weekly Activity Log, is completed and submitted by the WEI participant weekly to the worker who is monitoring that activity. The worker must enter the actual hours within two weeks of receipt. Note: Set the activity target date to the next date actual hours must be entered for each activity. PATH case managers continue to enter activities and actual hours on the OSMIS system. Activities documented in OSMIS will appear in the FSSP fields the day after they are saved on OSMIS. For any of a participant’s hours of work related activity to count towards the federal requirements, they must participate in at least 20 hours of core activities in addition to the remaining number of required hours in non-core activities per week. In a two-parent home that has a 35 hour/week work related partici- pation requirement, the group must participate in at least 30 hours of core activities in addition to the remaining number of required hours in non-core activities per week for their participation to count toward the federal requirement. In a two-parent home that has a 55 hour/week work related partici- pation requirement, the group must participate in at least 50 hours of core activities in addition to the remaining number of required hours in non-core activities per week for the their participation to count toward the federal requirement.

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PERSONAL CONTRACT The Personal Contract page of the FSSP is used to display activi- ties agreed to, target dates,changes made to the FSSP, and document the participant’s agreement to the plan. Initial development of the FSSP is considered complete when a date is entered on the Contract Agreements section for the first time of the current episode of cash assistance. This is documentation of the participant’s agreement to the goals and activities entered. Complete the Personal Contract when the FSSP is initially developed, and each time changes are made to the activities within the FSSP. Give or send a printed copy of the contract to the participant each time it is completed. The printed version of the Personal Contract includes a notification to the participant that s/he must contact the MDHHS/PATH worker if anything interferes with the completion of an agreed upon activity. A clear and accurate Personal Contract is important when it is developed as part of the triage or good cause determination. When the participant is available and willing, obtain the participant’s signature on the printed version of the Personal Contract. However, if the FSSP is completed or updated over the telephone, acknowledge the participant’s agreement in the comments section and mail a copy of the updated personal contract to the participant. FOLLOW-UP Participation in an activity entered on the FSSP is monitored by the agency that entered the activity. The target date entered for an activity is either the next time actual hours are to be entered for WEI’s activities or follow-up to non-WEI’s activities. The next target date entered for each completed FSSP appears on the FSSP Target Dates report for MDHHS to view the dates to follow up. Example: The PATH case manager assigned the participant to spend 20 hours per week developing a resume and seeking employment and the PATH case manager referred the participant to engage in parenting classes 10 hours per week. PATH monitors compliance with the hours of activity. The FSSP is a work in progress while the FIP case is active. Review the goals and activities frequently in the process of case management.

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• Ask the participant how s/he is coming along with the activities. The previous contact’s narrative may assist in this process. Ask the participant, “What’s better?” • Using strength-based interviewing, address concerns related to meeting participation requirement if the participant is not participating. • Update the dates activities were accomplished, comments and outcomes. Add new activities as appropriate. • Document new individual and family abilities and skills as they are developed or identified. FAILURE TO COMPLY The WEIs failure to submit the FAST within 30 days of the notice date is failure to meet eligibility requirements. A task/reminder is sent to the specialist to deny the pending application for FIP. The participant’s failure to participate (can not be local office fault) in the development of the FSSP within 90 days of the notice date creates a record of noncooperation and a task/reminder is sent to the case manager to determine good cause for the noncooperation ion the active FIP EDG. Policy Questions Questions regarding this policy may be submitted by authorized users to the Employment & Training policy email box at: Policy- Employment@Michigan.gov. VERIFICATION REQUIREMENTS

Wage Earning Activity Document actual hours of participation in wage earning activities that are not monitored by PATH when earnings start and every six months thereafter. Take the average of verified hours from one of the following sources: • MDHHS-38, Verification of Employment.

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• Minimum of two consecutive pay check stubs that represent expected hours of participation. • Collateral contact with employer or other person who has knowledge of the position and wages earned. Non-Wage Earning Activity Verification of the WEIs participation in core, non-core, and other activities that do not pay wages must be documented in the Actual Hours section of that activity at least biweekly. The only acceptable source of verification is the DHS-630, Weekly Activity Log. Monitor the non-WEIs participation in activities during any contact with the family. Verification is not required. VERIFICATION SOURCES

Wage Earning Activity • MDHHS-38, Verification of Employment. • Minimum of two consecutive pay check stubs that represent expected hours of participation. • Collateral contact with employer or other person who has knowledge of the position and wages earned. Non-Wage Earning Activity Monitor the non-WEIs participation in activities during any contact with the family. Verification is not required. LEGAL BASE FIP MCL 400.57e

