Michigan Medicaid Policy Final Draft Review Effective July1, 2011

8/7/2019 Michigan Medicaid Policy Final Draft Review Effective July1, 2011

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

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 MedicaidEMAIL TO:

DHS Director (Maura Corrigan)Office of Communications (Colleen Rosso)Legislative Services (Karyn Ferrick)Family Advocate (Stacie Bladen)Chief Deputy Director (Duane Berger)Deputy Children's Services (Steve Yager)Deputy Legal Services (Rebekah Visconti)Children & Adult Licensing (James Gale)Management & TechnologyHuman Resources (Susan King)Deputy Field Services (Dwayne Haywood)Deputy Financial Services (Susan Kangas)Deputy Strategic Services (Dudley Spade)Deputy Policy & Compliance (Brian Rooney)Quality & Adult Services (Barbara Anders)Public Assistance (Jane Goetschy)Budget Division (Jane Schultz)Grant ManagementStrategic Planning (Terri Gilbert)Logistics & Rate Setting

Revenue EnhancementCommunity Action (Stacie Gibson)MI Community Service (Paula Kaiser VanDam)Interagency/Community Services (Jocelyn Vanda

Adult & Family Policy (Kim Keilen)Disability Determination (Charles Jones)Early Education & Care (Lisa Brewer-Walraven)

Bureau of Child Support (Marilyn Stephen)Office of Inspector General (Alan Kimichik)Internal Audit (Rod Markowski)Quality Assurance (Julie Horn Alexander)Adult Services (Cynthia Ferrell)Poverty Unit (Linda Schmidt)Domestic Violence (Debi Cain)Homelessness (Pat Caruso)Accounting Divison()Contact Center (Edward Woods III)

FROM:

Office NameOffice of Communications, Grand Tower Suite 1510,PO Box 30037, Lansing, MI 48909

Contact Person Phone Number

Judith A. Galant 517-241-7084

Contact Email Fax Number

[email protected] 517-373-8471

Purpose

Clearance RequiredInformation Only Sent to all offices checked above.

Due Date

June 6, 2011

THIS SECTION COMPLETED BY RECEIVER

INSTRUCTIONSPlease 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 m

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 ChangesSignature Date Bureau/Office Name Phone Numbe

Comments

AUTHORITY: P.A. 280 of 1939.COMPLETION: Voluntary.CONSEQUENCE FOR NOT RESPONDING: Comments cannot beconsidered.

Department of Human Services (DHS) will not discriminate against aindividual or group because of race, religion, age, national origin, coheight, weight, marital status, sex, sexual orientation, gender identityexpression, political beliefs or disability. If you need help with reading, writhearing, etc., under the Americans with Disabilities Act, you are invitedmake your needs known to a DHS office in your area.


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STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES

DEPARTMENTPOLICY

Request forAssistance

All Programs

A request for assistance may be in person, by mail, telephone or an

application can be obtained on the Internet. The requester has the rightto receive the appropriate application form:

DHS-1171, Assistance Application (all programs). The DHS-1171packet includes an information booklet and the assistance applica-tion. A filing form used to preserve the application filing date isavailable on the last page of the information booklet and online atwww.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 Arabicon the DCH Web site at www.michigan.gov/mdch. Select MDCHbrochures Available for Download from the Quick Links in the rightnavigation.

DHS-4574, Medicaid Application for Nursing Facility Patients, LTCclients 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 familymoves to a new county.

Response toRequests

All Programs

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 clientto 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

APPLICATION FILING AND REGISTRATIONBAM 110

BRIDGES ADMINISTRATIVE MANUAL
http://www.michigan.gov/dhs-formshttp://www.michigan.gov/mdchhttp://www.michigan.gov/mdchhttp://www.michigan.gov/dhs-forms


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BAM 110 2 of 19 APPLICATION FILING AND REGISTRATION

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN


DHS-1171, Filing Form, to protect their application date. BAM 105 liststhe minimum information to file an application.

For a request by letter or telephone, mail the application by the end ofthe next workday. If the application is not returned, the requester mustbe 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 followingweb site: www.michigan.gov/dhs-forms.

Note: Your office may register requests for assistance on Bridges; seethe REQUESTS section in this item. The applicant may withdraw theirrequest 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) ApplicantInstructions.

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 ProviderManagement.

A DHS-4025, Child Care Provider Verification.

Explain the requestors right to file the application that day andencourage s/he to do so.

Explain that the application receipt date will affect the effectivedate 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, servesas a request for MA for all persons except:

Automatically eligible newborns, see BEM 145. Active MA recipients. Pending MA or FIP applicants.
http://www.michigan.gov/dhs-formshttp://www.michigan.gov/dhs-forms


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All other requests must be registered and the client must be sent thefollowing:

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 andother 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.

ForMedicaid brochures from the Michigan Department of CommunityHealth, select Medicaid and Health Brochures from the list on the DCHwebsite.

APPLICATION All Programs

The DHS-1171 is used for most applications and may also be used forredeterminations; 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 thewww.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, forLTC 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 Kidsapplication. 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 noteligible after the month of his death.
http://www.michigan.gov/mdch/0,1607,7-132--66857--,00.html#Medicaidhttp://www.michigan.gov/dhs-formshttp://www.michigan.gov/dhs-formshttp://www.michigan.gov/mdch/0,1607,7-132--66857--,00.html#Medicaid


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The following persons are automatically eligible without completingan application:

Department wards; see BEM 117.

Title IV-E recipients; see BEM 117.

Special Needs Adoption Assistance Agreement recipients; seeBEM 117.

Newborns of MA recipients; see BEM 145.

Retro MAApplications

MA Only

The DHS-3243, Retroactive Medicaid Application, is used along withthe DHS-1171, DHS-4574 or DCH-0373 for retro MA applications. Onlyone DHS-3243 is needed to apply for one, two or three retro MAmonths; 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. ForFAP only, an AR must apply on behalf ofcertain clients; see the AUTHORIZED REPRESENTATIVES sectionbelow.

Date of Application All Programs

Faxed and PaperApplications

The date of application is the date the local office receives the requiredminimum 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 ofapplication. Record the date of application on the application or filingform.

The date of application does not change for FIP, SDA, MA, CDC orAMP when the application is transferred to another local office.

FAP Only

See the WHERE TO APPLY/PROCESS APPLICATIONSsection in thisitem.

OnlineApplications

MA Only

For applications filed online, the date of the application is the submis-sion date regardless of the time received.


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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 Applicationfor Member Add

FIP and SDA Only

The date of application for a member add depends on whether themember being added is a mandatory, optional, or disqualified member.

Mandatory Group Members - The date of application is the datethe person joins the group. The group must update and completethe application form to provide the information necessary to deter-mine eligibility. You must ask when the person joined the groupand document the date on the application form.

Exception: For dependent child member adds, you may obtain

the information needed to determine eligibility and document thecase record. The client need not sign the updated application.

Optional Group Members - The date of application is the date theperson updates or completes the application form to request assis-tance.

Disqualified Group Members - The date of application is the datethe person meets the eligibility factor or agrees to cooperate, pro-vided he subsequently cooperates with the requirement thatcaused the disqualification. A disqualified person remains a mem-

ber of the applicant group during the disqualification period, so heis not required to update or complete an application, unless it isnecessary 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 newapplication form is received by the local office.

FAP Only

See BEM 550 for member add policy.


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Response toApplications

All Programs

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. Thispublication must be given to the client at application.

MultipleApplications

FIP, SDA, RAP-C, CDC and FAP

When an application is pending and additional application(s) arereceived 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 additionalapplication(s) are received, you must review the application forchanges in circumstances. Additionally, you must either complete aredetermination or deny the programs requested since they are alreadyactive.

SDA Only

Do not process an SDA application as interim assistance for a clientwith an application pending for FIP.

FAP Only

The local office must screen applications to identify those requiringexpedited 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 SSAdistrict office; see BAM 116. Your office must register the applicationupon receipt, using the procedures in BAM 116.
http://www.michigan.gov/dhs/0,1607,7-124-5458_7699---,00.htmlhttp://www.michigan.gov/dhs/0,1607,7-124-5458_7699---,00.html


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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 (forexample 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 policydefinition.

When no one in the group is able to make application for program ben-efits, any group member capable of understanding AR responsibilitiesmay 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 clients eligibility, he must be familiar enough withthe circumstances to complete the application, answer interview ques-tions, and collect needed verifications.

WHO MAY BE ANAUTHORIZEDREPRESENTATIVE(AR)

FIP, CDC, SDA andAMP Only

An AR must be at least age 18. The person is usually a guardian,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 otherwisequalified 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 theapplication 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 childcare 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


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not a spouse, parent, legal guardian, adult child, stepchild, or specifiedrelative the person must have a signed authorization to act on behalf ofthe client, by the client, clients 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 withoutthe applicants signature or without a signed document authorizingsomeone 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 clientexplaining the need for a valid signature. The signature page ofthe application may be copied and sent to the agency or individualwho filled out the application with the notice.

Allow 10 days for a response. You cannot deny an application dueto incompleteness until 10 calendar days from the date of your ini-tial request in writing to the applicant to complete the applicationform or supply missing information, or the initial scheduled inter-view.

Record the date the application or filing form with the minimuminformation is received. The application must be registered anddisposed of on Bridges, using the receipt date as the applicationdate.

An application received from an agency is acceptable if it is signed byan 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 others behalf withoutwritten permission from the applicant.

AuthorizedRepresentative

MA Only

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.


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Persons ProvidingMedical Care

MA Only

Persons who provide medical care to the client, or their agents, shouldnot act for the client when there is a relative, guardian or friend who iswilling and able to act. If a court has appointed a guardian for a clientsestate (such as income and assets), the guardian is usually expected to

act for the client.

Exception: An application may be made for newborns surrenderedunder the Safe Delivery Law, (MCL 712.1-712.20) by the provider hos-pital, child-placing agency, court appointed lawyer-guardian ad litem orprospective adoptive parent.

