Eligibility and Qualifications

To qualify for the Patient Assistance Program, a request must meet all three criteria below.

1. Service area: The patient must be a resident of Onondaga, Oneida, Herkimer, or Madison County in New York State, or be receiving treatment in one of those counties.
2. Completed application: The patient—or guardian if the patient is under 21—must complete and sign the Financial Assistance and Consent Form. The treating oncologist, radiologist, or an LMSW working with the oncology practice or treatment center must also sign the application.
3. Active cancer treatment and financial need: The patient must be diagnosed with cancer, currently receiving chemotherapy, radiation, targeted therapy, or cancer surgery, and experiencing financial challenges related to the illness.

Eligible assistance

Assistance may be available for eligible expenses not covered by insurance, including rent, utilities, groceries, treatment travel, hotel costs, and medically necessary equipment or supplies. Payments are generally made directly to the utility company or vendor.

The Foundation does not pay physician fees or copays and does not fund non-traditional treatment supplements.

Program terms and available funding can change. Contact the Foundation if you have questions about a patient’s eligibility.

Download the current application