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BEM 100 11 of 18 INTRODUCTION BPB 2026-014 5-1-2026

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

Policy exception requests must include: • Case name (group member needing exception). • Case number. • Name and phone number of local office contact person. • A detailed description as to why the exception is being requested. • What steps the local office has taken to resolve the issue. • How the case fits into one of the three allowable situations above. • Copies of all related material. Medicaid only Medicaid policy exception requests may be sent ID mail, fax or email to:

Department of Health and Human Services

Bureau of Medicaid Policy, Operations and Actuarial Services

Eligibility Policy Section

PO Box 30479

Lansing, MI 48909 Medicaid exception requests may be faxed to: 517-241-8969. Medicaid exceptions may be requested at eligibilitypolicy@michigan.gov Policy exception requests must include: • Beneficiary name. • Case number and beneficiary ID number. • Name and phone number of local office contact person. This should include a secure fax or email in which protected health information may be shared. • A detailed description as to why the exception is being requested, including the BEM policy item. • What steps the local office has taken to resolve the issue.

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Page 11

Official source

BEM 100 11 of 18 INTRODUCTION BPB 2026-014 5-1-2026

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

Policy exception requests must include: • Case name (group member needing exception). • Case number. • Name and phone number of local office contact person. • A detailed description as to why the exception is being requested. • What steps the local office has taken to resolve the issue. • How the case fits into one of the three allowable situations above. • Copies of all related material. Medicaid only Medicaid policy exception requests may be sent ID mail, fax or email to:

Department of Health and Human Services

Bureau of Medicaid Policy, Operations and Actuarial Services

Eligibility Policy Section

PO Box 30479

Lansing, MI 48909 Medicaid exception requests may be faxed to: 517-241-8969. Medicaid exceptions may be requested at eligibilitypolicy@michigan.gov Policy exception requests must include: • Beneficiary name. • Case number and beneficiary ID number. • Name and phone number of local office contact person. This should include a secure fax or email in which protected health information may be shared. • A detailed description as to why the exception is being requested, including the BEM policy item. • What steps the local office has taken to resolve the issue.