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Get Printable Medicaid Application

Application/Redetermination for Elderly and Disabled Programs Alabama Medicaid Agency Important Answer all questions on this form. An original signature in ink is required. You may have someone help you complete the application. If additional space is needed please provide information on the notes page at the end of the application. Anyone who makes or causes to be made a false statement misrepresentation or omission of a material fact in an appl.

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