The Catastrophic Illness in Children Relief Fund

The Catastrophic Illness in Children Relief Fund is a financial resource to help New Jersey families facing uncovered medical expenses for their children.   The fund was established in 1988 through legislation (P.L. 1987 C370), and is administered by the Catastrophic Illness in Children Relief Fund Commission.

According to the Commission, “a catastrophic illness is any illness or condition, acute or chronic, for which expenses are incurred that are not fully covered by insurance, state, federal programs, or other sources and exceed the program’s eligibility threshold.”

There are no specific exclusions by diagnosis. The fund will consider a wide variety of health and medical expenses, including those that may not be covered by health insurance.

In order for expenses to be eligible for reimbursement, they must have been incurred in any prior, consecutive, 12 month period (dating back to 1988), and the expenses must exceed 10% of the family’s income, plus 15% of any income over $100,000.  In addition, the child must have been 21 years or younger at the time of the expense.  The child’s parents or legal guardian must have been residents of New Jersey for at least three months prior to submitting an application.

Some families of children with autism face high medical expenses associated with treatment such as speech therapy, occupational therapy and Applied Behavior Analysis (ABA).  Even when some expenses are covered by insurance, out of pocket costs associated with high deductibles and copayments can be significant.   If the costs are in excess of the family’s income as described above, reimbursement to the family or direct payment of unpaid expenses are available up to certain dollar amounts.

For example, there is currently a $6,000 cap on reimbursement for ABA (the actual amount will vary according to percentage of gross income the expense exceeds).    There are also specific requirements regarding who is providing the therapy.  In order for ABA expenses to be eligible, services must be provided directly by a professional with any of the following certifications by the Behavior Analyst Certification Board (BACB):  Board Certified Assistant Behavior Analyst (BCaBA), Board Certified Behavior Analyst (BCBA) and Board Certified Behavior Analyst-Doctoral (BCBA-D).   At this time, services provided by non-certified individuals (even if supervised by a certified individual) are not eligible.

Families can apply for assistance online or by calling the Family Information Line and requesting an application at 800.335.FUND (3863).