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BEM 117 4 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

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.

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Official source

BEM 117 4 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

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.