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BEM 101 2 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

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

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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Official source

BEM 101 2 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

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

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.