div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: img028 - Medicaid · DEPARTMENT OF HEALTH HUMAN SERVICES Centers for Medicare Medicaid Services 7500 Security Boulevard Mail Stop S2-26-12 Baltimore Maryland 21244-1850 src=https:reader034vdocumentsusreader034viewer20220428075f7cea0271ddc217512ec1aahtml5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: img028 - Medicaid · DEPARTMENT OF HEALTH HUMAN SERVICES Centers for Medicare Medicaid Services 7500 Security Boulevard Mail Stop S2-26-12 Baltimore Maryland 21244-1850 src=https:reader034vdocumentsusreader034viewer20220428075f7cea0271ddc217512ec1aahtml5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: img028 - Medicaid · DEPARTMENT OF HEALTH HUMAN SERVICES Centers for Medicare Medicaid Services 7500 Security Boulevard Mail Stop S2-26-12 Baltimore Maryland 21244-1850 src=https:reader034vdocumentsusreader034viewer20220428075f7cea0271ddc217512ec1aahtml5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: img028 - Medicaid · DEPARTMENT OF HEALTH HUMAN SERVICES Centers for Medicare Medicaid Services 7500 Security Boulevard Mail Stop S2-26-12 Baltimore Maryland 21244-1850 src=https:reader034vdocumentsusreader034viewer20220428075f7cea0271ddc217512ec1aahtml5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: img028 - Medicaid · DEPARTMENT OF HEALTH HUMAN SERVICES Centers for Medicare Medicaid Services 7500 Security Boulevard Mail Stop S2-26-12 Baltimore Maryland 21244-1850 src=https:reader034vdocumentsusreader034viewer20220428075f7cea0271ddc217512ec1aahtml5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdiv