Costs and Eligibility
Cost of Services
The best way to find out the cost of a particular service, once you know your eligibility status, is to contact that service department directly. You can find contact information listed under each service's web page.
Many services are available to anyone; other services require you to meet certain eligibility requirements prior to receiving the service.
Services available to anyone
The following services have no eligibility requirements, though some require financial screening and/or fees:
- Birth control (contraceptives)
- Family planning
- Childhood immunizations (vaccinations)
- Immunizations for foreign travel
- Sexually transmitted disease (STD) testing, treatment, and counseling
Services requiring a Health Card
You must have a Health Card (previously called a Clinic Card) to receive some services. A Health Card allows access to our sliding fee scale (where fees vary depending on your ability to pay) even for services not covered by your health insurance. Eligibility specialists work with new clients to go over their individual situations and documentation.
Obtaining a Health Card
If you need Specialty Services, we ask that you first apply to Medicaid to see if you are eligible for that program.
To obtain a Health Card, you will be asked to provide the documentation listed below, if applicable.
To obtain a Health Card, please provide:
- Completed, signed and dated Client Registration Form
- IOS (Initiation Of Services) Form
- Verification of all Household Income
- Photo ID (U.S. or foreign government ID)
- Social Security cards/numbers (all family members)
- Proof of Sarasota County residency (required of some clients for referrals)One piece of mail received in your name within the last 30 days
- Proof of insurance (if applicable)
- Verification of Alien Status (if applicable - for non-U.S. citizens)
- Verification of total gross household income for the four most recent weeks, which may include:
- Pay stubs (or for a new job, provide a letter from your employer stating hours, rate of pay, and how often paid)
- Bank statements - from most recent month for all accounts
- Other income - proof of monthly amount of any income from Social Security, alimony, child support, Unemployment / Workers Compensation, pensions, trusts, bank accounts, rental income, etc.
- If self-employed, provide most recent 3 months’ business ledgers/records and most recent 3 months’ bank statements
- If you are supported by someone else, provide a written statement of support including that person’s name, address, and phone number; the date, and the amount you receive each month. Letter of support form.
- Additional information may be required on a case-by-case basis.
This list is for informational purposes only; please FAX all forms and information to 941-526-1531. To determine what information will be required of you, please provide a good phone number so we can contact you. You will be contacted if additional information is needed and to advise you of case status.
- Forms (English)
- Forms (Spanish)
Usted puede descargar las formas que aplican a su situación usando las enlaces abajo, llenarlas y traerlas consigo cuando viene a la oficina de Elegibilidad.
Formulario de Inicio de los Servicios (Eng. & Español) [884 KB PDF]
Registración de Elegibilidad [59KB PDF]
(Client Registration Form)
Verificación de Ingreso
(Income Verification Form)
Carta de Apoyo [224KB PDF]
(Letter of Support)
Inventario de Gastos [360KB PDF]
Formulario de Empleo Propio [142KB PDF]
What if I don't have health insurance?
Florida KidCare provides coverage for eligible children under age 19.