Get Michigan Dhs 1010 Form 2020-2024

Information Booklet Important Things about Programs and Services Michigan Department of Health and Human Services Read this booklet before you sign the Assistance Application/Redetermination form. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability. Michigan Department of Health and Human Services (MDHHS) no discrimina contra ning n individuo o grupo a causa de su raza, religi n, edad, origen nacional, color de piel, estatura, peso, estado matrimonial, informaci n gen tica, sexo, orientaci n sexual, identidad de sexo o expresi n, creencias pol ticas o incapacidad. Michigan Department of Health and ??? ????? ????? ??????? ?????? ? ????????? ?????? ???????? ? ?? ???????? ?? ???????? ?? ?????????? ?? ?? ??? ?? ?????? ???? ??????Human Services (MDHHS)1 ? ?? ?????? ????????? ?? ???????? ?? ????????? ?????????? ?? ?????? ?????????? ?? ???????? ?? ???????? ?? ??????????????? .? ?? ?????????? ?? ????????? ??????????????????? ??????? ?? ????????? MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Table of Contents Program Details Healthcare 4 Food 11 Cash 17 Child Care 23 SER 27 Your Responsibilities 29 Your Rights 33 Resources 37 Privacy Details 40 Penalties 42 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Healthcare Coverage Overview Healthcare coverage provides help to pay for the costs of: Affordable private health insurance plans that offer comprehensive coverage. A new tax credit that can immediately help pay premiums for health coverage. Free or low-cost insurance from Medicaid, Healthy Michigan Plan, or MIChild (Children s Health Insurance Program). Even if you have insurance, there might be a program with better coverage or lower costs. Did you consume water from the Flint Water System and live, work or receive childcare or education at an address that was served by the Flint Water System from April 2014 through present day? If yes, you may wish to apply for health care coverage at www.michigan.gov/mibridges or request a DCH-1426, Application for Health Coverage & Help Paying Costs. 4 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Healthcare Coverage (Continued) Who is eligible? In Michigan, there are many healthcare programs available to children, adults and families. Use the application to apply for anyone in your family. Apply even if you or your child has health coverage. You could be eligible for lower-cost or free coverage. Families that include immigrants can apply. You can apply for your child even if you aren t eligible for coverage. Applying won t affect your eligible immigration status or chances of becoming a permanent resident or citizen. To be eligible for coverage, parents requesting healthcare coverage for themselves must provide proof that the children have credible coverage, even if not applying for the children. Credible coverage is health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare; Medicaid; CHAMPUS and TRICARE; the Federal Employees Health Benefits Program; Indian Health Service, the Peace Corps; public health plan (any plan established or maintained by a state, the United States government or a foreign country); Children s Health Insurance Program (CHIP); or, a state health insurance high risk pool. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 5 Healthcare Coverage (Continued) Who do I need to include on the application/ redetermination? Complete the application for every person in your family and household, even if the person has health coverage already. The information in this application helps us make sure everyone gets the best coverage they can. If an adult is applying for coverage, include all of these people (even if they aren t applying for health care coverage themselves): Any spouse. Any son or daughter under age 21 they live with, including stepchildren. Any other person on the same federal income tax return (including any children over age 21 that are claimed on a parent s tax return). You don t need to file taxes to get health coverage. If a youth or child under age 21 is applying for coverage, include all of these people (even if they aren t applying for health coverage themselves): Any parent (or stepparent) they live with. Any sibling they live with. Any son or daughter they live with, including stepchildren. Any other person on the same federal income tax return. You don t need to file taxes to get health coverage. To get help with your application, visit our website: www.michigan.gov/mibridges or call the application help line at 855-276-4627. You can also call the Beneficiary Help Line at 800-642-3195 or TTY 866-501-5656. To purchase insurance through the Marketplace visit: www.healthcare.gov. 6 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. How are benefits calculated? The amount of assistance or type of program you qualify for is based on the number of people in your family and their incomes. If you don t include someone, even if they already have health coverage, your eligibility could be affected. What happens next? If you don t have all the information we ask for, sign and submit your application anyway. We ll follow up with you within 1-2 wseeks. You ll get instructions on the next steps to complete your health coverage. If you don t hear from us, call our application help line at 855-276-4627 or 800-642-3195. Filling out an application doesn t mean you have to buy health coverage. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 7 Healthcare Coverage (Continued) Additional program policies Renewal of coverage in future years To make it easier to determine your eligibility for help paying for health coverage in future years, you can agree to allow the Marketplace and the state of Michigan to use income data, including information from tax returns. The Marketplace and the state of Michigan will send you a notice and let you make any changes. You can opt out at any time. If anyone on this application is eligible for Medicaid, Healthy Michigan Plan, or MIChild You are giving MDHHS the rights to pursue and get any money from other health insurance, legal settlements, or other third parties. You are also giving MDHHS the rights to get medical support from a spouse or parent. If you believe getting medical support from a spouse or parent will harm you or your child, tell your MDHHS specialist. You may have a good cause reason to not help with your case. To claim good cause, tell your MDHHS specialist now. Medicaid estate recovery (MA - Long Term Care (LTC)) You understand that upon your death MDHHS has the legal right to seek recovery from your estate for services paid by Medicaid (including Healthy Michigan Plan). This means that some or all of your estate may be recovered. MDHHS will not seek to recover against the estate while there is a legal surviving spouse or a legal surviving child who is under the age of 21, or blind or disabled. An estate consists of real and personal property. If you have received an asset disregard due to a long-term care partnership policy, the amount disregarded will be subtracted from the amount sought under Estate Recovery. In these situations, Estate Recovery applies to all assets whether they are subject to probate administration or not. Estate Recovery only applies to certain Medicaid and Healthy Michigan Plan recipients who received services after the effective date of the estate recovery statute. MDHHS may agree not to pursue recovery if an undue hardship exists. 