FAMILY ASSISTANCE PROGRAM

The Children’s Cardiomyopathy Foundation’s Family Assistance Program helps qualifying families in need of financial assistance with cardiomyopathy-related medical and non-medical expenses not covered by their health insurance plan. For qualifying families, the program will cover reasonable fees up to $2,000.

Expenses Covered

  • Treatment fees, including clinical procedures and tests, medication, physical and occupational therapy, medical equipment, and medically necessary dietary supplements or formulas
  • Displacement fees during a child’s in-hospital evaluation and treatment period including travel, lodging, childcare, food, gas, parking, tolls, and local transportation
  • Health insurance premiums, deductibles, and copays

Qualifications

  • A child is diagnosed with cardiomyopathy and is under the care of a pediatric cardiologist at a medical center in the United States
  • A child who has received a heart transplant as a result of cardiomyopathy and is less than 3 months post-transplant
  • A child who is younger than 18 years of age
  • The child and parents/legal guardians are legal residents of the United States and have social security numbers.
  • The parent or legal guardian files a U.S. federal or U.S. territory income tax return claiming the child as a dependent
  • A family’s total adjusted gross income falls within 300% of the federal poverty level guidelines
  • A family is registered member with the Children’s Cardiomyopathy Foundation
  • An application for the diagnosed child has not been previously submitted in the past 12 months

Before completing an application, please review our Frequently Asked Questions and Application Guidelines. The application is a two-step process consisting of completing an online form and then submitting verifying documents. Required documents include:

  • Completed and signed online application form
  • Supporting letter from a doctor or healthcare professional (nurse, genetic counselor, social worker, or caseworker)
  • Vendor and provider bills/receipts showing applicant’s name, address, account number, date of expense, treatment description, and amount
  • Recent federal (form 1040, 1040-A, 1040EZ) or U.S. territory (in U.S. dollars) tax return listing child as a dependent
  • If applicable, a letter of denial or claim statement from health insurance company showing applicant/child’s name, date of service, service provider, and amount not covered
  • If applicable, a hospital affidavit verifying a family’s current income if the previous year’s federal tax return does not show the family’s financial hardship

If your family and child are eligible for this program, please continue to the application form.

Review Process

Applications are processed as they are received and reviewed monthly by CCF’s program committee. An applicant should hear from CCF within one month of submission. Upon approval of a family’s funding request, checks are made payable to the vendor or provider within two weeks.

The Children’s Cardiomyopathy Foundation (CCF) reserves the right to distribute funds at its sole discretion. The amount awarded may vary according to a family’s situation and depend on the availability of program funds. The Foundation also reserves the right to revise the Family Assistance Program at any time, including its criteria, coverage, application guidelines, and review process.