Adult Medicaid Application Information

Individuals must complete an application by picking one up from our office or by clicking here to view and print an Adult Medicaid Application. You can complete it while you are here or mailing the completed application to the following address: 319 N. Graham-Hopedale Road, Suite C, Burlington, NC 27217.

Applications generally need to be made in person by the applicant or his/her representative. A client or his/her representative may apply for Adult Medicaid at our office during the office hours of 8:00 am to 5:00 pm Monday through Friday.

Persons receiving SSI (Supplemental Security Income) are automatically eligible, and can apply at the local Social Security Administration Office.

Receipt of a completed application form begins the application process. An interview may be completed at DSS. Mail-In Applications are available.


Bringing the following items will help in the application process:

  • Identification (ex. North Carolina Driver’s License)
  • Social Security Cards or numbers of all persons in household
  • Copies of all medical or life insurance policies for people in your household
  • Most recent bank statements
  • Current statements of any source of income such as Social Security, retirement benefits, Veteran’s benefits, or child support
  • Proof of alien status for applicants who are not US citizens
  • A list of all cars, trucks, motorcycles, or any other vehicles your or anyone in your household own
  • Name and phone number of at least one person who can verify who lives with you