DHB‑2050 Voluntary Request to Terminate Medicaid – Fillable PDF

What is the DHB‑2050 Form?

The DHB‑2050 is the official "Voluntary Request to Terminate Medicaid" form used by the North Carolina Department of Health and Human Services. It allows eligible individuals to voluntarily end their Medicaid coverage and receive a written confirmation.

How to Complete the DHB‑2050 Online

Instead of downloading, printing, and mailing a paper copy, you can fill out the DHB‑2050 directly on our site. Simply click the “Fill out this form” button below, and the Formize PDF Filler app will load. The interface is intuitive—just type into each field, use the tab key to move forward, and save your progress at any time.

Common Mistakes to Avoid

• Using pencil or an unreadable handwriting style (if you ever print).
• Leaving required fields blank, especially the signature and date.
• Submitting an outdated version of the form; always use the latest PDF linked here.
• Forgetting to attach supporting documents when required.

Why Choose Formize’s Fillable PDF?

Formize provides a secure, browser‑based PDF filler that keeps your data private and saves you time. No additional software is needed, and the completed form can be downloaded as a certified PDF ready for submission.