Michigan Medicaid Policy Final Draft Review Effective July1, 2011

DEPARTMENTAL CLEARANCE/FINAL DEPARTMENTAL REVIEW
Michigan Department of Human Services

Date: 05/04/2011 Project Number: BPB 2011-MA Project Title: Bridges July Policy for Medicaid
EMAIL TO:
DHS Director (Maura Corrigan) Revenue Enhancement
Office of Communications (Colleen Rosso) Community Action (Stacie Gibson)
Legislative Services (Karyn Ferrick) MI Community Service (Paula Kaiser VanDam)
Family Advocate (Stacie Bladen) Interagency/Community Services (Jocelyn Vanda)
Chief Deputy Director (Duane Berger) Adult & Family Policy (Kim Keilen)
Deputy Children's Services (Steve Yager) Disability Determination (Charles Jones)
Deputy Legal Services (Rebekah Visconti) Early Education & Care (Lisa Brewer-Walraven)
Children & Adult Licensing (James Gale) Bureau of Child Support (Marilyn Stephen)
Management & Technology Office of Inspector General (Alan Kimichik)
Human Resources (Susan King) Internal Audit (Rod Markowski)
Deputy Field Services (Dwayne Haywood) Quality Assurance (Julie Horn Alexander)
Deputy Financial Services (Susan Kangas) Adult Services (Cynthia Ferrell)
Deputy Strategic Services (Dudley Spade) Poverty Unit (Linda Schmidt)
Deputy Policy & Compliance (Brian Rooney) Domestic Violence (Debi Cain)
Quality & Adult Services (Barbara Anders) Homelessness (Pat Caruso)
Public Assistance (Jane Goetschy) Accounting Divison()
Budget Division (Jane Schultz) Contact Center (Edward Woods III)
Grant Management
Strategic Planning (Terri Gilbert)
Logistics & Rate Setting
FROM:
Office Name Purpose
Office of Communications, Grand Tower Suite 1510, Clearance Required
PO Box 30037, Lansing, MI 48909 Information Only ± Sent to all offices checked above.
Contact Person Phone Number Due Date
Judith A. Galant 517-241-7084
Contact Email Fax Number June 6, 2011
galantj@michigan.gov 517-373-8471
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INSTRUCTIONS
Please review the attached manual material.
Combine all comments from your administration and forward one consolidated recommendation by the due date.
If you wish to discuss the mDWHULDOSOHDVHFRQWDFWWKHDERYHQDPHG³FRQWDFWSHUVRQ´
Clearance
No Comments Discussion Required Prior to Making Changes
Approved See Comments Below This Office Must Review After Changes
Disapproved See Comments in Text Review Not Necessary After Changes
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Comments

Department of Human Services (DHS) will not discriminate against any
AUTHORITY: P.A. 280 of 1939. individual or group because of race, religion, age, national origin, color,
COMPLETION: Voluntary. height, weight, marital status, sex, sexual orientation, gender identity or
CONSEQUENCE FOR NOT RESPONDING: Comments cannot be expression, political beliefs or disability. If you need help with reading, writing,
considered. hearing, etc., under the Americans with Disabilities Act, you are invited to
make your needs known to a DHS office in your area.
DHS-311 (Rev. 5-09) Previous editions obsolete. MS Word

BAM 110 1 of 19 APPLICATION FILING AND REGISTRATION
DEPARTMENT
POLICY
Request for All Programs

Assistance
A request for assistance may be in person, by mail, telephone or an
application can be obtained on the Internet. The requester has the right
to receive the appropriate application form:
• DHS-1171, Assistance Application (all programs). The DHS-1171

packet includes an information booklet and the assistance applica-
tion. A filing form used to preserve the application filing date is
available on the last page of the information booklet and online at
www.michigan.gov/dhs-forms.
• DHS-4583, Child Development and Care (CDC) Application.
• DCH-0373D, MIChild/Healthy Kids Application (Healthy Kids cate-

gories). Brochures are available in English, Spanish, and Arabic
on the DCH Web site at www.michigan.gov/mdch. Select MDCH
brochures Available for Download from the Quick Links in the right
navigation.
• DHS-4574, Medicaid Application for Nursing Facility Patients, LTC

clients only.
• DHS-1514, State Emergency Relief Application.
Note: Local offices must assist clients who need and request help to
complete the application forms; see BAM 115.
CDC
Migrant families must complete a new application each time the family
moves to a new county.
Response to All Programs

Requests
For a request in person, the local office must do all of the following:
• Give the requester an application the same day.
• Explain the right to file the application (or DHS-1171 Filing Form,
with the minimum information) that day and encourage the client
to do so.
• Explain that the application date might affect the amount of bene-
fits.
Encourage the person to complete the entire application that day. Per-
sons who cannot complete the entire application should complete the
BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
DHS-1171, Filing Form, to protect their application date. BAM 105 lists
the minimum information to file an application.
For a request by letter or telephone, mail the application by the end of

the next workday. If the application is not returned, the requester must
be contacted according to local office procedures.
Applicants must be informed of their option to obtain a DHS-1171,

Assistance Application, which includes a filing form, at the following
web site: www.michigan.gov/dhs-forms.
Note: Your office may register requests for assistance on Bridges; see
the REQUESTS section in this item. The applicant may withdraw their
request for assistance at any time.
CDC
For a request in person, the local office must:
• Give or send the client that same day the following forms:
•• A DHS-4583, Child Development and Care (CDC) Assis-

tance Application, or a DHS-1171, Assistance Application.
•• A DHS-4640, Child Development and Care (CDC) Applicant

Instructions.
•• A DHS-220, Child Development and Care Unlicensed Pro-

vider Application, if the client will be using an unlicensed pro-
vider and the provider is not currently enrolled in Provider
Management.
•• A DHS-4025, Child Care Provider Verification.
• Explain the requestor’s right to file the application that day and
encourage s/he to do so.
• Explain that the application receipt date will affect the effective
date of eligibility for CDC.
For a request by letter or telephone, mail the application and the

aforementioned forms to the requestor by the end of the next workday.
MA Only
Receipt of a completed MSA-2565-C, Facility Admission Notice, serves

as a request for MA for all persons except:
• Automatically eligible newborns, see BEM 145.

• Active MA recipients.
• Pending MA or FIP applicants.

All other requests must be registered and the client must be sent the
following:
• DHS-126, Medicaid Application Inquiry.

• The appropriate application form.
• MSA Pub. 726, Nursing Facility Eligibility (if LTC admission).
The following publications must be given or sent to MA applicants and

other interested parties:
• MDCH Pub.A Guide to Michigan Medicaid Health Plans.

• DCH Pub. 617, Medicaid Deductible Information.
• MSA Pub. 726, Nursing Facility Eligibility.
• MDCH Pub. 769, Medicare Savings Program.
For Medicaid brochures from the Michigan Department of Community

Health, select Medicaid and Health Brochures from the list on the DCH
website.
APPLICATION All Programs
The DHS-1171 is used for most applications and may also be used for
redeterminations; see Redeterminations in this item. It can accommo-
date six names of persons living in the household. A form-fillable ver-
sion of the assistance application is available on the
www.michigan.gov/dhs-forms website. Extra pages for reporting house-
hold members, income, assets, etc. are also available from this loca-
tion.
CDC
Either the DHS-4583 or the DHS-1171 may be used to apply for CDC.
MA Only
The DHS-1171 may be used for all MA categories. In addition, the fol-
lowing applications are used for MA:
• DHS-4574, Medicaid Application for Nursing Facility Patients, for

LTC clients only.
• DCH-0373, MIChild/Healthy Kids Application, for Healthy Kids cat-

egories only.
• The MIChild Renewal Form. This form is used as a Healthy Kids

application. MIChild sends the form to DHS when MIChild deter-
mines a person may be eligible for Healthy Kids.
An application may be made for a deceased person. The person is not

eligible after the month of his death.

The following persons are automatically eligible without completing

an application:
• Department wards; see BEM 117.
• Title IV-E recipients; see BEM 117.
• Special Needs Adoption Assistance Agreement recipients; see

BEM 117.
• Newborns of MA recipients; see BEM 145.
Retro MA MA Only
Applications
The DHS-3243, Retroactive Medicaid Application, is used along with
the DHS-1171, DHS-4574 or DCH-0373 for retro MA applications. Only
one DHS-3243 is needed to apply for one, two or three retro MA
months; see RETRO MA APPLICATIONS in BAM 115.
Who May Apply All Programs
Any person, regardless of age, or their authorized representative (AR)

may apply for assistance. For FAP only, an AR must apply on behalf of
certain clients; see the AUTHORIZED REPRESENTATIVES section
below.
Date of Application All Programs
Faxed and Paper The date of application is the date the local office receives the required
Applications minimum information on an application or the filing form. If the applica-
tion or filing form is faxed, the transmission date of the fax is the date of
application. Record the date of application on the application or filing
form.
The date of application does not change for FIP, SDA, MA, CDC or
AMP when the application is transferred to another local office.
FAP Only
See the WHERE TO APPLY/PROCESS APPLICATIONS section in this

item.
Online MA Only
Applications
For applications filed online, the date of the application is the submis-
sion date regardless of the time received.

FAP Only
If the application is filed online after close of business (such as week-

ends, holidays, after 5:00 p.m. on business days), the date of applica-
tion is the following business day.
Date of Application FIP and SDA Only

for Member Add
The date of application for a member add depends on whether the
member being added is a mandatory, optional, or disqualified member.
• Mandatory Group Members - The date of application is the date

the person joins the group. The group must update and complete
the application form to provide the information necessary to deter-
mine eligibility. You must ask when the person joined the group
and document the date on the application form.
Exception: For dependent child member adds, you may obtain

the information needed to determine eligibility and document the
case record. The client need not sign the updated application.
• Optional Group Members - The date of application is the date the

person updates or completes the application form to request assis-
tance.
• Disqualified Group Members - The date of application is the date

the person meets the eligibility factor or agrees to cooperate, pro-
vided he subsequently cooperates with the requirement that
caused the disqualification. A disqualified person remains a mem-
ber of the applicant group during the disqualification period, so he
is not required to update or complete an application, unless it is
necessary to update the form as a part of the cooperation require-
ments.
CDC
See BAM 220 for CDC member adds.
MA and AMP Only
The date of application for a member add is either the date the applica-
tion form is updated and re-signed in the local office or the date the new
application form is received by the local office.
FAP Only
See BEM 550 for member add policy.

Response to All Programs

Applications
An application or filing form, with the minimum information, must be reg-
istered on Bridges unless the client is already active for that pro-
gram(s); see REGISTERING APPLICATIONS in this item.
If there is no record on Bridges, the system assigns individual ID num-

ber(s) and an application number.
Note: A person may withdraw an application at any time before it is dis-

posed on Bridges; see WITHDRAWN APPLICATION in this item.
DHS Pub. 280, Reporting Changes - When To Report - How To Report -

What To Report, describes the client reporting responsibilities. This
publication must be given to the client at application.
Multiple FIP, SDA, RAP-C, CDC and FAP

Applications
When an application is pending and additional application(s) are
received prior to certification of the initial application, do not automati-
cally deny the application(s). You must do the following:
• Review the information for impact on eligibility and benefit level.
• Ensure the case record is documented with the additional applica-

tion(s) received and note the application(s) used to determine eli-
gibility and/or benefit levels.
• Attach the additional application(s) to the initial application.
When the case is already active for program benefits and additional
application(s) are received, you must review the application for
changes in circumstances. Additionally, you must either complete a
redetermination or deny the programs requested since they are already
active.
SDA Only
Do not process an SDA application as interim assistance for a client

with an application pending for FIP.
FAP Only
The local office must screen applications to identify those requiring

expedited service at the time the household requests assistance. Infor-
mation to identify those cases is provided on the assistance application.
SSI applicants and recipients may apply for FAP benefits at the SSA
district office; see BAM 116. Your office must register the application
upon receipt, using the procedures in BAM 116.

AUTHORIZED REP-
RESENTATIVES All Programs
An authorized representative (AR) is a person who applies for assis-

tance on behalf of the client and/or otherwise acts on his behalf (for
example to obtain FAP benefits for the group).
Note: An AR is not the same as an Authorized Hearings Representa-

tive (AHR); see the Bridges Policy Glossary (BPG) for hearings policy
definition.
When no one in the group is able to make application for program ben-
efits, any group member capable of understanding AR responsibilities
may designate the AR.
The AR assumes all the responsibilities of a client; see BAM 105.
The AR must give his name, address, and title or relationship to the cli-
ent. To establish the client’s eligibility, he must be familiar enough with
the circumstances to complete the application, answer interview ques-
tions, and collect needed verifications.
WHO MAY BE AN
AUTHORIZED
REPRESENTATIVE
(AR)
FIP, CDC, SDA and An AR must be at least age 18. The person is usually a guardian,
AMP Only spouse or relative outside the group.
Severe physical or mental limitations might prevent a client from apply-

ing or designating an AR. An unauthorized person who is otherwise
qualified to be an AR may then apply for the client.
DHS staff may be authorized or unauthorized representatives for FIP-

Foster Care clients only.
CDC The authorized representative designated by the applicant may sign the
application if:
• There is an immediate need for services.

• The applicant is unable to sign the application due to an emer-
gency (for example; hospitalization, incapacity).
Exception: For CDC the authorized representative cannot be the child

care provider, a department employee, or a recruiter.
MA Only Application may be made on behalf of a client by his spouse, parent,

legal guardian, adult child, stepchild, specified relative or any other per-
son provided the person is at least age 18 or married. If this person is

not a spouse, parent, legal guardian, adult child, stepchild, or specified

relative the person must have a signed authorization to act on behalf of
the client, by the client, client’s spouse, parent(s) or legal guardian.
The application form must be signed by the client or the individual act-
ing as his authorized representative.
When an assistance application is received in the local office without

the applicants signature or without a signed document authorizing
someone to act on the applicants behalf you must do the following:
• Register the application as a request if it contains a signature.
• Send a DHS-330, Notice of Missing Information, to the client

explaining the need for a valid signature. The signature page of
the application may be copied and sent to the agency or individual
who filled out the application with the notice.
• Allow 10 days for a response. You cannot deny an application due

to incompleteness until 10 calendar days from the date of your ini-
tial request in writing to the applicant to complete the application
form or supply missing information, or the initial scheduled inter-
view.
• Record the date the application or filing form with the minimum
information is received. The application must be registered and
disposed of on Bridges, using the receipt date as the application
date.
An application received from an agency is acceptable if it is signed by

an individual and is accompanied by written documentation from the cli-
ent authorizing the agency to act as their authorized representative.
Note: If unrelated adults living in the same home apply for assis-
tance, neither has the authority to act on the other’s behalf without
written permission from the applicant.
Authorized MA Only
Representative
An authorized representative must be:
• An adult child or stepchild.

• A specified relative, see BEM 135.
• Designated in writing by the client.
• Court appointed.
• A representative of an institution (such as jail or prison) where the
client is in custody.

Persons Providing MA Only

Medical Care
Persons who provide medical care to the client, or their agents, should
not act for the client when there is a relative, guardian or friend who is
willing and able to act. If a court has appointed a guardian for a client’s
estate (such as income and assets), the guardian is usually expected to
act for the client.
Exception: An application may be made for newborns surrendered

under the Safe Delivery Law, (MCL 712.1-712.20) by the provider hos-
pital, child-placing agency, court appointed lawyer-guardian ad litem or
prospective adoptive parent.
A department employee may apply on behalf of a member of the

employee's family or a child committed to, or placed with, the depart-
ment by court order.
MA Only
An authorization to represent is a form of a power of attorney. When a

person who gave the authorization dies, the power of attorney ends.
After death, the person does not exist as a legal entity, so no one can
represent the person. However, if a person dies while the application is
pending, the application should be processed.
An estate may be created to handle the remaining business and finan-

cial issues that were outstanding at the time of death. Only a probate
court can create a decedent’s estate. The court will also appoint some-
one to act as a representative of the estate.
A court, agency or guardian legally responsible for a client must be

identified as an authorized representative (AR) by Type on Bridges.
FAP Only To apply for benefits, an AR who is a member of the group may be any
age. If outside the group, he must be at least age 18. The age limit does
not apply to a non-group member designated by the group to pick up
benefits or to use them to buy food on behalf of the household.
An AR who completes the application must be designated in writing by

the client, except for substance abuse treatment center (SATC) resi-
dents (see below).
Ensure that the group is informed of the following:
• The client or his spouse should prepare or review the application,

if possible.
• The group is responsible for incorrect information provided by the

AR that results in an overissuance.

Exception: When the AR is an SATC or AFC Home, the facility is

responsible for such an overissuance.
AR - SPECIALIZED
SITUATIONS
Substance Abuse FAP Only

Treatment Center
(SATC) An SATC resident must be represented by the center. The SATC desig-
nates a responsible staff member as the AR.
The resident should assist his AR to complete the application, and both
must sign it.
Adult Foster Care FAP Only

(AFC) Home
An AFC resident with a guardian who has legal control over their
finances or protective payee must apply through that person, unless
the guardian/payee requests in writing that the home act as the AR.
The AFC home determines which other residents are capable of apply-
ing on their own. Such a resident may apply individually or as part of a
group of residents. He may submit the application in one of the follow-
ing ways:
• Personally/In person.
• Through an AR they choose.
• Through an AR employed by and designated by the home.
Note: An AFC home may have some residents apply in groups and
others as individuals.
Restrictions on AR FAP Only

Appointments
A provider of meals for the homeless cannot be authorized to represent
them.
A person disqualified due to IPV cannot be an AR unless there is no

responsible group member or anyone else available.
Medical All Programs

Information
Acknowledgment When the AR completes the application, give or send the client a DHS-
4609, Medical Information Acknowledgment, to sign. The DHS-4609
tells the client that DHS may share medical information for purposes of
eligibility determination and program administration.
If the client is unable to sign the DHS-4609 and his condition is such
that medical information might need to be shared, refer the AR to Adult
Services.

Note: If the form remains unsigned, there is no penalty and eligibility

determinations must not be delayed.
OTHER
AUTHORIZED
REPRESENTATIVE
FUNCTIONS FAP Only
An AR may make food purchases from the FAP benefits account using
the Bridge Card. There is no age requirement for the AR who uses the
group’s FAP benefits on behalf of the group.
Note: This can be a different person than the AR who applies for bene-
fits on the client’s behalf.
Enter on the Alternate Payee/Authorized Representative screen in

Bridges the name of the person who is authorized to purchase food for
the group and indicate the Type of Authorized Representative. The
authorized representative’s name will appear on the Bridge Card fol-
lowed by ARFS.
DOCUMENTATION
AND CONTROL FAP Only
The name of every AR must be in the group's case file.
Ensure that a person who purchases food for the group is properly des-
ignated on the current DHS-1171, Assistance Application. Grantees can
call the Automated Response Unit (ARU) to terminate a Food Stamp
Authorized Representative’s (FSAR’s) access. However, grantees must
contact the FIS/ES to request a new FSAR. Ask the caller a question
only the grantee could answer to ensure the request is valid and docu-
ment the case record.
Enter the new FSAR on the Alternate Payee/Authorized Representative

screen in Bridges and mail a DHS-247, EBT Food Stamp Authorized
Representative form to the client for completion and return; see BAM
401E.
A person may represent any number of groups. When one person

(such as an employer of migrants) represents numerous clients or has
access to large amounts of food assistance benefits, use caution to
ensure the following:
• The group freely requested the AR.

• The group's circumstances are correctly represented.
• The group is receiving the correct amount of benefits.
• The AR is using the food assistance benefits properly.

DISQUALIFICATION
OF AN
AUTHORIZED
REPRESENTATIVE FAP Only
Disqualify the AR from that role for up to one year if they do one of the
following:
• Misrepresents the group's circumstances by giving false informa-

tion.
• Improperly uses the group's FAP. The disqualification begins 30

days after the client is notified (see below).
Exception: The disqualification does not apply to an SATC or AFC

home acting as AR. Report such acts by a facility representative to the
Office of Inspector General.
Send a DHS-176, Client Notice, to the group(s) and the AR, specifying:
• The proposed action.

• The reason for the proposed action.
• The group's right to request a hearing.
• The name and telephone number of a local office contact person
for more information.
WHERE TO APPLY/
PROCESS
APPLICATIONS
FIP, CDC, SDA, and A person may request or apply for assistance in any local office in Mich-
AMP Only igan. The application must be processed by a local office serving the
county or district where the person lives or is institutionalized.
Exceptions:
• A person who lives in a county participating in the Transparent

County Line project may apply and have his/her application pro-
cessed by any county that is also participating in the Transparent
County Line project.
• For MA only, see BAM 120, DCH/DHS Coordination.
• For MA only, see Transfers: Prohibited Transfers and Transfer

Guidelines in BAM 305 for exceptions to transferring cases.
• For MA and AMP, incarcerated individuals, the application should

be processed and maintained in the local office in which the indi-
vidual lived prior to the incarceration.

• For an SDA applicant in a special living arrangement (SLA), there

are specific processing responsibilities; see DEPARTMENT POL-
ICY in BEM 616.
• In Wayne County specialized districts process applications for indi-

viduals in supervised settings, or living arrangements, including:
•• Adult and children's foster care.

•• Nursing homes.
•• Hospitals.
•• Youth residential placements.
Separate adult medical districts and child and family districts serve
these special client populations.
• An application for a person living in another state must be pro-

cessed by the local office that receives it.
If a client contacts your local office in error:
• Give or send him an application and the address and phone num-
ber of the correct office.
• If he chooses to complete the application and turns it in at your

office:
•• Accept and register it as an application or request as appro-

priate.
Exception: A request for CDC must always be registered as

an application.
•• Mail it promptly to the correct office so the transfer-in office

may act within the standard of promptness; see BAM 115.
MA A Medicaid application can be processed by the local office serving the

client or the authorized representative.
MA applications for incarcerated individuals must be handled by the

county of residence prior to incarceration.
Healthy Kids MA A person may request or apply for the Healthy Kids MA categories
(BEM 129, 130, 131) at:
• Any local DHS office in Michigan

• Any local health department
• Any other DCH authorized contract agencies.
FAP Only The application must be processed by a local office serving the county
or district where the group lives.
Exception: Clients who apply online may have their FAP application
processed by any Self-Service Processing Center regardless of the
county in which they live.
For application filing purposes, persons who are county residents when
physically present in your county include:
• Students either attending school or living at home during a school

break.
• Elderly persons living with others for part of the year.
• Persons who are working or seeking work.
If a client contacts your local office in error, do the following:
• Give or send them an application and the address and phone

number of the correct office.
• Inform them that the processing time begins when the correct
office receives the application.
• If they choose to complete the application and turn it in at your

office, accept it, and mail it the same day to the correct office.
Exception: A person who lives in a county participating in the transpar-

ent county line project may apply and have their application processed
by any county that is also participating in the transparent county line
project.
WITHDRAWN
APPLICATION All Programs
A client/AR may withdraw the application any time before it is disposed

on Bridges. However, if the client has an AR, they must first revoke the
AR’s authorization to represent them before the client may withdraw the
application. The signature of the AR is not required. Document the with-
drawal on the Bridges Program Request screen.
To confirm it, Bridges will automatically generate a notice of case action

to the client and, if the client has identified a CDC provider, a DHS-198,
stating the client withdrew the application. The client may reapply any
time.
REGISTRATION All Programs
All applications, FAP redeterminations, referrals, initial asset assess-

ments, member adds and program adds are registered on Bridges. The
Bridges Registration process:
• Performs file clearances on name and address.

• Assigns individual ID numbers to individuals new to the system.
• Allows you to reuse individual ID numbers of individuals known to

the system.
• Allows you to associate an application to a group’s existing case

number.
• Assigns an application number for applications not associated to

an existing case.
• Generates a pending registration to track standard of promptness.
Bridges also assigns and reassigns applications and cases to staff.
See BAM 305 ASSIGNMENT, REASSIGNMENT AND TRANSFER.
REQUESTS
All Programs Requests for assistance may be oral or written. Those containing
enough identifying information may be registered.
MA only A completed MSA-2565-C, Facility Admission Notice, is a request for

MA and must be registered.
Exception: Do not register the MSA-2565-C as a request if the person

is one of the following:
• An automatically eligible newborn; see BEM 145.

• An active MA recipient.
• A pending MA or FIP applicant.
Use the Bridges Reception Log process to register a request.
INITIAL ASSET
ASSESSMENTS
MA Only Register an initial asset assessment using the Bridges Registration

function upon receipt of a signed DHS-4574-B, Assets Declaration.
REGISTERING
APPLICATIONS
All Programs Register a signed application or filing form, with the minimum informa-
tion, within one workday for all requested programs.
See Right To Apply in the CLIENT RIGHTS section in BAM 105 for the
minimum information necessary to register an application.
All department programs are registered using the registration functions

on Bridges.

Register signed applications for the following programs:
• Cash assistance (FIP/RAPC/SER.)

• Medical Assistance, Medicare Cost Sharing (MSP).
• FAP (by the local office where the client lives).
• Child Development and Care (CDC).
• Direct Support Services.
• SER (includes energy, non-energy, Migrant hospitalization and
burial.)
When registering an application with minimum information, use your

best judgment to code race and sex. The assigned specialist must
update the coding, if necessary, when the application is completed.
Note: For FAP only, select unknown when the client chooses not to
declare their ethnicity and/or race. If you have an in-person interview
with the client, use your best judgment to choose an ethnicity/race for
them.
FIP, SDA, and Treat a fax of an application or filing form as an incomplete application.
RAPC However, the original signed application must be received by DHS
before benefits are approved.
CDC Only Faxed applications and filing forms are acceptable and must be regis-
tered if it includes the required minimum information. If the faxed appli-
cation is complete and all the necessary verifications are provided, a
paper copy of the application is not required in order to determine eligi-
bility and authorize benefits.
See Right to Apply in the Client Rights section of BAM 105.
MA, AMP and A photocopy or fax of a DHS-1171, DHS-3243, DHS-4574, DCH-0373,

TMAP, FAP DHS-1046, DHS-1010 or the filing form is acceptable.
FAP Only Register joint applications received from the Social Security Administra-
tion following normal registration procedures, register all programs the
client has checked on page 1. Bridges screens for expedited process-
ing of all FAP applications; see BAM 116 for SSI/FAP Joint Applica-
tion Processing.
REDETERMINATIONS Upon receipt of a signed DHS-1010, Redetermination Form, record the

receipt of a redetermination packet in Bridges. Use Initiate Redetermi-
nation to start the redetermination process. The redetermination packet
receipt date is the date the signed form is received in the local office.
FAP Only If an untimely redetermination application (see BAM 210) is the client’s
fault, record receipt of the redetermination packet as described above
and document client fault in Bridges. The standard of promptness is
extended 30 days when the household/client is at fault.

MEMBER ADD
All Programs All individuals in a household must be identified and included in the
household. Complete an Add Member case action on Bridges for all
individuals who move into a household to add them to the existing
household and eligibility determination groups (EDGs).
Use the Add Member case action to add a new member to existing
EDGs and to request assistance in the appropriate group(s) for the new
member.
Example:
Joan and her son, Todd, receive FIP and FAP. Joan’s cousin, Polly,
moves in and will be purchasing and preparing food with them.
You process an Add Member case action to add Polly. On the Program
Request screen, you indicate that she is requesting benefits on Joan’s
FAP EDG but not on Joan’s FIP EDG.
Bridges will show Polly’s Status for the FAP EDG as requesting and Not
Requesting for the FIP EDG.
ADD A PROGRAM
All Programs All new applications must be registered by registration support. How-
ever, once an application for any program is pending or active, you may
use the Add Program case action in Bridges to add an additional pro-
gram(s) to the existing case.
Example: The applicant/grantee has a gas shut-off notice and brings it

in shortly after you disposed the application. The grantee states he
needs help with the bill. Use the Add Program case action to add SER
to the grantee’s case.
Bridges records the SER application, using the new application date
you enter for the program being added.
REINSTATEMENTS
All Programs Reinstatements are not registered in the Registration function. Record
reinstatements on Bridges using the Reinstatement case action if all
programs were closed on the case. Use the Case Change case action if
any program is still active on the case.
An application is not required.
REGISTRATION
DISPOSITION All Programs
All denials, including withdrawals, are recorded in Bridges.

An application or initial asset assessment pends on Bridges until you

run eligibility determination and benefit calculation (EDBC) and certify
the results. Dispose of applications and initial asset assessments within
the standard of promptness (SOP).
BAM 115 has SOP timeframes. Certifying eligibility results automatically

disposes an application.
Note: Report MH-132,Worker Registration Report, shows SOP data

based on the Bridges application and disposition dates. The LOR man-
ual describes these reports.
Initial Asset MA Only

Assessments
When processing an initial asset assessment, run EDBC and certify
results within one workday of completing the initial asset assessment.
Applications All Programs
When a program is withdrawn, enter the reason on the program request

screen in Bridges.
Certifying the eligibility results automatically records the approval,

denial or pend (such as waiting for FIP client to attend at the MWA.)
Bridges automatically sends the client a notice of case action upon cer-
tification and also sends a DHS-198 to the client’s CDC provider when a
provider has been authorized to provide care.
SSI Coordination MA Only
Most SSI approvals are opened automatically by the State Data

Exchange (SDX) system. Those that cannot be opened automatically
are opened by the SSI Coordination Unit in central office.
Inquiries regarding SSI openings are handled by the SSI Coordination

Unit (517-335-3627 or 517-335-3608).
See BEM 150 for details about handling new SSI transfer-ins.
LEGAL BASE FIP
45 CFR 206.10(a)(1)(i)(ii)(iii)
MCL 400.56
R400.2(3),(4) (MAC)
CDC
Child Care and Development Block Grant of 1990 as amended, (42

USC 9858 et seq.)
45 CFR Parts 98 and 99

Social Security Act, as amended. Title IVA (42 USC 601 et seq.); Title
IVE (42 USC 670 et seq.); Title XX (42 USC 1397 et seq.)
R 400.5001 - 400.5015 MAC
RAPC
45 CFR 400.65 - 400.69
SDA
Current Annual DHS Appropriations Act
MA
42 CFR 435.906-908
AMP
Title XIX of the Social Security Act (1115) (a) (1)
FAP
7 CFR 273.2
7 CFR 273.2(n)
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).

BEM 257 1 of 7 THIRD PARTY RESOURCE LIABILITY
DEPARTMENT
POLICY
FIP, MA As a condition of eligibility, the client must identify all third-party

resources unless he has good cause for not cooperating. Failure, with-
out good cause, to identify a third-party resource results in disqualifica-
tion.
A third-party resource is a person, entity or program that is, or might be,

liable to pay all or part of a group member's medical expenses.
The Third Party Liability Division, Bureau of Financial Management, in

the Department of Community Health uses third-party resource infor-
mation to reduce MA expenditures by both:
• Rejecting MA claims until liable third-parties have paid.

• Seeking reimbursement from liable third-parties after MA payment
has been made.
For MA program codes A, B and E, the Social Security Administration

determines client cooperation and reports third-party resources to the
Third Party Liability Division. Policy in this item does not apply to those
MA groups.
AMP A client who has other comprehensive health insurance or Medicare, is

not AMP eligible. A client may have insurance that only covers dental or
vision services and still qualify for AMP.
RESOURCE TYPES
- FIP, MA Usually, the resource is Medicare or a health/casualty insurance com-
pany. Resources often exist in the following situations:
• A person has private health insurance.
• Work-related injury.
• An injury occurs outside the home (for example: an auto accident).
• Other accident/incident resulting in illness or injury (for example:

crime, medical malpractice, slip and fall, faulty product).
• LTC insurance (for example: Cigna, John Hancock, AFLAC, Con-

seco).
Note: Medicare Part B is not mandatory to pursue as a potential

resource. However, when an individual refuses Medicare part B,
Medicaid will not pay for any Medicare part B covered services
they receive.
BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN

RESOURCE LEADS
- FIP, MA When you learn of a potential third-party resource, contact the client.
See REPORTING RESOURCES below. The following will help you
identify resources:
Age Persons age 65 and over often have supplemental health insurance in
addition to Medicare.
Employment Many employers provide health insurance for the employee, spouse
and (step)children. Separate policies might cover dental, vision or other
health needs.
Medical Medical reports or information (for example at application or redetermi-

Information nation) might indicate a third-party resource for an accident/illness or
LTC services. The DCH-2565-C, Facility Admission Notice, frequently
lists health insurance.
Military Service Dependents of active, retired, deceased or totally disabled military ser-
vice personnel are eligible for medical coverage through the Civilian
Health and Medical Program of the Uniformed Services (CHAMPUS),
Civilian Health and Medical Program of the Veterans Administration
(CHAMPVA), or the TRICARE Program.
Monthly Expense This might show payment of private insurance premiums. Medicare
Information recipients often buy supplemental health insurance.
Retirement Many employers provide health insurance for retirees.
School Often the school's insurance covers injuries during school activities (for
example sports).
Union Membership Unions often have a group health plan for members and dependents.
This might be in effect even if the member is not working.
COOPERATION -
FIP, MA The following persons are required to cooperate in identifying third-
party resources unless they have good cause for not cooperating:
• An adult who has a third-party resource.
• A parent whose unmarried child under age 18 has a third-party

resource.
• A legal guardian whose ward has a third-party resource.
• A caretaker or caretaker relative whose dependent child has a

third-party resource.

GOOD CAUSE
CLAIMS - FIP, MA Give or send a DHS-4469, Claim of Good Cause-Third Party
Resources, to clients who indicate any concern about identifying third-
party resources. The DHS-4469 explains:
• The department's mandate to seek third-party resources.

• Cooperation requirements.
• Procedures for claiming and documenting good cause.
• Good cause reasons.
• Disqualification for noncooperation.
• The right to a hearing.
If the client claims good cause, both of you must sign section 1 of the
DHS-4469. The client must complete section 2 specifying the type of
good cause and person(s) affected. Give or send the client a copy of
the DHS-4469 within two workdays after it is completed.
A claim of good cause may be made at any time. You are responsible
for determining good cause and making a finding. To do so, follow all of
the instructions in the GOOD CAUSE CLAIMS section of BEM 255,
Child Support, except:
• Use the DHS-4469 instead of the DHS-2168.

• Support specialists are not involved with third-party resource good
cause claims.
Do not deny an application or delay benefits because a good cause

claim is pending.
IMPOSING A
DISQUALIFICATION
FIP, MA Failure to cooperate without good cause results in disqualification. The

following person who failed to cooperate is not eligible:
• The adult who fails to cooperate in identifying his own third-party

resource.
• The parent who fails to cooperate in identifying a third-party

resource of his unmarried child under age 18 who is a FIP or MA
recipient.
• The legal guardian who fails to cooperate in identifying a third-

party resource of his ward who is a FIP or MA recipient.
• The caretaker or caretaker relative who fails to cooperate in identi-

fying a third-party resource of any dependent child on whom the
relative's FIP, LIF or Caretaker Relative MedicaidMA BEM 110 or
MA BEM 135 eligibility is based.

FIP Do not include a disqualified person's needs when determining group

eligibility or benefits.
A disqualified person cannot serve as an ineligible grantee unless he is

the only adult in the case and no suitable protective payee can be
found.
REMOVING A
DISQUALIFICATION
- FIP, MA End the disqualification when any of the following occurs:
• The disqualified person cooperates.

• Good cause is established for not cooperating.
• The resource no longer exists.
• Eligibility ends for the person on whose resource the disqualifica-
tion is based.
REPORTING
RESOURCES
DHS Reporting - Report to the Third Party Liability Division when a third-party resource is
FIP, MA, AMP identified at application, redetermination or any time a resource
becomes known. Use one of the following forms:
• DCH-1354, Third Party Liability Health Insurance Information, for

health insurance, (including long term care insurance.)
Complete all required information and forward the DCH-1354 tofax

the DCH-0078, Request to Add, Terminate or Change Other Insur-
ance to the Third Party Liability Division as quickly as possible. If
available, attach copies (front and back) of insurance identification
cards. Include copies of identification cards for additional cover-
ages (vision, LTC or dental) available to the client. TPL Division
FAX (517) 346-9817.You may also use the email address on the
form to send the information to DCH.
The Third Party Liability Division uses third party resource informa-
tion, such as LTC insurance, to reduce Medicaid expenditures by
rejecting Medicaid claims until liable third parties have paid or
seeking reimbursement from third parties after Medicaid payments
have been made. This coordination of benefits is vital to ensure
claims are paid correctly.
Note: Do not report Medicaid managed care enrollments. If a cli-

ent reports that his insurance is a managed care plan such as a
health maintenance organization (HMO), check the level of care
(LC) code in Bridges. LC 07 indicates enrollment in a Medicaid
managed care plan. It is unlikely the client also has private insur-
ance through the same plan.