A department employee may apply on behalf of a member of theemployee'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 aperson who gave the authorization dies, the power of attorney ends.After death, the person does not exist as a legal entity, so no one canrepresent the person. However, if a person dies while the application ispending, 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 probatecourt can create a decedents 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 beidentified 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 anyage. If outside the group, he must be at least age 18. The age limit doesnot apply to a non-group member designated by the group to pick upbenefits or to use them to buy food on behalf of the household.

An AR who completes the application must be designated in writing bythe 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 theAR that results in an overissuance.


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Exception: When the AR is an SATC or AFC Home, the facility isresponsible for such an overissuance.

AR - SPECIALIZEDSITUATIONS

Substance AbuseTreatment Center(SATC)

FAP Only

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 bothmust sign it.

Adult Foster Care(AFC) Home

FAP Only

An AFC resident with a guardian who has legal control over theirfinances 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 agroup 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 andothers as individuals.

Restrictions on ARAppointments

FAP Only

A provider of meals for the homeless cannot be authorized to representthem.

A person disqualified due to IPV cannot be an AR unless there is noresponsible group member or anyone else available.

Medical

InformationAcknowledgment

All Programs

When the AR completes the application, give or send the client a DHS-4609, Medical Information Acknowledgment, to sign. The DHS-4609tells the client that DHS may share medical information for purposes ofeligibility determination and program administration.

If the client is unable to sign the DHS-4609 and his condition is suchthat medical information might need to be shared, refer the AR to AdultServices.


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Note: If the form remains unsigned, there is no penalty and eligibilitydeterminations must not be delayed.

OTHERAUTHORIZEDREPRESENTATIVE

FUNCTIONS FAP Only

An AR may make food purchases from the FAP benefits account usingthe Bridge Card. There is no age requirement for the AR who uses thegroups FAP benefits on behalf of the group.

Note: This can be a different person than the AR who applies for bene-fits on the clients behalf.

Enter on the Alternate Payee/Authorized Representative screen inBridges the name of the person who is authorized to purchase food forthe group and indicate the Type of Authorized Representative. Theauthorized representatives name will appear on the Bridge Card fol-lowed by ARFS.

DOCUMENTATIONAND 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 cancall the Automated Response Unit (ARU) to terminate a Food Stamp

Authorized Representatives (FSARs) access. However, grantees mustcontact the FIS/ES to request a new FSAR. Ask the caller a questiononly 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 Representativescreen in Bridges and mail a DHS-247, EBT Food Stamp AuthorizedRepresentative form to the client for completion and return; see BAM401E.

A person may represent any number of groups. When one person

(such as an employer of migrants) represents numerous clients or hasaccess to large amounts of food assistance benefits, use caution toensure 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.


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DISQUALIFICATIONOF ANAUTHORIZEDREPRESENTATIVE 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 30days after the client is notified (see below).

Exception: The disqualification does not apply to an SATC or AFChome acting as AR. Report such acts by a facility representative to theOffice 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/PROCESSAPPLICATIONS

FIP, CDC, SDA, andAMP Only

A person may request or apply for assistance in any local office in Mich-igan. The application must be processed by a local office serving thecounty or district where the person lives or is institutionalized.

Exceptions:

A person who lives in a county participating in the TransparentCounty Line project may apply and have his/her application pro-cessed by any county that is also participating in the TransparentCounty Line project.

For MA only, see BAM 120, DCH/DHS Coordination.

For MA only, see Transfers: Prohibited Transfers and TransferGuidelines in BAM 305 for exceptions to transferring cases.

For MA and AMP, incarcerated individuals, the application shouldbe processed and maintained in the local office in which the indi-vidual lived prior to the incarceration.


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For an SDA applicant in a special living arrangement (SLA), thereare 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 servethese 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 youroffice:

Accept and register it as an application or request as appro-priate.

Exception: A request for CDC must always be registered asan application.

Mail it promptly to the correct office so the transfer-in officemay act within the standard of promptness; see BAM 115.

MA A Medicaid application can be processed by the local office serving theclient or the authorized representative.

MA applications for incarcerated individuals must be handled by thecounty 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 countyor district where the group lives.


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Exception: Clients who apply online may have their FAP applicationprocessed by any Self-Service Processing Center regardless of thecounty in which they live.

For application filing purposes, persons who are county residents whenphysically present in your county include:

Students either attending school or living at home during a schoolbreak.

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 phonenumber of the correct office.

Inform them that the processing time begins when the correctoffice receives the application.

If they choose to complete the application and turn it in at youroffice, 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 processedby any county that is also participating in the transparent county lineproject.

WITHDRAWNAPPLICATION All Programs

A client/AR may withdraw the application any time before it is disposedon Bridges. However, if the client has an AR, they must first revoke theARs authorization to represent them before the client may withdraw theapplication. 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 actionto the client and, if the client has identified a CDC provider, a DHS-198,

stating the client withdrew the application. The client may reapply anytime.

REGISTRATION All Programs

All applications, FAP redeterminations, referrals, initial asset assess-ments, member adds and program adds are registered on Bridges. TheBridges Registration process:

Performs file clearances on name and address.


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Assigns individual ID numbers to individuals new to the system.

Allows you to reuse individual ID numbers of individuals known tothe system.

