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[I know that if Medicaid pays for a medical expense, any money I get from other health insurance or legal settlements will go to Medicaid in an amount equal to what Medicaid pays for the expense.]
[I know I''ll be asked to cooperate with the agency that collects medical support from an absent parent. If I think that cooperating to collect medical support will harm me or my children, I can tell the agency and won''t have to cooperate.]
[I understand that if I''m eligible for help paying for health insurance, I may also be able to renew the coverage. During the renewal process, the Marketplace will use income data including information the tax returns of household members. This will determine yearly eligibility for help paying for health insurance for the next 5 years. The Marketplace will send me a notice and let me make changes. If I don''t respond, the Marketplace will continue my eligibility at the level indicated by the data. I understand this renewal process will occur each year for the next 5 years unless I tell the Marketplace that I don''t want to renew, or if I leave the Marketplace. I also understand that I can change my answer later. If I don''t check the box, I can select less than 5 years.]
[I know that I must tell the program I''m enrolled in if information I listed on this application changes.]
[I''m signing this application under penalty of perjury. This means I''ve provided true answers to all the questions on this form to the best of my knowledge. I know that if I''m not truthful, there may be a penalty.]