• DCH-1354-A, Third Party Liability Casualty Insurance Information,

for reporting accidents and work-related illness or injury.
Have the client or an authorized representative sign the DCH-

1354-A, if possible. However, if you must wait to obtain a signa-
ture, send the unsigned form to the Third Party Liability Division.
DCH staff may send you a completed DCH-0078 or DCH-1354 or DCH-

1354-A for clients in any of the following placements:
• DCH facilities
• Community Living Facilities (CLF)
• Receiving Children's Special Health Care Services (CSHCS).
Upon receipt of either form, enter the basic identifying information (for
example: case number) and forward the form to the Third Party Liability
Division.
The Third Party Liability Division often learns of a resource indepen-

dently. Cooperate with Third Party Liability Division staff by providing
the information or clarification requested.
Bridges Coding - When the Other Insurance (OI) code in Bridges is blank or zeroes, enter
FIP, MA the appropriate code to reflect the client's Medicare and/or health insur-
ance coverage. See SIC, Item O.
Any further changes to the OI code must be initiated by the DCH Third
Party Liability Division or Buy-In Unit. See Change or Termination of a
Resource below.
When Resources Do not report a third-party resource to the Third Party Liability Division
Are Not Reported - in any of the following circumstances:
FIP, MA
• The resource is Medicare. However, do report supplemental
health insurance and long term care insurance.
• The resource is court-ordered medical, but no insurance informa-

tion is provided.
• You have documented good cause for failure to cooperate on a

DHS-2169, Notice of Good Cause Finding-Child Support/Third
Party Resources, and reporting the resource would endanger the
client or dependents. However, do report any resource not cov-
ered by good cause.
Note: When good cause has been approved and there is an OI

code on the Insurance Policy Information screens or on the Medi-
care Claim screens in Bridges, send a copy of the DHS-2169 to
notify the Third Party Liability Division of the need to delete the OI
code.

• You impose a disqualification for failure to cooperate. Send a

DCH-0078 or DCH-1354 or DCH-1354-A when the disqualification
ends.
• The case is reopened with no lapse in MA. However, if the

resource has changed or was never reported, send a DCH-1354
ora DCH-0078 or DCH-1354-A.
Change or SendFax a DCH-0078, Request to Add, Terminate or Change Other

Termination of a InsuranceOther Insurance Code Change Request as an email attach-
Resource - FIP, MA ment to the Third Party Liability Division at:(517) 346-9817 when:
TPLHealth@Michigan.gov when:
• Health insurance changes or ends. If available, send documenta-

tion from the employer or insurer indicating the date coverage
changed or ended.
• The insurance information in Bridges was not provided by the cli-

ent and he is unaware of the coverage. When the client contacts
you, check the case record to determine if there is a DCH-1354
information aboutfor the resource. If not, note on the DCH-0078
that the case record does not indicate OI coverage. In the above
situations, the Third Party Liability Division staff must:
•• Verify the circumstances, and

•• Update the TPL coverage file. Bridges will be updated effec-
tive the following month.
Third-party resource information is stored in a computerized TPL cover-

age file maintained by the Third Party Liability Division. It includes claim
information such as health insurance company, policy number, health
scope codes and coverage dates.
The TPL file updates Medifax weekly and updates the OI code monthly.
The monthly update occurs the evening of the regular cut-off date and
selects the OI code based on priority. See RFS 104. See “OI Order of
Priority” in SIC, Item O.
Claims are paid or rejected based on information on the TPL coverage

file, not other insurance information in Bridges. It is imperative that the
corresponding DCH-13540078 is received in the Third Party Liability
Division so that the correct OI code is entered on the TPL coverage file.
Without the completed DCH-13540078, even if you enter an OI code in
Bridges,, claims will continue to be paid by Medicaid.
Medifax is the system MA providers call to verify MA eligibility and

obtain third-party resource information. Retroactive (up to one year)
health insurance changes are available on Medifax.

TINQUIRIES BY
MAIL Direct inquires or complaints about other insurance problems to:
Department of Community Health

Third Party Liability Division
Bureau of Financial Management
PO Box 30479
Lansing, MI 48909
TPL Health@michigan.gov
PHONE INQUIRIES
Enrolled Providers Provider Inquiry HelplineHotline: 1-800-292-2550 or providersup-

port@michigan.gov.
DHS Staff • MA Exceptions Unit at 1-800-292-9570 (Option 5) for all third-party

resource concerns (except Medicare) including the non-Medicare
portions of OI code 95.
• Medicare Buy-In Unit at 1-517-335-5488 (fax number 1-517-335-

0478) for Medicare concerns, including OI codes 50, 90, 91 and
the Medicare portions of 95-96.
Note: Do not NOT give recipients the phone numbers listed above.
Recipients Recipient HotlineBeneficiary Helpline: 1-800-642-3195.
VERIFICATION
REQUIREMENTS -
FIP, MA For good cause claims, follow verification policy in BEM 255.
LEGAL BASE FIP
P.A. 280 of 1939, as amended
MA
42 CFR 433.135-.153
MCL 400.106
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

BEM 400 1 of 42 ASSETS
DEPARTMENT
POLICY FIP, SDA, RAPC, LIF, Group 2 Persons Under Age 21, Group 2
Caretaker Relative, SSI-Related MA, and AMP
Assets must be considered in determining eligibility for FIP, SDA,

RAPC, LIF, Group 2 Persons Under Age 21 (G2U), Group 2 Caretaker
Relative (G2C), SSI-related MA categories and AMP.
FIP, SDA, RAPC, LIF, G2U, G2C and AMP consider only the following
types of assets:
• Cash (which includes savings and checking accounts).

• Investments.
• Retirement Plans.
• Trusts.
Assets Defined Assets means cash, any other personal property and real property.
Real property is land and objects affixed to the land such as buildings,
trees and fences. Condominiums are real property. Personal property
is any item subject to ownership that is not real property (examples:
currency, savings accounts and vehicles).
Overview of Asset FIP asset rules apply to RAPC

Policy
Countable assets cannot exceed the applicable asset limit. Not all
assets are counted. Some assets are counted for one program, but not
for another program. Some programs do not count assets; see Pro-
grams With No Asset Test in this item.
You must consider both of the following to determine whether, and how
much of, an asset is countable.
• Availability:
•• See Available.
•• See Jointly Owned Assets.
•• See Non-Salable Assets.
• Exclusions.
An asset is countable if it meets the availability tests and is not

excluded.
Note: Only certain types of assets are considered by FIP, RAPC, SDA,
LIF, G2U, G2C, and AM. See below in this section.
You must consider the assets of each person in the asset group. See
the program's asset group policy in this item.

An asset converted from one form to another (example: an item sold for
cash) is still an asset.
Exception: See SALE OF PROPERTY IN INSTALLMENTS in BEM

500.
FIP, SDA, LIF, G2U, G2C, and AMP Only
The following types of assets are the only types considered for FIP,
SDA, LIF, G2U, G2C, and AMP:
• Cash (which includes savings and checking accounts).

• Investments.
• Retirement plans.
• Trusts.
SSI-Related MA
All types of assets are considered for SSI-related MA categories.
PROGRAMS WITH
NO ASSET TEST CDC
There is no asset test for CDC.
Healthy Kids, Group 2 Pregnant Women, TMAP, RAPM
There is no asset test for the following:
• Healthy Kids (BEM 125, 129 and 131).

• Group 2 Pregnant Women (BEM 126).
• TMA-Plus (BEM 645).
• Refugee Assistance Program Medical (RAPM) BEM 630)
Do not deny or terminate those benefits because of a refusal to provide

asset information or asset verification requested for purposes of deter-
mining eligibility for a category or program that has an asset test, such
as FIP or LIF.
Example: The Smith family (Mrs. Smith and daughter age 12) failed to
return verification of their bank account by the due date. Therefore, LIF
eligibility cannot be determined. However, Healthy Kids must still be
considered.
FAP Only
There is no asset test for the food assistance program as all groups are
either:
• Categorically eligible.

• All members of the group are eligible for domestic violence com-
prehensive services.
FIP, RAPC AND SDA

ASSET ELIGIBILITY FIP, RAPC and SDA
Policy Overview Determine asset eligibility prospectively using the asset group's assets
from the benefit month. Asset eligibility exists when the group’s count-
able assets are less than, or equal to, the applicable asset limit at least
one day during the month being tested.
Application At application, do not authorize the Family Independence Program

(FIP), Refugee Assistance Program Cash (RAPC), or State Disability
Program (SDA) for future months if the person has excess assets on
the processing date.
Pending For pending FIP, RAPC, and SDA applications, use asset policy that is
Application in effect for the month you are determining eligibility.
Months
Ongoing If an ongoing FIP, RAPC, or SDA recipient has excess assets, initiate
closure. However, reinstate the program if it is verified that the excess
assets are under the limit on or before the timely hearing request date.
FIP, RAPC and SDA Only
Bridges produces an over payment referral for benefits issued after the
last month of eligibility only if a closure delay was caused by the group's
failure to report the asset change timely. BAM 700 and 705 explain
overissuance and recoupment policies and procedures.
RAPC Only
Do not consider the assets of a refugee's sponsor in determining the

refugee's eligibility.
Exclude as an asset any cash assistance given to a refugee from a

resettlement agency.
Evaluate and treat other assets as they are evaluated and treated for
FIP.
FIP/RAPC/SDA/ FIP, RAPC, SDA and AMP Only

AMP Asset Group
The asset group includes individuals with an EDG participation status of
eligible or disqualified; see BEM 210, 214 and 215.
FIP, RAPC and FIP, RAPC and SDA Only

SDA Asset Limit
$3,000

AMP Asset Limit AMP Only
$3,000
MA ASSET
ELIGIBILITY LIF, G2U, G2C, AMP and SSI-Related MA Only
Asset eligibility is required for LIF, G2U, G2C, AMP and SSI-related MA
categories.
Note: Do not deny or terminate TMA-Plus, Healthy Kids or Group 2

Pregnant Women because of a refusal to provide asset information or
asset verification requested for purposes of determining LIF, G2U, G2C
or SSI-related MA eligibility.
Use the special asset rules in BEM 402 for certain married L/H and
waiver patients. See BPG Glossary, for the definition of L/H patient and
BEM 106 for the definition of waiver patient.
Asset eligibility exists when the asset group's countable assets are less
than, or equal to, the applicable asset limit at least one day during the
month being tested.
At application, do not authorize MA for future months if the person has

excess assets on the processing date.
If an ongoing MA recipient or active deductible client has excess

assets, initiate closure. However, delete the pending negative action if it
is verified that the excess assets were disposed of. Payment of medical
expenses, living costs and other debts are examples of ways to dispose
of excess assets without divestment. LTC and waiver patients will be
penalized for divestment; see BEM 405.
LIF Asset Group LIF Only
See BEM 110.
LIF Asset Limit LIF Only
$3,000
G2U and G2C G2U and G2C

Asset Group
See BEM 211.
G2U and G2C G2U and G2C

Asset Limit
$3,000

SSI-Related MA SSI-Related MA Only

Asset Group
See BEM 211.

Asset Limit
For Freedom to Work (BEM 174) the asset limit is $75,000. IRS recog-
nized retirement accounts (including IRA’S and 401(k)’s) may be of
unlimited value.
For Medicare Savings Programs (BEM 165) and QDWI (BEM 169) the
asset limit is:
• $6,60080 for an asset group of one.

• $9,91010,020 for an asset group of two.
For all other SSI-related MA categories, the asset limit is:
• $2,000 for an asset group of one.

• $3,000 for an asset group of two.
DEEMING OF
PARENTAL ASSETS SSI-Related MA Only
Deeming means counting a portion of parents' assets as their child's

assets. Do not deem when:
• Any parent living with the child (see BEM 211) is an SSI or FIP
recipient.
• When determining a child's eligibility under BEM 170, Home Care

Children.
• When determining a child's eligibility under BEM 171, Children’s

Waiver.
Deeming SSI-Related MA Only

Calculation
Use the following to calculate the deemed amount.
1. Determine the total value of the parents’ countable assets, as if

they were an asset group, even if they are not married.
Note: The child is not eligible for SSI-related MA if the parents

refuse to provide asset information or a required verification.
2. Subtract $2,000 for one parent ($3,000 for two parents) from the
amount of the parents' countable assets (step 1). The result is the
deemable asset amount.

3. Divide the deemable asset amount (step 2) by the number of the

parents' unmarried children under age 18 in the parents' home
who are:
• SSI recipients.
• Applicants for, or recipients of, MA based on blindness or dis-
ability, who also meet both:
•• The nonfinancial eligibility factors in BEM 155 or

166.Are not Home Care Children (BEM 170) or Chil-
dren’s Waiver (BEM 171).
The result is the amount of assets deemed to the child whose eligibility
is being determined.
AVAILABLE FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
An asset must be available to be countable. Available means that

someone in the asset group has the legal right to use or dispose of the
asset.
Exception: This does not apply to trusts. There are special rules about
trusts. See Trusts below for FIP, SDA and AMP; see BEM 401 for MA
trust policy.
Assume an asset is available unless evidence shows it is not available.
An asset remains available during periods in which a guardian or con-

servator is being sought. This includes situations such as:
• A person's guardian dies and a new guardian has not been

appointed yet.
• A court decides a person needs a guardian, but has not appointed

one yet.
• A person is unconscious and his family asks the court to appoint a

guardian.
Availability might also be affected by joint ownership and efforts to sell

or the possibility of domestic violence. See Jointly Owned Assets, Non-
Salable Assets and Victims of Domestic Violence in this item.
SSI-Related MA and AMP Only
A person's death and probating his estate does not make his assets
unavailable for purposes of determining his eligibility. Determine asset
eligibility for the days of the month the person was alive.

ESTATE
RECOVERY MA ONLY
The federal government requires Medicaid to recover money that it paid

for services from the estates of Medicaid beneficiaries who have died.
Medicaid will only recover the amount Medicaid paid for a beneficiary.
This is estate recovery. The state will not seek recovery of certain Medi-
care cost-sharing benefits.
What is an estate?
An estate includes all property and assets that pass through probate
court.
Example: homes, cars, insurance money and bank accounts.
Who is subject to estate recovery?
Medicaid beneficiaries who are age 55 or older.
Are there exceptions to estate recovery?
The state may decide not to recover money if it creates an “Undue

Hardship” or if any of the following people lawfully live in the benefi-
ciary’s home
• Beneficiary’s spouse.
• Beneficiary’s child who is under the age of 21, blind, or perma-

nently disabled.
• Beneficiary’s sibling who has an equity interest in the home and

was living in the home for at least 1 year immediately before the
beneficiary’s death.
• A survivor who:
•• was living in the beneficiary’s home for at least 2 years imme-

diately before the beneficiary went into a medical facility: and
•• provided care so the beneficiary could stay at home during

that period.
What is an undue hardship?
An undue hardship exists when:
• The estate is the sole source of income for the survivors, such as a
family farm or business; or
• The estate is a home of modest value; or

• A survivor would become or remain eligible for Medicaid if recov-

ery occurred.
How does estate recovery work?
When a Medicaid beneficiary age 55 or older dies, the state sends an

estate recovery notice to the estate representative or heirs. The estate
recovery notice tells them:
• the state plans to file a claim;
• how much the state will claim;
• how to apply for an undue hardship waiver.
If no exceptions apply, then the state will file a claim with the estate.
How to apply for an undue hardship waiver?
An Undue Hardship application must be completed. Applications are

available from the following sources:
• online at www.michigan.gov/estaterecovery
• by email at miestaterecovery@hms.com
• by sending a letter to P.O. Box XXXX.
The completed application must be received no later than 60 days from

the date of the estate recovery notice. Send copies of any documents
the notice specified. The state will determine if a waiver is warranted.
Victims of FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP

Domestic Violence
Assets owned by victims of domestic violence may be unavailable due
to domestic violence. These assets do not have to be jointly owned but
accessing them could put the client in danger. You may exempt these
assets for a maximum of three months. With FIM approval one three-
month extension is permitted. Document in the case record the reasons
for the temporary exclusion, and, if any extension is requested, docu-
ment what steps have been taken to secure the asset. Clients should
be advised at the time of the exemption that they are required to report
any changes in the status of the asset within 10 days.
JOINTLY OWNED
ASSETS FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Jointly owned assets are assets that have more than one owner.
Note: For FTW determinations jointly owned assets are considered to

belong to the initial person.

An asset is unavailable if an owner cannot sell or spend his share of an

asset:
• Without another owner's consent, and

• The other owner is not in the asset group, and
• The other owner refuses consent.
Exception: In SSI-related MA, when ownership is shared by an SSI-

related child and his parent(s) and parental asset deeming applies,
refusal to sell by either the child or the parent(s) does not make an
asset unavailable.
Exception: Jointly owned real property is only excludable if it creates a

hardship for the other owners; see hardship in this item.
Note: In SSI related MA a divestment has occurred if joint owners are

added during the five year look back period. See BEM 405 for determi-
nation of a divestment penalty.
Ownership documents for jointly owned real property commonly use

one of four phrases:
• Joint Tenancy: no owner can sell unless all owners agree.
• Joint Tenancy with Right of Survivorship: no owner can sell

unless all owners agree.
• Tenancy by the Entirety: same as joint tenancy except the own-

ers are husband and wife. Neither owner can sell unless both own-
ers agree.
• Tenancy-in-Common: each owner can sell his share without the

other owner's agreement.
Joint Cash and FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Retirement Plans
This section applies to the types of assets listed under CASH and
RETIREMENT PLANS in this item.
Count the entire amount unless the person claims and verifies a differ-
ent ownership. Then, each owner's share is the amount he owns.
SSI-Related MA Only
Exception: Apply the following when an L/H or waiver patient (see

PRG, Glossary, and BEM 106) and his spouse jointly own the asset:
• Consider the client the sole owner in determining the community

spouse resource allowance (CSRA). BEM 402 describes the
CSRA.

