Request a pediatric grant

• Age
  
  • The child/grant recipient must be 18 years of age or younger.
  • Special consideration may be given to a person aged 19 – 21 years of age if they are incapable of living independently due to a medical condition.
• Income
  
  • Quick Tips
    
    • Our preferred form of income documentation is your most recent tax return.
    • We always consider the household income (both parents, if applicable).
      
      • If parents/guardians are separated, we will request the income of the parent claiming the child as a dependent.
    • All out of pocket medical expenses from the child over the last 12 months are deducted from your income during our processing to obtain your qualifying income; there is a place to note this amount on the application.
    • We do not require income verification if the child is residing with foster parents.
  • Travel and Lodging
    
    • Qualification is solely based on qualifying income, not family size.
    • Income must be less than $60,000 annually to qualify.
  • Vehicle Modifications
    
    • Qualification is solely based on qualifying income, not family size.
    • Income must be less than $60,000 annually to qualify.
  • Clinical and Equipment
    
    • Qualifying income is based upon the number of dependent children in the home.
    • Income starts at $40,000 annually with one dependent child in the home and increases $15,000 with each additional child.

• Clinical
  
  • Grant to provide funding for clinical procedures, medicine, therapy, evaluations, service dogs, dental care, etc.
    
    • CANNOT assist with medical bills, reimbursements, copays or deductibles.
    • All requests must be for future treatment, to be received AFTER grant has been reviewed for funding.
    • CANNOT assist with therapy/emotional support animals, research funding, or alternative/experimental treatments and therapies.
    • CANNOT assist with any education-related therapies or expenses.
• Equipment
  
  • Grant to provide funding for durable medical equipment to include, but not limited to: wheelchairs, prostheses and orthotics, positioners, standers, lifts, communication devices, hearing aids, mobility bicycles, and feeding supplies.
    
    • CANNOT assist with medical bills, reimbursements, copays or deductibles. All requests must be for future equipment, to be ordered AFTER grant has been reviewed for funding.
    • CANNOT assist with permanent home modification projects—any equipment added to the home MUST be able to be moved if the family were to relocate (i.e., ramp, stair lift, ceiling track system).
• Travel/Lodging
  
  • Grant to provide funding for future lodging, gas, parking and transportation, if related to child’s care.
    
    • CANNOT assist with rent payments.
    • CANNOT reimburse or assist with travel expenses that have already been incurred. Must be for future travel needs.
    • Must be directly related to the child’s care with documentation from the child’s provider. (i.e., travel expenses to weekly cancer treatments, lodging for intensive therapies, travel expenses to visit specialist, lodging for care that must be received more than 50 miles from home, travel expenses to see baby in the NICU).
    • Grants for gas to get to and from appointments are calculated at $0.33/mile up to $600 or $1,000 based on family income.
      
      • Additional expenses for parking and/or tolls should be outlined by social worker or care navigator in their letter.
    • Check will be made payable to parent/guardian; but must be mailed to a social worker or care navigator. Under no circumstances will we mail a check direct to a parent or family. If you do not adequately provide the relevant social worker mailing information, grant will be delayed and/or denied.
• Vehicle Modification
  
  • Grant to provide funding to modify an existing vehicle to make it accessible for child.
    
    • CANNOT assist with the purchase of a vehicle or a vehicle loan payment.

• Letter from Doctor
  
  • Required for all application requests.
  • Must be in a letter format, on letterhead, outlining child’s diagnosis, explanation of medical necessity regarding this specific request for funding and any other relevant information.
    
    • If this letter is for travel, your provider (or social worker) should outline the expected dates and duration of treatment you are requesting travel assistance for.
  • We cannot accept the following documentation in place of a letter: patient portal chart notes, prescriptions, IEP evaluations.
• Income Verification
  
  • Upload first page of your most recent federal income tax return or W-2. If you have not filed taxes, please submit three months of bank statements and/or a letter from your employer.
    
    • If you are a US Citizen, you must submit the first page of your most recent federal income tax return.
    • If uploading bank statements, please ensure the monthly summary page showing total deposits is included.
• Evaluation from Specialist
  
  • Please include an evaluation from your specialist (audiologist, therapy, etc.,) if it pertains to your grant.
  • If this document does not pertain to your request, please upload an additional copy of your physician letter in lieu of an evaluation.
• Quote
  
  • All clinical, equipment and vehicle modification requests MUST have a quote included.
  • Price MUST be reflected on document; do not provide a link to look online.
  • Quote needs to reflect who payment is to be remitted to if funding is approved.
  • All quotes should reflect a discount. No discount may result in your application being delayed and/or declined.
  • If requesting clinical treatment that result in more than one visit (i.e., therapies), the number of sessions must be reflected on the quote.
• Insurance Denial
  
  • There must be no existing insurance coverage for the requested expenses.
  • We cannot assist with copays or deductibles.
  • Must submit a letter of denial from insurance company or policy documentation showing exclusion.
  • If seeking out-of-network care, please read next section.

There must be no existing insurance coverage for the requested expenses. However, we do consider out-of-network care on a case-by-case basis.

• If you are seeking care at an out of network provider, please note the following:
  
  • You may only be eligible for the difference of what your insurance covers in-network and what your OON provider is charging.
  • Some of the things that will be considered when determining grant eligibility for out-of-network care may include: continuity of care, distance to care and wait time for in-network care.
  • Parent/guardian must provide a letter of justification for choosing an out-of-network provider.

• Under no circumstance will a payment be sent direct to family.
• All clinical and equipment grant payments will be made payable to and mailed directly to provider/company noted on the application and quote.
• All travel/lodging grant payments will be made payable to the parent/guardian but MUST be mailed to the social worker or care navigator.
  
  • If you do not adequately provide the relevant social worker mailing information, grant will be delayed and/or denied.
• All checks automatically void after 90 days; however, funds are active in the child’s name for 12 months from date of approval.
• All approved funding must be utilized only for the request outlined in the grant details.
• Any unused funds must be returned to Oracle Health Foundation so that those funds can be utilized by the organization to benefit other families.