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us-wy/manual/wdh/medicaid/tables-table5a/block-1 — Effective Date: March 1, 2021 · Axiom

Effective Date: March 1, 2021

All of the following must be provided:

A document from the Proof of Identification located in Medicaid Table 5 must be provided as well as ONE of the following:

The following documents will confirm both status and date of entry of Iraqi and Afghan Special Immigrants: