S MICHIGAN DEPARTMENT OF HEALTH & HUMAN …

1 Issued: 6-1-2020 STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services Bridges Administrative Policy Manuals ROBERT GORDON DIRECTOR GRETCHEN WHITMER GOVERNOR STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services LANSING BAM 105 1 of 21 RIGHTS AND RESPONSIBILITIES BPB 2020-021 7-1-2020 BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services DEPARTMENT POLICY All Programs Clients have rights and responsibilities as specified in this item. The local office must do all of the following: Determine eligibility. Calculate the level of benefits. Protect client rights. CLIENT RIGHTS Right to Apply All Programs On the same day a person comes to the local office, a person has the right to file an application and get local office help to provide the minimum information for filing.

2 An application or filing form, whether faxed, mailed or received from the Internet must be registered with the receipt date, if it contains at least the following information: Name of the applicant. Birth date of the applicant (not required for the Food Assistance Program (FAP) or the Child Development and Care (CDC) program). Address of the applicant (unless homeless). Signature of the applicant/authorized representative. An application/filing form with the minimum information listed above must be registered in Bridges using the receipt date as the applica-tion date even if it does not contain enough information needed to determine eligibility; see Bridges Administrative Manual (BAM) 110. If an application/filing form does not contain the minimum informa-tion listed above, send it back to the client along with a DHS-330, Notice of Missing Information, informing the client of the missing information.

3 BAM 105 2 of 21 RIGHTS AND RESPONSIBILITIES BPB 2020-021 7-1-2020 BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services Note: If an applicant applies for multiple programs which include FAP and/or CDC and the birthday of the applicant is missing, the FAP and/or CDC programs must be registered. Do not return an application for HEALTH care coverage to an applicant. See BAM 115 for when to use the DHS-330, Notice of Missing Information. A MDHHS-1171, filing form is not acceptable for any category of HEALTH care coverage. Family Independence Program (FIP), State Disability Assistance (SDA), Refugee Cash Assistance (RCA) and Refugee Medical Assistance (RMA) Treat a faxed or emailed application or filing form as an incomplete application. The MICHIGAN DEPARTMENT of HEALTH and HUMAN services (MDHHS) must receive an original signature before benefits are approved.

4 See Right to Apply in the Client Rights section of this item. FAP A photocopy, facsimile (fax) or an Internet version of a MDHHS-1171, Assistance Application, or the filing form is acceptable. An original signature is not required. Medicaid (MA) A photocopy, facsimile (fax) or an electronic version of a DCH-1426, DHS-3243, MDHHS-1171, and DHS-4574 is acceptable. The federal application for HEALTH coverage is acceptable for any Medicaid category. Additional information may be required for an SSI-related category. An original signature is not required. Note: Individuals applying for disability-related MA and/or SDA who have previously been denied by the Disability Determination Service (DDS) must have a new or worsening condition to be referred back to DDS when they submit a subsequent application for these programs; see BAM 815, Medical Determination and Disability Determination Service.

5 BAM 105 3 of 21 RIGHTS AND RESPONSIBILITIES BPB 2020-021 7-1-2020 BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services Right to Confidentiality All Programs Information concerning individual clients is confidential and pro-tected; see BAM 310, Confidentiality and Public Access to Case Records. Right to Nondiscrimination All Programs Clients have the right to be treated with dignity and respect. For FAP complaints alleging discrimination, clients have the right to make complaints to the: MICHIGAN DEPARTMENT of HEALTH and HUMAN services Specialized Action Center 235 S. Grand Avenue Box 30037 Lansing, MI 48909 Or call 855-275-6424 or 855-ASK-MICH. Complaints that are deemed to be potential Americans with Disabilities Act (ADA) or discrimination claims will be routed directly to the county director.

6 The county director will use the Office of HUMAN Resources (OHR) to properly address all aspects of the allegations. All other complaints that come through the specialized action center will be routed to the customer information specialist in the district/county office for follow-up. MICHIGAN DEPARTMENT of Civil Rights (MDCR) and/or US Equal Employment Opportunity Commission complaints regarding clients must be routed directly to OHR for review and a coordinated response with the district/county office. Any mediations, settlements or appeals will be directed to The Legal Affairs Administration for further review and coordination with the district/county office. The Office of HUMAN Resources is responsible for all agency equal opportunity and diversity efforts. For more information, visit the MICHIGAN DEPARTMENT of HEALTH and HUMAN services website Inside MDHHS/Legal/Equal Opportunity.

7 BAM 105 4 of 21 RIGHTS AND RESPONSIBILITIES BPB 2020-021 7-1-2020 BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services Non-Discrimination Statements/Complaints FIP US HEALTH and HUMAN services (HHS) Nondiscrimination Statement 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 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 (for example, Braille, large print, audiotape, American Sign Language, etc.)

8 , 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 AD-3027, USDA Program Discrimination Complaint Form, found online at The DEPARTMENT of Agriculture (USDA) under Complaint Resolution/Filing a Program Discrimination Complaint as a USDA Customer, 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 completed form or letter to USDA either by: (1) mail: DEPARTMENT of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, 20250-9410 (2) fax: 202-690-7442.

9 (3) email: BAM 105 5 of 21 RIGHTS AND RESPONSIBILITIES BPB 2020-021 7-1-2020 BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN services 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 the United State DEPARTMENT of Agriculture (USDA) Food and Nutrition Service (FNS) Supplemental Nutrition Assistance Program (SNAP) State Hotline Numbers. To file a complaint of discrimination regarding a program receiving federal financial assistance through the DEPARTMENT of HEALTH and HUMAN services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200 Independence Avenue, , Washington, 20201 or call 202-619-0403 (voice) or 800-537-7697 (TTY).

10 This institution is an equal opportunity provider. A client or a client s authorized representative must sign the complaint form. The client is not required to use the complaint form. The client may write a letter instead. If the client writes a letter, it must contain all of the information below and be signed by the client or the client s authorized representative/attorney. Complaints of alleged discrimination should contain the following: Name, address and telephone number or other means of contacting the complainant. Name, address and telephone number of client s attorney or authorized representative, if the client is represented. Name of the individual(s) or entity the client believes discriminated against the client and the agency or recipient that employs that/those employees. Issue of the client s complaint. The issue is a description of what happened, or the action that was taken by the individual(s) or agency that the client believes discriminated against him or her, resulting in some harm.