8 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. An application must be submitted to determine if the applicant qualifies for an undue hardship waiver. Undue hardship waivers are temporary. For further information regarding Estate Recovery or to request an undue hardship application, call 800-642-3195. Coordination of health care programs and providers (MA) The State s medical assistance program relies on a large number of managed care health programs, mental health and substance abuse programs and private providers to deliver quality care to individuals like you. To make sure you receive a high level of care and that your benefits are coordinated, providers in the program may share information about your care (or your child or ward) with other providers in the program when such information and consultation are clinically needed. Information about you, your child or ward (MA) Necessary information may be shared between health plans and programs in which you participate. Health plans, programs and providers that deliver healthcare to you may share necessary information in order to manage and coordinate health care and benefits. This information may include, when applicable, information relative to HIV, AIDS, AIDS-related complex (ARC) or other communicable diseases, information about behavioral or mental health services, and referral or treatment for alcohol and drug abuse as permitted by 42 CFR Part 2. Your right to appeal If you think the Health Insurance Marketplace or Medicaid, Healthy Michigan Plan or MIChild has made a mistake, you can appeal its decision. To appeal means to tell someone at the Health Insurance Marketplace, Medicaid, Healthy Michigan Plan or MIChild that you think the action is wrong, and ask for a fair review of the action. Contact the Marketplace at 800-318-2596 or see Resources for details on how to request a hearing. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 9 Healthcare Coverage (Continued) Healthy Michigan Plan Exemption Definitions and Information A Healthy Michigan Plan exemption means you may be excused from: Healthy Michigan Plan work requirements and/or Other Healthy Michigan Plan program requirements. Exemptions can last up to one year. Some exemptions can be renewed. Once you tell us about an exemption, Michigan Department of Health and Human Services (MDHHS) will send you a letter with the date of exemption ends. Exemption reasons are explained below: Pregnancy exemption - I am pregnant or was pregnant in the last 2 months. Medically Frail exemption - I am medically frail due to one or more of the following: I have a physcial, mental, or emotional condition that limits a daily activity, like bathing I have a physical, intellectual, or developmental disability that makes it hard to do daily living activities I have physical, mental, or emotional condition that needs to be checked often I have a disability based on Social Security criteria (SSDI) I have chronic substance use disorder (SUD) I have a serious and complex medical condition, or special medial needs I am in a nursing home, hospice, or get home help services I am homeless I am a survivor of domestic violence 10 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Food Assistance Program (FAP) Overview FAP provides benefits to buy or grow food for your household. Who is eligible? You may qualify for the food assistance program if you have low income and $15,000 or less in assets. Interviews Most FAP interviews are held by telephone. However, you may request an in-person interview. If you are also reapplying for cash assistance, you may be scheduled for an in-person interview. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 11 Food Assistance Program (Continued) How are benefits calculated? Eligibility and benefit amounts are calculated based on the number of people in your FAP household and your household income (subtracting some deductions and allowable expenses). Deductions from countable income include: 20 percent of earned income; and A standard deduction based on the number of people in your FAP group. Allowable expenses include: Medical expenses over $35 a month that are not paid by a third party (only for people age 60 and older, a veteran with a disability, or a person with a disability). Some housing and utility costs. Homeless households which are not receiving free shelter throughout the month and who do not opt to claim an excess shelter deduction may be eligible for a homeless shelter deduction. Some child care costs and costs for care of persons with disabilities. Court-ordered child support paid to a non-household member. Failure to report or verify any listed expenses will be seen as a statement by you that you do not want to receive a deduction for the unreported or unverified expenses. Verifications must be received within 10 days. Tell us on your application/redetermination if you have received the Home Heating Credit (HHC) or a Michigan Energy Assistance Program (MEAP) Payment in an amount greater than $20 in the last year. If you do not tell us about the credit, we will assume you do not want to receive a deduction for heat expenses. 12 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Food Assistance Program (Continued) What are my program responsibilities? 1. Cooperate with Child Support to provide information MDHHS will enroll you in the child support program if a child in your home receives food assistance and one or both of the child s parents does not live in your home. Child support services will help you, if needed, to establish a legal father and/or get a support order for your child. The Office of Child Support will send you a letter. Follow the directions in the letter. You must help child support workers with your child support case by 1) giving them information they ask for and 2) going to appointments about your child support case. If you do not help, you may lose some of your food assistance. If you believe helping with your case will harm you or your child, tell your MDHHS specialist. Your MDHHS specialist will determine if you have a good cause reason to not help with your case. Some examples of good cause reasons are rape, incest, history of abuse, or threats of abuse. There are other good cause reasons. To claim good cause, tell your MDHHS specialist now. 2. Follow work rules All group members who don t meet an exception to the work rules (see below) will be registered for work and may be required to perform specific work activities including cooperation with employment and training activities. Specific work requirements will vary depending on whether you receive cash assistance (FIP) or have time-limited FAP benefits (if you receive both cash and food benefits, you must follow FIP work rules). If you are already working, you are not allowed to: Quit a job of 30 hours or more per week without good cause. Voluntarily reduce work hours below 30 hours per week without good cause. If you are not working, or you work less than 30 hours per week, you are not allowed to: Refuse a suitable job offer. Refuse to participate in required employment-related activities that must be done to receive FAP. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 13 What happens if I break work rules? If you receive FAP and you break the work rules without good cause, your benefits will stop or be reduced for at least 1 month (first time) and 6 months (for any time after that). Reasons for a good cause include: An unplanned event or factor that does not allow you to meet the work rules (for example, domestic violence, religion, health or safety risk, or homelessness). Illness or injury. Lack of child care. Lack of transportation. Long commute (more than 2 hours per day or more than 3 hours per day with child care). You quit a job to take a comparable job. Your job required you to commit illegal activities. You are physically or mentally unable to do the job. Your employer discriminated against you based on age, race, religion, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. You are working 40 hours per week for at least the state minimum wage. Reasonable accommodation was not provided. You are deferred. You moved due to another household member s job or education/ training. You have a job that requires you to retire or join, resign from, or refrain from joining a labor union or organization. Have a job that is on strike or at a lockout state. Have unreasonable work conditions. Have been offered a job that is outside of your work experience during the first 30 days as a mandatory FAP work participant. Employer is not able to keep the promise of work. If you think you have a good cause reason, contact your MDHHS specialist right away. 14 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Food Assistance Program (Continued) What are the exceptions to the work rules? Some people who receive food assistance may be excused from work rules - if you think you should be excused, talk to your MDHHS specialist. You may be excused from FAP work rules if you are: Under the age of 16. Age 60 or older. Personally caring for a child under the age of 6. Working 30 hours per week or earning at least the federal minimum wage times 30 hours per week. Attending high school, adult education or a GED program. Physically or mentally unfit for work. Personally caring for an incapacitated person. Applying for FAP at a Social Security office. In substance abuse treatment or rehabilitation. Applying for or receiving unemployment benefits. Appealing the denial of unemployment benefits. Reasons for being excused may change. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 15 Time-limited food assistance rules Special time limits and work requirements might apply to you if you are: A person without a disability; At least 18 years old but under the age of 50; and Living in a household with no children under the age of 18 (related or unrelated). Time limits are not always in effect, so check with your MDHHS specialist. 16 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Cash Assistance Overview The main goal of cash assistance programs is to help families become self-supporting and independent. Family Independence Program (FIP) is temporary cash assistance for pregnant women or families with minor children. State Disability Assistance (SDA) provides cash assistance for adults with disabilities, live-in caretakers, people in a special living arrangement, or people age 65 and older. Who is eligible? You may qualify for cash assistance programs if you have low income, $15,000 or less in cash assets, and $200,000 or less in property assets. FIP: You may be eligible for FIP if you are either a pregnant woman or a parent, legal guardian, or relative acting as a parent for a child under the age of 18 (or a high school student age 18). You cannot receive FIP for more than the federal 60 month time limit or the state s 48 month lifetime limit unless you qualify for an exception or exemption month (ask your MDHHS specialist for details). This includes any cash assistance you may have received in another state. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 17 Cash Assistance Program (Continued) SDA: You may be eligible for SDA if you are not eligible for FIP and you are 65 or older, or permanently or temporarily disabled, or taking care of a person with a disability who lives with you. Individuals may be considered disabled if they are: Age 65 or older. Unable to work for 90 days or more because of a medical condition. Receiving Supplemental Security Income (SSI) or Social Security disability benefits. Receiving medical assistance based on disability or blindness. Receiving special education services. Receiving help from Michigan Rehabilitation Services. Diagnosed as having AIDS. Living in an adult foster care home, a home for the aged, a county infirmary, a substance abuse treatment center, or a post substance abuse treatment center. How are benefits calculated? The FIP grant amount is based on: Number of people in your household group. Court-ordered child support expenses paid by your household. Total income. You may have the option to exclude a new spouse from your FIP Certified Group for up to 18 months after the month of the marriage when all of the following criteria are met: You are active FIP Your new spouse is not already a FIP group member Program group s total assets are equal to or less than twice the FIP asset limits Program group s net income is less than double the FIP monthly payment standard for the group size. 18 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Cash Assistance (Continued) What are my program responsibilities? 1. Cooperate with Child Support to provide information (FIP only) MDHHS will enroll you in the child support program if a child in your home receives FIP and one or both of the child s parents does not live in your home. Child support services will help you, if needed, to establish a legal father and/or get a support order for your child. The Office of Child Support will send you a letter. Follow the directions in the letter. You must help child support workers with your child support case by: 1) giving them information they ask for and 2) going to appointments about your child support case. If you do not help, you may lose your FIP. If you believe helping with your case will harm you or your child, tell your MDHHS specialist. Your MDHHS specialist will determine if you have a good cause reason to not help with your case. Some examples of good cause reasons are rape, incest, history of abuse, or threats of abuse. There are other good cause reasons. To claim good cause, tell your MDHHS specialist now. You cannot get child support payments and FIP at the same time. While you get FIP, your child support payments will go to MDHHS. That support is used to repay MDHHS for the cash it gives you. If MDHHS receives more in child support than it gives you in FIP for at least 2 months, MDHHS may close your FIP so you can get child support directly. 2. Immunize your children (FIP only) Children under age 6 must be immunized as recommended by MDHHS. Your cash benefits may be reduced by $25 per month until your children are up-to-date on their immunizations. A child is exempt from the immunization requirement if they are under 2 months of age, immunizations are medically inappropriate for the child, or immunizations are against the family s religious beliefs. 3. Send your children to school (FIP only) Children ages 6 18 must attend school full-time. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 19 4. Agree to Repay Agreements (FIP and SDA) If you receive SDA, you agree to repay MDHHS if you receive lump sum payments (such as an inheritance, insurance settlement, etc.) or benefits that are paid retroactively (such as unemployment benefits or workers compensation). If you receive SDA or state-funded FIP and receive a lump sum SSI payment, the Social Security Administration (SSA) may automatically take the money you received while your SSI application was pending out of your first check and reimburse MDHHS. If MDHHS is not reimbursed in the first check you receive, you agree to repay MDHHS right away. If you disagree with the amount MDHHS keeps, see Resources for details on how to request a hearing. 5. Follow work rules (FIP only) FIP work rules: Complete a Family Automated Screening Tool (FAST). Develop and comply with a Family Self-Sufficiency Plan (FSSP): The FSSP will list the work activities that you must do up to 40 hours per week to receive FIP. You design this plan with your MDHHS specialist and the work participation program. Do not quit, refuse work or reduce work hours. Do not get fired from a job due to misconduct or missing work. 20 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Cash Assistance (Continued) What happens if I break work rules? If you receive FIP and break the work rules without good cause (see good cause reasons below), MDHHS will: Deny your application (you may reapply). Stop FIP for your whole family for 3 months for the first time, 6 months for the second time and permanently for the third time. Count all penalty months toward your state 48 month lifetime limit (FIP only). If you receive both FIP and FAP, we may stop or reduce your FAP benefits for at least 1 month if you are not excused from FAP work rules and count your FIP grant amount as income. Good cause reasons Reasons for a good cause include: An unplanned event or factor that does not allow you to meet the work rules (for example, domestic violence, religion, health or safety risk, or homelessness). Illness or injury. You requested child care that was not provided. You requested transportation services that were not provided. Long commute (more than 2 hours per day or more than 3 hours per day with child care). You quit a job to take a comparable job. Your job required you to commit illegal activities. You are physically or mentally unable to do the job. Your employer discriminated against you based on age, race, religion, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. You are working 40 hours per week for at least the state minimum wage. Reasonable accommodation was not provided. If you think you have a good cause reason, contact your MDHHS specialist right away. Reasons for good cause may change. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 21 What are the exceptions to the work rules? Some people who receive cash assistance may be excused from work rules. If you receive FIP and are excused from the work rules, you may have to do other activities. If you think you should be excused from work rules, talk to your MDHHS specialist. You may be excused from FIP work rules if you are: Age 65 or older. A parent of a baby less than 2 months old. You may be assigned to family strengthening activities once the baby is 6 weeks old. Working 40 hours per week. Caring for a child or spouse with a disability (depending on the person s needs and the child s school attendance). A person with a disability or medical limitations. Experiencing a domestic violence situation (determined by MDHHS). 22 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Child Development + Care (CDC) Overview CDC helps pay for the cost of child care for those who need it due to: Work. High school completion classes (including General Educational Development (GED), adult basic education and English as a second language). Approved education or training. Approved treatment activities for a health or social condition. The CDC Handbook (which contains all of the program guidelines for parents and providers) can be found at: www.michigan.gov/childcare. Who is eligible? A family with low income. A licensed foster parent requesting care for foster children. A member of a MDHHS protective services case participating in a treatment plan. A FIP or Supplemental Security Income (SSI) recipient. A FIP applicant doing a required work participation program activity. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 23 Child Development + Care (Continued) How are benefits calculated? The income eligibility scale and reimbursement rates can be found at: www.michigan.gov/childcare. The actual CDC payment amount may not cover all child care expenses. You are responsible for any child care costs not covered by the CDC program. You are responsible for any child care expenses before your case is approved and the child care provider is added to your case. The department may request information from you at any time to verify your provider s billing. If overpayment is made to the child care provider for any reason, the provider must repay the extra payments. The department may reduce future payments to the provider by up to 20 percent. 24 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Child Development + Care (Continued) How do I select a child care provider? The child care you choose must be provided in Michigan by a: Licensed child care center. Licensed group child care home. Licensed family child care home. Michigan Department of Education (MDE) enrolled license exempt child care provider who has completed the Great Start to Quality Orientation and provides care in the child s home or is related by blood, marriage or adoption as a grandparent/great-grandparent, aunt/ great-aunt, uncle/great-uncle or sibling (only if the provider and the child do not live together) and provides care in his/her own home. If you need help finding an eligible child care provider, contact your Great Start to Quality Resource Center at 877-614-7328 or visit www.greatstarttoquality.org. If you use a friend or family member as a provider, the payments will be issued to you, and you will be responsible for paying the provider. To apply to be an license exempt provider, they must complete the application at www.michigan.gov/childcare and follow the instructions listed on the application. You are also responsible for reporting payments to the Internal Revenue Service (IRS) and issuing either a W-2 or 1099-MISC if appropriate. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 25 What are my program responsibilities? Cooperate with Child Support to provide information MDHHS will enroll you in the child support program if a child in your home receives CDC assistance and one or both of the child s parents does not live in your home. Child support services will help you, if needed, establish a legal father and/or get a support order for your child. The Office of Child Support will send you a letter. Follow the directions in the letter. You must help child support workers with your child support case by 1) giving them information they ask for and 2) going to appointments about your child support case. If you do not help, you may lose some or all of your CDC assistance. If you believe helping with your case will harm you or your child, tell your MDHHS specialist. Your MDHHS specialist will determine if you have a good cause reason to not help with your case. Some examples of good cause reasons are rape, incest, history of abuse, or threats of abuse. There are other good cause reasons. To claim good cause, tell your MDHHS specialist now. 26 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. State Emergency Relief (SER) Overview SER provides limited help to households with low income that have an emergency that threatens their health or safety. Covered services include: Relocation payments to avoid or eliminate homelessness. Mortgage, insurance and/or property tax payment to stop forfeiture, foreclosure or tax sale. Limited home repairs. Home heating, electric and utility bills. Burial costs. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 27 State of Emergency Relief (Continued) Who is eligible? You may qualify for SER if: You have low income and limited assets. The emergency situation is not likely to happen again (example: for help with rent or house payments, you must show you have enough income to pay your housing costs in the future). You have made certain required payments on your shelter, heat, electric and/or utility bills. How are benefits calculated? The amount of help you may receive depends on the number of people in your household, income, assets, type of service requested and other factors. 28 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Your Responsibilities By signing your application/redetermination, you are agreeing to fulfill these responsibilities. In order to get and keep benefits, it is your responsibility to... Release information for program needs You consent to the gathering, use and disclosure of your information by MDHHS and third parties. You understand the information is needed for the purpose of providing benefits or services, obtaining payment for your benefits or services, and for normal business operations of the department. You release the department from all liability for sharing this information with other agencies for this purpose. See Privacy Details on page 40 for examples of information that MDHHS will get from others and give to others. Tell the truth You are responsible for providing information on this application that is true and accurate. You could be sanctioned if you have intentionally given false or misleading information, or hidden/withheld facts that may cause you to receive assistance you should not receive or more assistance than you should receive. Sanctions may include administrative, civil or criminal actions, including prosecution. See Penalties on page 42 for details. Use your benefits legally It is illegal to give your FAP benefits or Bridge card away or to trade the benefits on your card for cash, lottery tickets, firearms, drugs, or other goods and services. Benefits that are sold or traded are treated as extra benefits and must be repaid. Penalties include fines, imprisonment and disqualification from future benefits. If you receive cash assistance, it is prohibited to use FIP, or SDA to purchase lottery tickets, alcohol, tobacco, or for gambling, illegal activities, massage parlors, spas, tattoo shops, bail-bond activities, adult entertainment, cruise ships or other nonessential items. See Penalties on page 42 for details. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 29 Your Responsibilities (Continued) Repay any benefits you should not have received If you or anyone in your household receives benefits they are not eligible for, the adults in the household must repay the extra benefits. The benefits must be repaid even if there was no fraud. If the department makes an error, the adults in the household must repay the extra benefits. For FAP, an authorized representative (who has access to your benefits and can shop for you) may also be responsible for repayment of any extra FAP benefits. MDHHS may keep part of your future benefits as repayment for extra benefits you received. If you disagree with the amount MDHHS keeps, see Resources on page 38 for details on how to request a hearing. Cooperate with Child Support to provide information If you are receiving Medicaid, FAP, FIP and/or CDC assistance, you must help child support workers with your child support case by 1) giving them information they ask for and 2) going to appointments about your child support case. If you do not help, you may lose some or all of your benefits. If you believe helping with your case will harm you or your child, tell your MDHHS specialist. Your MDHHS specialist will determine if you have a good cause reason to not help with your case. Some examples of good cause reasons are rape, incest, history of abuse, or threats of abuse. There are other good cause reasons. To claim good cause, tell your MDHHS specialist now. Report changes You are responsible for telling the department of any changes to the information you provided. These changes should be reported as soon as they happen, but no later than within 10 days of the change. For FIP only, you must report a child leaving your home within 5 days (if they will be absent for 30 days or more). If you do not report a change, you may be prosecuted for fraud or denied benefits. See Resources on page 37 for details on how to report changes. Your MDHHS specialist will tell you if different reporting rules apply to you, such as simplified reporters. 30 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Your Responsibilities (Continued) Lottery/Gambling winnings For all FAP groups, you must report all lottery or gambling winnings of $3,500 or more within 10 days of receipt of the winnings regardless if you have an asset test. Cooperate with state or federal reviewers You may be required to cooperate with state or federal reviewers who are making sure your benefits are correct. You may not be eligible to receive benefits if you do not cooperate. Pursue other benefits that you may qualify for For most programs, you must apply for other benefits you may qualify for, such as unemployment benefits, Social Security and Supplemental Security Income (SSI) benefits and Veterans Administration benefits. MDHHS will tell you if you need to apply for benefits. If you do not pursue benefits when required, your MDHHS benefits may be reduced, closed or denied. Provide Social Security numbers (SSN) For most programs, under federal law 42 USC 1320b-7, you must provide Social Security numbers. You do not need to provide Social Security numbers for household members who are not applying (with the exception of SER), adults applying for child care, or FAP recipients who cannot provide or obtain a Social Security number based on religious grounds. MDHHS will use Social Security numbers to check whether you are eligible and receiving the correct benefits. If you are applying for a Social Security number, give MDHHS the Social Security number as soon as you receive it. If you do not, your benefits may be reduced or denied. For healthcare coverage, providing your SSN can be helpful even if you don t want health coverage since it can speed up the application process. We use SSNs to check income and other information to see who s eligible for help paying for health coverage. If you need help getting an SSN, visit socialsecurity.gov, or call Social Security at 800-772-1213. TTY users should call 800-325-0778. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 31 Provide proof For most programs, you will have to provide papers that show what you ve told the department is true. You must give the department all required papers and documents before your eligibility for benefits can be determined. If you do not provide proof, your application may be denied. Report any tribal benefits that you receive You cannot receive food benefits from the tribal food distribution program and the food assistance program at the same time. You cannot receive tribal TANF (cash) from a tribe and FIP cash benefits from MDHHS at the same time. Tribal organizations may receive Low Income Home Energy Assistance Program (LIHEAP) funds from the federal government. Payments are limited to the highest amount available from either MDHHS or the tribal organization. MDHHS will ask you to prove any tribal LIHEAP payment you receive. 32 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Your Rights No matter who you are, you have the right to... Ask for a hearing You have the right to request a hearing if you do not agree with any action or decision the department makes (including failure to act with reasonable promptness). You can ask for a hearing for FAP by phone. Hearings for all other programs must be requested in writing. At the hearing you can explain why you disagree with the action or decision and present evidence. You may have your assistance continued if you file your request for hearing within 10 days of the denial/closure notice. You may be required to repay any assistance that you receive while your appeal is pending if 1) the department s proposed action is upheld in the hearing decision, or 2) your request for appeal is withdrawn, or 3) you or your authorized representative do not attend this hearing. A hearing will be granted if we receive your request for an appeal within 90 days of the date an action was taken by MDHHS or loss of your benefits. MDHHS must receive your request for an appeal within 10 days of the mailing date of the notice to continue receiving your benefits. You may choose anyone to represent you. If that person is not a lawyer or is not appointed by a court, you must give us your signed authorization. Attach a copy of the court s order if the person is courtappointed to help you. The Michigan Administrative Hearing System (MAHS) will deny the request for an administrative hearing made by the representative if you do not provide proof of authorization. The authorized hearing representative needs to be authorized before they can make the request. See Resources on page 38 for details on how to request for a hearing. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 33 Your Rights (Continued) Apply without discrimination This institution is prohibited from discriminating on the basis of race, color, national origin, disability, age, sex and in some cases religion or political beliefs. The U.S. Department of Agriculture also prohibits discrimination based on race, color, national origin, sex, religious creed, disability, age, political beliefs or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at 800-877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027), found online at: http://www.ascr.usda.gov/complaint filing cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call 866-632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W. Washington, D.C. 20250-9410 (2) fax: 202-690-7442 or (3) email: program.intake usda.gov. For any other information dealing with Supplemental Nutrition Assistance Program (SNAP) issues, persons should either contact the USDA SNAP Hotline Number at 800-221-5689, which is also in Spanish or call the State Information/Hotline Numbers (click the link for a listing of hotline numbers by State); found online at: http://www.fns.usda.gov/snap/contact info/hotlines.htm. To file a complaint of discrimination regarding a program receiving Federal financial assistance through the U.S. Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200 Independence Avenue, S.W., Washington, D.C. 20201 or call 202-619-0403 (voice) or 800-537-7697 (TTY). This institution is an equal opportunity provider. 34 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Your Rights (Continued) Providing ethnicity and race is voluntary Answering questions about race and ethnicity is voluntary. The information is collected to ensure that program benefits are distributed without regard to race, color or national origin. If you do not answer these questions, your eligibility or benefit levels will not be affected. If you choose not to answer these questions, your MDHHS specialist may choose an answer for you. Apply as an immigrant You may be eligible to receive benefits if you are a qualified immigrant, including: Lawful permanent residents or LPRs (people with green cards). Asylees and refugees. Parolees for more than 1 year. Cuban and Haitian entrants. Certain abused immigrants, their children, and/or their parents. Victims of trafficking. Veterans and active military, and their spouses and children. Receiving food or emergency assistance will not affect your immigration status. A referral to USCIS (U.S. Citizenship and Immigration Services) will only be made when an applicant/ recipient of food assistance or FIP either 1) presents a final order of deportation during the eligibility or redetermination process, or 2) a determination of ineligibility based on immigration status is upheld in the administrative hearing process and is supported by a determination by USCIS or immigration court (EOIR), such as a formal order of deportation. Individuals who are not applying for assistance for themselves and adults applying for CDC are not required to provide a social security number or information about immigration status. Apply as a United States citizen or national For some programs, people claiming United States citizenship must provide proof of citizenship and identity. Acceptable proof of citizenship includes, but is not limited to, a United States passport, a certificate of naturalization, or a United States public birth record MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 35 showing birth in the United States or United States territories. People receiving SSI, Social Security, Medicare, or adoption assistance, foster children and newborn safe delivery babies are not required to provide proof of United States citizenship. Receive services for domestic violence We may be able to waive some program requirements (such as working, looking for a job, pursuing child support or going to school) if participating would 1) put you or your family member in danger of physical or emotional harm 2) subject you to sexual abuse, or 3) otherwise be unfair to you. If any of these things apply to you or your family member, tell your MDHHS worker now. Also, see Resources on page 38 for details on how to access domestic violence services. Receive help if you have a disability You do not have to tell us about disabilities, but some help is only available to persons with disabilities. If you or someone in your household has a disability, we can make exceptions or give you special help. If you are denied special help or an exception you need because of a disability, and you think the denial was wrong, you may file a complaint of discrimination. If you do not tell us about a disability now, you can tell us about it later. Contact your MDHHS specialist if you need help. Register to vote If you select Yes or do not respond on your application, a voter registration application will be sent to you. If you select No , an application will not be sent to you. Applying or declining to register to vote will not affect the amount of assistance you will be provided by this department. If you would like help filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the voter registration application in private. If you believe someone has interfered with your right to 1) register to vote 2) decline to register to vote 3) privacy in deciding whether to register or in applying to register to vote or 4) choose your own political party or other political preference, you may file a complaint with: Secretary of State, PO Box 20126, Lansing, MI 48901-0726. 36 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Resources Here are resources that can help you take action. Find your local office Go online www.michigan.gov/contactmdhhs. Get help with your application/redetermination Your local MDHHS office will provide help with reading, writing, hearing, etc. or finding an interpreter during the application process. To get help: Call your local office to notify them that you will require assistance. If you are refused help, call the specialized action center: 855-275-6424. You may also bring your own interpreter. Report a change You can report changes by 1) calling your MDHHS specialist (their name and number is listed on any correspondence you ve received from MDHHS) 2) reporting online through MI Bridges 3) submitting a written statement or DHS-2240, Change Report form to your local office. Ways to request the DHS-2240 form: In person: Visit your local office and request form DHS-2240 or; Print from home: Download form DHS-2240 online Complete and sign form. Include your name and case number when sending any document. Mail completed form to your local office. If you file for bankruptcy, send a copy of the official bankruptcy notice to: MDHHS, Overpayment Research and Verification Section, PO Box 30820, Lansing, MI 48909. Report fraud Go to www.michigan.gov/welfarefraud or call 800-222-8558 to report suspected welfare fraud. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 37 Resources (Continued) Request a hearing Ways to request a hearing include: By phone (FAP only): Call your specialist (their name and number are listed on any correspondence you ve received from MDHHS) and request a hearing; or In person: Visit your local office and ask for a DHS-18, Request for Hearing form; or By mail: Download form DHS-18 online Print, complete and sign form. Include your name, address, and case number. Attach a copy of the notice you received from MDHHS, if possible. Mail the signed and dated form to your local office, addressed to the hearings coordinator. Keep a copy of the request and any other document you attach for yourself. Once a hearing is requested, you will receive a hearing date notice by mail. File a general complaint Call the specialized action center: 855-275-6424; or Write your complaint and mail it to: Michigan Department of Health and Human Services, Specialized Action Center, PO Box 30037 Lansing, MI 48909. Information on domestic violence You are authorized to receive domestic violence comprehensive services. Find information online: www.michigan.gov/domesticviolence. Call the Domestic Violence Helpline: 800-799-7233. Read DHS-Pub-859, Is Someone Hurting You or Your Children? online at www.michigan.gov/domesticviolence. 38 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Resources (Continued) Receive help with debts owed to MDHHS Call Overpayment Dispute Resolution Unit toll-free at 800-419-3328 if you 1) have a debt with MDHHS pertaining to FAP, Cash Assistance or CDC recoupment 2) need direction on where to send your repayment 3) are inquiring on debt balance 4) need reissuance of a receipt for prior repayment 5) are considering disputing any pending collection action underway for the programs above, or 6) are looking for clarification or guidance about a collection notice from MDHHS involving these programs. Receive Bridge Card help Cash and/or FAP benefits are accessed by using a debit card. This debit card is called the Bridge Card or Electronic Benefit Transfer (EBT) card. Call EBT Customer Service toll-free at 888-678-8914 to 1) report a lost, stolen or damaged card 2) request a replacement card 3) establish/change your personal ID number (PIN), or 4) find your balance. Customer service is available 24 hours a day, 7 days a week (Spanish and Arabic service is available). If you are hearing or speechimpaired, call the Michigan Relay Center at 800-649-3777. After your first replacement card, your benefits may be reduced to cover the cost of replacing any additional cards. The same replacement card policy applies if you have someone who has access to your cash benefits (protective payee), or (for FAP) someone whom you approved to purchase food for your household (authorized representative). Contact other programs If you have questions about any of the following programs, call: MIChild MDHHS: 888-988-6300. Medicare: 888-633-4227. State SSI Supplements: 855-275-6424. Energy Assistance: 855-275-6424. Community Resources and Referrals: 2-1-1. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 39 Privacy Details Information MDHHS will get from others Social Security Administration information (all programs) - You agree the Social Security Administration may give MDHHS all information needed to determine your eligibility. Quality Control (QC), Overpayment Research and Verification Section (ORVS) and/or Office of Inspector General (OIG) investigations - MDHHS might choose your case for a quality control review or a complete investigation. If your case is chosen, MDHHS will contact you, other people, employers and/or agencies for proof of the information provided on your assistance application. Law enforcement check (FAP, FIP, SER) - MDHHS may give or receive information from law enforcement officials for the purpose of arresting persons fleeing to avoid the law. Child care billing information (CDC) - Information submitted by your child care provider will be used in determining payment amounts. Computer cross-checking (all programs) - MDHHS will check income and eligibility verification systems along with federal, state and private agencies to make sure the information you provide on the assistance application is correct. If the information does not match, we may ask you to send us proof. Verification of the information you provide may affect your household s eligibility and level of benefits. MDHHS may check wages, income, assets, unemployment benefits, income tax refunds, Social Security benefits and numbers, child support, immigration status, etc. Other states - MDHHS will check records from other states. You may be denied benefits in Michigan if you or other household members were disqualified in another state. Healthcare coverage - You can consent to the gathering and use of income data, including information from tax returns for determining eligibility for help paying for health coverage in future years (up to 5 years). You will receive notice when this occurs, be able to make changes, and may opt out at any time. If you give any information that does not match, MDHHS may ask you to send us proof to find out what is correct. You may be asked for permission to contact employers, banks or other people. 