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DENIAL LETTER OF MEDICAID-or Presumptive Eligibility Assessment If you have applied for Medicaid and were denied you must send a copy of your denial letter or explain why you have not applied for Medicaid. 6. I agree to reimburse NMHS for any amount provided in financial assistance by NMHS if I later receive payment by a third party source for my illness or injury. You are authorized to check my credit and employment history. I understand and agree that any false statement or misinformation...

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