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Cal assistance recipient from any third-party source as a result of injury, accident or illness. I understand that the amount payable to the Department will never exceed the amount of the Medicaid liability. I authorize payment of any such third-party resources directly to the Department. If the liable third-party makes payment directly to me, I agree to refund the Department an amount up to but not exceeding the amount of Medicaid liability. I understand that this repayment must be made even if.

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