Families can qualify in a few different ways. Some may be eligible through Government Assistance Programs, which is designed for those experiencing financial hardship.

Others may qualify if their income is less than five times the Federal Poverty Level and they’ve had out-of-pocket expenses in the last 12 months that exceed 67% of their income.

Please ensure you complete the application form in its entirety and submit it promptly for review. The application takes approximately 3 minutes, not including time to gather necessary records.

If you’re not able to complete the form today, that’s completely fine. We’ll send you the link by email tomorrow so you can return to it when you're ready.

Kindly have any necessary supporting documentation available before you begin, as you may be required to attach these files. 

If you have an assistance program, you'll need at least one of the following:

• Medicaid Card or Proof of Eligibility
• Social Services or photo of physical card (SNAP, WIC, TANF)
• Statement of government assistance
• ID Card, approval or award letter from a county, health department, or community clinic showing coverage under a Medical - Safety Net program
• Award letter from Charitable Organization

If you don't have an assistance program, you'll need at least two of the following:

• Most recent Federal Tax Return
• W-2 form from most recent year
• Last 2 months of pay stubs
• Letter of income from employer
• Explanation of Benefits (EOBs)
• Medical bills and receipts
• Credit card or bank statements showing payment
• Pharmacy expense summaries
• Provider invoices or payment plans