Allows you to associate an application to a groups existing case

number.

Assigns an application number for applications not associated toan existing case.

Generates a pending registration to track standard of promptness.

Bridges also assigns and reassigns applications and cases to staff.

See BAM 305ASSIGNMENT, REASSIGNMENT AND TRANSFER.

REQUESTS

All Programs Requests for assistance may be oral or written. Those containingenough identifying information may be registered.

MA only A completed MSA-2565-C, Facility Admission Notice, is a request forMA and must be registered.

Exception: Do not register the MSA-2565-C as a request if the personis 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 Logprocess to register a request.

INITIAL ASSETASSESSMENTS

MA Only Register an initial asset assessment using the Bridges Registrationfunction upon receipt of a signed DHS-4574-B, Assets Declaration.

REGISTERINGAPPLICATIONS

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 theminimum information necessary to register an application.

All department programs are registered using the registration functionson Bridges.


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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 yourbest judgment to code race and sex. The assigned specialist mustupdate the coding, if necessary, when the application is completed.

Note: For FAP only, select unknown when the client chooses not todeclare their ethnicity and/or race. If you have an in-person interviewwith the client, use your best judgment to choose an ethnicity/race for

them.

FIP, SDA, andRAPC

Treat a fax of an application or filing form as an incomplete application.However, the original signed application must be received by DHSbefore 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, apaper 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 andTMAP, FAP

A photocopy or fax of a DHS-1171, DHS-3243, DHS-4574, DCH-0373,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 theclient has checked on page 1. Bridges screens for expedited process-ing of all FAP applications; see BAM 116 forSSI/FAP Joint Applica-tion Processing.

REDETERMINATIONS Upon receipt of a signed DHS-1010, Redetermination Form, record thereceipt of a redetermination packet in Bridges. Use Initiate Redetermi-nation to start the redetermination process. The redetermination packetreceipt 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 clientsfault, record receipt of the redetermination packet as described aboveand document client fault in Bridges. The standard of promptness isextended 30 days when the household/client is at fault.


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MEMBER ADD

All Programs All individuals in a household must be identified and included in thehousehold. Complete an Add Membercase action on Bridges for allindividuals who move into a household to add them to the existinghousehold and eligibility determination groups (EDGs).

Use the Add Membercase action to add a new member to existingEDGs and to request assistance in the appropriate group(s) for the newmember.

Example:

Joan and her son, Todd, receive FIP and FAP. Joans cousin, Polly,moves in and will be purchasing and preparing food with them.

You process an Add Membercase action to add Polly. On the ProgramRequest screen, you indicate that she is requesting benefits on Joans

FAP EDG but not on Joans FIP EDG.

Bridges will show Pollys Status for the FAP EDG as requesting and NotRequesting 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 mayuse 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 itin shortly after you disposed the application. The grantee states heneeds help with the bill. Use the Add Program case action to add SERto the grantees case.

Bridges records the SER application, using the new application dateyou 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 allprograms were closed on the case. Use the Case Change case action ifany program is still active on the case.

An application is not required.

REGISTRATIONDISPOSITION All Programs

All denials, including withdrawals, are recorded in Bridges.


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An application or initial asset assessment pends on Bridges until yourun eligibility determination and benefit calculation (EDBC) and certifythe results. Dispose of applications and initial asset assessments withinthe 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 databased on the Bridges application and disposition dates. The LOR man-ual describes these reports.

Initial AssetAssessments

MA Only

When processing an initial asset assessment, run EDBC and certifyresults within one workday of completing the initial asset assessment.

Applications All Programs

When a program is withdrawn, enter the reason on the program requestscreen 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 clients CDC provider when aprovider has been authorized to provide care.

SSI Coordination MA Only

Most SSI approvals are opened automatically by the State DataExchange (SDX) system. Those that cannot be opened automaticallyare opened by the SSI Coordination Unit in central office.

Inquiries regarding SSI openings are handled by the SSI CoordinationUnit (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 400.56R400.2(3),(4) (MAC)

CDC

Child Care and Development Block Grant of 1990 as amended, (42USC 9858 et seq.)45 CFR Parts 98 and 99


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Social Security Act, as amended. Title IVA (42 USC 601 et seq.); TitleIVE (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 273.27 CFR 273.2(n)

JOINT POLICYDEVELOPMENT

Medicaid, Adult Medical Program (AMP), Transitional Medical Assistance (TMA/TMA-Plus), andMaternity Outpatient Medical Services (MOMS) policy has been developed jointly by the

Department of Community Health (DCH) and the Department of Human Services (DHS).


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STATE OF MICHIGAN


DEPARTMENTPOLICY

FIP, MA As a condition of eligibility, the client must identify all third-partyresources 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, inthe 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 Administrationdetermines client cooperation and reports third-party resources to theThird Party Liability Division. Policy in this item does not apply to thoseMA groups.

AMP A client who has other comprehensive health insurance or Medicare, isnot AMP eligible. A client may have insurance that only covers dental orvision 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 potentialresource. However, when an individual refuses Medicare part B,Medicaid will not pay for any Medicare part B covered servicesthey receive.

