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Primary Applicant Age
Household Members
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Female
Any Events in the Last 60 Days?
Select an option:
Loss or Change in Coverage
I lost coverage or lost eligibility for coverage.
My Medicaid or CHIP was denied or is ending.
Household Changes
I had or adopted a child.
I got married.
Living Changes
I moved to a new residence.
I was released from incarceration.
None
None of the following happened to me.
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