Where to Apply

To apply for Medicaid, choose from the following options:

1.  Download and complete a copy of the form for the service you are applying for:

• Adult Medicaid Application (DMA-5000 Updated 09/27/06)   
  This form is intended for medical assistance for the aged, blind and disabled or those who want family planning services.
  
  
• Health Check / NC Health Choice for Children Application (DMA-5063 Updated 04/2007) 
  English | en español
  Health Check (the Medicaid Insurance Program) and Health Choice are two similar health insurance programs. Your family’s income, the number of people in your family and the age of the children determine if you or your children qualify.
  
  Viewing the forms requires the free Adobe Acrobat Reader.    
  
  Both forms above are PDF files and use the free Adobe Acrobat Reader. The forms can be filled out using your computer and printed to be either mailed or brought to one of our locations listed below.

  You can mail your completed form to:
  
       Wake County Human Services
       PO Box 46833 
       Raleigh, NC 27620

    – or –  

2.  You can bring in your completed from or apply in person at one of the Wake County Human Services locations:

Location	Address		Hours	Phone# (919)
Swinburne Building	220 Swinburne St. Raleigh, NC 27610	View map	Mon.–Fri. 8 a.m.–5 p.m.	212-7000
Southern Regional Center	130 N. Judd Parkway NE Fuquay-Varina, NC 27526	View map	Mon.–Fri. 8:30 a.m.–5:15 p.m.	557-2501
Eastern Regional Center	1002 Dogwood Drive Zebulon, NC 27597-6814	View map	Mon.–Fri. 8:30 a.m.–5:15 p.m.	404-3900
Northern Regional Center	350 E. Holding Ave. Wake Forest, NC 27587	View map	Mon.–Fri. 8:30 a.m.–5:15 p.m.	562-6300