Financial Assistance Program (FAP)

Eligibility Criteria:

Applicants must meet the following qualifications to be considered for the FAP. 

• Reside in the CFNEGA service area which includes: Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, and Walton counties.
• Must be at least 18 years old. 
• Have a cancer diagnosis as certified by healthcare provider.
• Be receiving active chemotherapy and/or radiation, hormone therapy, or be within a 3 month post-treatment period.
• Have household* income less than or equal to 200% of the 2009 Federal Poverty Limits.

*Household is defined as any persons residing together related by blood, marriage, commitment, or legal adoption that are dependent on the combined income.

• Must be able to provide proof of income for each person in household over 18 years.  Choose one of the following items for  proof of income:
  • Bank statements from the last two months
  • Pay stubs from the last two months
  • Social Security benefit letter
  • Social Security 1099
  • Notarized statement from employer
  • Copy of Social Security check
• If a patient has no income
  • Patient needs to provide a notarized letter stating the reason for no income.
• Have resources** totaling less than   
  • $9,000 (single individual)
  • $12,000 (couple)

    **Resources Include:	**Resources do not include:
    Checking Accounts and/or cash Savings/Money Market Accounts Stocks/Bonds CDs Mutual Funds/Taxable Annuities	Primary residence Two automobiles Retirement Accounts Personal Possessions

  • $15,000 (family)
• Demonstrate attempts to apply for other forms of community financial assistance.
  • List other agencies from which you have requested funding. 
• Financial assistance will be considered for applicants that meet the aforementioned qualifications
• Financial assistance  will be awarded to assist with the following expenses:
  • Past due gas, electric, water, propane and phone
  • Past due rent/mortgage
  • Insurance Premiums (COBRA included)
  • Health insurance co-payments
  • Nutritional  Assistance 
  • Durable medical equipment not covered by insurance, i.e., walkers, wheelchairs, bedside toilets, etc.
  • Pharmacy prescription costs
• Payments will be made directly to company owed. Therefore  applicants must supply copies of the bill, late notice, mortgage statement, statement from landlord and his/her contact information, or any additional information necessary for grant payment.
• There is an annual cap of $500.00 per applicant (Amount may vary based on availability of funds)
• Applicants must wait one year to reapply for financial assistance.
• Applicants must be referred by a physician, physician assistant, nurse, social worker, or patient account representative.
• Only completed applications will be considered.

Referral:

The Financial Assistance Program is based on a referral system. A patient must be referred by a social worker, nurse, physician, physician assistant, or patient account representative.

Click to download Referral Form.

Application:

Referring professionals are asked to mail a completed application to the following address or fax number: The Cancer Foundation of Northeast Georgia
P.O.Box 49309
Athens, GA 30604-9309
Or  Fax to (706) 353-4353

Click to download Application Letter.

Click here to download Application Form.

Application Process:

• Applications are reviewed by The Cancer Foundation’s staff for completeness and whether the patient meets eligibility criteria. 
• If the patient is approved for assistance the referring professional is notified by phone or email regarding the amount of assistance. 
• Financial Assistance checks are made directly to the creditor owed.

What we fund:

Financial assistance  will be awarded to assist with the following expenses:

• Past due gas, electric, water, propane and phone
• Past due rent/mortgage
• Insurance Premiums (COBRA included)
• Health insurance co-payments (does not include deductibles) 
• Nutritional  Assistance 
• Durable medical equipment not covered by insurance, i.e., walkers, wheelchairs, bedside toilets, etc.
• Pharmacy prescription costs