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BEM 105 6 of 8 MEDICAID OVERVIEW BPB 2024-001 1-1-2024

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

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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Page 6

Official source

BEM 105 6 of 8 MEDICAID OVERVIEW BPB 2024-001 1-1-2024

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

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.