• Proceed as follows for all other purposes:
•• If the spouse is an MA-only client or receives FIP or SSI,

each spouse owns an equal share unless otherwise claimed
and verified.
•• If the spouse is not an MA-only client and does not receive

FIP or SSI, consider the asset totally available unless other-
wise claimed and verified.
Exception: Count equal shares of an asset owned by more than one

SSI-related MA child unless the person claims and verifies a different
ownership.
Exception: If the owners are an SSI-related MA child and his parent(s)

and asset deeming applies, count the total amount as the child's unless
the person claims and verifies a different ownership.
Other Joint Assets FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
This applies to all assets that are not included under Cash or Retire-
ment Plans.
Count an equal share for each owner.
Note: For jointly owned real property count the individual’s share
unless sale of the property would cause undue hardship. Undue hard-
ship for this item is defined as: a co-owner uses the property as his or
her principal place of residence and they would have to move if the
property were sold and there is no other readily available housing.
Exception: If specified otherwise by the ownership document, each

owner's share is the amount specified.
NON-SALABLE
ASSETS

Non-Salable
Assets Give the asset a $0 countable value when it has no current market
value as shown by one of the following:
• Two knowledgeable appropriate sources (example: realtor,

banker, stock broker) in the owner's geographic area state that the
asset is not salable due to a specific condition. This applies to any
assets listed under:
•• Investments.
•• Vehicles.
•• Livestock.

•• Burial Space Defined.

•• Employment and Training Assets.
•• Homes and Real Property (see below)
• In addition, for homes, life leases, land contracts, mortgages, and

any other real property an actual sale attempt at or below fair mar-
ket value in the owner's geographic area results in no reasonable
offer to purchase. The asset becomes salable when a reasonable
offer is received. Count an asset that no longer meets these condi-
tions.
For applicants, an active attempt to sell must have started at least

90 days prior to application and must continue until the property is
sold. For recipients, the asset must have been up for sale at least
30 days prior to redetermination and must continue until the prop-
erty is sold. An active attempt to sell means the seller has a set
price for fair market value, is actively advertising the sale in publi-
cations such as local newspaper, and is currently listed with a
licensed realtor.
CASH FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
This section is about the following types of assets:
• Money/currency.
• Uncashed checks, drafts and warrants.
• Checking and draft accounts.
• Savings and share accounts.
• Money market accounts.
• LTC patient trust fund.
• Money held by others-- Example: Sally does not have a bank

account. She puts money in her mother's checking account, but it
is not a joint account.
• Time deposits-- A time deposit is a contract between a person

and a financial institution whereby the person agrees to leave
funds on deposit for a specified period in return for a specified
interest rate. Common time deposits are certificates of deposit
(CDs) and savings certificates.
Lump Sums and Lump sums and accumulated benefits are defined in the PRG, Glos-
Accumulated sary.
Benefits

FIP, SDA and AMP Only
Lump-sums and accumulated benefits are assets starting the month

received.
A person might receive a single payment that includes both accumu-

lated benefits and benefits intended as a payment for the current
month. Treat the portion intended for the current month as income.
LIF, G2U, G2C, SSI-Related MA
Lump sums and accumulated benefits are income in the month

received. See BEM 500 about countable income policy.
Exception: The following are assets:
• Income tax refunds; see Tax Refund & Tax Credit exclusions in this
item.
• Nonrecurring proceeds from the sale of assets.
• Payments that are excluded assets.
Retroactive SSI FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Benefits
Retroactive SSI benefits may be paid as a one-time payment or in
installments over several months. The Social Security Administration
determines how payment will be made.
Retroactive SSI benefits are treated as accumulated benefits (see

above) even when paid in installments. See Retroactive RSDI and SSI
Exclusion in this item for SSI-related MA determinations.
Value of Cash FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
The value of the types of assets described above is the amount of the:
• Money/currency.
• Uncashed check, draft or warrant.
• Money in the account or on deposit.
• Money held by others.
Exception: Reduce the value of a time deposit by the amount of any

early withdrawal penalty, but not the amount of any taxes due.
CASH EXCLUSIONS
Homestead-Loss FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP

Funds Exclusion
Use this exclusion only if the funds are not commingled with countable
assets and not in time deposits.

Exclude funds an owner received for repairs or replacement of a dam-

aged or destroyed homestead (example: insurance settlement) if:
• The owner intends to reoccupy the home, and

• There is a written repair/replacement agreement.
The client must declare an estimated completion date. The exclusion

lasts until that date. The local office may grant extensions.
Exclude funds for temporary housing while the homestead is being

repaired or replaced.
Also see Homestead-Loss Land Exclusion in this item regarding the

land the home was on.
Homestead Sale FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Exclusion
assets and are not in time deposits.
Exclude funds received from the sale of a homestead, or the land the
home was on, for 12 months if there is a written agreement to purchase
another homestead. The 12-month period starts the month the funds
are received.
Note: See Homestead Land Retained Exclusion below if ownership of

the land was retained.
Nonhomestead FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP

Loss Exclusion
Exclude funds received for the planned repair or replacement of a non-

homestead exempt item (example: furniture, clothing, vehicle) that was
lost, stolen or destroyed. Exclude the funds until the item is repaired or
replaced.
Loan Exclusion FIP
Exclude funds a person has borrowed provided it is a bona fide loan.

This includes a loan by oral agreement if it is made a bona fide loan.
Bona fide loan means all the following are present:
• A loan contract or the lender's written statement clearly indicating

the borrower's indebtedness

• An acknowledgment from the borrower of the loan obligation
• The borrower's expressed intent to repay the loan by pledging real

or personal property or anticipated income
This exclusion does not apply to:
• Interest earned on borrowed money.

• Purchases made with borrowed money.
Note: When a client has loaned money to another person please refer
to the policy in Promissory Notes/Land Contracts/Mortgages/Loans.
Reverse Mortgage FIP and SDA only

Exclusion
A reverse mortgage allows a homeowner to borrow some percentage of

the value of his home via a mortgage. The homeowner receives peri-
odic payments (or a line of credit) that does not have to be repaid while
the homeowner lives in the home. Exclude these payments.They are
loans.
Tax Refund and FIP, SDA

Tax Credit
Exclusion Exclude tax refunds and credits.
LIF, G2U, G2C, SSI-Related MA and AMP
Exclude tax credits for 9 months after the month of receipt. Tax credits
include credit such as Earned Income Tax Credit and Child Tax Credit.
Exclude tax refunds.
Excluded Income FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Under BEM 500
BEM 500 identifies certain sources of funds that are excluded as both
income and assets. Time limits and other conditions applicable to the
income exclusion also apply to the asset exclusion.

Current Income FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Exclusion
Do not count funds treated as income by a program as an asset for the
same month for the same program.
When income must be prorated or averaged (example: self-employ-

ment) exclude the resulting assets for the months of proration.
Business Account FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Exclusion
Exclude a savings, share, checking or draft account used solely for the
expenses of a business. Continue the exclusion while the business is
not operating provided the person intends to return to the business.
Retroactive RSDI SSI-Related MA Only

and SSI Exclusion
Exclude retroactive RSDI and SSA-issued SSI benefits for nine calen-
dar months beginning the month after payment is received. Do not
exclude purchases made with such funds including CDs and other time
deposits.
This exclusion applies only to any unspent portion of the retroactive

payment from RSDI or SSI. Once the money from the retroactive pay-
ment has been spent, this exclusion does not apply to the items pur-
chased with the money, even if the nine month period has not expired.
The money may be commingled with other funds but, if this is done in
such a fashion that the retroactive amount can no longer be separately
identified, that amount will count toward the resource limit.
Use the following to separate countable and excluded funds that are
commingled:
• Assume that countable funds are withdrawn first, leaving as much

of the excluded funds as possible.
• Excluded funds withdrawn are not excluded if redeposited. The

excluded amount can be increased only by deposits of subse-
quently received excluded payments.
• Count any interest paid to the account.

Example: A person received a $1,000 retroactive RSDI payment on

December 3 via direct deposit. The account already contained $1,800.
DATE DEPOSIT WITHDRAW BALANCE EXCLUDE COUNTABLE
12/3 $1,000 $2,800 $1,000 $1,800

12/4 $500 2,300 1,000 1,300
12/31 5 2,305 1,000 1,305
1/3 400 250 2,455 1,000 1,455
1/4 1,500 955 955 0
2/10 50 1,005 955 50
2/12 400 605 605 0
3/8 100 705 605 100
3/15 50 655 605 50
Funds for Burial SSI-Related MA Only

Arrangements
Money set aside for burial expenses might be excludable. See Burial
Fund Exclusion in this item.
Student Savings FIP, LIF, G2U, and G2C

Exclusion
Exclude funds in a separate account under a student's name and

accrued solely from a student's earnings; see Student Earnings in BEM
500.
INVESTMENTS FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
• U.S. Savings bonds.

• Securities such as:
•• Stocks.
•• Bonds.
•• Mutual funds.
Value of FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP

Investments
The value of a U.S. Savings bond is the amount the owner could get if
the bond were cashed-in.
LIF, G2U, G2C, SSI-Related MA and AMP
U.S. Savings bonds cannot be cashed in until twelve months after the
date of issuance. However, if bonds are in this waiting period and the

value of the bond(s) and other assets is over the client’s asset limit, the
client must seek a waiver of the waiting period.
The waiver is a written request from the bond holder or representative

to the United States Department of Treasury outlining why a waiver of
the waiting period is necessary. If the waiver is granted the value of the
U.S. Savings bond is considered available. If the waiver is denied the
bond becomes available at the expiration of the waiting period.
The value of other investments is the amount the asset is selling for:
• Use the closing price for publicly traded stocks.

• Use the bid price or net asset value (NAV) for mutual funds.
• Use the bid price for bonds.
If a security was not paid for in full at the time of purchase (bought on
margin), the securities firm has made a loan to the buyer. Deduct the
balance owed from the price if there is written proof that the balance
owed must be repaid when the security is sold.
INVESTMENT
EXCLUSION SSI-Related MA Only
Investments set aside for burial expenses might be excludable. See

Burial Fund Exclusion in this item.
RETIREMENT
PLANS FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
• Individual retirement accounts (IRAs).

• Keogh plans (also called H.R. 10 plans).
• 401k plans.
• Deferred compensation.
• Pension plans.
• Annuities-- An annuity is a written contract establishing a right to
receive specified, periodic payments for life or for a term of years.
Retirement Plan FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Value
The value of these plans is the amount of money the person can cur-
rently withdraw from the plan. Deduct any early withdrawal penalty, but
not the amount of any taxes due.
Funds in a plan are not available if the person must quit his job to with-
draw any money.
Freedom to Work (FTW) only

Exclude the total value of funds in retirement accounts and individual

retirement accounts.
Annuity LIF, G2U, G2C and SSI-Related MA
Annuities are similar legal devices to trusts. Annuities are a written con-
tract with a commercial insurance company, establishing a right to
receive specified, periodic payments for life or for a term of years. They
are usually designed to be a source of retirement income. Only certain
types of annuities are excluded as resources. Policy in BEM 401 Trusts
applies, including referring annuities to Medicaid Eligibility Policy Sec-
tion.
TRUSTS FIP, SDA and AMP Only
A trust is a right of property created by one person for the benefit of

himself or another.
Trust Definitions FIP, SDA and AMP Only
Beneficiary - the person for whose benefit a trust is created.
Grantor or settlor - the person who established the trust. It includes

anyone who furnishes real or personal property for the creation of the
trust.
Principal (or corpus) - the assets in the trust. The assets may be real
property (example: house, land) or personal property (example: stocks,
bonds, life insurance policies, saving accounts).
Trustee - the person who has legal title to the assets and income of a
trust and the duty to manage the trust for the benefit of the beneficiary.
FIP/SDA/AMP Trust FIP, SDA and AMP Only

Policy
The Probate Court decides availability of the trusts it administers. A
grantor must petition the Probate Court to make the principal available.
For other trusts, the principal is an available asset of the person who is
legally able to:
• Direct use of the principal for his needs.

• Direct that ownership of the principal revert to himself.
MA Trust Policy LIF, G2U, G2C, and SSI-Related MA Only
See BEM 401.
Referrals to Send all trusts and annuities to Medicaid Eligibility Policy Section for
Medicaid Eligibility evaluation. Your referral must be in writing and include the following
Policy Section information:

• Your name, telephone number and local office.
• Client's name.
• Grantor's relationship to the client.
• Source of the assets used to establish the trust (example: money

from client's lawsuit settlement, client's savings).
• Legible copies of the complete trust document, any amendments

or addenda to the trust, correspondence, and similar information.
• Legible copies of all documents transferring ownership of property

to the trustee.
• Relationship to the client of persons who transferred resources to

trustee (example: client's parent, client's guardian).
Send referrals to:
Michigan Department of Human Services

Attn: Trusts and Annuities
P.O. Box 30037
Suite 1307
Lansing, MI 48909
Advice is only available to local offices and only for purposes of deter-
mining eligibility when a trust actually exists. Advice is not available for
purposes of estate planning, including advice on proposed trusts or pro-
posed trust amendments.
HOME CARETAKER
AND PERSONAL
CARE CONTRACTS A contract that prospectively pays for expenses such as repairs, main-
tenance, property taxes, homeowner’s insurance, heat and utilities for
real property/homestead or that provide for monitoring health care,
securing hospitalization, medical treatment, visitation, entertainment,
travel and/or transportation, financial management or shopping, etc.
would be considered a divestment. Consider all payments for care and
services which the client made during the look back period as divest-
ment; refer to BEM 405.
Note: The preceding are examples and should not be considered an all
inclusive or exhaustive list.
Assets transferred in exchange for a contract/agreement for a personal

services/assistance or expenses of real property/homestead provided
by another person after the date of application are considered an avail-
able and countable asset even if the contract is irrevocable.

INDIVIDUAL
DEVELOPMENT
ACCOUNTS FIP, SDA, LIF, G2U, G2C, SSI-Related MA, AMP
Individual Development Accounts (IDA) are established pursuant to

Michigan Public Act 361 of 1998 and section 404(h) of the Social Secu-
rity Act or Public Law 105-285. IDAs allow low-income families to pro-
mote their economic independence by saving for:
• Postsecondary educational expenses.

• First home purchase.
• Business capitalization.
IDAs are funded by periodic contributions from the family’s earnings

and matching contributions by or through a nonprofit organization. The
IDA must be a trust or a joint account that requires the signatures of
both the nonprofit organization and a family member to authorize with-
drawals.
An IDA is excluded as an asset.
A 529 college savings plan is similar to an IDA. See Education and

Training Exclusion in this item for FIP, SDA, LIF, G2U, and G2C.
HOMES AND REAL

PROPERTY SSI-Related MA Only
• Real property.
• Mobile homes.
• Life estates and life leases.
Real Property SSI-Related MA Only

Definition
Real property is land and objects affixed to the land such as buildings,
trees and fences. Condominiums are real property.
Real Property and SSI-Related MA Only

Mobile Home Value
The value is the equity value. Equity value is the fair market value
minus the amount legally owed in a written lien provision.
To determine the value of real property and mobile homes use:
• Deed, mortgage, purchase agreement or contract.
• State Equalized Value (SEV) on current property tax records multi-

plied by two.
• Statement of real estate agent or financial institution.

• Attorney or court records.
• County records.
Liens must be filed with the register of deeds or other appropriate

agency.
Deeds are considered legal if they are signed and notarized. It does not
have to be registered with the registrar of deeds to be a legal document.
Note: In Michigan, a lien on a mobile home is on record with the Secre-

tary of State. If the mobile home is on land the person owns, the lien
may also be recorded with the land deed.
Life Estate/Life SSI-Related MA Only

Lease Definition
A life estate or life lease gives the person who holds it certain rights to
property during the person's lifetime. Usually, the right is the right to live
on the property. The person holding the life estate or life lease can sell
it, but does not own the actual property and normally cannot sell the
actual property.
Life Estate/Life SSI-Related MA Only

Lease Value
Use the life estate factors in Exhibit II to compute the value of a life
estate or life lease. Choose the life estate factor that corresponds to the
person's age. Multiply the fair market value of the actual property by the
appropriate life estate factor. The result is the value of the life estate or
life lease.
Use the value of the life estate to determine if the purchase price was
for fair market value when a person purchases a life estate in another
individuals’ home.
When a person purchases a life estate in another individuals’ home,

they must actually reside there for at least one year after the date of
purchase to qualify for the homestead exclusion. If the person resides
in the home for less than one year treat the transaction as a transfer of
assets. The amount of the transfer is the entire amount used to pur-
chase the life estate. See BEM 405 to determine the penalty period.
Exception: Use a lower amount if verified. Verified means statements

from two financial institutions or real estate firms with a lower value and
the reason for it (example: terminal illness). Use the lowest amount if
the statements have different values.

HOMES AND REAL

PROPERTY
EXCLUSIONS
Homestead SSI-Related MA Only

Definition and
Exclusion A homestead is where a person lives (unless Absent from Homestead,
see below) that he owns, is buying or holds through a life estate or life
lease. It includes the home, all adjoining land and any other buildings
on the land. Adjoining land means land which is not completely sepa-
rated from the home by land owned by someone else. Adjoining land
may be separated by rivers, easements and public rights-of-way (exam-
ple: utility lines and roads).
Determine the equity value of the homestead; see Real Property and
Mobile Home Value in this item.
MA will not pay the client’s cost for:
• Home health services.

• Home and community based services (MIChoice Waiver).
• LTC services.
• Home Help.
When the equity in the client’s homestead exceeds $500,000.
Exclude the asset group's homestead. Do not apply the home equity
limit to the client if the spouse, child under 21, or the client’s blind or dis-
abled child is residing in the home.
Exclude only one homestead for an asset group. If a migrant claims two
homesteads, exclude the homestead of the migrant's choice.
See below about exempting a homestead when the owner is Absent

from Homestead.
SSI-Related MA Only
BEM 402 describes when both a client's and community spouse's

assets are counted. If a client and community spouse own two homes
or they are separated and each owns a homestead, exclude the home-
stead with:
• The lower equity value for purposes of the initial asset assess-
ment, and
• The higher equity value for purposes of determining initial eligibil-

ity.

