SFN 687, "Medicaid Budget Worksheet" 510-05-100-90

(Revised 6/01 ML #2590)

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SFN 687 is intended to serve as a basic tool to be utilized in understanding the determination of initial and continuing eligibility for Medicaid.

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms . (158 kb pdf)

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