2024 Transportation Assistance Program

This program is based on the amount of funding available and is limited to the Foundation’s thirty-seven county service area. The program provides financial aid to people who need help paying for safe, reliable, and affordable transportation to and from dialysis or transplant appointments. Approved applicants must have at least one standing appointment per month related to kidney disease. If approved, a $200 reimbursement check is mailed out in March and a second $200 check is mailed out in August. The Kidney Foundation of Ohio does not provide or have the means to provide transportation to appointments. If approved, a renewal form must be submitted by July 1st to receive the August check.


  • Application must be completed by a healthcare professional.
  • Transportation assistance cannot be awarded in conjunction with medication assistance.
  • The Kidney Foundation of Ohio’s ability to assist patients is based on the availability of funds. An application for assistance is not a guarantee of acceptance or “entitlement” to services.
  • U.S. Federal Poverty Guidelines will be used to determine the patient’s level of eligibility. Intentionally misleading information on the application is cause for denial of assistance.
  • There is a minimum two-week review process for all applications.
  • Programs may be changed or discontinued at any time without notice.
For questions, contact (216) 771-2700 or programs@kfohio.org.

Patient Information

Gender *
Ethnicity (for reporting purposes only) *
Diagnosis (check all that apply) *
Mode of Treatment (check all that apply) *
To receive a FREE ID Band for patient, select their access location

Healthcare Professional Information

What is your discipline? *

Financial Information

Is patient presently employed? *
Household Members *
List all dependents, and ages, living in household (adults, children, grandchildren, etc.)
Monthly Household Income *
 ApplicantSpouse/PartnerChild #1Child #2OtherTotal
Child Support
TANF (include Ohio Works First Program)
Food Assistance Program
Child Tax Rebate/Tax Credit
Unemployment Compensation
Other Assistance
Monthly Expenses *
 Monthly Payment Amount
Medication (out of pocket cost only)
Utilities (combined monthly average)
Transportation (bus fare, gas, taxi, Uber/Lyft)
Car Payment
Telephone (include cell phone)
Tuition/Education (include Student Loans)
Other Loan Payments
Credit Card Payments (total per month)
Doctor/Hospital (copays, deductibles, out of pocket)
Medicare (Premiums, Part B, Supplemental)
Other Medical Expenses
Other Expenses

Coverage Information

Is patient on Medicaid? *
Is patient on a Medicaid Waiver? *
Is patient covered by Medicare? *
Does patient's insurance cover transportation? *
Is patient enrolled in LIS (Limited Income Subsidy)? *
Does patient have private or secondary insurance? *
Is patient uninsured? *
Is patient a Veteran? *



Provide as many details as possible.  Funding is allocated to individuals who demonstrate the most need.  Include the circumstances behind the applicant’s request.  See examples below:

Acceptable:  Client is unable to work due to dialysis treatments.  They are requesting assistance because their copays for medication is a burden to them.  The client has been unable to purchase necessary medications for 3 months. DO NOT USE THIS EXAMPLE.

Unacceptable:  Client is applying for assistance due to financial hardship

Required Additional Data

Information provided to be utilized solely for program evaluation purposes.
Primary source of transportation for dialysis/transplant appointments (check all that apply) *
Did patient receive funding from the Kidney Foundation of Ohio's Transportation Assistance Program in 2023? *
At this time, you can Save Progress and finish completing the application at another time or select Next to sign and submit the application.

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