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Easing the Financial Burden Caused by Lupus 

Individual & Family Assistance Application

At Marlene’s Kaleidoscope, we are committed to easing the financial challenges faced by individuals and families living with lupus-diagnosed or lupus-related autoimmune diseases. We understand the financial strain that comes with managing a chronic illness and strive to provide reduced payment options or free care to those who meet the eligibility requirements for financial assistance.

Eligibility Requirements 

You may qualify for financial assistance if you:​

  • Have limited or no health insurance coverage.

  • Do not qualify for government assistance programs (e.g., Medicare or Medicaid).

  • Can demonstrate financial need.

  • Reside in the Greater Kansas City Metropolitan area, including Missouri and Kansas.

  • Provide all necessary household financial information​

Application Process

Have limited or no health insurance coverage.

  • Complete the application below. 

  • Upload required documentation including:

    • Proof of income (e.g., pay stubs, tax returns).

    • Copies of relevant bills.

    • A written explanation of your need for financial assistance.

    • Medical documentation of diagnosis 

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Individual & Family Assistance Application

Please complete the application below in its entirety. A member from our team will be in touch once submitted. Beyond financial assistance, Marlene's Kaleidoscope connects individuals to other programs and services through our collaborative partnerships and referral network. By submitting your application, you will join our secure, coordinated network of community resources powered by Unite Us.

Do you or someone in your household have Lupus?
Yes
No
What is the Lupus diagnosis or Lupus-related disease? Select all that apply.
What areas of assistance are you applying for? Check all that apply.
If emergency assistance is required, please check the option that best describes your situation:
Gender
Ethnicity
Employment Status
Annual Income:
Do you own or rent?
Household Type?
Is anyone in your household disabled?
Do you have insurance?

Account Information

Please provide the account information you need help with. You may include up to two accounts.



Individual & Family Assistance Disclaimer:

Please note that submitting a request for financial assistance to Marlene's Kaleidoscope does not guarantee approval of your application. Our team will review each form upon receipt, and only a limited number of requests will be approved based on available funds. We will only contact you if your request is approved or if we require additional information.

If you have yet to receive a response from us within ten days, please don’t hesitate to email us at info@mk4lupus and add Individual & Family Financial Assistance Request in the subject line. By submitting this form, you certify that all the information provided is accurate to the best of your knowledge.

If you need to mail in your application, please send the completed form to our Financial Assistance PO BOX 14425, Kansas City, MO 64152, or email it to llipprand@mk4lupus.org.

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