Get ready to apply
Hawaii Department of Health, Children with Special Health Needs Branch
Specialty Support Program Care Coordination
What you get
B-ALL is conditionally in scope only when all criteria are met; no oncology clinic is promised. The amount isn't published. Ask. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- PDF form, sent the way they ask
- Your time
- About 30 minutes
- Last checked
- Aug 27, 2026
Before you start, check you fit
- Your child is 20 or under.
- B-ALL is not explicitly named and must satisfy the general chronic-condition and specialist-care rules.
- The program does not pay old medical bills or reimburse parents directly.
-
What their form asksA preview, so you can gather things first. Fill it in on their site.
Open the application PDF ↗ Checked Aug 27, 2026What the form asks for
Published intake questionsISLAND (child/youth resides)DATE SUBMITTEDCHILD/YOUTH INFORMATION — LAST NAME / FIRST NAMEBIRTHDATEGENDERLANGUAGE PREFERENCES / INTERPRETER NEEDEDETHNICITY(IES) OF CHILD/YOUTH (list all)PARENT/GUARDIAN NAME, RELATIONSHIP, PHONE, EMAILRESIDENTIAL ADDRESSHOUSELESSMAILING ADDRESS if different from RESIDENTIALPRIMARY CARE PROVIDER NAME / PHONE / FAXHEALTH INSURANCE INFORMATIONINFORMATION OF PERSON COMPLETING FORMMEDICAL DOCUMENTATION SENT IN, IF AVAILABLEREASON FOR REFERRALSUSPECTED CONDITIONS/DIAGNOSIS(ES)OTHER AGENCIES INVOLVED (if applicable)OTHER AGENCIES REFERRED TO (if applicable)Parent/Guardian has given consent for this referralHOW DID YOU HEAR ABOUT US
After you send
Confirm receipt and respond to any eligibility or verification request. If you have not heard back in two weeks, write and ask whether it arrived.