Children's Special Health Services
Application Process for Genetic Testing Financial Assistance
Children’s Special Health Services (CSHS) is accepting applications for financial assistance to Montana residents who have out of pocket expenses related to clinical genetic laboratory testing. Assistance is available for patients who have no health care coverage or whose health coverage does not include genetic laboratory testing.
To request financial assistance, please provide the following:
- Completed, signed, and dated application.
- If the applicant is covered by Healthy Montana Kids Plus or Medicaid please complete page 1 of the application.
- If the applicant is covered by any other assistance program or insurance please complete both pages of the application and supply a copy of your insurance card.
- CSHS will receive the testing request from a genetic counselor/physician. (A completed application must be received and processed before any testing procedure may begin.)
All information will be kept strictly confidential.
When eligibility has been determined, the requesting genetic counselor/physician will be notified.
An application will not be processed if:
- The application is voluntarily withdrawn.
- The applicant cannot be contacted.
- The application is not completed.
- There is no funding left in the program year; or
- There is not enough information to support the request.
Eligibility begins on the date CSHS receives the completed application, including all documents requested. Eligibility will be determined within thirty (30) days after receipt of a completed application and supporting documents.
To complete an application for financial assistance:
- Download the PDF form by clicking here: Download PDF Form Now
- Complete the printed form. There is no option to save entered information. When the form is closed the entered information will be lost.
- Fill in any additional information by hand, if necessary.
- Mail the completed and signed form to CSHS at:
Children's Special Health Services
PO Box 20295
Helena MT 59620-2951
Note: Faxed applications will be accepted, however assistance cannot be provided without an original completed application.
When filling out the form on your computer, you can use the following tools:
- Click on a field with your mouse to select the field. A cursor will appear and you can type in your information.
- The tab key will move you forward from field to field. Shift + Tab key will move you backwards from field to field.
- An entry can be deleted by highlighting the information and pressing delete, backspace, or just type over the highlighted information.
- Check boxes can be checked by clicking on the box with your mouse or by selecting the box and pressing the Enter key or space bar. (Hitting the Enter key or space bar again will remove the checkmark.)
- Standard Windows-based commands will work in the PDF file. Control + C will copy, Control + V will paste and Control + X will cut.
The following tools only work when the cursor is not in a field:
- Arrow keys right and left move page to page through the document. Arrow keys up and down scroll thought the document.
- The Enter key will move you through the document a half-page at a time.
Places you can locate an application:
- Print out the form: Download PDF Form Now
- Call CSHS at: contact CSHS
- Call the Shodair Medical Genetics staff at 406-444-7500.
- Contact one of the Regional Clinic sites at: clinic contacts