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Enrolling Due to Loss of Medicaid Status
If you or your dependent loses Medicaid coverage, you have 60
days from the date of loss to enroll yourself or your dependent
with MCHCP. Coverage is effective on the first of the month following
receipt of the form and required documentation. However coverage
can be effective the first of the month in which Medicaid coverage
is lost if forms are received by MCHCP prior to the first of the
month of the loss.
Submit the following:
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