If you would like assistance with your Medicaid application, please complete the form below. A Project HEAL representative will be in touch shortly.

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* 1. If you would like assistance with your Medicaid application, please complete the form below. A Project HEAL representative will be in touch shortly.

How old are you?

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* 2. How old are you?

What is your annual income? Please approximate your income if you do not know the exact figure.

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* 3. What is your annual income? Please approximate your income if you do not know the exact figure.

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