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REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-011

Example 5 (MAGI example only) The MAGI-based household submitted their annual renewal form with attested monthly income. VCI interface information is not available. The SEW interface report shows income from this employment, however the SEW report is not reasonably compatible. Paper verification is requested for current income and allowable expenses.