THIRD PARTY RESOURCE LIABILITYBEM 257

BRIDGES ELIGIBILITY MANUAL


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BEM 257 2 of 7 THIRD PARTY RESOURCE LIABILITY

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 youidentify 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, spouseand (step)children. Separate policies might cover dental, vision or otherhealth needs.

MedicalInformation

Medical reports or information (for example at application or redetermi-nation) might indicate a third-party resource for an accident/illness orLTC services. The DCH-2565-C, Facility Admission Notice, frequentlylists health insurance.

Military Service Dependents of active, retired, deceased or totally disabled military ser-vice personnel are eligible for medical coverage through the CivilianHealth and Medical Program of the Uniformed Services (CHAMPUS),Civilian Health and Medical Program of the Veterans Administration(CHAMPVA), or the TRICARE Program.

Monthly ExpenseInformation

This might show payment of private insurance premiums. Medicarerecipients 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 athird-party resource.


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GOOD CAUSECLAIMS - 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 theDHS-4469. The client must complete section 2 specifying the type ofgood cause and person(s) affected. Give or send the client a copy ofthe DHS-4469 within two workdays after it is completed.

A claim of good cause may be made at any time. You are responsiblefor determining good cause and making a finding. To do so, follow all ofthe instructions in the GOOD CAUSE CLAIMSsection 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 causeclaim is pending.

IMPOSING ADISQUALIFICATION

FIP, MA Failure to cooperate without good cause results in disqualification. Thefollowing person who failed to cooperate is not eligible:

The adult who fails to cooperate in identifying his own third-partyresource.

The parent who fails to cooperate in identifying a third-partyresource 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 therelative's FIP, LIF or Caretaker Relative MedicaidMA BEM 110 orMA BEM 135 eligibility is based.


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FIP Do not include a disqualified person's needs when determining groupeligibility or benefits.

A disqualified person cannot serve as an ineligible grantee unless he isthe only adult in the case and no suitable protective payee can befound.

REMOVING ADISQUALIFICATION- 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.

REPORTINGRESOURCES

DHS Reporting -FIP, MA, AMP

Report to the Third Party Liability Division when a third-party resource isidentified at application, redetermination or any time a resourcebecomes known. Use one of the following forms:

DCH-1354, Third Party Liability Health Insurance Information, forhealth insurance, (including long term care insurance.)

Complete all required information and forward the DCH-1354 tofaxthe DCH-0078, Request to Add, Terminate or Change Other Insur-

ance to the Third Party Liability Division as quickly as possible. Ifavailable, attach copies (front and back) of insurance identificationcards. Include copies of identification cards for additional cover-ages (vision, LTC or dental) available to the client. TPL DivisionFAX (517) 346-9817.You may also use the email address on theform 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 byrejecting Medicaid claims until liable third parties have paid orseeking reimbursement from third parties after Medicaid payments

have been made. This coordination of benefits is vital to ensureclaims 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 ahealth maintenance organization (HMO), check the level of care(LC) code in Bridges. LC 07 indicates enrollment in a Medicaidmanaged care plan. It is unlikely the client also has private insur-ance through the same plan.


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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 orDCH-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 (forexample: case number) and forward the form to the Third Party LiabilityDivision.

The Third Party Liability Division often learns of a resource indepen-dently. Cooperate with Third Party Liability Division staff by providingthe information or clarification requested.

Bridges Coding -FIP, MA

When the Other Insurance (OI) code in Bridges is blank or zeroes, enterthe 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 ThirdParty Liability Division or Buy-In Unit. See Change or Termination of aResource below.

When ResourcesAre Not Reported -FIP, MA

Do not report a third-party resource to the Third Party Liability Divisionin any of the following circumstances:

The resource is Medicare. However, do report supplementalhealth 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 aDHS-2169, Notice of Good Cause Finding-Child Support/Third

Party Resources, and reporting the resource would endanger theclient or dependents. However, do report any resource not cov-ered by good cause.

Note: When good cause has been approved and there is an OIcode on the Insurance Policy Information screens or on the Medi-care Claim screens in Bridges, send a copy of the DHS-2169 tonotify the Third Party Liability Division of the need to delete the OIcode.


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TINQUIRIES BYMAIL Direct inquires or complaints about other insurance problems to:

Department of Community HealthThird Party Liability DivisionBureau of Financial Management

PO Box 30479Lansing, MI 48909TPL [email protected]

PHONE INQUIRIES

Enrolled Providers ProviderInquiry HelplineHotline: 1-800-292-2550 or [email protected].

DHS Staff MA Exceptions Unit at 1-800-292-9570 (Option 5) for all third-partyresource concerns (except Medicare) including the non-Medicareportions 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 andthe Medicare portions of 95-96.

Note: Do not NOT give recipients the phone numbers listed above.

Recipients Recipient HotlineBeneficiary Helpline: 1-800-642-3195.

VERIFICATIONREQUIREMENTS -

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-.153MCL 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 theDepartment of Community Health (DCH) and the Department of Human Services (DHS).


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STATE OF MICHIGAN


DEPARTMENTPOLICY 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 followingtypes 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 propertyis any item subject to ownership that is not real property (examples:currency, savings accounts and vehicles).