Absent from SSI-Related MA Only

Homestead
Exclude a homestead that an owner formerly lived in if any of the fol-
lowing are true:
• The owner intends to return to the homestead.
• The owner is in an LTC facility, a hospital, an adult foster care

(AFC) home or a home for the aged.
• A co-owner of the homestead uses the property as his home.
Relative Occupied. Exclude a homestead even if the owner never

lived there provided:
• The owner is in an institution (see BPG Glossary), and

• The owner's spouse or relative (see below) lives there.
Relative for this purpose means a person dependent in any way (finan-
cial, medical, etc.) on the owner and related to the owner as any of the
following:
• Child, stepchild or grandchild.

• Parent, stepparent or grandparent.
• Aunt, uncle, niece or nephew.
• Cousin.
• In-law.
• Brother, sister, stepbrother, stepsister, half brother or half sister.
Homestead Land SSI-Related MA Only

Retained
Exclusion If an owner sells his homestead (example: mobile home), but retains
ownership of the land it was on, exclude the land for 12 months. The
first month is the month the owner receives any payment from the sale.
Also, exclude the land for the time between the sale and the receipt of
such payment.
Homestead-Loss SSI-Related MA Only

Land Exclusion
Exclude the land of a damaged, destroyed or condemned homestead if:
• The owner intends to reoccupy it, and

• There is a written repair or replacement agreement.
The client must declare an estimated completion date. The exclusion

lasts until that date. The local office may grant extensions.


Employment
Assets Employment-related assets such as farmland and the building where a
business is located might be excluded; see Employment Asset Exclu-
sions in this item.

Burial
Arrangements Property intended as burial space might be excludable; see Burial
Space Exclusion in this item.
Income-Producing SSI-Related MA Only

Real Property
Exclude up to $6000 of equity in income producing real property if it
produces annual countable income equal to at least six percent of the
asset group's equity in the asset. Countable income is total proceeds
minus actual operating expenses.
Exception: Use the Employment Asset Exclusions in this item for

property used in a business or trade.
HOUSEHOLD AND
PERSONAL GOODS
DEFINED SSI-Related MA Only
Household Goods- those items customarily found in the home and

used in connection with the maintenance, use and occupancy of the
premises. This includes items necessary for an adequate standard of
sustenance, accommodation, comfort, information and entertainment of
occupants and guests. Examples are appliances, furniture, television
sets, carpets, cooking utensils, eating utensils and dishes.
Personal Goods- items of personal property that are worn or carried by

a person or that have intimate relationship to him. Examples are per-
sonal clothing and jewelry, personal care items, and educational or rec-
reational items such as books, musical instruments or hobby material.
HOUSEHOLD AND
PERSONAL GOODS
EXCLUSION SSI-Related MA Only
Exclude household and personal goods.
VEHICLES SSI-Related MA Only
A vehicle is a device used to transport people or goods. Vehicle

includes passenger cars, trucks, motorcycles, motorbikes, trailers,
campers, motor homes, boats and all-terrain vehicles.
Note: See Homes and Real Property about mobile homes.

Vehicle Value SSI-Related MA Only
The value of a vehicle is its equity value. Equity value is the fair market
value minus the amount legally owed in a written lien provision.
Liens must be on record with the Secretary of State or other appropriate

agency.
VEHICLE
EXCLUSIONS

Vehicle Exclusion
Exclude one motorized vehicle owned by the asset group. If the asset
group owns multiple motorized vehicles:
• Use the Employment Asset Exclusions first, then

• From any remaining motorized vehicles, exclude the one with the
highest equity value.
PROMISSORY
NOTES/LAND
CONTRACTS/
MORTGAGES
LOANS SSI-Related MA Only
A note is a written promise to pay a certain sum of money to another

person at a specified time. The note may call for installment payments
over a period of time (installment note) or a single payment on a speci-
fied date. The most common type of note involves the sale of real prop-
erty and is called a land contract or a mortgage. A homeowner might
also sell his home via a sale-leaseback agreement.
The person who sold the property is holder of the note. The note is the
holder's asset.
Example: John sells land to Irma on a land contract. John is the land
contract holder. The land contract is John's asset. The land is Irma's
asset.
Count money used to purchase a promissory note, loan, or mortgage

unless all of the following are true:
• The repayment schedule is actuarially sound; and
• The payments are made in equal amounts during the term of the
agreement with no deferral of payments and no balloon payments;
and

• The note, loan, or mortgage must prohibit the cancellation of the

balance upon the death of the lender; see Uncompensated Value
in BEM 405 to determine the value.
Note Value SSI-Related MA Only
The value of a land contract or mortgage is the amount it can be sold for
in the holder's geographic area on short notice (usually at a commercial
discount rate) minus any lien on the property the holder must repay.
Sale-Leaseback SSI-Related MA Only

Agreement Defined
In a sale-leaseback agreement, a homeowner sells his home on an
installment note and receives monthly payments from the buyer. The
buyer allows the former homeowner to live in the home in exchange for
rent. The difference between the buyer's payment and the rent is
money the former homeowner can use for current expenses. Some-
times the arrangement involves purchase of an annuity that pays
money to the former homeowner.
Sale-Leaseback SSI-Related MA Only

Asset Value
The note held by the former homeowner is an asset. The value is the
amount the note can be sold for in the holder's geographic area on
short notice (usually at a commercial discount rate) minus any liens on
the property the former homeowner must repay.
The sale might also create income for the note holder; see Sale-Lease-
back Income in BEM 500.
LIFE INSURANCE SSI-Related MA Only
A life insurance policy is a contract between the policy owner and the
company that provides the insurance. The company agrees to pay
money to a designated beneficiary upon the death of the insured. Pure
Endowment Life Insurance Contracts pay out on a specific date in the
future not just when the beneficiary dies, and does not meet the defini-
tion of life insurance for Medicaid.
Life Insurance SSI-Related MA Only

Definitions
Cash surrender value (CSV) - the amount of money the policy owner
can get by canceling the policy before it matures or before the insured
dies. It may be titled the cash surrender value or the cash value.
Face value (FV) - the amount of the basic death benefit contracted for
at the time the policy is purchased. It might be titled the face value, face
amount, amount of insurance, amount of policy or sum insured. It does
not include dividends or additional amounts payable because of acci-
dental death or other special circumstances.

Insured- the person whose life the policy insures.
Insurer- the company that contracts with the policy owner.
Policy owner- the person who has the right to change the policy. This
is usually the person who pays the premiums. The policy owner and the
insured can be different people.
Life Insurance SSI-Related MA

Value
A life insurance policy is an asset if it can generate a CSV. A policy is
the policy owner's asset.
• A policy's value is its CSV. A policy can generate a CSV, but have
a CSV of zero. Such a policy is an asset with zero value.
• Generally, term insurance does not have a CSV. Whole or straight

life policies generate a CSV. Policies called graded term or level
term may have a CSV and must be verified and counted as an
asset.
• The CSV usually increases over time. A loan against a policy

reduces its CSV. Pre-death payment of the death benefit might
reduce the CSV. See Accelerated Life Insurance Payments in
BEM 500 about the payments received.
• CSV and FV are not the same thing.
• Tables included with a life insurance policy are not considered

accurate. Verification of the CSV should be either a current notice
(within the year) from the company or by contacting the company
for the current value.
LIFE INSURANCE
EXCLUSIONS
Life Insurance for SSI-Related MA

Funeral
In addition to the general exclusion below, some or all of the value of
insurance might be excluded to pay for funeral expenses. See Funeral
Plans below.
General SSI- SSI-Related MA Only

Related MA Life
Insurance Look at each policy owner's life insurance separately.
Exclusion
Exclude the entire cash surrender value when the total face values of
all policies a policy owner has for the same insured are $1,500 or less.
See the example and exceptions below.

Example:
Mr. and Mrs. Smith own the following policies:
Policy Owner FV Insured CSV
1 Mr. $1,000 Mrs. $500

2 Mr. 800 Mrs. 300
3 Mr. 1,500 Mr. 1,000 Exclude
4 Mr. 2,000 Son 1,000
5 Mrs. 1,500 Mr. 500 Exclude
6 Mrs. 2,000 Mrs. 1,000
CSVs for policies 1 and 2 are not excludable under this policy for Mr.
Smith. He owns both policies. They insure the same person. The com-
bined FVs exceed $1,500.
CSV for policy 4 is not excludable under this policy for Mr. Smith. The
FV exceeds $1,500.
CSV for policy 6 is not excludable under this policy for Mrs. Smith. The
FV exceeds $1,500.
Exceptions: Do not count the face value of:
• Term insurance that does not generate a CSV.
• Burial insurance. Burial insurance is an insurance policy whose

terms prevent the use of its proceeds for anything other than pay-
ment of the insured's burial expenses. A policy is not burial insur-
ance if the policy has a CSV the owner can access. A policy used
for a Life Insurance Funded Funeral below is not burial insurance.
Michigan does not have burial insurance, but a person from
another state could have such insurance.
• Endowment policies. An endowment policy is a policy which

enables the insured to accumulate a sum of money payable to him
at a date named in the policy (the maturity date). The policy says
whether the money is paid over time or all at once. The policy
matures on the maturity date. An endowment policy is not life
insurance. Because the applicant gives up the rights to control
the money until the maturity date, a non-matured endowment pol-
icy must be considered a divestment; see BEM 405.
FUNERAL PLANS SSI-Related MA Only
Funeral plan refers to the prearrangement for cemetery and/or funeral

goods and services. Normally, the plan is established using one or more
of the following:
• Burial fund.
• Purchase of burial space.
• Prepaid funeral contract.
• Life insurance funding.
Burial Fund SSI-Related MA Only

Exclusion
A limited amount of certain types of assets a person has clearly desig-
nated to pay for burial expenses are excluded as a burial fund. See
below for information about:
• Types of assets.
• Burial expenses.
• Clearly designated.
• Not commingled.
• Amount excluded.
• Misuse of funds.
See Exhibit I of this item for examples of this exclusion.
Types of Assets Assets under the following headings in this item can be a burial fund:
• Cash.
• Investments.
• Life insurance.
• Prepaid funeral contract.
Other types of assets (example: real property, vehicles, livestock) may

not be a burial fund.
Burial Expenses Expenses that qualify for the burial fund exclusion are generally those
related to preparing a body for burial and any services prior to burial.
Examples are:
• Services of funeral director and staff.

• Transportation of the body.
• Embalming.
• Cremation.
• Clothing.
• Cost of guest registry book.
• Cost of obituary.
• Flowers not displayed at gravesite.
• Cleric's honorarium if no services at gravesite.
• Burial space items that do not meet the held for test described in
SSI-Related MA Burial Space Exclusion in this item.
Note: Luncheons or similar services do not meet the definition of a

burial fund expense as it is not related to the preparation of the body for
burial. Do not certify a DHS-8A with such an expense and do not con-
sider it as an allowable burial fund expense item.
Clearly The asset must be clearly designated. The designation can be on the
Designated asset (example: title on a bank account, prepaid funeral contract) or on
a signed statement from the client. The designation must include the
following information:
• Value and owner of the asset.

• Whose burial the fund is for.
• Date the funds were set aside for the person's burial.
• Form in which the asset is held (example: bank account, life insur-
ance).
Not Commingled Burial funds may not be commingled with any assets except excluded
burial space assets; see SSI-Related MA Burial Space Exclusion in this
item.
Amount Exclude up to $1,500 for each qualified fiscal group member and/or
Excluded spouse. In addition, exclude accumulated interest and dividends.
Reduce the $1,500 per person maximum by the following:
• The face value of excluded life insurance policies (including term

insurance) when the person is the insured and:
•• If an adult, the policy is owned by the person or the person's

spouse.
•• If a child, the policy is owned by the child, the child's parent or

the parent's spouse.
• The principal amount (not accumulated interest or dividends) held

in an irrevocable prepaid funeral contract for the person's burial
expenses (see above). Do not count the identifiable cost of burial
space assets; see Burial Space Defined in this item.
• The cost of burial expenses (see above) identifiable in a life insur-

ance funded funeral plan that was irrevocably transferred (see Life
Insurance Funded Funeral and Life Insurance Irrevocably Trans-
ferred in this item.
• The face value of burial insurance on the person. See Life Insur-
ance above for the definition of burial insurance.
Count only the original principal amount and any additions to the princi-
pal to determine if the maximum limit has been reached. Do not count
accumulated interest and dividends.
Note: The principal amount of a life insurance policy is the cash sur-
render value (CSV) of the policy, not the face value. Increases in the
CSV count against the limit. Increases in the CSV above the person's
burial fund limit are countable as the policy owner's assets.

Misuse of Fund Count the amount of an excluded burial fund used for another purpose
while the person was an MA recipient as unearned income for one
month. The month must be far enough in the future so that any negative
action pend period would end before the month begins.
Exception: Do not do this if the value of countable assets plus the

misused funds were within the asset limit for the month the misuse
occurred.
Burial Space SSI-Related MA and AMP

Defined
A burial space is a(n):
• Burial plot, gravesite.
• Crypt, mausoleum.
• Casket, urn, niche.
• Some other type of repository customarily and traditionally used

for the deceased's bodily remains.
• Necessary and reasonable improvements or additions to or upon

such spaces including:
•• Vaults.
•• Headstones, markers or plaques.
•• Burial containers.
•• Opening and closing of the gravesite.
•• Contracts for care and maintenance of the gravesite.
Note: Reasonable and necessary are those items required by the

cemetery.
• Flowers if displayed at gravesite.

• Cleric’s honorarium for service at gravesite.
Note: Of the items that serve the same purpose, exclude only one item
per person.
Example: Exclude a cemetery lot and casket for the same person, but
not a casket and an urn.
Value of Burial SSI-Related MA and AMP

Space
The value of a burial space item is its equity value. Equity value is fair
market value minus the amount legally owed in a written lien provision.
SSI-Related MA SSI-Related MA and AMP

and AMP Burial
Space Exclusion Exclude one burial space held for (see below) each of the following:

• Each qualified fiscal group member.

• Whether by blood, adoption or marriage, the member's:
•• Parents.
•• Minor and adult children.
•• Siblings.
• The spouse of each person listed above.
For a member's relatives only by marriage, apply the exclusion only if

the marriage has not ended by death or divorce.
Burial space items in a prepaid funeral contract must be identified and

valued separately from non-burial space items to be excluded.
If the contract shows the purchase of a specified burial space at a spec-

ified price, determine whether such space is held for the client or mem-
ber of the client’s immediate family. If the space is held for the
individual, determine if the contract is irrevocable or revocable. If irrevo-
cable, it is not a resource. If the contract is revocable, it is an excludable
resource. The burial space must continue to meet the held for criteria
to be excluded.
Held For. A burial space is held for an individual when someone cur-
rently has:
• Title to and/or possesses a burial space intended for the individ-

ual's use (example: has title to a burial plot, owns a burial urn
stored in the basement for his own use).
• A contract with a funeral service company for specified burial

spaces for the individual's burial (that is, an agreement that repre-
sents the individual's current right to the use of the items at the
amount shown).
Until the purchase price is paid in full, a burial space is not held for an
individual under an installment sales contract or similar device unless
all of the following are true:
• The individual does not currently own the space.
• The individual does not currently have the right to use the space.
• The seller is not currently obligated to provide the space.
Until all payments are made on the contract, the amounts paid might be
considered burial funds; see Burial Fund Exclusion in this item.

Prepaid Funeral SSI-Related MA and AMP

Contract
A prepaid funeral contract means a contract requiring payment in
advance for funeral goods or services. Contracts may be revocable or
irrevocable.
• See Revocable Prepaid Funeral Contract Exclusions and

Value below if the contract is revocable.
• See Irrevocable Prepaid Funeral Contracts below if the contract

is irrevocable.
• See BAM 805 about making Michigan contracts irrevocable.
Revocable Prepaid SSI-Related MA and AMP

Funeral Contract
Exclusions and Funds in a revocable prepaid funeral contract might be excludable
Value using the Burial Fund Exclusion and/or the SSI-Related MA Burial
Space Exclusion above.
The countable amount of the contract is the amount remaining on

deposit after deducting those exclusions and any commissions or fees
that would be charged upon withdrawal. Exclude only burial space
items for AMP. There is no burial funds exclusion.
Irrevocable LIF, G2U, G2C, SSI-Related MA and AMP

Prepaid Funeral
Contracts Funds in an irrevocable prepaid funeral contract are unavailable and
thus are not counted.
Funds in a Michigan contract (DHS-8A, Irrevocable Funeral Contract

Certification) certified irrevocable are excluded.

Funded Funeral
A funeral plan can be funded using life insurance. A person purchases
a life insurance policy and directs the proceeds to be used to pay for his
funeral. In addition, the person might irrevocably/permanently transfer
ownership of the policy to:
• A trust, or
• A funeral director who then transfers ownership to a trust.
Note: An annuity can be used in the same way to fund a funeral plan.
Proceeds of a life insurance policy means the face value of the policy
plus any additions payable at maturity or death. Proceeds are reduced
by the amount of outstanding loans against the policy and Accelerated
Life Insurance Payments; see BEM 500.

A funeral plan funded with life insurance is not a prepaid funeral con-
tract per BAM 805.

Funded Funeral
Trusts Life Insurance funded trusts, regardless of including specific goods or
services, or naming a funeral provider, are countable if revocable and a
divestment if irrevocable. Send a life insurance funded trust to the Trust
and Annuity Evaluation Unit.
Other Funded Other funded funeral trusts, regardless of including specific goods or
Funeral Trusts services, or naming a funeral provider, are countable assets if revoca-
ble and divestment if irrevocable. These trusts are not prepaid funeral
agreements and do not qualify for any funeral exemptions. A DHS-8A
cannot be used to certify a revocable trust as irrevocable for purposes
of exclusion.
SSI-Related MA Only
If a person has directed the proceeds of a life insurance policy be used

to pay for his funeral, but has not irrevocably transferred ownership, the
policy is treated as life insurance. See Life Insurance and Burial Fund
Exclusion in this item.

Irrevocably
Transferred Use the following when a person directs that the proceeds of a life
insurance policy be used for his funeral and has irrevocably trans-
ferred ownership of the policy. Do this even if the person retains the
right to change funeral providers, items or services.
• Do not count the cash surrender value of the policy as an asset

effective the month of transfer.
• Do not count the funeral contract as an asset.
• Do not apply policy in BEM 401, Trusts - MA.
• Do not consider the ownership transfer as divestment when all of

the following are true:
•• The proceeds are still to be used to pay the insured’s funeral

expenses.
•• The value of the goods and contracted services at least

equals the cash surrender value of the insurance.
•• The new owner cannot use the cash surrender value of the
insurance policy for himself.

Note: If the value of the goods and services contracted for is less than
cash surrender value of the insurance, the difference is transferred for
less than fair market value.
Limited Liability SSI-Related MA Only

Companies
Count any assets in a Limited Liability Company (LLC).
LIVESTOCK SSI-Related MA Only
Exclude farm animals used for personal consumption. Exclude family

pets.
Other livestock might be excluded as an employment asset; see

Employment Asset Exclusions in this item.
EMPLOYMENT AND
TRAINING ASSETS SSI-Related MA Only
Employment assets are those assets commonly used in a business, a

trade or other employment. Examples:
• Farmland.
• Tools, equipment and machinery.
• Inventory, livestock.
• Savings or checking account used solely for a business.
• The building a business is located in.
• Vehicles used in business such as a farm tractor or delivery truck.
It does not include vehicles used solely for transportation to and
from work.
Such assets might also be used in education or job training.
Employment or SSI-Related MA Only

Training Asset
Value See the appropriate sections above regarding the value of vehicles, real
property and savings or checking accounts. The value of other employ-
ment or training assets is their equity value. Equity value is fair market
value minus the amount legally owed in a written lien provision.
Payment-In-Kind SSI-Related MA Only

(PIK) Program
A PIK commodity or commodity certificate may be an asset; see BEM
500, PAYMENT-IN-KIND (PIK) PROGRAM.

EMPLOYMENT
ASSET
EXCLUSIONS
General SSI-Related MA Only

Employment
Exclusion Exclude employment assets (see above) that:
• Are required by a person's employer.

• Produce income directly through their use.
Such assets remain excluded when a person is unemployed only if the

person intends to return to that type of work.
EDUCATION AND
TRAINING
EXCLUSION FIP, SDA, LIF, G2U, G2C
529 college savings plans are designed to allow individuals to make

after-tax deposits for their children’s future higher education expenses.
In Michigan, these plans are administered by the Department of Trea-
sury and are known as Michigan Education Savings Plans. Funds
deposited into these accounts may qualify for matching funds. After a
child reaches age 18, the funds may be used for post secondary educa-
tion or a certified training program.
Disregard funds on deposit in a 529 college savings plan, interest

earned on a 529 plan, and any matching funds deposited in a 529 plan.
SSI-Related MA Only
Exclude assets directly related to a person's current education or job

training program. Directly related means the asset is necessary for the
major program of study or related occupation. Current means ongoing
participation except for school breaks.
Example: Exclude tools the person needs for his ongoing auto
mechanics program.
Continue this exclusion for six calendar months following the month the
program is completed if the person intends to seek employment in that
occupation.
Note: This exclusion does not apply to real property, life estates and
life leases.

VERIFICATION
REQUIREMENTS FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
Do not require verification when countable assets exceed the limit

based on a person's own statement of value.
Verify the value of countable assets at application, redetermination and

when a change is reported.
Verify joint ownership and that the countable amount is less than that
presumed by policy at application and when a change is reported.
Verify the following factors affecting exclusion of an asset at application,

redetermination, and when a change is reported:
• An asset is not available.
• Joint ownership prevents sale (other owner refuses to sell).
• There is a written agreement to repair/replace a damaged or

destroyed homestead (cash exclusion for FIP, SDA, LIF, G2U,
G2C, SSI-related MA and AMP; land exclusion for SSI-related
MA).
• There is a written agreement to purchase another homestead.
• The asset is a bona fide loan.
SSI-Related MA Only
• An asset is non-salable.
• The equity value in income-producing real property
• Any transfer of ownership of life insurance to fund a funeral
VERIFICATION
SOURCES FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP
The following prove ownership and/or value of assets. You may use the
DHS-20, Verification of Assets, the DHS-27, Release of Information, the
DHS-503, Asset Verification, or other specified form as appropriate,
when assisting a person verify assets.
Document information verified by telephone contact on a DHS-223,

Documentation Record.
Other sources of verification are listed by asset type.
Checking or Draft Monthly statement (Examination of checkbook is not sufficient.)

Account Telephone contact with financial institution

Individual Copy of documents establishing the IDA

Development Statement from the trustee or custodian of the account
Account
• Documentation must specify the purpose for which the trust or
account is established, that the trust or account will receive match-
ing funds, and that withdrawals must be authorized by the trustee
or custodian.
Irrevocable Copy of DHS-8A, Irrevocable Funeral Contract Certification, certifying

Funeral Contract contract irrevocable or equivalent form used by the Department of Com-
munity Health.
Loan Copy of financial institution loan contract.

Lender's financial statement showing withdrawal of borrowed amount.
Life Insurance DHS-4786, Life Insurance Verification, completed by agent or company.

Statement from insurance company or agent.
LTC Patient Trust Written statement from LTC facility.

Fund
Money Held By Written statement from person holding the money.

Other
Prepaid Funeral Statement of funeral home or contract seller.

Contract Copy of contract.
Real Property Deed, mortgage, purchase agreement or contract.
State Equalized Value (SEV) on current property tax records multiplied

by two.
Attorney or court records.
County records.
Statement of real estate agent or financial institution.
Retirement Plan Written statement from plan administrator.

Current plan statement.
Savings or Share Passbook with current entries posted.

Account Christmas club coupon book.
Written statement from financial institution.
Telephone contact with financial institution.
Savings Certificate Written statement from financial institution.

Certificate itself.
Stocks and Bonds Written statement from broker or company.

Listing in current newspaper.

Trust Copy of trust document.

Copy of documents transferring ownership of assets to the trust.
Appropriate source for the asset types owned by the trust.
U.S. Savings Bond Statement from financial institution.

Bond itself.
Vehicles Secretary of State inquiry.
Title, registration or proof of insurance.
Blue book or NADA book wholesale (trade-in) value.
• Do not add the value of optional equipment, special equipment or

low mileage when determining value.
Kelley Blue Book at www.kbb.com:
• Enter the greater of actual mileage or 12,000 per year.

• Enter the client’s zip code.
• Do not change the preset typical equipment.
• Enter “fair” as the condition.
• Use the trade-in value.
Loan statement or payment book.
Statement of vehicle dealer or junk dealer, as appropriate.
Allow the person to verify a claim that the vehicle is worth less (exam-
ple: due to damage) than wholesale book value. If the vehicle is no
longer listed, accept the person's statement of value.
Exception: Verify the value of antique, classic or custom vehicles.
EXHIBIT I - BURIAL
FUNDS EXAMPLES:
SSI-RELATED MA
CATEGORIES
ONLY
EXAMPLE 1: EXAMPLE 2:
Client has: Client has:
1. $2500 Savings Account 1. $2500
2. $2000 Savings Account
Irrevocable Funeral Contract - No Burial
Space Items
BURIAL FUNDS MAXIMUM: BURIAL FUNDS MAXIMUM:
$1500 - MAXIMUM $1500
-2000 Principal Sum of Irrevocable Funeral
0 Contract
Maximum


Client may: Designate up to $1500 for self as Client may not designate any assets as excludable
excludable burial funds. burial funds. However, the client could use savings to
purchase burial space items.
Client must: Establish a separate account for the
amount designated.
Client has: Client has:
1. $2500 Savings Account 1. $2500 Savings Account
2. $2000 Irrevocable Funeral Contract as 2. $1000 Face Value of Excludable Life Insurance
follows:
- $1000 Casket
- $600 Headstone
- $400 Assorted Professional Services
$1500 Principal Amount of Irrevocable $1500
- $400 Funeral -1000 Face Value of Excludable Life Insurance
Contract for Non-Burial Space Items
$1100 $500 MAXIMUM
Client may: Designate up to $1100 excludable Client may: Designate up to $500 as excludable
burial funds or buy more burial space. burial funds or buy burial space items.
Client must: Establish a separate account for the Client must: Establish a separate account for the
amount designated. amount designated.
Client has: Couple has:
1. $2500 Savings Account 1. $2800 Savings Account (Joint)
2. $400 Irrevocable Funeral Contract for Profes- 2. $1300 Common Stock Account (Husband)
3. $500 sional Services 3. $1600 Face Value Life Insurance - CSV=$300
Face Value of Excludable Life Insurance. (Wife)
$1500
- $400 Principal Amount of Irrevocable $1500 - MAXIMUM PER PERSON
$1100 Funeral Contract
- 500
$600 Face Value of Excludable Life Insur-
ance
MAXIMUM
Client may: Designate up to $600 as excludable Client may: Designate up to $1500 per person as
burial funds or buy burial space items. excludable burial funds. One way to do
this is:
HUSBAND WIFE
$200 Savings Account $1200
$1300 Common Stock 0
_0 Life Insurance $300
$1500 $1500
Client must: Establish a separate savings account for Client must: Establish a separate savings account for
the amount designated. any amounts designated from savings.

EXHIBIT II - LIFE
ESTATE AND LIFE
LEASE FACTOR
TABLE
Age Factor Age Factor Age Factor
0 .97188 40 .91571 80 .43659
1 .98988 41 .91030 81 .41967
2 .99017 42 .90457 82 .40295
3 .99008 43 .89855 83 .38642
4 .98981 44 .89221 84 .36998
5 .98938 45 .88558 85 .35359

6 .98884 46 .87863 86 .33764
7 .98822 47 .87137 87 .32262
8 .98748 48 .86374 88 .30859
9 .98663 49 .85578 89 .29526
10 .98565 50 .84743 90 .28221

11 .98453 51 .83674 91 .26955
12 .98329 52 .82969 92 .25771
13 .98198 53 .82028 93 .24692
14 .98066 54 .81054 94 .23728
15 .97937 55 .80046 95 .22887

16 .97815 56 .79006 96 .22181
17 .97700 57 .77931 97 .21550
18 .97590 58 .76822 98 .21000
19 .97480 59 .75675 99 .20486
20 .97365 60 .74491 100 .19975

21 .97245 61 .73267 101 .19532
22 .97120 62 .72002 102 .19054
23 .96986 63 .70696 103 .18437
24 .96841 64 .69352 104 .17856
25 .96678 65 .67970 105 .16962

26 .96495 66 .66551 106 .15488
27 .96290 67 .65098 107 .13409
28 .96062 68 .63610 108 .10068
29 .95813 69 .62086 109 .04545
30 .95543 70 .60522
31 .95254 71 .58914
32 .94942 72 .57261
33 .94608 73 .55571
34 .94250 74 .53862
35 .93868 75 .52149
36 .93460 76 .50441
37 .93026 77 .48742
38 .92567 78 .47049
39 .92083 79 .45357

LEGAL BASE FIP
P.A. 280 of 1939, as amended
MA
Social Security Act, Sections 1902(a)(10); (r)(2)

Deficit Reduction Act of 2005
42 CFR 435.840 -.845
MCL 400.106
SDA
Annual Appropriations Act
AMP
Title XXI of the Social Security Act (1115) (a) (1)

(1115) (a) (1) of the Social Security Act

BAM 402 1 of 21 MA/AMP BENEFITS
DEPARTMENT
POLICY MA, AMP
General lists of MA and AMP covered services are located at the end of
this item; see EXHIBIT I and EXHIBIT II.
In this item MA includes:
• FIP recipients.
• SSI recipients.
• TMA-Plus recipients.
AMP includes those SDA recipients who also receive AMP.
CHOICE OF
PROVIDERS MA
The recipient is usually free to select a provider or health care plan.

However, there are some situations when the recipient may be
restricted to a primary provider. Reimbursement for services rendered
is limited to enrolled providers except for emergencies.
AMP
The recipient is free to select a provider unless the county has a health
plan enrollment.
HEALTH PLANS MA
Health Plans provide Medicaid-covered health care services for an

enrolled group of recipients in a defined service area.
Enrollment Recipients are given an opportunity to select a Health Plan. If no selec-

tion is made, the recipient is automatically enrolled by the state’s con-
tracted enrollment broker, Michigan ENROLLS, with a Health Plan in
the recipient’s county of residence.
Health Plan enrollees are identified by Level of Care (LC) code 07

(HMO ENROLLEE). Health Plan enrollees will also receive an identifi-
cation card from their Health Plan.
There are recipients who:
• Must enroll in a Health Plan.

• May voluntarily enroll in a Health Plan.
• Are excluded from enrollment in a Health Plan.
Persons Who Must The following must enroll in a Health Plan, unless they are Persons
Enroll In A Health Who May Voluntarily Enroll In A Health Plan or Persons Excluded
Plan From Enrollment In A Health Plan.

• Family Independence Program (FIP) recipients.
• Healthy Kids MA recipients.
• Pregnant women.
• Under Age 21 (G2U) MA recipients.
• Caretaker Relatives and LIF MA recipients.
• Supplemental Security Income (SSI) recipients who do not receive

Medicare.
• Blind, disabled, and aged MA recipients who do not receive Medi-

care.
Persons Who May The following may voluntarily enroll in a Health Plan:
Voluntarily Enroll
In A Health Plan • Migrants.
• Native Americans.
• Persons in the traumatic brain injury program.
Exception: Migrants and Native Americans must enroll in a Health

Plan when receiving TMA-Plus.
Persons Excluded The following are excluded from enrollment in a Health Plan:
From Enrollment In
A Health Plan • Persons with both Medicare and Medicaid eligibility.
Note: Letters are mailed out each month to Medicaid recipients

who are also eligible for Medicare. The letter informs recipients
that they are being disenrolled from their Health Plan; see
EXHIBIT III for further information.
• PlusCare recipients.
• Persons eligible for a Medicare Savings Program; see BEM 165.
• Persons limited to emergency MA coverage (ESO).
• Persons enrolled in the Children’s Special Health Care Services

(CSHCS) program only.
• Persons residing in an ICF/MR (intermediate care facility for the

mentally retarded) or a state psychiatric hospital.
• Persons receiving long-term care (custodial care) in a licensed

nursing facility.
• Persons receiving MI Choice waiver services for the elderly and

disabled (LC code 22); see BEM 106.

• Persons with commercial HMO coverage, including Medicare

HMO coverage.
Note: Letters are mailed out each month to Medicaid recipients

who have private HMO coverage. This letter informs recipients
that they are being disenrolled from their Health Plan; see
EXHIBIT IV for further information.
• PACE (Program for All-inclusive Care for the Elderly) recipients.
• Deductible clients.
• Children in foster care or child caring institutions.
• Refugee Assistance Program Medical Aid-only recipients.
• Repatriate Assistance Program Medical-only recipients.
Note: When a person(s) is excluded from Health Plan enrollment,

other members of that person’s family may enroll in a Health Plan.
If a client enrolled in a Health Plan enters a long-term care facility for

custodial purposes, the Health Plan may initiate a request for disenroll-
ment from the Health Plan; see BAM 120. The Health Plan may request
disenrollment by calling:

Quality Assessment and Improvement Section
1-517-335-5205
Additional For additional information regarding Health Plans, contact:

Information About
Health Plans Department of Community Health
Comprehensive Health Plan Division
CCC Bldg
PO Box 30479
Lansing, MI 48909-7979
Michigan Enrolls: 1-888-367-6557
A list of the Health Plans available in each county is on the DCH Web
pages (Medicaid Link). This list is updated monthly. The DCH Web
page address is: www.michigan.gov/mdch.
Other Insurance Health Plan enrollees with other insurance should advise their Health
Plan of their insurance coverage.
Covered Services The Health Plan is responsible for providing and arranging for all medi-
cally necessary services covered by Medicaid with the exception of:

• Dental care (Services rendered by an oral surgeon are included in

the Health Plan capitation rate).
• Mental health services including inpatient psychiatric services (the

Health Plan is responsible for up to 20 outpatient visits).
• Substance abuse treatment.
• Medical transportation for the three services listed above; see

BAM 825.
• Personal care services.
• School-based services.
The Health Plan is responsible for providing up to 45 days of restorative

health care which is intermittent or short-term, restorative or rehabilita-
tive nursing care.
The Health Plan may also provide services that are not covered by MA.
MICHIGAN
PHARMACEUTICAL
BEST PRACTICES MA, AMP
DCH has contracted with First Health Services to be the pharmacy ben-
efits manager for its fee-for-service health programs and pregnancy-
related pharmacy services for Maternity Outpatient Medical Services
(MOMS) beneficiaries. The pharmacy benefits manager is responsible
for all of the following:
• Prior authorizing certain drugs.Processing claims.

• Approving payment to pharmacies.
• Other administrative functions to ensure that appropriate pay-
ments are being made.
First Health Services does not prior authorize or pay claims for Medi-
caid contracted health plans.
Prior Authorization Drugs that require prior authorization appear on the Michigan Pharma-
ceutical Products List (MPPL). Physicians or other prescribers may
request prior authorization by contacting First Health Services.
First Health Services

MAP Department
4300 Cox Road
Glenn Allen, VA 23060
Telephone: 1-877-864-9014
Fax: 1-888-603-7696 or 1-800-250-6950

Hearing Rights A client is notified in writing within 10 days of a prior authorization

denial. The notice tells the client how to apply for a DCH administrative
hearing. The DCH hearings application form and a stamped envelope
are included with the notice.
HEALTHY KIDS
DENTAL MA
Healthy Kids Dental is currently operating in 61 counties. DCH has con-

tracted with Delta Dental Plan of Michigan to be the fiscal administrator.
Delta Dental Plan administers the Medicaid dental benefit to all Medic-
aid recipients under age 21 in the participating counties.
The dental services provided through Delta Dental Plan are the same
dental services provided through fee-for-service Medicaid.
Healthy Kids Dental is not limited to persons receiving MA under

Healthy Kids. It is for all MA recipients under age 21, including FIP
recipients, in participating counties.
Recipients must see a dentist that participates with Delta Dental. Clients
may call Delta Dental’s Customer Service with questions at 1-800-482-
8915.
Note: Clients must use their Social Security number (SSN) when call-
ing Delta Dental. If a client does not have an SSN, a 9 is added to the
beginning of the MA recipient ID number to resemble an SSN. Clients
may access Customer Service using the modified MA recipient ID num-
ber as their SSN identifier.
Enrollment Enrollment in Healthy Kids Dental is automatic based on the recipient’s

county of residence and age. Recipients do not choose a plan. Healthy
Kids Dental is currently available in the following counties:
Alcona Hillsdale Ontonogan

Alger Houghton Oscoda
Allegan Huron Otsego
Alpena Ionia Presque Isle
Antrim Iosco Roscommon
Arenac Iron Saginaw
Baraga Isabella Sanilac
Barry Kalkaska Shiawassee
Benzie Keweenaw St. Clair
Branch Lake St. Joseph
Charlevoix Lapeer Tuscola
Cheboygan Leelenau Van Buren

Chippewa Lenawee
Clare Livingston
Clinton Luce
Crawford Mackinac
Delta Manistee
Dickinson Marquette
Eaton Menominee
Emmet Midland
Genesee Missaukee
Gladwin Monroe
Gogebic Montmorency
Gratiot Ogemaw
Enrollment in Delta Dental is done monthly. Delta Dental receives a

monthly file at the beginning of the month. A client must be active MA
on Bridges by the last day of the previous month in order to appear on
the file.
Clients have Medicaid fee-for-service dental coverage until enrolled in

Healthy Kids Dental.
ID Cards In addition to the mihealth card, Healthy Kids Dental recipients will
receive a Delta Dental card. If the card is lost the client must call Delta
Dental at 1-800-482-8915 to request a replacement card. The client’s
SSN is on the card, not the MA recipient ID number.
Retroactive Enrollment in Healthy Kids Dental is not retroactive even if MA cover-

Enrollment age goes back to the beginning of a month (or earlier). Enrollment is
prospective.
If a client’s MA is opened in the middle of the month, the client has Med-
icaid fee-for-service dental until the following month when the file is sent
to Delta Dental.
Covered Dental Healthy Kids Dental provides services that are applicable to persons
Services under age 21. These services include:
• X-rays.
• Cavity fillings.
• Extractions.
• Teeth cleanings.
• Root canals.
• Sealants and fluoride treatment.
• Examinations.
• Dentures.

The scope of these services is the same as for fee-for-service MA.
MEDICAID
VERIFICATION OF
BRIDGES
INFORMATION MA
Sometimes the Health Plan or Delta Dental Plan may have different
information about the recipient than what is in Bridges. In those
instances, the Health Plan or Delta Dental Plan will send you a DCH-
2010, Verification of Bridges Information Medicaid Beneficiaries, with
the information they have on file for the recipient; see EXHIBIT V.
The Health Plan or Delta Dental will enter the information and indicate
what information they have received that is different. They will also indi-
cate how the information was received (that is by: beneficiary, returned
mail, provider) and attach supporting documentation, if available.
Review the information from the Health Plan or Delta Dental Plan, take
appropriate action and respond in Section 4 of the DCH-2010. Return
the form to the Health Plan or Delta Dental Plan address in Section 2.
BENEFICIARY
MONITORING
PROGRAM (FEE-
FOR- SERVICE) MA
DCH regularly reviews fee-for-service utilization of MA benefits. Some

clients may be restricted to a primary provider.
A client subject to the restricted provider control mechanism is identified

by LC code 13 or 14 in Bridges. With the exception of life threatening
emergency care, only the client’s provider may render or approve ser-
vices.
For further information or to make a referral contact:

Beneficiary Monitoring Program
CCC Bldg
PO Box 30479
Phone: (517) 335-5060
EPSDT/WELL
CHILD PROGRAM MA
The EPSDT/Well Child Program consists of well-child visits, immuniza-

tions and early detection and treatment of diseases for clients under

age 21. The objective of this preventive health care is early intervention
to detect and treat mental or physical disease.
The same components of a well-child visit and the same interval sched-
ule is used regardless of whether the child is in a Health Plan or is fee-
for-service.
A client not enrolled in a Health Plan receives MSA Publication 492, A

Hug Shows You Care, which advises the client that it is time for a well-
child visit. This notice urges the client to set up a free health checkup by
calling his doctor.
MDCH Publication (795), Michigan Free Health Check-ups for persons

21 and younger, explains the well-child visits.
ENROLLED
PROVIDER BILLING
PROCEDURES
(FEE-FOR-
SERVICE) MA, AMP
Enrolled providers are aware of the covered and excluded services

available to MA and AMP recipients. Providers must use MA billing pro-
cedures to obtain payment for services performed. Billings should be
submitted within 12 months from the date of service.
Twelve Month Exceptions to the 12 month billing policy can be made if the delay is
Billing Exceptions caused by agency error or as a result of a court or administrative hear-
ing decision. Agency errors are limited to:
• Delayed Bridges coding, including level of care changes.

• MRT review.
• SHRT decision.
• Administrative review.
• Delayed eligibility determination.
Exceptions cannot be granted due to provider delays in billing or failure

of a recipient or provider to obtain prior authorization.
Form MSA-1038, Request for Exception to the Twelve Month Billing

Limitation For Medical Services, is an internal document and must be
completed by local office staff to begin the exception process. The com-
pleted MSA-1038 should be sent to: 1038@michigan.gov.
A family independence manager, district manager, or other office desig-

nee must be copied on the email. A copy of the hearing decision is no
longer required, however, the hearing registration number must be indi-
cated on the MSA-1038.

DCH will notify the specialist within 30 days of their decision. If

approved DHS will notify providers to bill Medicaid as usual but to enter
in the comments section of the claim “MSA 1038 approval on file”.
MEDICAL
SERVICES
PROVIDER
POLICIES MA, AMP
Local office staff are not expected to be the recipient’s primary source of
information for MA and AMP covered services. The providers of medi-
cal services are best equipped to determine medical needs and
whether those services are covered by MA or AMP as specified in the
MA provider manuals.
Some basic guidelines:
• The provider is required to bill all other insurances prior to billing

MA.
• Providers must be appropriately licensed and/or certified before

entering into an agreement with DCH to participate in the MA/AMP
programs.
• Enrolled providers receive direct payment for services rendered

but must agree to provide services according to the policies pub-
lished in the MA provider manuals.
• Certain medical/dental services require the provider to obtain prior

approval from DCH.
• A copayment is required for persons age 21 and over for:
•• Hearing aid services.

•• Dental.
•• Vision.
•• Podiatry.
•• Chiropractic services.
•• Pharmacy.
Exception: There is no copayment for persons:
•• Under age 21.
•• Who reside in a nursing home.
•• Who are enrolled in an HMO.
•• Whose services are covered by Medicare.

•• Who are enrolled in the Children’s Special Health Care Ser-

vices program (CSHCS).
•• Who receives family planning or pregnancy-related services.
•• Who receives mental health, substance abuse, or develop-

mental disability services provided and paid through a local
community mental health services program, state psychiatric
hospital, state developmental disabilities center, or the Center
for Forensic Psychiatry.
• The provider is required to accept payments received from MA/

AMP as payment in full, except for patient-pay amounts autho-
rized by DCH and co-payments.
• The provider may seek payment from a client for services not cov-
ered if the client elects to receive the services with the prior knowl-
edge that such services are not covered.
• Institutional and nursing home providers holding a client’s funds in

trust are accountable to the client and may not require the deposit
of such funds with the facility. The management of such funds is
subject to review by DCH.
Local offices may obtain more information on medical/dental care cov-

erage by consulting the MA provider manuals or contacting DCH at:

Provider Inquiry
CCC Bldg
PO Box 30479
Phone: 1-800-292-2550
MEDICAL/DENTAL
SERVICES IN
ANOTHER STATE MA, AMP
A Michigan MA/AMP recipient may receive medical/dental care outside

of Michigan. The areas beyond the Michigan borders are classified as
either borderland or beyond borderland. Borderland and beyond bor-
derland providers must comply with applicable Michigan MA/AMP poli-
cies and procedures, including prior authorization, to be reimbursed for
services.
Borderland Areas The borderland areas are the out-of-Michigan counties which are adja-
cent to the Michigan border and certain cities beyond these adjacent
counties. The specific counties and cities which are borderland areas
are:

States, Counties/Cities
Ohio Wisconsin
• Fulton County • Ashland
• Lucas County • Green Bay
• Williams County • Rhinelander
Indiana Indiana
• Elkhart County • Fort Wayne
• Lagrange County
• LaPorte County
• St. Joseph County
• Steuben County
Wisconsin Minnesota
• Florence County • Duluth
• Iron County
• Marinette County
• Forest County
• Vilas County
A client is covered for medical/dental services rendered in a borderland

area to the same extent that such services are covered in Michigan.
Borderland providers are considered to be Michigan providers. They

must be enrolled in Michigan Medicaid and adhere to the same policies
as Michigan providers.
Beyond The beyond borderland areas are all areas of the U.S. outside of Michi-
Borderland Areas gan which are not borderland areas.
Beyond borderland medical/dental services received by a Michigan MA/

AMP recipient will be covered only when:
• The recipient is temporarily out-of-state and the services are nec-

essary because the recipient's health would be endangered if he
was required to travel to Michigan,.
• The recipient is temporarily out-of-state and the services are nec-

essary because of a medical/dental emergency (as defined by the
program).
• The service is prior authorized by DCH as more readily available in

another state.

Prior Authorization Certain services provided by borderland providers require prior autho-
rization the same as services requiring prior authorization by Michigan
providers.
Except in emergencies, the services of a beyond borderland provider

must be prior authorized. The recipient’s local physician should submit
the following to DCH:
• Documentation of the need for beyond borderland services.

• Recipient identification.
• Eligibility data.
The address to submit the above information is:

Review and Evaluation Division
400 S. Pine
PO Box 30170
The recipient's physician and the local office may also make telephone
inquiries regarding beyond borderland services when it appears that
time is of the essence.
Phone: 1-800-622-0276
The Prior Authorization and Review Section may request information

from local offices when evaluating the need for beyond borderland ser-
vices. Prompt assistance from the local offices is appreciated. A copy of
the prior authorization decision will be sent to the appropriate local
office.
Inquiries Refer non-enrolled provider questions about borderland or beyond bor-

derland coverage and billings to:

Provider Inquiry
400 S. Pine
PO Box 30239
Providers may phone:
1-800-292-2550
Claims Medicaid will pay nonenrolled Michigan and borderland providers for:
• Emergency services, and

• Nonemergency services with prior approval.

The following occurs when nonemergency services claims are submit-

ted by a nonenrolled provider:
• The miscellaneous transactions unit will process the claim and

send a letter to the provider with a Medical Assistance Provider
Enrollment/Trading Partner Agreement form.
• If the provider elects not to complete the Medical Assistance Pro-

vider Enrollment/Trading Partner Agreement form the claim will not
be paid.
Reimbursement for services not paid by Medicaid is between the client

and the provider. The provider must notify the client prior to rendering
the service that it is not covered by Medicaid.
Borderland providers who are not enrolled and all beyond borderland
providers should submit claims to:

Provider Enrollment
Medicaid Payments
PO Box 30238
Budget and Finance Administration
Miscellaneous Transactions Unit
PO Box 30239
DHS INQUIRIES MA, AMP
Two telephone numbers are available to contact the Enrollment Ser-

vices Section in DCH:
• (517) 241-8759.
This is a voicemail line for you to use to request removal of LC

code 07 or 88 in Bridges. A series of questions prompts you to
leave the information necessary to remove the LC code. You will
be told when the LC code will be removed and how to verify the
removal by checking Bridges. If the Enrollment Services Section is
unable to remove the LC code or has any questions, you will be
contacted.
• 800-292-9570.
DCH staff are responsible for adding or ending LC code 16 or 55.

However, call the Exception Unit at the above number if informa-
tion on Bridges needs to be updated or if you have questions
about these LC codes.

PROVIDER
INQUIRIES
Eligibility MA, AMP

Verification
System (EVS) Client information is available to medical/dental providers through an
automated system called the Eligibility Verification System (EVS). Cur-
rently, it is commonly called Emdeon.
By telephone with either a touch-tone system or a tone-dialer, the num-

ber is:
• 1-888-696-3510
EVS provides the following eligibility information for MA, AMP, MOMS,
and CSHCS for the date of service:
• Details on program codes; scope/coverage; patient-pay amounts;

DHS district, section, unit, specialist ID and phone numbers; social
security claim number; and pending eligibility.
• Other insurance information, carrier ID number, other insurance

code, policy number, contract number, service codes, employer
and policyholder name.
• Level of care information, Health Plan enrollments, nursing home

residence, and beneficiary monitoring program.
Additional information is not available through EVS.
Health Plans MA
Refer provider questions about Medicaid Health Plans to:
Provider Inquiry: 1-800-292-2550
Covered Services After consulting the MA provider manuals, providers may call the follow-
ing number to verify covered services or to receive billing assistance:
Provider Inquiry: 1-800-292-2550.
CLIENT INQUIRIES
Covered Services MA, AMP
Fee-for-Service -Refer client questions about MA/AMP covered ser-

vices or billing problems to:
Medicaid Beneficiary Helpline: 1-800-642-3195.

Health Plans MA
Refer client questions about MA Health Plans, including available pro-

viders in their area and enrollment to:
Michigan Enrolls: 1-888-367-6557.
Refer client complaints and questions about MA providers to:
Medicaid Beneficiary Helpline: 1-800-642-3195.

Enrollment Services Section
CCC Bldg
PO Box 30470
COMPLAINTS
ABOUT
PROVIDERS MA, AMP
Refer complaints about enrolled providers to:

Comprehensive Health Plan Division
400 S Pine
PO Box 30479
Michigan Department of Attorney General

Health Care Fraud Division
PO Box 30218
Lansing, MI 48909
24 hour hotline:1-800-24-ABUSE
E-mail: hcf@michigan.gov
EXHIBIT I - MA
COVERED
SERVICES The following are general categories of MA covered services. This list-
ing should be used for reference purposes only. Some of the services
listed are available only to certain age groups, may be limited in their
scope or may require prior approval.
Local office staff are not expected to be the recipient's primary source of
information for MA covered services. The recipient should be advised to
contact the medical services provider directly whenever information is
needed regarding MA covered services.

Allergy Testing/Treatment
Ambulance Services
Chiropractic Services
Dental Services
Diabetic Patient Education Program
EPSDT/Well Child Services
Family Planning Services
Hearing Aid Dealers
Hearing & Speech Center Services
Home and Community-Based Waiver Services
Home Health Services
Hospice Services
Hospital Services (Inpatient/Outpatient)
Laboratory & X-Ray Services
Long-Term Care (LTC)
Maternal and Infant Support Services
Medical Supplies and Equipment
Mental Health Services
Methadone Maintenance Treatment
Nurse-Midwife and Nurse Practitioner Services
Orthotics, Prosthetics and Special Shoes
Personal Care Services
Pharmacy Services
Physician Services (MD/DO)
Podiatric Services
Psychiatric Care
School-Based Services
Substance Abuse Treatment Services
Therapy (Occupational, Physical, Speech)
Transportation (BAM 825)
Vision Services
If you have questions regarding a specific service, you may contact

Provider Inquiry at 1-800-292-2550.
Do not give the above number to clients.
EXHIBIT II - AMP
COVERED
SERVICES AMP covered services include:
• Physician services (covered by the Medicaid program) provided by

nurse practitioners, oral surgeons MDs and DOs, including immu-
nizations, injections, mammograms, and annual physical exams
(to include pelvic, pap test, and breast exam), in an office, urgent
care or clinic. $3.00 Copay required for professional services.
Note: Dental services are not covered. Services provided by an

oral surgeon (who is enrolled as a physician) are covered.
• Pharmacy drug products (covered by the Medicaid program),

ordered by an MD, DO, or DDS. $1 copay for prescriptions. Labo-
ratory and radiology services if ordered by an MD, DO or nurse
practitioner for diagnostic and treatment purposes.
• Outpatient hospital diagnostic and treatment services, including

diabetes education services. Excluded: Occupational, speech
and physical therapy, partial hospitalization and labor room.
• Limited medical supplies.
• Ambulance - limited to ground transportation to a hospital emer-

gency room.
• Mental health services and substance abuse treatment covered

through local Community Mental Health Services Program.
• Family planning services.
• Hospital emergency room services.
Exception: Services are only available for emergency conditions for

aliens limited to emergency AMP.

EXHIBIT III -
NOTICE TO
MEDICAID
BENEFICIARIES
WHO ARE ALSO
ELIGIBLE FOR
MEDICARE

EXHIBIT IV -
NOTICE TO
MEDICAID
BENEFICIARIES
WHO HAVE
PRIVATE HMO
INSURANCE

EXHIBIT V - DCH-
2010,
VERIFICATION OF
BRIDGES
INFORMATION
MEDICAID
BENEFICIARIES
LEGAL BASE MA
42 CFR 431, Subpart B

42 CFR 431.107
42 CFR, Part 440
42 CFR 441, Subpart B
42 CFR 456.3
MCL 400.109,.110
Social Security Act, Section 1927

TMA-PLUS
DCH Appropriations Act
AMP
Title XIX of the Social Security Act(1115) (a) (1)

(1115) (a) (1) of the Social Security Act
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

BEM 531 1 of 5 HEALTHY KIDS INCOME BUDGETING
DEPARTMENT
POLICY This item applies to income budgets for:
• BEM 125, Healthy Kids for Pregnant Women.

