How do I obtain a mail-in application for Medicaid?

Requesting an Application

You may contact the Department of Social Services (DSS) at 704-216-8330 to request an application to be mailed to you, or you may go to the North Carolina Division of Medical Assistance website. You may select from the Adult Medicaid Mail-in, form number DMA-5000, or you may choose the form DMA-5063 for Medicaid for families and children. 

Application Process

DSS cannot accept applications received by fax or email. Your eligibility will be determined by the date of your application. The date of the application is the date a completed, signed, and dated application is received in the DSS in the county where you reside. Once you have completed the application, you may mail the application or bring it in person to:

Rowan County Department of Social Services 
1813 E Innes Street 
Salisbury, NC 28146 
Monday through Friday, 7:30 a.m. to 5:00 p.m.

Show All Answers

1. What are the Medicaid eligibility requirements?
2. How do I apply for Medicaid?
3. How do I obtain a mail-in application for Medicaid?
4. Is Medicaid transportation available?