Emergency Assistance Program

Who is Eligible:

(1) Health-Related Needs

• Applicant must state the child’s specific medical diagnosis, condition and duration of illness.
• Request for assistance must relate to the medical diagnosis or condition and the applicant must explain how the desired support will impact the child’s medical diagnosis or condition.

(2) Age and Residency Qualifications:

• Children age 0-17.
• Child and custodial parent or guardian must be a San Diego County or Imperial County resident with intent to remain permanently or indefinitely in either of those counties.

(3) Financial Qualifications:

• At least one of the following criteria must be met:

1. 1. Child/parent(s)/guardian(s) are currently enrolled in Medi-Cal.
   2. Military families that are enrolled in Tri-Care must also be eligible for Medi-Cal.
   3. Child is currently enrolled in California Children’s Services (CCS).
   4. Child is currently enrolled in Women, Infants & Children (WIC).
   5. If not enrolled in any of the programs set forth above, applicants must attest that their family income is at or below 138% of the Federal Poverty Level as shown HERE.

• Applicants that do not qualify under any of the criteria set forth above are presumed ineligible, but can inquire on a case-by-case basis.
• Applicants must also briefly describe their need for financial assistance by explaining:

1. 1. Family’s financial circumstances, including others living in the home in order to show other potential forms of economic support.
   2. Relevant family dynamics that impact that child’s health and family’s financial support.
   3. Employment and financial status of parent(s) or guardian(s).
   4. Any extenuating circumstances that support the request.

(4) Funder of Last Resort

• Applicant must state other providers, both public and private, that they requested funds from and describe the result of that request. Failure to apply for other assistance (except for burial/cremation expenses) will result in an automatic denial.
• Funding is for only one-time assistance (lifetime) per eligible child.

(5) Funding Amounts:

• Funding is generally limited to reasonable, out-of-pocket expenses for items not otherwise covered by insurance.
• Average amount is $300 per child, generally not to exceed $500.
• Adaptive equipment can be considered up to $800.
• Burial or cremation up to $250 per child. Funeral services are not covered.

(6) Application Process:

• No self-referrals.
• Only one child per application.
• All applications must be generated by a licensed social worker, medical social worker, therapist, school counselor, medical professional, or similarly qualified professional who can help ascertain the health-related need and financial qualifications.

 (7) Types of Items Funded:

• Emergency Family Services: Gift cards to major retailers such as Walmart.com or Amazon.com to purchase specific items for eligible child. This also includes prepaid gas cards or ride share at the discretion of the funder to help defray the cost of gas to/from medical appointments for the child.
• Emergency Basic Needs: Specific items that will help make a positive impact on the health of the child, such as diapers, formula, supportive non-medical equipment, specialized car seats, portable bassinets.
• Special Diet: Special food or supplements as prescribed by a medical professional.
• Adaptive Equipment: Specialized equipment that helps with the special day-to-day medical needs of a child with disabilities.
• Dental: Dental treatments not otherwise covered by insurance. We do not cover orthodontic treatment.
• Cremation/Burial: Up to $250 toward the cost of cremation or burial for an infant or fetal death (20+ weeks gestation).
• Glasses: Pre-approved directly through San Diego Unified School District's Vision Clinic. Parents should contact child's school health office directly.

(8) Additional information

• Home or delivery address will be confirmed by CHF as accurate and legitimate; referring partner will confirm address is safe for delivery of items, as necessary.
• CHF makes direct purchases of eligible items. No reimbursements are permitted.
• Utilities, rent, and cash distributions are not eligible or permitted.
• All donations are limited for the benefit of the child and cannot be granted for the general support of the family.

How to Request Funds:

Any referring partner working with a child who meets the eligibility criteria may refer a child for funding assistance by completing and submitting the online Emergency Assistance Program Application. Types of referring partners include social workers, health care providers, school nurses, counselors, case managers, therapists, dentists, and doctors. If you are a parent and your child has a health related need who meets the eligibility requirements, please contact the service provider working with your child to ask them to consider making a referral to Children's Health Foundation.

Because our mission is to assist children ages 0-17, all referrals must be made on behalf of a specific child, not the family. If more than one child in the family needs assistance for, the referring partner should complete one referral form for each child. Make sure to upload supporting documentation (i.e. treatment plan, medical support letter, funding source denial letter, etc.) that will assist in our determination of whether the child is qualified for assistance.

If applicable, upload vendor quote, description of item and item number showing cost (including tax and shipping if applicable) and any other pertinent information helpful in determining eligibility.

**All requests should be for funding future services or supplies. We do not reimburse for past expenditures.**

What to Expect:

Once we receive the application, we will contact the referring partner by email or phone to gather more information or to notify them of the approval or denial of the request. If we approve the application, payment will be made directly to the vendor, agency, therapist, etc. We will then email a conformation letter to the referring partner and the child's family to confirm payment or purchase.