Patient Aid Application

CARE was established to provide assistance to our Las Cruces and Dona Ana County community.  CARE’s focus is to provide assistance to cancer patients and their families to help them cope with their cancer treatment by assisting them with non-medical expenses/basic living needs expenses while they are in active treatment for any type of cancer. We realize this is a very difficult time and we hope to do everything possible to make this process go smoothly for cancer patients and their families. This financial assistance is for a person who has recently been diagnosed with any type of cancer and is undergoing active treatment. This is defined as: (1) the period after a positive diagnosis of cancer has been made with a diagnostic biopsy and the Pathology Report coincides with diagnosis date being within one year of application date; and (2) during which therapies to to cure, shrink or stop the progression of their cancer are being administered: receiving chemotherapy, radiation, surgery or a transplant. . Eligibility for patients needing a transplant is treatment up to the transplant and the approximate 100 days of outpatient care at the out of state medical treatment center where the transplant was performed.  Active treatment usually may typically consist of one month to up to 12 months. This is typically the active period CARE may assist cancer patients and their families with financial assistance so that financial stressors are reduced and they concentrate on treatment and recovery. Patients are eligible to receive CARE’s financial assistance up to the cap amount and for one application only. Patient will complete Patient Request for Financial Assistance Form for assistance each time they request CARE’s assistance.

Financial assistance is based on eligibility and funds availability.  Please review “Patient Services”  for more information.

Most patients CARE has helped has provided assistance to them for 3 to 6 months, all based on what each patient says will benefit them most.  Some patients choose assistance that will help them more months, which has been up to 12 months.

All financial assistance provided by CARE is disbursed to third parties through our fiscal sponsor, Community Action Agency of Southern New Mexico.  Financial assistance disbursements are made once per week.

Dona Ana County cancer patients who meet the above eligibility and need financial assistance may apply to CARE by completing: 

  1.  Application for Patient Assistance
  2.  Patient Request for Financial Assistance Form 
  3.  Having their physician complete: (1) Application for Patient Financial Assistance – Physician Form and (2) the certification (bottom of form) of the Patient Request for Financial Assistance Form.  Please click and download the three forms that are part of the initial application process in PDF format below:

01-APPLICATION FOR PATIENT ASSISTANCE

02-APPLICATION FOR PATIENT FINANCIAL ASSISTANCE – PHYSICIAN FORM

03-PATIENT REQUEST FOR FINANCIAL ASSISTANCE FORM

Page 1 is an information page; please read it fully and initial boxes that you have read each section.  Pages 2 and 3 are the patient’s information portion of the application to complete.  Page 4 includes a checkoff list; please be sure to check off that you are including each document requested with your application. Application for Patient Financial Assistance – Physician Form must be completed and signed (original signature/no stamps) by the patient’s oncologist, radiologist or surgen.  The completed application with requested documentation must be submitted to CARE in person at an application intake appointment.  We encourage the patient to bring a family member or caregiver with her/him; we encourage the patient to not attend this appointment alone.  Incomplete applications will not be considered.  Once the application is complete and requested documents have been compiled, please contact CARE at 575-652-5407 or 575-649-0598 to set up an appointment for consideration to the program.

Patients who are approved for financial assistance through CARE will continue to complete the Patient Request for Financial Assistance form each time that they are requesting financial assistance to CARE based on the policy provided to the patient and up to the cap amount as long as their physician is providing any of the following treatment:  chemotherapy, radiation, surgery or a transplant. Patient’s physician must complete the bottom portion of this form each time also to certify they are providing aforementioned active treatment at the time of the request.  Please be sure to have your form in hand before contacting CARE to set up your next appointment.  Please download the form above.

Cancer Aid Resource & Education, Inc.
118 S. Water St.
Las Cruces, NM  88001

Should you have any questions, please call 575-652-5407 or 575-649-0598.

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