Dma 5201-2026

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  1. Click ‘Get Form’ to open the dma 5201 application in the editor.
  2. Begin by filling out Step 1, which requires your personal information. Enter your first name, middle name, last name, and suffix. Provide your home address, city, state, and zip code. If applicable, include your mailing address and phone numbers.
  3. In Step 2, provide details about your current job and income. Indicate if you are employed or self-employed and fill in the required fields regarding employer information and wages.
  4. Proceed to Step 3 to disclose your health coverage status. Indicate whether you are currently enrolled in any health insurance plans and provide relevant policy numbers.
  5. Finally, review all entered information for accuracy before signing the application in Step 4. Ensure that you understand the implications of your signature regarding eligibility and privacy.

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Medicaid Managed Care: The largest NC Medicaid program. People join one of several available standard health plans, officially known as prepaid health plans, or PHPs. Four PHPs are available in all the N.C. counties (with one additional plan also available in a few of the southernmost counties that Access East serves).
Everyone is potentially eligible for emergency Medicaid as long as they meet the income and North Carolina state residence eligibility requirements (provide proof they live in North Carolina, such as photo ID with your address, a utility bill, a lease or documentation of employment).
A child ages 0-18 may be eligible if the family income is $6,432/month or less. An adult ages 19-64 may be eligible if the family income is about $4,207/month or less.
Upon applying for Medicaid, the program conducts an initial financial assessment. This assessment thoroughly reviews your financial status and bank accounts to determine if you meet the asset and income criteria.
Emergency Medicaid is limited to medical treatment that is necessary following a medical emergency. This means that treatments of chronic conditions are NOT covered, even if the results of the condition could potentially threaten the patients life.

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NC Medicaid Direct is North Carolinas health care program for NC Medicaid beneficiaries who are not enrolled in NC Medicaid Managed Care. It includes care management by Community Care of North Carolina (CCNC), the primary care case management entity for physical health services.

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