CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND
In 2010 funding for the The Catastrophic Illness in Children Fund (CICRF) was decreased. To assure the long-term viability of the Fund, the program subsequently issued some policy changes. These changes are indicated in red below. (See article)
At the request of the Social Service Department’s Women & Children’s team Community Resource Center staff facilitated a presentation at their May team meeting by Laurie Paskewich, Program Coordinator of the Massachusetts Catastrophic Illness in Children Fund.
The Catastrophic Illness in Children Fund (CICRF) is a trust fund housed in the state Department of Public Health, but overseen by a Board of Commissioners.
Program Description and Benefits
The CICRF was established in 2000 as a reimbursement program for illness-related costs not covered by insurance or other assistance. Typical requests include payment for non-direct medical services such as for home modifications, special vehicle purchases, transportation. The program does not have a maximum reimbursement per family, but there are sliding scale reimbursements and limits on large projects/purchases like home modifications, vehicle purchases, and vehicle modifications.
Eligibility
- Ill child age 21 and under
- Massachusetts resident (but no citizenship requirement)
- Medically related expenses must exceed 10% of annual family income up to $100,000 plus 15% of annual family income in excess of $100,000. (For example, a family with an income of $120,000 would have to have $13,000 in medically-related expenses to be eligible: 10% of the first $100,000 is $10,000, plus 15% of $20,000 is $3,000)
Verifications & Definitions
Income – there is no maximum income, but expenses must exceed the applicable percentage. They count gross income from all sources including unearned income such as public benefits including food stamps.
Illness & Medical necessity – Letter from physician on letterhead with a brief medical history and, if applicable, explaining medical necessity of expense.
Frequency of visits – Letter from social worker on letterhead that estimates how often the family visited during inpatient stay, or frequency of outpatient appointments.
Expenses – The process for determining if an applicant has reached the required percentage of income: they review past 24 months worth of expenses. Then they determine if there is one or two years worth of eligibility during that time period. Receipts are required (not required for per diem payment- see below). The program cannot cover costs for fees related to going “out of network”, unless there is a compelling medical reason. These fees also do not count as qualifying expenses for eligibility.
Payer of Last Resort – Health insurance and other options must have been exhausted. Massachusetts has two programs the Assistive Technology Loan Program and the Home Modification Loan Program that they encourage families to explore.
Reimbursement – There is an exception to the “reimbursement only” rule– if the family is still making payments (e.g., a car loan, payment plan for uncovered medical expenses). The program can also pay medical bills directly to the provider.Special Programs/Rules
“Family Support” program- When families qualify based on the above criteria, this program can offer an inpatient per diem stipend to reimburse for costs related to a child’s hospitalization. It can help offset costs for mileage, meals, parking, tolls, etc. Those families who need to take children to frequent outpatient appointments, may qualify for an outpatient per diem when these appointments entail being away from home/work for 4 or more hours per appointment. Receipts are not necessary for these per diem payments. (As of 3/10 this per diem benefit is capped at 150 days per 12-month eligibility period.)
Central air conditioning is no longer reimbursable (as of 3/10), but the program will continue to reimburse eligible families for room-sized air conditioner units if medically indicated.
Childcare for Well Sibling(s)- This is a reimbursable expense when the “applicant child” is receiving medical care. This is reimbursable up to $20 per child, per day. (Suspended 3/10) However- these expenses may be submitted as medically-related expenses for CIRCF program-eligibility.
Lodging- Lodging expenses are reimbursable if the child is receiving care over 50 miles (one-way) from their home.
Funeral/burial services- For those up to a maximum of 300% of FPL they may reimburse for up to $6,500.
Home and Vehicle Modifications may be covered expenses. Significant changes instituted in 3/10: no longer able to offer prospective approvals. Also see Vehicle Purchases or Modifications & Home Modifications.
FAQs
How many staff members?
Three staff- not all of whom are full-time.
How long does it take to process an application?Currently they expect it take about 2 months to review an application. Advocacy tip: since they expect a 2 month delay, they advise that it is safe to submit an application about two months in advance of when the family expects they will have spent enough of their income to qualify.
Can a family apply more than once?There is no limit to the number of times a family can apply for assistance for the per diem/family support program. There is a limit of four projects such as home modifications or vehicle purchase/modifications per family.
Are there similar programs in other states?More information: www.mass.gov/cicrfThere is a similar program in New Jersey. Connecticut is attempting to establish a program, but otherwise no other states have anything similar.
05/08, rev 5/10