• BEM 129, Healthy Kids under Age 1.
• BEM 131, Other Healthy Kids.
See BEM 647 for TMA-Plus budgeting policy. See BEM 530 for budget-
ing policy for other MA categories.
BUDGET MONTH Determine income eligibility and post-eligibility patient-pay amounts

(PPA) on a calendar month basis. Use one budget to determine income
eligibility (or post-eligibility PPA) for multiple months if the circum-
stances for each of the months are identical.
Document budget computations. MA worksheets and LOA2 are avail-

able. See BEM 549.
COUNTABLE
INCOME Apply the policies in BEM 500 series to determine countable income.
Use only the countable amount of income. Also see “COUNTABLE
INCOME” in BEM 546 for post-eligibility patient-pay amount computa-
tions.
Disregard all parental income for all pregnant women applying for or
receiving MA under the Healthy Kids for Pregnant Women category.
HEALTHY KIDS
APPLICANTS Determine eligibility for the application month first for Healthy Kids cate-
gories (BEM 125, 129 and 131).
Eligible for If a person is eligible for Healthy Kids for the application month proceed
Application Month as follows:
• See “Healthy Kids Retro MA Eligibility Requirements” in BAM

115.
• Determine continued MA eligibility starting with the month a

change occurred if the person reported a change that could affect
eligibility.
Note: Determine continued MA eligibility if the person attained age 1 or

19 while the application was pending.
Not Eligible for If a person is not eligible for Healthy Kids for the application month pro-
Application Month ceed as follows:
• See “Standard Retro MA Eligibility Requirements” in BAM 115.

if the retro MA question on the application is answered yes.

Note: BEM 125 says that a pregnant woman who is income eligi-
ble for one month remains income eligible through the second
month after pregnancy ends. A pregnant woman who is eligible for
a retro MA month is income eligible for the application month.
• If the income limit increased after the application month, determine

eligibility starting with the month of the increase.
• A person who is eligible starting after the application month may

reach age 1 or 19 in the processing month. Determine if eligibility
continues after the month the age limit was reached.
• If a person completed the DHS-1171, determine if eligibility exists

under a different MA category. It is important to determine eligibility
in order, beginning with the oldest month, when using medical
expenses to determine Group 2 income eligibility. See “Appli-
cants and Deductible Cases” BEM 530.
Referrals to If you determine that a person under age 19 is not eligible for Healthy
MIChild Kids due to excess income, proceed with the MIChild interface referral
process.use an DHS-45, DHS to DCH/MIChild/FTW Transmittal, or
LOA2 equivalent, and send or FAX (517) 324-9925 legible photocopies
of the following to MIChild:
• DHS-1171 or DCH-0373-D.
• Healthy Kids budget sheet.
• Any other Healthy Kids eligibility information.
• Any Healthy Kids verifications.
Use an DHS-14, MIChild/Freedom to Work Referral, or the LOA2 equiv-

alent, to inform the family of the referral to MIChild.
Refer to MIChild promptly to reduce the possibility of a lapse in cover-

age. MIChild eligibility begins the first day of the month following
approval.
When MIChild approval occurs after the MIChild enrollment cutoff date,
eligibility begins the second month after approval. MIChild is not retro-
active. See BEM 655.
MIChild will use your budget and income information to process the
MIChild application. The client will not be contacted for additional
income information.
HEALTHY KIDS
RECIPIENTS Do a future month budget at redetermination. Financial eligibility is only
considered at initial eligibility and annual redetermination. Income and
income limit changes are not considered until the next redetermination.

INCOME FOR
HEALTHY KIDS
DETERMINATIONS
Healthy Kids Special rules apply when MIChild refers an application to DHS for a
Referrals from Healthy Kids determination.
MIChild
• Use the income budget provided by MIChild unless you already
have more accurate information. See “Client’s Declaration of
Income and Other Information” below.
• Do not request more income information for the application month.
Available Income Use only available income. Available means income which is received
or can reasonably be anticipated. Available income includes amounts
garnished from income, joint income and income received on behalf of
a person by his/her representative. See BEM 500 series for more
details.
Client’s Consider the income declared by the client as available income unless
Declaration of you already have verification that more accurately reflects the client’s
Income and Other income as follows:
Information
• Verification of an unreported source of income. This applies to
unreported sources of income and not the amount of income from
a source. Examples of this are:
•• Child care provider did not report the DHS payments being
received.
•• FAP case contains BENDEX report showing that a person is

receiving RSDI that was not reported.
• Client declared net income instead of the gross amount of income.
• Verification of a different rate of pay or a different frequency of pay.

Examples of this are:
•• Client declared an hourly rate different from the verified

hourly rate in the FAP case.
•• Client declared a frequency of pay different from the fre-

quency verified in the CDC case.
• For persons whose income from a given source does not fluctuate,
verification of a different amount of income. An example of this is
the client’s declared gross RSDI differs from the current BENDEX
amount.

Note: Income does not fluctuate when the countable income

received from a given source is the same amount each time a pay-
ment is received.
• Verified income for a calendar month is different than the amount

declared by the client for the same month.
Example: The Jones family submitted verification of October’s

income for FAP benefits. They also applied for Healthy Kids in
October. The income declared for Healthy Kids for the application
month (October) is different from the gross amount shown on the
October pay stubs obtained for the FAP eligibility determination.
Averaged Income Average income received in one month which is intended to cover sev-
eral months. Divide the income by the number of months it covers to
determine the monthly available income. The average amount is con-
sidered available in each of the months.
Converting Income Convert the pay-period amount to a monthly amount using the follow-
to a Monthly ing:
Amount
• Multiply a person’s income by four if paid weekly.
• Multiply a person’s income by two if paid bi-weekly or twice a

month.
• Multiply a person’s income by 30 if paid daily.
CIMS
INSTRUCTIONS Enter the gross income amounts at the recipient level on CIMS. Enter
the income used in FAP when different income is used for FAP and
Healthy Kids determinations.
AUTOMATED
UPDATES Central office automatic updates, such as Social Security cost-of-living
increases, take effect the month the change occurs.
Social Security cost-of-living increases are calculated from BENDEX

information. The increase is added to existing post-eligibility patient-pay
amounts (PPAs). Since this increase is determined independently of the
person’s total income, the result (e.g., post-eligibility PPA) may be
affected by truncating (i.e., dropping cents), but is considered correct.
LEGAL BASE Social Security Act, Sections 1902(r)(2), 1931(b)

42 CFR 435.600-832

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).

BAM 805 1 of 5 PREPAID FUNERAL CONTRACTS
DEPARTMENT
POLICY FIP, SDA and MA Only
Michigan law allows a person to contract and pay in advance for a

funeral. This is called a prepaid funeral contract. See PBEM 400.
In this item, the act refers to MCL 328.211.
General provisions of the act are as follows:
• The contract seller is the person/establishment providing the pre-

paid funeral contract. The seller may be the funeral provider.
• The funeral provider is the person/establishment shown in the

prepaid funeral contract as agreeing to furnish specified funeral
goods and/or services. The provider need not be a party to the
contract.
• Contract sellers and funeral providers must be registered with the

Michigan Department of Labor and Economic Growth
(DLEG).Licensing and Regulatroy Affairs (LARA).
• Only a guaranteed price contract may be certified irrevocable.
• The purchaser, beneficiary, funeral provider and/or contract seller

decide what funeral goods and services are contracted for.
• Only DHS or the Department of Community Health (DCH) may

certify a funeral contract irrevocable.
• Amounts paid for contracted funeral goods and services may be

reallocated to other funeral goods and services. However, an irre-
vocable contract cannot be terminated.
• Interest or dividends earned on an irrevocable contract fund are

considered part of that fund and may not be given to the pur-
chaser/beneficiary.
• 8A’s can not be used to certify a life insurance funded funeral as

irrevocable.
• Transfers of a funeral contract with an 8A must be purchased as a

Prepaid Guaranteed Price contract with the funeral provider.
TYPES OF
MICHIGAN
FUNERAL
CONTRACTS A guaranteed price contract fixes the price to be charged for funeral
goods and services listed in the contract.

A non-guaranteed price contract states clearly that the price of listed

goods and services might fluctuate. Actual costs at delivery might be
more or less than the amount in the contract fund.
A revocable contract can be terminated by the purchaser and the

money refunded. The refund might be less than the contract's total
value. A contract is revocable unless certified irrevocable.
For program eligibility purposes, an irrevocable contract means

money in the contract fund, including interest or dividends, is perma-
nently unavailable to the purchaser/beneficiary.
See “CONDITIONS TO CERTIFY CONTRACTS IRREVOCABLE” in

this item.
OUT-OF-STATE
FUNERAL
CONTRACTS DHS and DCH can certify as irrevocable a funeral contract with an out-
of-state contract seller or funeral provider only if the seller and provider
(if separate) are registered with the Michigan Department of Licensing
and Regulatory Affairs.Labor and Economic Growth. If they are, refer to
“CONDITIONS TO CERTIFY CONTRACTS IRREVOCABLE” in this
item.
A prepaid funeral contract with an unregistered out-of-state seller or

provider is controlled by the other state's laws. The contract funds are
unavailable if the contract is irrevocable under the other state's law.
Assist clients needing help to determine the status of out-of-state con-

tracts. Inform them that revocable contracts with unregistered individu-
als may be reestablished using sellers/providers registered with the
Michigan Department of Labor and Economic Growth.
Local Office Tell the applicant/recipient in order to certify a funeral agreement as

Responsibilities irrevocable they and their funeral director must complete a DHS 8-A
(available on the internet or through the funeral director) and return the
completed form to the local office. Tell them they must:
• Complete Section I, and

• Have the contract seller complete Section II, and
• Give DHS a copy of the contract.
Forward the returned DHS-8A and contract to the local office director
or designee for certification (completion of Section III). If a disapproval
is necessary, it must be explained on that form.
A photocopy or facsimile (fax) of a DHS-8A is acceptable.
SSI clients might be referred to DHS to have a contract certified irrevo-

cable. The local office must act on these requests as soon as possible.

Note: Funeral contracts certified irrevocable are treated as unavailable

assets for SSI.
CONDITIONS TO
CERTIFY
CONTRACTS
IRREVOCABLE A prepaid funeral contract(s) must be certified irrevocable, provided all
of the requirements below are met:
1. The contract purchaser requests via DHS-8A that the contract be

certified irrevocable.
2. The contract purchaser is
• The beneficiary, and

• Alive, and
• A FIP/SDA/MA/SSI applicant or recipient.
Note: Someone else may act as purchaser for a living beneficiary

if the beneficiary’s own money is used. The beneficiary’s name
must follow the person's signature on the DHS-8A (e.g., John
Smith for Sara Smith).
3. DHS has a copy of the contract.
4. The principal value(s) (i.e., amount paid at the time the contract
was made, excluding interest or dividends) is not over the “Allow-
able Principal Value” explained below.
• A revocable contract(s) with a principal value over the maxi-

mum may be ended and a new contract made which can be
certified irrevocable. The excess, including interest and/or
dividends, is a countable asset.
• Multiple contracts for a beneficiary may be certified irrevoca-

ble if the combined principal values are not over the maxi-
mum.
Note: The limit is not affected by the types of goods and services
contracted for. For example, the value of burial space items is not
deducted to decide if the principal value is within the limit.
5. Sections I and II of the DHS-8A are properly completed. This

ensures the following:
• The purchaser/beneficiary has notice of limits on state liability

for additional funeral expenses.(Covered expenses are
included in ERM 306.)

• The purchaser/beneficiary has notice that an irrevocable con-

tract remains irrevocable even if assistance ends.
• The contract seller asserts that the contract is a guaranteed

price contract and complies with the act.
• The contract seller is registered with the Michigan Depart-

ment of Licensing and Regulatory Affairs.Labor and Eco-
nomic Growth.
Note: An employer's registration covers his employees. The

employer's registration number may be entered in Section II of the
DHS-8A.
• The contract seller certifies that all funeral providers listed in,
or party to, the contract are registered with the Michigan
Department of Licensing and Regulatory Affairs Labor and
Economic Growth and complying with the act.
6. Ten or more business days have passed since all parties signed
the contract. The purchaser may cancel the contract during this
period.
The local office director or his designee is authorized to certify agree-

ments irrevocable.
Allowable Principal The allowable principal value for a contract to be certified irrevocable is
Value Effective calculated as follows:
June 1, 200911
• The absolute maximum (see below).
• MINUS the amount already assigned to pay the beneficiary’s

funeral expenses under either:
•• A life-insurance-funded funeral, or
•• An annuity-funded funeral.
Note: The DHS-8A asks for this information.
This deduction applies even if ownership of the life insurance pol-

icy or annuity contract has been irrevocably transferred to a
funeral director, a trust or another person. This deduction applies
regardless of the types of funeral goods and services covered by
the assignment.
• EQUALS the allowable principal value.
Use the absolute maximum for the date the DHS-8A is received. The
absolute maximum is:
• $11,450 starting June 1, 2009.

• $11, 393 startingeffective June 1, 2010.

• $11,466 effective June 1, 2011.
TRANSFER OF
CONTRACTS Transfer of a funeral contract to another seller or provider is an issue
between the purchaser, contract seller and funeral provider. The parties
to the contract are responsible for the transfer. A transferred contract
remains irrevocable.
LEGAL BASE MCL 328.229
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).

BPB 2011-009 1 of 2 BRIDGES POLICY BULLETIN
EFFECTIVE July 1, 2011.
MA
BAM 110
The phrase, “without a signed document authorizing someone to act on

the applicant's behalf” has been removed.
Reason: Management directive.
MA/AMP BAM 402

BENEFITS
Information for borderland providers has been revised.
Reason: Informational for local office staff.
PREPAID BAM 805

FUNERAL
CONTRACTS The allowable principal value for a funeral contract to be certified irrevo-
cable has been revised effective June 1, 2011.
Reason: OFIR has released the current figures.
THIRD PARTY BEM 257

RESOURCE
LIABILITY Third party liability forms have been revised or obsoleted.
The DCH-0078, DCH-0079 and DCH-1354 have been combined into

one form.The form, DCH-0078 is renamed, Request to Add, Terminate
or Change Other Insurance.
This form must be faxed to Third Party Liability Division.
Reason: Work load reduction for local office staff.
ASSETS BEM 400
• Medicare Savings Program asset limits have increased.

• Clarification regarding deeds has been added.
• Reference to DHS-503 has been removed as the form is obsolete.
• Preliminary information regarding estate recovery has been
added.
Reason: Federal poverty limits have been released by the federal gov-
ernment.
Reason: Request from DCH legal department.
Reason: Comply with federal regulations.
Issued: STATE OF MICHIGAN

Distribution: DEPARTMENT OF HUMAN SERVICES
BPB 2011-009 2 of 2 BRIDGES POLICY BULLETIN
HEALTHY KIDS BEM 531

INCOME
BUDGETING References to CIMS and LOA2 have been removed. Referral process
for MIChild is completed via an interface with Maximus.
Reason: Referral process is completed through an interface rather

than mailing paper copies.
AD-CARE AND RFT 242

MEDICARE
SAVINGS The limits for 2011 have been added.
PROGRAM
INCOME LIMITS
ernment.
MA POVERTY RFT 246

LEVELS
The poverty levels for 2011 have been added.
ernment.
FORMS The following forms have been obsoleted:
• DCH-0079, Notice of Insurance Code Changes

• DCH-1354, Third Party Liability Health Insurance Information.
• MSA-Pub 492, A Hug Shows You Care.
• MSA-3054, Case or Recipient Delete Request.
STATE OF MICHIGAN

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DEPARTMENTAL CLEARANCE/FINAL DEPARTMENTAL REVIEW

Michigan Department of Human Services

DHS-311 (Rev. 5-09) Previous editions obsolete. MS Word

Request for All Programs

• DHS-1171, Assistance Application (all programs). The DHS-1171

• DHS-4583, Child Development and Care (CDC) Application.

• DCH-0373D, MIChild/Healthy Kids Application (Healthy Kids cate-

• DHS-4574, Medicaid Application for Nursing Facility Patients, LTC

• DHS-1514, State Emergency Relief Application.

Response to All Programs

• Give the requester an application the same day.

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

For a request by letter or telephone, mail the application by the end of

Applicants must be informed of their option to obtain a DHS-1171,

For a request in person, the local office must:

•• A DHS-4583, Child Development and Care (CDC) Assis-

•• A DHS-4640, Child Development and Care (CDC) Applicant

•• A DHS-220, Child Development and Care Unlicensed Pro-

•• A DHS-4025, Child Care Provider Verification.

For a request by letter or telephone, mail the application and the

Receipt of a completed MSA-2565-C, Facility Admission Notice, serves

• Automatically eligible newborns, see BEM 145.

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

• DHS-126, Medicaid Application Inquiry.

The following publications must be given or sent to MA applicants and

• MDCH Pub.A Guide to Michigan Medicaid Health Plans.

For Medicaid brochures from the Michigan Department of Community

APPLICATION All Programs

• DHS-4574, Medicaid Application for Nursing Facility Patients, for

• DCH-0373, MIChild/Healthy Kids Application, for Healthy Kids cat-

• The MIChild Renewal Form. This form is used as a Healthy Kids

An application may be made for a deceased person. The person is not

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

The following persons are automatically eligible without completing

• Department wards; see BEM 117.

• Title IV-E recipients; see BEM 117.

• Special Needs Adoption Assistance Agreement recipients; see

• Newborns of MA recipients; see BEM 145.

Who May Apply All Programs

Any person, regardless of age, or their authorized representative (AR)

Date of Application All Programs

See the WHERE TO APPLY/PROCESS APPLICATIONS section in this

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

If the application is filed online after close of business (such as week-

Date of Application FIP and SDA Only

• Mandatory Group Members - The date of application is the date

Exception: For dependent child member adds, you may obtain

• Optional Group Members - The date of application is the date the

• Disqualified Group Members - The date of application is the date

See BAM 220 for CDC member adds.

MA and AMP Only

See BEM 550 for member add policy.

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN

Response to All Programs

If there is no record on Bridges, the system assigns individual ID num-

Note: A person may withdraw an application at any time before it is dis-

DHS Pub. 280, Reporting Changes - When To Report - How To Report -

Multiple FIP, SDA, RAP-C, CDC and FAP

• Review the information for impact on eligibility and benefit level.

• Ensure the case record is documented with the additional applica-

• Attach the additional application(s) to the initial application.

Do not process an SDA application as interim assistance for a client

The local office must screen applications to identify those requiring

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN