Grants for Dialysis Patients & Kidney Disease Financial Assistance
Dialysis patients with End-Stage Renal Disease (ESRD) can access Medicare coverage for treatment costs, plus financial assistance from nonprofit kidney organizations for medications, transportation, medical equipment, and emergency expenses. While Medicare covers 80% of dialysis treatment after a 3-month waiting period, supplemental financial assistance helps with copays, premiums, and living expenses. Below are 77 verified funding opportunities related to healthcare and patient support.
Types of Financial Assistance for Dialysis Patients
Medicare ESRD Coverage
Medicare Part B (Medical Insurance) covers 80% of dialysis treatment costs after 3-month waiting period. Coverage includes in-center hemodialysis, home dialysis, peritoneal dialysis, dialysis equipment and supplies, physician services during dialysis, self-dialysis training, and kidney transplant surgery (Medicare Part A). Premium-free Part A if worked 40 quarters or qualify through disability/spouse. Part B premium $185.00/month (2026 standard, income-based adjustments apply). Dialysis patients can enroll in Medicare regardless of age (under 65) after ESRD diagnosis. 3-month waiting period begins first month of regular dialysis treatment (waived if home dialysis training started before ESRD month or receive kidney transplant before 3 months).
Premium & Medication Assistance
American Kidney Fund (AKF) Health Insurance Premium Program covers Medicare premiums, prescription costs, and insurance copays for eligible dialysis patients. National Kidney Foundation (NKF) Patient Emergency Fund provides up to $300 grants for rent, utilities, groceries, or other emergencies. HealthWell Foundation Chronic Kidney Disease Fund assists with medication copays and insurance premiums (income limits apply). Pharmaceutical patient assistance programs (PAPs) provide free or low-cost medications for dialysis patients (income typically under 300-500% FPL ~$45K-$75K individual). Extra Help/LIS (Low-Income Subsidy) for Medicare Part D prescription drug coverage (income under $23,276 individual, $31,523 couple in 2026).
Transportation Assistance
Medicaid Non-Emergency Medical Transportation (NEMT) provides free rides to dialysis appointments for Medicaid beneficiaries (available in all states, varies by state program - typically 15 one-way trips/month minimum). Medicare Advantage plans may cover dialysis transportation (12-24 trips annually, check plan benefits). American Kidney Fund Transportation Grants assist with mileage reimbursement, public transit, or ride services for dialysis appointments. National Renal Administrators Association (NRAA) Renal Support Network provides transportation vouchers, gas cards, or bus passes. Call 211 or contact dialysis social worker for local transportation programs (many community organizations provide volunteer driver networks, medical ride services for low-income, disabled, or senior dialysis patients).
Emergency & Living Expense Support
National Kidney Foundation (NKF) Patient Emergency Fund provides up to $300 one-time grants for rent, utilities, groceries, or emergency expenses for dialysis patients in crisis. Modest Needs provides small grants (typically under $1,000) for emergency expenses preventing financial crisis (job loss, medical bills, housing emergencies). HealthWell Foundation offers emergency financial assistance for dialysis-related expenses and medication copays (income and diagnosis-specific eligibility). Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) provide monthly income for dialysis patients unable to work (SSDI based on work credits, SSI income/asset tested ~$1,000 individual monthly, expedited ESRD review within 1-3 months vs standard 3-6 months). State Emergency Assistance Programs (varies by state) may provide one-time grants for rent, utilities, or essential expenses for dialysis patients in crisis (contact state Department of Social Services or 211).
Eligibility Requirements
Medical Eligibility
- ESRD Diagnosis: End-Stage Renal Disease diagnosis requiring regular dialysis (3+ times weekly hemodialysis or continuous peritoneal dialysis) or kidney transplant. Medicare ESRD coverage begins after 3-month waiting period from first dialysis treatment or immediately upon kidney transplant before 3 months elapse. Physician documentation required (nephrologist or treating physician must certify ESRD diagnosis and treatment plan).
- Dialysis Treatment Plan: Active dialysis treatment plan (in-center hemodialysis, home hemodialysis, or peritoneal dialysis). Compliance with prescribed treatment schedule typically required for financial assistance programs (3x weekly minimum for hemodialysis, continuous for peritoneal dialysis). Home dialysis patients may receive higher assistance amounts or expedited aid due to self-care commitment.
- Kidney Transplant Candidates: Patients on transplant waiting list may qualify for additional assistance programs. Pre-transplant financial planning services available through kidney organizations. Post-transplant patients eligible for immunosuppressant drug coverage through Medicare Part B (80% coverage after deductible) or group health plan (if employer has 100+ employees, group plan pays first for 30 months).
Income & Financial Requirements
- AKF Premium Assistance: Income typically under 400% FPL (~$60,240 individual, $124,800 family of 4 in 2026). Asset limits may apply (typically $10,000-$25,000 liquid assets excluding home, car, and retirement accounts). Verification required (tax returns, pay stubs, Social Security benefits statements).
- NKF Emergency Fund: Financial hardship demonstration required (bank statements showing inability to cover rent, utilities, or groceries). One-time assistance within 12-month period (typically lifetime limit varies by state chapter). Emergency nature of need required (eviction notice, utility shutoff, food insecurity).
- HealthWell Foundation: Income under 500% FPL (~$75,300 individual, $156,000 family of 4) for most funds. No asset limits. Active insurance policy required (cannot assist uninsured patients, commercial insurance or Medicare preferred). Annual funding caps apply (first-come, first-served when funds available, check fund status before applying).
- Medicaid Eligibility: Income limits vary by state (typically 138% FPL ~$20,783 individual in expansion states, or categorical eligibility like SSI recipients ~74% FPL ~$11,138 in non-expansion states). Dialysis patients may qualify for Medicaid based on disability status regardless of age. Asset limits apply ($2,000 individual, $3,000 couple in most states).
Insurance & Documentation
- Medicare Enrollment: Must enroll in Medicare Part B (Medical Insurance) to receive dialysis coverage. Enrollment typically begins first day of third month of dialysis treatment or month of kidney transplant. If currently have group health insurance (employer-based), group plan pays first for 30 months coordination period, then Medicare becomes primary payer. Enroll during ESRD Medicare Initial Enrollment Period (4 months starting with first month of dialysis or transplant).
- Medical Documentation: ESRD diagnosis documentation (CMS-2728 form - Medical Evidence Report Medicare Entitlement and/or Patient Registration completed by physician). Dialysis treatment records (facility treatment schedule, home dialysis logs if applicable). Physician letter confirming ESRD diagnosis, treatment plan, and prognosis if requested by assistance programs.
- Financial Documentation: Proof of income (tax returns, W-2s, 1099s, pay stubs, Social Security benefits statement SSA-1099). Bank statements (typically 2-3 months for asset verification). Insurance cards (Medicare card, Medicaid card, supplemental insurance if applicable). Bills or invoices requiring assistance (premiums, medications, medical expenses, rent, utilities).
- Residency & Identification: U.S. residency (U.S. citizen or legal permanent resident for Medicare, citizenship not required for emergency medical assistance through Medicaid). Government-issued ID (driver's license, state ID, passport). Proof of address (utility bill, lease, mortgage statement). Social Security Number (required for Medicare enrollment and most assistance programs).
Frequently Asked Questions
How do I apply for Medicare ESRD coverage?
Contact Social Security Administration (1-800-772-1213 or SSA.gov) to apply for Medicare based on ESRD. Dialysis facility social worker typically assists with Medicare enrollment (required to help patients apply within 60 days of starting dialysis). Bring ESRD diagnosis documentation (CMS-2728 form completed by physician), Social Security Number, proof of U.S. citizenship or legal residency, and proof of work history if applicable (for premium-free Part A). Coverage begins first day of third month after month of dialysis treatment start, or month of kidney transplant if before 3 months. If currently insured through employer group health plan, Medicare becomes primary payer after 30-month coordination period (group plan pays first for 30 months). Apply during Initial Enrollment Period (4 months beginning with first month of dialysis or transplant) to avoid delays or gaps in coverage.
What costs does Medicare cover for dialysis?
Medicare Part B covers 80% of approved costs for dialysis treatment after annual deductible ($257 in 2026). Covered services include in-center hemodialysis treatments (3+ weekly sessions), home hemodialysis or peritoneal dialysis (equipment, supplies, support services), self-dialysis training (teaches patient/helper to perform home dialysis - covered 100% first 15 training sessions), dialysis medications administered during treatment (erythropoiesis-stimulating agents/ESAs like epoetin alfa for anemia, IV iron, vitamin D analogs, phosphate binders), physician services during dialysis (evaluation and management visits, monthly labs, dialysis access monitoring). Patient pays 20% coinsurance after deductible. Medicare Advantage (Part C) plans must cover all Part B dialysis services, often with lower out-of-pocket costs. Dialysis facility cannot charge more than Medicare-approved amounts (balance billing prohibited). Home dialysis patients receive Medicare reimbursement for supplies and equipment (monthly composite rate covers dialysis machine, solutions, catheters, tubing). Dialysis-related hospital admissions covered under Medicare Part A (after $1,676 deductible per benefit period in 2026).
Can I get help paying Medicare premiums and copays?
Yes, several programs assist dialysis patients with premiums and copays: American Kidney Fund (AKF) Health Insurance Premium Program covers Medicare Part B premiums ($185/month standard 2026), Medicare Advantage premiums, Medigap (supplemental insurance) premiums, and prescription drug plan (Part D) premiums. Income typically under 400% FPL (~$60K individual). Apply online at KidneyFund.org or call 1-800-795-3226. Medicare Savings Programs (MSPs) - state Medicaid programs that pay Medicare premiums and copays for low-income beneficiaries: QMB (Qualified Medicare Beneficiary) income under 100% FPL (~$15,060 individual 2026) pays Part A and B premiums, deductibles, and coinsurance; SLMB (Specified Low-Income Medicare Beneficiary) income 100-120% FPL (~$18,072 individual) pays Part B premium only; QI (Qualifying Individual) income 120-135% FPL (~$20,331 individual) pays Part B premium (first-come, first-served limited funds). Extra Help/LIS (Low-Income Subsidy) assists with Medicare Part D prescription drug costs - income under $23,276 individual ($31,523 couple) - covers Part D premiums, deductibles, and copays (automatic if receiving SSI or Medicaid). HealthWell Foundation Chronic Kidney Disease Fund helps with medication copays and insurance premiums (income under 500% FPL ~$75K individual). Apply online at HealthWellFoundation.org.
How do I get transportation assistance for dialysis appointments?
Multiple transportation options available for dialysis patients: Medicaid Non-Emergency Medical Transportation (NEMT) - free rides to dialysis appointments for Medicaid beneficiaries (call state Medicaid office or Medicaid transportation broker listed on Medicaid card, schedule 2-3 business days in advance typically, service varies by state but minimum 15 one-way trips/month). Medicare Advantage Transportation Benefits - many plans cover 12-24 trips annually to dialysis appointments (check plan benefits or call plan member services). American Kidney Fund Transportation Grants - mileage reimbursement, gas cards, or public transit passes for dialysis patients (apply online at KidneyFund.org, income typically under 400% FPL ~$60K individual). Dialysis Facility Social Worker - contact your dialysis center's social worker (required by Medicare regulations, must help arrange transportation) for local resources and volunteer driver programs. National Renal Administrators Association (NRAA) Renal Support Network - transportation vouchers, ride services, or gas cards for low-income dialysis patients (RSNhope.org or 1-866-903-1728). 211 Helpline - dial 211 or visit 211.org to find local transportation programs (community organizations often provide volunteer driver networks, medical transportation services for low-income, disabled, or senior dialysis patients).
Can I receive emergency financial assistance for rent, utilities, or food?
Yes, several programs provide emergency financial assistance for dialysis patients: National Kidney Foundation (NKF) Patient Emergency Fund - up to $300 one-time grants for rent, utilities, groceries, or other essential expenses (apply online at Kidney.org or call local NKF chapter, financial hardship demonstration required like eviction notice or utility shutoff). Modest Needs Self-Sufficiency Grants - small grants typically under $1,000 for emergency expenses preventing financial crisis (ModestNeeds.org, low-income workers facing temporary hardship, grants for rent, utilities, car repairs, medical bills). HealthWell Foundation Emergency Assistance - medication copays and dialysis-related expenses (HealthWellFoundation.org, income under 500% FPL ~$75K individual, active insurance required). State Emergency Assistance Programs - one-time grants for rent, utilities, essential expenses through state Department of Social Services (contact 211 or state welfare office, eligibility varies by state, often requires financial crisis demonstration). Catholic Charities USA - emergency financial assistance for rent, utilities, food, medical expenses (find local Catholic Charities at CatholicCharitiesUSA.org, services available to all faiths regardless of religion). Supplemental Nutrition Assistance Program (SNAP) - monthly food assistance for low-income individuals (income typically under 130% FPL ~$19,578 individual, expedited processing for emergencies within 7 days, dialysis patients may qualify based on disability status). Low-Income Home Energy Assistance Program (LIHEAP) - utility bill payment assistance and crisis intervention for heating/cooling emergencies (FederalBenefits.gov/liheap or 211, income typically under 150% FPL ~$22,590 individual).
What if I'm waiting for Medicare to start and can't afford dialysis now?
During the 3-month Medicare waiting period, several options help cover dialysis costs: Current Health Insurance - if you have group health insurance through employer, it will cover dialysis during waiting period (group plan is primary payer for first 30 months even after Medicare starts). Private insurance through Affordable Care Act (ACA) marketplace (HealthCare.gov) - ESRD qualifies for Special Enrollment Period (enroll outside open enrollment after diagnosis, coverage begins quickly). Medicaid - emergency Medicaid covers dialysis immediately regardless of immigration status (no waiting period, apply through state Medicaid office, income/asset limits apply but ESRD may qualify based on disability). Medicaid expansion states (38 states + DC) cover dialysis for adults under 138% FPL (~$20,783 individual) immediately upon approval. Dialysis Facility Charity Care or Financial Assistance - all dialysis facilities provide charity care or sliding scale fees for uninsured/underinsured patients (federal requirement under Emergency Medical Treatment and Labor Act/EMTALA that dialysis is emergency care and cannot be denied). Contact facility billing or social worker to complete financial assistance application (typically income under 200-300% FPL qualifies for 100% charity care). Kidney Organization Emergency Funds - American Kidney Fund (AKF) and National Kidney Foundation (NKF) may provide emergency grants during Medicare waiting period (call AKF 1-800-795-3226 or NKF 1-855-653-2273 for immediate assistance). Expedite Medicare Enrollment - contact Social Security Administration (1-800-772-1213) to ensure Medicare enrollment processed immediately when waiting period ends (dialysis social worker typically handles this but confirm enrollment 1-2 months before waiting period ends to avoid delays or coverage gaps).
How to Access Financial Assistance
Enroll in Medicare & Connect with Dialysis Social Worker
Contact Social Security Administration (1-800-772-1213 or SSA.gov) to apply for Medicare ESRD coverage. Bring ESRD diagnosis documentation, Social Security Number, and proof of citizenship/residency. Coverage begins first day of third month after dialysis start. Connect with your dialysis facility social worker immediately (required by Medicare, must be on staff at every facility). Social worker assists with Medicare enrollment, Medicaid application if eligible, identifying financial assistance programs, arranging transportation, and completing insurance paperwork. Request assistance within first 2 weeks of starting dialysis to ensure coverage begins on time and you don't miss application deadlines.
Apply for Kidney Organization Financial Assistance Programs
American Kidney Fund (AKF) Health Insurance Premium Program (KidneyFund.org or 1-800-795-3226) - assists with Medicare premiums, insurance copays, prescription costs (income typically under 400% FPL ~$60K individual, apply online with tax returns and insurance bills). National Kidney Foundation (NKF) Patient Emergency Fund (Kidney.org or local NKF chapter) - up to $300 grants for emergency rent, utilities, groceries (financial hardship documentation required like eviction notice or shutoff). HealthWell Foundation Chronic Kidney Disease Fund (HealthWellFoundation.org) - medication copays and insurance premiums (income under 500% FPL ~$75K individual, active insurance required, apply online when fund open). National Renal Administrators Association (NRAA) Renal Support Network (RSNhope.org or 1-866-903-1728) - transportation assistance, emergency grants, peer support. Apply to multiple programs simultaneously (not mutually exclusive, receiving AKF assistance doesn't prevent NKF or HealthWell grants).
Explore Additional Government Benefits
Apply for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) if unable to work due to dialysis (SSA.gov or 1-800-772-1213, expedited ESRD review typically 1-3 months vs standard 3-6 months, SSI provides ~$1,000/month income for low-income disabled individuals, SSDI based on work credits). Apply for Medicaid if income-eligible (state Medicaid office or HealthCare.gov, income typically under 138% FPL ~$20,783 individual in expansion states, Medicaid covers Medicare premiums/copays through QMB program if under 100% FPL ~$15,060, Medicaid NEMT covers free transportation to dialysis). Apply for SNAP (food stamps) if income-eligible (SNAP.gov or state SNAP office, income typically under 130% FPL ~$19,578 individual, expedited processing for emergencies within 7 days). Apply for LIHEAP utility assistance (FederalBenefits.gov/liheap or 211, helps with heating/cooling bills, crisis intervention for shutoffs). Explore Medicare Savings Programs (QMB/SLMB/QI) to pay Medicare premiums and copays (apply through state Medicaid office).
Arrange Transportation to Dialysis Appointments
Contact Medicaid transportation broker if you have Medicaid (call number on Medicaid card, schedule rides 2-3 business days in advance, free transportation to dialysis appointments typically 15+ trips/month). Contact Medicare Advantage plan member services if enrolled in MA plan (check transportation benefits, typically 12-24 trips annually). Apply for AKF Transportation Grants (KidneyFund.org, mileage reimbursement, gas cards, or transit passes). Contact dialysis social worker to arrange local volunteer driver programs or medical transportation services (many communities have free or low-cost medical ride services for low-income, disabled, or senior patients). Call 211 to find local transportation resources (community organizations, volunteer driver networks, nonprofit transportation programs).
Get Help with Medications & Emergency Expenses
Apply for Extra Help/LIS (Low-Income Subsidy) for Medicare Part D prescription drug coverage (SSA.gov or 1-800-772-1213, income under $23,276 individual $31,523 couple, covers Part D premiums deductibles and copays, automatic if receiving SSI or Medicaid). Contact pharmaceutical companies directly for Patient Assistance Programs (PAPs) - free or low-cost dialysis medications (income typically under 300-500% FPL ~$45K-$75K individual, visit drug manufacturer websites or call 1-888-477-2669 for medicine assistance tool). Apply for NKF Patient Emergency Fund for rent, utilities, groceries (Kidney.org or local NKF chapter, up to $300 one-time grants for financial emergencies). Apply for Modest Needs grants for emergency expenses under $1,000 (ModestNeeds.org, low-income workers facing temporary crisis). Contact Catholic Charities or local community organizations for emergency assistance (find local agencies at CatholicCharitiesUSA.org or call 211). If denied or need additional help, contact AKF Helpline 1-800-795-3226 for personalized assistance navigating financial resources.
Essential Resources for Dialysis Patients
American Kidney Fund (AKF)
Comprehensive financial assistance for dialysis patients including Health Insurance Premium Program (covers Medicare premiums, insurance copays, prescription costs), Transportation Grants (mileage reimbursement, gas cards, transit passes), Emergency Financial Assistance (crisis grants for dialysis patients), and Helpline (1-800-795-3226 for personalized assistance). Apply online at KidneyFund.org. Income typically under 400% FPL (~$60K individual) for premium assistance. AKF is largest kidney-specific charity providing direct financial assistance to dialysis patients.
Medicare ESRD Coverage
Call Social Security Administration at 1-800-772-1213 or visit SSA.gov to apply for Medicare based on ESRD diagnosis. Coverage begins first day of third month after dialysis treatment starts or month of kidney transplant. Medicare Part B covers 80% of dialysis costs after annual deductible ($257 in 2026). All dialysis facilities must have social worker to assist with Medicare enrollment (within 60 days of starting dialysis). Enroll during Initial Enrollment Period (4 months beginning with first month of dialysis or transplant) to avoid delays.
National Kidney Foundation (NKF)
Visit Kidney.org or call 1-855-NKF-CARES (1-855-653-2273) for kidney disease education, patient support services, Patient Emergency Fund (up to $300 grants for rent, utilities, groceries - one-time assistance for financial emergencies), Peer Mentoring Programs (connect with other dialysis patients), and local chapter resources. NKF provides comprehensive kidney disease information, advocacy, and patient support. Find local NKF chapter at Kidney.org for regional financial assistance programs and community resources.
211 Helpline & Community Resources
Dial 211 (United Way's free confidential helpline) or visit 211.org to find local resources for dialysis patients including emergency financial assistance (rent, utilities, food), medical transportation services, prescription assistance programs, support groups and counseling, and disability benefits assistance. 211 specialists connect you to county-specific resources, nonprofit organizations providing emergency aid, and government benefit programs. Available 24/7 in most areas, multilingual services. Essential first call for dialysis patients facing financial crisis or needing help navigating local assistance programs.
Related Healthcare & Patient Support Grants (77)
While most direct dialysis assistance comes from Medicare and kidney-specific nonprofits, these federal grants fund healthcare organizations, research institutions, and community programs that may benefit dialysis patients indirectly through improved care, medical services, or patient support programs.
The CEA-LAT Grant will provide up to $200,000 in funding to Community Based Organizations (CBOs) in Los Angeles County that perform outreach and education on the Technology for Equipment and Clean Heating Clean Initiative (TECH Clean CA). It focuses on building decarbonization, healthy homes, electrification technologies, and health-related impacts. Proposals will undergo a competitive selection process. Please refer to the CEA-LAT Grant Guidelines and application forms, located on the right sidebar under Applicant Resources, to create a complete and competitive application. Activities: Potential activities include, but are not limited to: Conducting community outreach and education activities that enrich outreach and education, such as: staff training evaluating grant project impact...
The California Department of Fish and Wildlife (CDFW) is pleased to announce funding opportunities under the 2026 Fisheries Restoration Grant Program (FRGP) Proposal Solicitation Notice (Solicitation) for projects that lead to process-based restoration, enhancement, or protection of anadromous salmonid habitat. Proposal applications will be accepted for the types of projects outlined in the solicitation, subject to the funding program criteria. Priority 1 Projects are those that restore, enhance, or protect salmonid habitat in anadromous watersheds through implementation or design projects that lead to implementation. Approximately 65% of the PCSRF grant award will fund Priority 1 Projects. Priority 2 projects are those that support implementation projects through watershed-scale...
The purpose of this RFA is to increase public awareness of Domestic Violence (DV), specifically Interpersonal Violence (IV), and support community-led efforts to adopt and implement primary prevention strategies that improve the scope and quality of services provided to victims of IV. The California Department of Public Health, Injury and Violence Prevention Branch (CDPH/IVPB) anticipates releasing Request for Application (RFA): 25-10031, Local Training and Education Program for the Prevention of DV. CDPH/IVPB anticipates awarding up to one (1) local project with (3) three or more years of demonstrated experience and capabilities implementing local community organizing and/or public health policy, system, and environmental (PSE) change work. Funding will be available from State of...
The Conservancy's Proposition 4 program aims to support watershed improvement, forest health biomass utilization, chaparral and forest restoration, and workforce development, and to reduce the risks of climate change impacts upon communities, fish and wildlife, and natural resources, and to increase public access. The California Tahoe Conservancy (Conservancy) leads California's efforts to restore and enhance the extraordinary natural and recreational resources of the Lake Tahoe Basin (Basin). The Conservancy uses available funding to accomplish its mission and Strategic Plan through grants for land acquisition, planning, implementation, and monitoring on the California side of the Basin. California voters approved Proposition 4 (the Climate Bond), the Safe Drinking Water, Wildfire...
The 2025 Multifamily Finance Super NOFA - Los Angeles Disaster makes funds more accessible to developers enables the funding to further serve the lowest income Californians and increases the range of potential applicants and target populations to achieve better outcomes in health, climate, and household stability. The 2025 Multifamily Finance Super NOFA - Los Angeles Disaster (MFSN-LA Disaster NOFA) provides funding for Los Angeles disaster The California Department of Housing and Community Development (Department or HCD) is pleased to announce the release of this Multifamily Finance Super Notice of Funding Availability for approximately $101 million in funds, which may be augmented based on availability of funds. This NOFA is issued to distribute funds through a combination of...
To protect biodiversity or nature, restore landscape health, or achieve California’s climate goals. Climate projects are covered under Chapter 6 of Proposition 4 and must satisfy Section 93000, while also addressing at least one priority from Section 93020. Eligible projects protect biodiversity or nature, restore landscape health, or achieve California’s climate goals. To qualify, each project must also reduce climate change risks to communities, fish and wildlife, or natural resources, or increase public access to nature. Proposition 4 – Nature Based