New Jersey atastrophic Illness in Children Relief Fund can help pay the medical bills from your child's illness
New Jersey runs a program that pays families back for the medical bills that come with a child's serious illness, injury, or disability. It is called the Catastrophic Illness in Children Relief Fund. If your child's care has left you with costs that insurance did not cover, the Fund may pay you back for what you have already spent, or pay the remaining balance directly to the hospital, doctor, or supplier.
This page explains who the Fund helps, what kinds of bills it covers, how much you need to have spent before you qualify, and how to apply. It is written for New Jersey parents and guardians, and in some cases for young adults applying for their own past bills. Read the eligibility part closely, because this program works differently from most: it pays you back for costs you have already had, rather than helping with a bill before your child receives care.
- NOTE: There is no income limit, and it covers any medical condition. The state sums it up in five words: any child, any condition, any income.
What kinds of bills the Fund covers
The Fund does not limit help to any one disease or diagnosis. The word "catastrophic" in its name refers to how large the bills are compared to your income, not to how severe the illness is. A child with a chronic condition, a sudden injury, a mental health or substance use problem, or a disability can all qualify, as long as the costs are high enough relative to your household income.
The expenses it will consider include, but are not limited too: hospital stays and outpatient care, doctor visits in any setting, prescription drugs, medical equipment and supplies, and home health care. It also covers things many programs leave out: mental health and addiction treatment, physical, occupational, and speech therapy, medically necessary changes to your home, a modified vehicle, and medical transportation. The bills have to be for care that insurance, Medicaid, or another program did not fully pay.
Who can apply
Three things decide whether your family can apply.
- First, you have to live in New Jersey and have lived here for at least three months before you apply. The child also has to be a U.S. citizen, a green card holder, or have another legal immigration status that lets the family live in the state.
- Second, the bills have to have been run up before the child turned 22. If your child is older than that now, you can still apply for bills from before their 22nd birthday, as long as those bills fall within the last seven years.
- Third, the bills have to be large enough compared to your income.
How much you need in bills before you qualify
This is the part that decides most cases. Your child's uncovered medical costs, added up over any 12-month period, have to come to more than 10 percent of your household income up to $100,000, plus 15 percent of any income above that.
In plain terms: if your household made about $50,000, you would need roughly $5,000 in uncovered bills to qualify. At $100,000 of income, the bar is about $10,000. At $150,000, it is about $17,500. Income above $100,000 raises the bar more steeply, but families at every income level have been helped, including working parents with insurance whose out-of-pocket costs still climbed past the line.
It pays you back, so the care has to have already happened
This is what often surprises people most. The Fund is a reimbursement program. It cannot approve money for care your child has not received yet, and you cannot open an application to get ahead of a surgery or treatment that is coming up. You apply after the care has happened and after your insurance has finished processing the claims.
When you apply, you will need the itemized bills and the Explanation of Benefits forms your insurance company sent you. If pulling that together feels like a lot, county offices can help, which is covered below.
You do not need to have paid the bills in full
You do not have to have the money to clear these bills before the Fund will help. If you have already paid out of pocket, the Fund can pay you back. If you still owe a balance, the Fund can pay the hospital, doctor, or supplier directly. Either way, the point is to take the uncovered cost off your family. There are limits on the size of an award: changes to your home are capped at $25,000 per application, and the most any single application can be approved for is $100,000. For additional ways to get out of medical debt, including settling past due bills (which can be combined with the Catastrophic Illness in Children Relief Fund, see our guide to how a medical bill in collections is often settleable.
A few common situations are worth knowing. You can file separate applications for more than one 12-month period if the bills stretch across years, but you cannot combine two children on one application; each child is applied for on their own. Divorced parents can each apply for the share of the costs they are responsible for under their divorce agreement. A young adult who now supports themselves can apply for their own past medical bills. And if you raised money through a fundraiser or a site like GoFundMe, that does not shut you out, but the money you raised has to have been spent on the bills first, and you have to tell the Fund about it.
What the Fund will not cover
The Fund pays for medical costs only. It will not help with rent or a mortgage, utility bills, lost wages, or the cost of taking time off work to care for your child, even though those are real pressures when a child is sick. It also will not reimburse your health insurance premiums, though a portion of what you pay in premiums can sometimes be counted toward reaching the bill threshold. If you need help with everyday bills on top of the medical costs, the broader list of New Jersey assistance programs covers rent, food, and utility help by county.
How to apply
You apply online through the Fund's official site, run by the New Jersey Department of Human Services. The same site has a calculator that gives you a quick read on whether your bills and income might qualify before you fill out the full application. You can reach the Fund's family information line at 1-800-335-FUND (3863) with questions. Start at the official New Jersey Catastrophic Illness in Children Relief Fund site: https://www.nj.gov/humanservices/cicrf/..
And you do not have to do the paperwork alone: the Fund works with county Special Child Health Services offices that help families complete the application, and you can ask for that help when you call.
The program rules, dollar limits, and application details on this page come from the New Jersey Department of Human Services (website: https://www.nj.gov/humanservices/) and can change over time. Confirm the current eligibility details with the Fund directly, at the phone number and official website listed above, before you apply. This is not medical advice but it is a review of potential benefits that may help pay medical costs.
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