Eligibility

Financial Information

* Red asterisk indicates required
How many adults are in your household?*
Is anyone age 65 or older?*
How many children are in your household?*
Is at least one member a resident of Iowa? *
How much total money (before taxes) did all of the people in your household get last month? Include Income, Social Security, Child Support, etc.*
How much does the household have on hand? Include cash, money in checking accounts and saving accounts, etc.*
How much does the household pay for medical expenses monthly?*
Are all the household members United States citizens?*
If not, do they have legal documents to stay in the US?*
Does anyone have a disability?*
Is anyone pregnant?*
Is anyone in the household enrolled in Medicare?*
Do you want to find out if you or your family can get help paying for health insurance? *