Apply for Reduced Copayments

If your income falls below the federal poverty line, you're copay drops to $7.50

Clients that make less than current Federal Poverty Guidelines qualify for Reduced Copayments, if you believe you're eligible, complete this form to pay half what you normally would for our paid services.

Qualifying for Reduced Copayments is simple, if your household makes less than this years Federal Poverty Guidelines, you're automatically eligible so long as your provide income verification.

1 Person

$15,960

100% Annual FPL

$1,330
Monthly FPL

2 People

$21,640

100% Annual FPL

$1,804
Monthly FPL

3 People

$27,320

100% Annual FPL

$2,277
Monthly FPL

4 People

$33,000

100% Annual FPL

$2,750
Monthly FPL

5 People

$38,680

100% Annual FPL

$3,230
Monthly FPL

6 People

$44,360

100% Annual FPL

$3,697
Monthly FPL

Provide us with the e-mail address used in your original application so we can pull up your account. Then just answer a few quick questions about your income.

You will need to prove that paying the full copayment for our services is a significant financial burden in order to be approved. To accomplish this, you'll need to upload two forms of income verification, including but not limited to:

Medi-Cal
CalFresh/SNAP/EBT
CalWorks
Bank Statement
Payroll Stub
Tax Return (most recent)
Self-certification letter
SSI statement

Confidential and Secure: Our funders require us to collect this information in order to prove your tax dollars are being spent correctly. Your information is securely collected and stored. Your name and personal information are never shared with anyone, just demographics.

Once approved you can begin saving on copayments for Wheelchair Repair, Attendant Care, and Emergency Transportation. You'll pay half the typical rate for paid services with EDI, $15.

Start my Application

Apply for Reduced Copayments

Thanks for taking the time to verify your eligibility for Easy Does It Emergency Services. Please fill out all the required fields to complete your application for service. Upon completion of this form, we'll review your application for accuracy and notify you via e-mail when you are approved.

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Contact Info

E-mail Address

Please use the same e-mail address you provided in your full application so that we can pair this information to your account with us.

Demographics

Number of Adults in your Household

Number of Children in your Household

In order for us to process your reduced Co-Payment Application, we need to verify that you're eligible for them. Please provide us with two forms of income verification, this information remains confidential and is required to proceed.

First form of Income Verification

Please submit any of the following documents which shows you're enrolled in any of the following programs:

Medi-Cal
CalFresh/SNAP/EBT
CalWorks
Other

Upload your First Document Here

Second form of Income Verification

Attach one of the following documents to verify your income:

Bank Statement
Payroll Stub
Tax Return (most recent)
Self-certification letter (contact our office at 510-845-5513)
SSI statement
Other

Please remove any account numbers, social security numbers or other confidential information.

Upload your Second Document Here

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Apply for Reduced Copayments

If your income falls below the federal poverty line, you're copay drops to $7.50

1 | Verify that you're eligible

1 Person

$15,960

2 People

$21,640

3 People

$27,320

4 People

$33,000

5 People

$38,680

6 People

$44,360

2 | Complete Application

3 | Submit Income Verification

4 | Pay only $7.50 an hour of care or 10 miles of travel

Apply for Reduced Copayments

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fringi dictum, augue purus