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APPENDIX C Designation of Authorized Representative You can give a trusted person permission to talk about this application with us, see your information, and act for your on matters related to this.

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North Carolina expanded who can get Medicaid starting December 1, 2023. Adults ages 19 through 64 earning up to 138% of the federal poverty line (e.g., singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible.

Verify eligibility, health plan and primary care provider enrollment using the NCTracks Recipient Eligibility Verification/Response or calling the NCTracks Call Center for more information: 800-688-6696.

Proof you live in North Carolina, such as a photo ID with your address, a utility bill, a lease, or documentation of employment. Employer and income information for you and everyone in your household, such as paystubs, W-2 forms, tax returns or business records. Copies of all medical or life insurance policies.

After you apply It can take up to 45 days for DSS to decide if you qualify for NC Medicaid. Disability applications can take up to 90 days. We may contact you to ask for more information.

NCTracks also offers a Secure Recipient Portal where you can check your eligibility status with Medicaid, Health Choice, Public Health, and the Office of Rural Health and Community Care.

“Authorized Representative” means any individual who is legally authorized or designated in writing by the applicant/recipient (a/r) to act on behalf of the applicant/recipient.

Division of Medical Assistance (DMA) is Now the Division of Health Benefits (DHB) | NC Medicaid.

If you need to use your medical, pharmacy, mental health or substance use benefits before you get your Medicaid card, please call Member Services at 1-855-375-8811 (TTY 1-866-209-6421). We will give you your member ID number.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232