Document Category: Health Benefits/NC Medicaid
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dma-5150 Documentation of Passalong Eligibility or Ineligibility
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dma-5150A Screening for Medicaid under the COLA Passalong
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dma-5147 HCWD Denial for Non-Payment of Premium
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dma-5148 HCWD Termination for Non-Payment of Premiums
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dma-5149 HCWD Enrollment Fee Notice
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dma-5141 Medicare/Medicare Part B Enrollment Advisory Letter (Automated)
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dma-5146 Health Coverage for Workers with Disabilities Premium Notice
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dma-5134 Emergency Medical Services Request for Missing Information
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dma-5135 Dates of Emergency Services Requested for an Alien
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dma-5131 FAX Request Form – From County DSS to EOIR