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    Please have a local representative call me with more information on the following:

  1. I am inquiring about services for:
  2. I already have Medicaid.
  3. I already have a Medicaid waiver.
  4. If so, please specify which waiver:
  5. I am interested in learning more about the EPSDT program.
  6. I have questions about qualifying for a Medicaid waiver.
  7. I have questions about hiring someone I know to become my Medicaid attendant.
  8. I have questions about becoming a Medicaid attendant for someone I know.
  9. I would like to hear more about the services that Moms In Motion provides.
  10. Additional Information: