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il medical renewal form

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State of Illinois Department of Healthcare and Family Services Illinois Medicaid Redetermination Name Address City State ZIP Letter Date Barcode Case ID Case ID Dear Name It is time to renew your medical coverage Special Message Text Here s what to do 1. If the Illinois Department of Healthcare and Family Services pays medical bills for me the State of Illinois may collect my medical support payments instead of me. I am signing this form under the penalty of perjury. That means the...
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