Get ready to apply
Hawaii Department of Health, Children with Special Health Needs Branch
Specialty Support Program Limited Medical Financial Assistance
What you get
Help paying for specialty care. 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
- Insurance and other assistance must be used first.
- Well-child care, immunizations, infant formula, mental-health services, developmental therapies, and respite are not covered.
- Funding is limited and payment requires preauthorization.
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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.