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EXHIBIT I - PATH ROLE

PATH ROLE Employment Code Required Hours In Federal WPR In State WPR 3 month, 6 month lifetime Sanction Eligible Work Eligible Individual (WEI): FIP recipients required to participate in employment-related activities. S/he counts in either the Federal or State WPR. S/he complete the FAST and participate in the development of an FSSP in conjunction with an employment service provider and MDHHS. WD/WL/WF (single) Y Y Y Y WD/WL/WF (two-parent) Y N Y Y VV Y Y Y Y TC Y Y Y Y WU (FIP) Y Y Y Y OL N Y Y Y SE (grantee) Y Y Y Y SE (not grantee) N Y N N VN Y Y Y Y EI Y N Y Y IN Y N Y Y DV Y Y Y Y DC Y Y Y N

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PATH ROLE Employment Code Required Hours In Federal WPR In State WPR 3 month, 6 month lifetime Sanction Eligible TE Y Y Y Y CA (2-month limit) N N Y Y PG Y Y Y Y OM* (WF) Y Y Y Y Non-WEI: FIP member and/or grantee not required to participate in employment-related activities but is required to complete a FAST and assist in the development of an FSSP in conjunction with MDHHS that may include family strengthening activities (such as, other in FSSP). 00 N N N N NC N N N Y NS N N N Y * New with Bridges.

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

DEPARTMENT PHILOSOPHY Clients must be made aware that public assistance is limited to 60 months to meet their family’s needs and they must take personal responsibility to achieve self-sufficiency. This message, along with information on ways to achieve independence, direct support ser- vices, non-compliance penalties, and good cause reasons, is initially shared by Michigan Department of Health and Human Services (MDHHS) when the client applies for cash assistance. The Partnership. Accountability Training. Hope. (PATH) program requirements, education and training opportunities, and assessments will be covered by PATH when a mandatory PATH participant is referred at application. DEPARTMENT POLICY

PATH Application Eligibility Period Completion of the 10-day PATH application eligibility period (AEP) part of orientation which is an eligibility requirement for approval of the FIP application. PATH participants must complete all of the fol- lowing in order for their FIP application to be approved: • Begin the AEP by the last date to attend as indicated on the DHS-4785, PATH Appointment Notice. • Complete PATH AEP requirements. • Continue to participate in PATH after completion of the 10-day AEP. Deny the FIP application if an applicant does not complete all of the above three components of the AEP. Jobs and Self-Sufficiency Survey At application, the registration support staff must provide clients with a DHS-619, Jobs and Self-Sufficiency Survey. For applications received from MI Bridges, the questions from the DHS-619 have been incorporated into the screens. Specialists must do all of the following: • Review the survey or the PDF copy of the application from MI Bridges, and other information in the case record and Bridges

BEM 229 2 of 7 PATH PROGRAM REFERRALS & THE APPLICATION ELIGIBILITY PERIOD BPB 2025-008 4-1-2025

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

during the intake interview to make a preliminary barrier assessment to determine the client’s readiness for PATH refer- ral. Note: Be alert to indicators that the client or family members suffer from undisclosed or undiagnosed disabilities. Some disabilities diminish the individual’s ability to recognize or articulate his/her needs or limitations. Temporarily defer clients who need further screening or assessment. • Identify and provide direct support services as needed. Child care and transportation barriers are common. MDHHS is responsible and must assist clients who present with child care or transportation barriers before requiring PATH attendance; see BEM 232 Direct Support Services. • Open/edit the Family Self-Sufficiency Plan (FSSP) and enter strength and barrier information identified and addressed during the intake process. • Temporarily defer an applicant with identified barriers until the barrier is removed. • Temporarily defer an applicant who has identified barriers that require further assessment or verification before a decision about a lengthier deferral is made, such as clients with serious medical problems or disabilities or clients caring for a spouse or child with disabilities. Note: Clients should not be referred to orientation and AEP until it is certain that barriers to participation such as lack of child care or transportation have been removed, possible reasons for deferral have been assessed and considered, and disabilities have been accommodated. Work and Self- Sufficiency Rules Use the DHS-1538, Work and Self-Sufficiency Rules, to explain all of the following to clients at FIP application for each episode of assistance: • Direct support services opportunities, including transportation and child care required to attend AEP orientation. • Work requirements and reasons why a person may be deferred from PATH and work requirements.