Overview of AssetPolicy

FIP asset rules apply to RAPC

Countable assets cannot exceed the applicable asset limit. Not allassets are counted. Some assets are counted for one program, but notfor 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 howmuch 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. Seethe program's asset grouppolicy in this item.

ASSETSBEM 400

BRIDGES ELIGIBILITY MANUAL


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BEM 400 2 of 42 ASSETS



An asset converted from one form to another (example: an item sold forcash) is still an asset.

Exception: See SALE OF PROPERTY IN INSTALLMENTS in BEM500.

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 WITHNO 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 provideasset information or asset verification requested for purposes of deter-mining eligibility for a category or program that has an asset test, suchas FIP or LIF.

Example: The Smith family (Mrs. Smith and daughter age 12) failed toreturn verification of their bank account by the due date. Therefore, LIF

eligibility cannot be determined. However, Healthy Kids must still beconsidered.

FAP Only

There is no asset test for the food assistance program as all groups areeither:

Categorically eligible.


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All members of the group are eligible for domestic violence com-prehensive services.

FIP, RAPC AND SDAASSET ELIGIBILITY FIP, RAPC and SDA

Policy Overview Determine asset eligibility prospectively using the asset group's assetsfrom the benefit month. Asset eligibility exists when the groups count-able assets are less than, or equal to, the applicable asset limit at leastone day during the month being tested.

Application At application, do not authorize the Family Independence Program(FIP), Refugee Assistance Program Cash (RAPC), or State DisabilityProgram (SDA) for future months if the person has excess assets onthe processing date.

PendingApplicationMonths

For pending FIP, RAPC, and SDA applications, use asset policy that isin effect for the month you are determining eligibility.

Ongoing If an ongoing FIP, RAPC, or SDA recipient has excess assets, initiateclosure. However, reinstate the program if it is verified that the excessassets 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 thelast month of eligibility only if a closure delay was caused by the group'sfailure 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 therefugee's eligibility.

Exclude as an asset any cash assistance given to a refugee from aresettlement agency.

Evaluate and treat other assets as they are evaluated and treated forFIP.

FIP/RAPC/SDA/AMP Asset Group

FIP, RAPC, SDA and AMP Only

The asset group includes individuals with an EDG participation status ofeligible or disqualified; see BEM 210, 214 and 215.

FIP, RAPC andSDA Asset Limit

FIP, RAPC and SDA Only

$3,000


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AMP Asset Limit AMP Only

$3,000

MA ASSETELIGIBILITY LIF, G2U, G2C, AMP and SSI-Related MA Only

Asset eligibility is required for LIF, G2U, G2C, AMP and SSI-related MAcategories.

Note: Do not deny or terminate TMA-Plus, Healthy Kids or Group 2Pregnant Women because of a refusal to provide asset information orasset verification requested for purposes of determining LIF, G2U, G2Cor SSI-related MA eligibility.

Use the special asset rules in BEM 402 for certain married L/H andwaiver patients. See BPG Glossary, for the definition of L/H patient andBEM 106 for the definition of waiver patient.

Asset eligibility exists when the asset group's countable assets are lessthan, or equal to, the applicable asset limit at least one day during themonth being tested.

At application, do not authorize MA for future months if the person hasexcess assets on the processing date.

If an ongoing MA recipient or active deductible client has excessassets, initiate closure. However, delete the pending negative action if itis verified that the excess assets were disposed of. Payment of medical

expenses, living costs and other debts are examples of ways to disposeof excess assets without divestment. LTC and waiver patients will bepenalized for divestment; see BEM 405.

LIF Asset Group LIF Only

See BEM 110.

LIF Asset Limit LIF Only

$3,000

G2U and G2CAsset Group G2U and G2C

See BEM 211.

G2U and G2CAsset Limit

G2U and G2C

$3,000


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SSI-Related MAAsset Group

SSI-Related MA Only

See BEM 211.

SSI-Related MAAsset Limit

SSI-Related MA Only

For Freedom to Work (BEM 174) the asset limit is $75,000. IRS recog-nized retirement accounts (including IRAS and 401(k)s) may be ofunlimited value.

For Medicare Savings Programs (BEM 165) and QDWI (BEM 169) theasset 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 OFPARENTAL ASSETS SSI-Related MA Only

Deeming means counting a portion of parents' assets as their child'sassets. Do not deem when:

Any parent living with the child (see BEM 211) is an SSI or FIPrecipient.

When determining a child's eligibility under BEM 170, Home CareChildren.

When determining a child's eligibility under BEM 171, ChildrensWaiver.

DeemingCalculation

SSI-Related MA Only

Use the following to calculate the deemed amount.

1. Determine the total value of the parents countable assets, as ifthey were an asset group, even if they are not married.

Note: The child is not eligible for SSI-related MA if the parentsrefuse to provide asset information or a required verification.

2. Subtract $2,000 for one parent ($3,000 for two parents) from theamount of the parents' countable assets (step 1). The result is thedeemable asset amount.


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3. Divide the deemable asset amount (step 2) by the number of theparents' unmarried children under age 18 in the parents' homewho 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 or166.Are not Home Care Children (BEM 170) or Chil-drens Waiver (BEM 171).

The result is the amount of assets deemed to the child whose eligibilityis 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 theasset.

Exception: This does not apply to trusts. There are special rules abouttrusts. See Trustsbelow for FIP, SDA and AMP; see BEM 401 for MAtrust 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 beenappointed yet.

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

A person is unconscious and his family asks the court to appoint aguardian.

Availability might also be affected by joint ownership and efforts to sellor 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 assetsunavailable for purposes of determining his eligibility. Determine asseteligibility for the days of the month the person was alive.


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ESTATERECOVERY MA ONLY

The federal government requires Medicaid to recover money that it paidfor 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 probatecourt.

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 UndueHardship or if any of the following people lawfully live in the benefi-ciarys home

Beneficiarys spouse.

Beneficiarys child who is under the age of 21, blind, or perma-nently disabled.

Beneficiarys sibling who has an equity interest in the home andwas living in the home for at least 1 year immediately before thebeneficiarys death.

A survivor who:

was living in the beneficiarys 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 duringthat period.

What is an undue hardship?

An undue hardship exists when:

The estate is the sole source of income for the survivors, such as afamily farm or business; or

The estate is a home of modest value; or


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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 estaterecovery 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 areavailable from the following sources:

online at www.michigan.gov/estaterecovery

by email at [email protected]

by sending a letter to P.O. Box XXXX.

The completed application must be received no later than 60 days fromthe date of the estate recovery notice. Send copies of any documents

the notice specified. The state will determine if a waiver is warranted.

Victims ofDomestic Violence

FIP, SDA, LIF, G2U, G2C, SSI-Related MA and AMP

Assets owned by victims of domestic violence may be unavailable dueto domestic violence. These assets do not have to be jointly owned butaccessing them could put the client in danger. You may exempt theseassets for a maximum of three months. With FIM approval one three-month extension is permitted. Document in the case record the reasonsfor the temporary exclusion, and, if any extension is requested, docu-ment what steps have been taken to secure the asset. Clients shouldbe advised at the time of the exemption that they are required to reportany changes in the status of the asset within 10 days.

JOINTLY OWNEDASSETS 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 tobelong to the initial person.


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An asset is unavailable if an ownercannot sell or spend his share of anasset:

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 anasset unavailable.

Exception: Jointly owned real property is only excludable if it creates ahardship for the other owners; see hardship in this item.

Note: In SSI related MA a divestment has occurred if joint owners areadded 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 useone of four phrases:

Joint Tenancy: no owner can sell unless all owners agree.

Joint Tenancy with Right of Survivorship: no owner can sellunless 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 theother owner's agreement.

Joint Cash andRetirement Plans


This section applies to the types of assets listed under CASH andRETIREMENT 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 (seePRG, Glossary, and BEM 106) and his spouse jointly own the asset:

Consider the client the sole owner in determining the communityspouse resource allowance (CSRA). BEM 402 describes theCSRA.


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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 claimedand verified.

If the spouse is not an MA-only client and does not receiveFIP or SSI, consider the asset totally available unless other-wise claimed and verified.

Exception: Count equal shares of an asset owned by more than oneSSI-related MA child unless the person claims and verifies a differentownership.

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 unlessthe 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 underCash orRetire-ment Plans.

Count an equal share for each owner.

Note: For jointly owned real property count the individuals shareunless 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 orher 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, eachowner's share is the amount specified.

NON-SALABLEASSETS

SSI-Related MANon-SalableAssets

SSI-Related MA Only

Give the asset a $0 countable value when it has no current marketvalue as shown by one of the following:

Two knowledgeable appropriate sources (example: realtor,banker, stock broker) in the owner's geographic area state that theasset is not salable due to a specific condition. This applies to anyassets listed under:

Investments. Vehicles. Livestock.


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Burial Space Defined. Employment and Training Assets. Homes and Real Property (see below)

In addition, for homes, life leases, land contracts, mortgages, andany other real property an actual sale attempt at or below fair mar-

ket value in the owner's geographic area results in no reasonableoffer to purchase. The asset becomes salable when a reasonableoffer is received. Count an asset that no longer meets these condi-tions.

For applicants, an active attempt to sell must have started at least90 days prior to application and must continue until the property issold. For recipients, the asset must have been up for sale at least30 days prior to redetermination and must continue until the prop-erty is sold. An active attempt to sell means the seller has a setprice for fair market value, is actively advertising the sale in publi-

cations such as local newspaper, and is currently listed with alicensed 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 bankaccount. She puts money in her mother's checking account, but itis not a joint account.

Time deposits-- A time deposit is a contract between a person

and a financial institution whereby the person agrees to leavefunds on deposit for a specified period in return for a specifiedinterest rate. Common time deposits are certificates of deposit(CDs) and savings certificates.

Lump Sums andAccumulatedBenefits

Lump sums and accumulated benefits are defined in the PRG, Glos-sary.


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FIP, SDA and AMP Only

Lump-sums and accumulated benefits are assets starting the monthreceived.

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

lated benefits and benefits intended as a payment for the currentmonth. 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 monthreceived. See BEM 500 about countable income policy.

Exception: The following are assets:

Income tax refunds; see Tax Refund & Tax Credit exclusions in thisitem.

Nonrecurring proceeds from the sale of assets.

Payments that are excluded assets.

Retroactive SSIBenefits


Retroactive SSI benefits may be paid as a one-time payment or ininstallments over several months. The Social Security Administrationdetermines how payment will be made.

Retroactive SSI benefits are treated as accumulated benefits (see

above) even when paid in installments. See Retroactive RSDI and SSIExclusion 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 anyearly withdrawal penalty, but not the amount of any taxes due.

CASH EXCLUSIONS

Homestead-LossFunds Exclusion


Use this exclusion only if the funds are not commingled with countableassets and not in time deposits.


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

Exclude funds for temporary housing while the homestead is beingrepaired or replaced.

Also see Homestead-Loss Land Exclusion in this item regarding theland the home was on.

Homestead SaleExclusion


Use this exclusion only if the funds are not commingled with countable

assets and are not in time deposits.

Exclude funds received from the sale of a homestead, or the land thehome was on, for 12 months if there is a written agreement to purchaseanother homestead. The 12-month period starts the month the fundsare received.

Note: See Homestead Land Retained Exclusion below if ownership ofthe land was retained.

NonhomesteadLoss Exclusion


Use this exclusion only if the funds are not commingled with countableassets and are not in time deposits.

Exclude funds received for the planned repair or replacement of a non-homestead exempt item (example: furniture, clothing, vehicle) that waslost, stolen or destroyed. Exclude the funds until the item is repaired orreplaced.

Loan Exclusion FIP

Use this exclusion only if the funds are not commingled with countable

assets and are not in time deposits.

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 indicatingthe borrower's indebtedness


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An acknowledgment from the borrower of the loan obligation

The borrower's expressed intent to repay the loan by pledging realor 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 referto the policy in Promissory Notes/Land Contracts/Mortgages/Loans.

Reverse MortgageExclusion

FIP and SDA only


A reverse mortgage allows a homeowner to borrow some percentage ofthe 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 whilethe homeowner lives in the home. Exclude these payments.They areloans.

Tax Refund andTax CreditExclusion

FIP, SDA

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 creditsinclude credit such as Earned Income Tax Credit and Child Tax Credit.

Exclude tax refunds.


Excluded Income

Under BEM 500



BEM 500 identifies certain sources of funds that are excluded as bothincome and assets. Time limits and other conditions applicable to theincome exclusion also apply to the asset exclusion.


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Current IncomeExclusion


Do not count funds treated as income by a program as an asset for thesame 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 AccountExclusion



Exclude a savings, share, checking or draft account used solely for theexpenses of a business. Continue the exclusion while the business isnot operating provided the person intends to return to the business.

Retroactive RSDI

and SSI Exclusion

SSI-Related MA Only

Exclude retroactive RSDI and SSA-issued SSI benefits for nine calen-dar months beginning the month after payment is received. Do notexclude purchases made with such funds including CDs and other timedeposits.

This exclusion applies only to any unspent portion of the retroactivepayment 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 insuch a fashion that the retroactive amount can no longer be separatelyidentified, that amount will count toward the resource limit.

Use the following to separate countable and excluded funds that arecommingled:

Assume that countable funds are withdrawn first, leaving as muchof the excluded funds as possible.

Excluded funds withdrawn are not excluded if redeposited. Theexcluded amount can be increased only by deposits of subse-

quently received excluded payments.

Count any interest paid to the account.


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Example: A person received a $1,000 retroactive RSDI payment onDecember 3 via direct deposit. The account already contained $1,800.

Funds for BurialArrangements

SSI-Related MA Only

Money set aside for burial expenses might be excludable. See BurialFund Exclusion in this item.

Student SavingsExclusion

FIP, LIF, G2U, and G2C


Exclude funds in a separate account under a student's name andaccrued 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 ofInvestments


The value of a U.S. Savings bond is the amount the owner could get ifthe bond were cashed-in.

LIF, G2U, G2C, SSI-Related MA and AMP

U.S. Savings bonds cannot be cashed in until twelve months after thedate of issuance. However, if bonds are in this waiting period and the

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


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value of the bond(s) and other assets is over the clients asset limit, theclient must seek a waiver of the waiting period.

The waiver is a written request from the bond holder or representativeto the United States Department of Treasury outlining why a waiver ofthe 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 thebond 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 onmargin), the securities firm has made a loan to the buyer. Deduct thebalance owed from the price if there is written proof that the balanceowed must be repaid when the security is sold.

INVESTMENTEXCLUSION SSI-Related MA Only

Investments set aside for burial expenses might be excludable. SeeBurial Fund Exclusion in this item.

RETIREMENTPLANS 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 PlanValue


The value of these plans is the amount of money the person can cur-rently withdraw from the plan. Deduct any early withdrawal penalty, butnot the amount of any taxes due.

Funds

Michigan Medicaid Policy Final Draft Review Effective July1, 2011

Documents

Transcript of Michigan Medicaid Policy Final Draft Review Effective July1, 2011