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Get SC WKR002 2016-2024

Eturn this form. If you do not, you may lose Medicaid benefits. What do I do with this form? • Please complete this form and return it by the date listed above so that we can determine if you and your family still qualify for Medicaid. If you do not return this form, your Medicaid benefits will end. What if my household has changed? • If a member has moved out of your home, indicate that they no longer live with you in Step 2. If someone has moved into your home, use the New Household .

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