Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Dma 5052

Get Dma 5052

IMPORTANT NOTICE YOUR ESTATE IS SUBJECT TO MEDICAID RECOVERY Individuals age 55 and over This is NOTICE that Federal and State law authorize the Division of Medical Assistance to file a claim against.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the DMA 5052 online

This guide provides comprehensive instructions on how to fill out the DMA 5052 form online. Designed to assist individuals with varying levels of experience, this guide clarifies each step for a smooth completion process.

Follow the steps to successfully complete your DMA 5052 form online.

  1. Press the ‘Get Form’ button to access the DMA 5052 form, which will open it in your preferred editor for online completion.
  2. Begin by entering your personal information in the designated fields, including your full name, address, and contact details.
  3. Provide your case number and the name of your caseworker as prompted. Ensure that these details are accurate to avoid processing delays.
  4. Indicate whether you are the applicant, a recipient, or a representative by selecting the appropriate option.
  5. Review the instructions regarding Medicaid recovery and heartedly acknowledge the conditions that apply by checking the corresponding box.
  6. If applicable, include information about any surviving heirs and any relevant hardship circumstances that may apply.
  7. After ensuring all information is complete and accurate, choose to save your changes, download a copy of the completed form, print it, or share it as necessary.

Complete your DMA 5052 form online today to ensure accurate processing.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

dma-5052sa State/County Special Assistance...
Medicaid Form Number, dma-5052sa. Agency/Division, Health Benefits/NC Medicaid (DHB). Form...
Learn more
Music D.M.A.
The Doctor of Musical Arts (DMA) offers emphases in instrumental performance, ... WRIT...
Learn more
Untitled - Bitsavers
Interface to PRIME Computer: Received data and/or line status. - DMA/ DMC ... 5052, 5054...
Learn more

Related links form

Cat Breeder Contract Template B2B Sale Contract Template Artist Feature Contract Template Behavior Management Behavior Contract Template

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

The NCFAST-20020 is a prepopulated renewal form for the beneficiary to validate that current information remains the same or indicate changes and provide self-attestation of eligibility requirements, including income.

State Exemptions From Medicaid Recovery They cannot recoup expenses if your spouse is still living. As long as your spouse lives longer than 1 year after you die, Medicaid cannot make a claim on the estate for your expenses. Have a Child Under 21 or a blind or disabled child.

Estate Recovery means a claim is filed against the estate of a deceased beneficiary to recover Medicaid dollars paid on behalf of the individual.

However, Medicaid keeps a running tab of all of the payments they make on your behalf. After you pass away, Medicaid will try to seek reimbursement from your estate and can force the sale of your home in order to pay Medicaid back.

North Carolina has a 60-month Medicaid Look-Back Period that immediately precedes one's Nursing Home Medicaid or Medicaid Waiver application date. During the “look back”, Medicaid checks all past asset transfers to ensure no assets were sold or gifted under fair market value.

To be eligible for North Carolina Medicaid, you must be a resident of the state of North Carolina, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

If a beneficiary's Medicaid is terminated prior to their death, an invoice will not be generated. TPR will pursue estate recovery for those individuals upon notification by the Local Agency. the manual recovery process. Contact TPR at 866-455-0109 and provide the beneficiary's name, Medicaid ID, and date of death.

State Exemptions From Medicaid Recovery Marriage:If you are married when you die, Medicaid Recovery only has 1 year to recoup the expenses. They cannot recoup expenses if your spouse is still living. ... Have a Child Under 21 or a blind or disabled child. ... Hardship.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Dma 5052
Get form
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
  • Real Estate Handbook
  • All Guides
  • Notarize
  • Incorporation services
  • For Consumers
  • For Small Business
  • For Attorneys
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Form Packages
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
Form Categories
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
Customer Service
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
Legal Guides
  • Real Estate Handbook
  • All Guides
Prepared for you
  • Notarize
  • Incorporation services
Our Customers
  • For Consumers
  • For Small Business
  • For Attorneys
Our Sites
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
© Copyright 1999-2026 airSlate Legal Forms, Inc. 3720 Flowood Dr, Flowood, Mississippi 39232
  • Your Privacy Choices
  • Terms of Service
  • Privacy Notice
  • Content Takedown Policy
  • Bug Bounty Program