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Medicaid, SNAP, SSI, CHIP, disability, housing, Medicare.
State Medicaid Agency
OFFICIAL BUSINESS · PENALTY FOR PRIVATE USE $300
SAMPLE-MED-01
CASE ····4471
PAGE 1 OF 3
“Failure to submit verification of income within the specified timeframe may result in termination of benefits.”
SEE ENCLOSED: NOTICE OF RIGHTS (2)
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