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Get SC WKR002 2015

Dicaid benefits. Send to: SCDHHS-Central Mail PO Box 100101 Columbia, SC 29202-3101 things to know Annual Review Form 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. .

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