DSS-5251. ICPC Financial-Medical Plan - info dhhs state nc-2025

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The document outlines the financial and medical plans required for children placed in relative or foster care across state lines in North Carolina. It details the responsibilities of the Division of Social Services (DSS) regarding the child's needs, including shelter, food, clothing, and medical coverage. The document specifies eligibility for various financial resources such as TANF Child-Only Grants and Medicaid, and emphasizes that the custodial DSS retains ultimate responsibility for the child's welfare during interstate placements.

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Click ‘Get Form’ to open the DSS-5251 in the editor.
Begin by entering the child's name and resource details in the designated fields. Ensure accuracy as this information is crucial for processing.
Select the appropriate financial plan option that describes how the child's needs will be met in the receiving state. You can check only one box, so choose carefully based on your situation.
Provide a detailed description of how shelter, food, clothing, and maintenance needs will be addressed. This section is vital for ensuring proper support for the child.
For the medical plan section, check one option that best fits the child's medical coverage situation. Include any necessary details about eligibility and agreements.
If applicable, fill out third-party health insurance information, specifying coverage sources and policy numbers where required.
Finally, ensure all signatures are obtained from both caseworker and supervisor before submitting. Attach any required documents as indicated.

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