40 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Privacy Policy (Continued) Information MDHHS will give to others Release information for program needs - MDHHS may release information for purposes directly related to administration of certain assistance programs. Limited information may also be released in a response to government officials acting in their official duties or certain charitable organizations. MDHHS may release your name and benefit amount to the general public if you have provided a signed consent or if ordered by a court. Eligibility information (FAP) - MDHHS sends food assistance program (FAP) eligibility information to schools. This information allows your child(ren) to receive free or reduced-cost meals. CDC - Notice will be sent to your child care provider when your CDC has been approved and authorized, changes occur that impact your CDC eligibility or your CDC eligibility has ended. Undocumented aliens - MDHHS may send information about certain undocumented aliens to the Department of Homeland Security. Survey information - You may be contacted for survey information to help evaluate MDHHS quality of programs and customer service. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 41 Penalties These penalty policies apply to FAP, FIP, SDA and CDC. Intentional Program Violation (IPV) is when you make a false or misleading statement, hide, misrepresent or withhold facts on purpose to receive or continue to receive extra benefits. If we think you committed fraud/IPV, we may hold an administrative hearing, bring criminal charges, or ask you to voluntarily sign a disqualification agreement. FAP trafficking You may also be guilty of fraud/IPV if you trade, attempt to trade or sell your FAP benefits or Bridge Card online or in person. You may not use or attempt to use FAP benefits or Bridge Cards that belong to another household for your household. You may not use FAP benefits or Bridge Cards to purchase or attempt to purchase anything other than food, seeds and plants to grow your own food for your household. If it is proven in court that you are guilty of fraud: You are subject to criminal penalties (for example, fines up to $250,000, jail/prison time up to 20 years, or both). You may be charged under other federal laws and a court may prevent you from receiving benefits for an additional 18 months; and You must repay any extra benefits you received because of the fraud/ IPV; and You will be disqualified from receiving FIP/SDA and/or FAP benefits see the table on next page. If it is proven in an administrative hearing you are guilty of IPV or you voluntarily sign a disqualification: You will be disqualified from receiving FIP/SDA and/or FAP benefits see the table on next page; and You will have to repay the extra benefits you received because of the fraud/IPV. These policies apply to other household members and authorized representatives as well. See Resources on page 37 for details on how to report suspected welfare fraud. 42 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Penalties (Continued) If you do any of the following: You will lose FIP/SDA and/ or FAP benefits for: Make a false or misleading statement. Hide, misrepresent or withhold facts to receive or continue to receive benefits. Trade, attempt to trade or sell less than $500 in FAP benefits or Bridge Cards online or in person. Use or attempt to use FAP benefits to buy ineligible items such as alcoholic drinks or tobacco. 1 year for the first violation 2 years for the second violation Life for the third violation Purchase beverages with FAP benefits then immediately empty the contents and return container for the cash. Use or attempt to use FAP benefits or Bridge Cards that belong to someone else for your household. If you are: Found by a court or an administrative hearing to have lied about your identity or where you live to receive benefits in two or more states at one time. If you are: Convicted in court of lying about your identity or where you live to receive benefits in two or more states at one time. Benefits include programs funded under Title IV-A of the Security Act, Medicaid and Supplemental Security Income. If any member of the household is found guilty in court of: Trading FAP benefits for drugs. You will lose FAP benefits for: 10 years You will lose FIP benefits for: 10 years You will lose FAP benefits for: 2 years for the first offense Life for the second offense If any member of the household is found guilty in court of: Trading or attempting to trade FAP benefits for firearms, ammunition or explosives. You will lose FAP benefits for: Life Trading, buying, or selling or attempting to trade, buy, or sell FAP benefits of $500 or more for anything other than food online or in person. Paying or attempting to pay for food purchased on credit with FAP. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 43 CDC Penalties Violation of program rules may result in a disqualification of 6 months, 12 months or a lifetime. 44 MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. Quick Look at Submitting Proof After you submit your application/redetermination, your MDHHS specialist will send you a list of any documents you need to provide based on your specific case. These are examples of the types of proof documents you may be asked to provide. Household Identification: driver s license, state ID or passport. Your Social Security Card and numbers for everyone in the household who is applying. Proof of alien status (green card or resident alien card). Assets Account statements (checking, savings, 401ks, etc). Deeds for any property you own (houses, buildings, land/lot, other property). Income Pay stubs. Receipt for unemployment compensation benefits (UCB). Award letters (for SSI, RSDI, worker s compensation, etc). Expenses Receipts for child care or adult disabled care. Medical receipts from recurring monthly expenses (like dialysis, monthly medication etc.) or bills from one-time expenses. Proof of rent or mortgage. When you submit documents provide copies we are not able to return original documents. Copies can be made free of charge at your local MDHHS office. If you need help getting proof, ask your MDHHS specialist. MDHHS-Pub-1010 (Rev. 3-20) Previous edition obsolete. 45.