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Nsition to Private Living) Request Gross Income Information Request SAIH Eligibility Release of Information is attached From: LME/MCO Transition Coordinator Name: Title: Phone Number: Email address: LME/MCO Name: LME/MCO Mailing Address: To: City & Zip Code: DSS (County Name) CASE NAME: Medicaid ID #: The below question should be answered by the LME/MCO and provided to the DSS for ALL SAIH recertifications: Is the individual still eligible for and participating in the.

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