Medicare’s Expanded Program: How It Can Help You Access Autism Supports for Your Child
If your child has is undergoing assessment for autism, you might be wondering what financial support is available to help with the process. The good news is that recent changes to Medicare mean families can now access more affordable support for autism assessments and therapy services. Here, the Kids First team shares what this could mean for your child, or a child you care about.
Medicare Rebates for Older Children and Young Adults
Previously, Medicare rebates for these types of autism assessments and treatments were only available for children under 13. But now, the age range has been extended, meaning young people up to 25 years of age can access these vital services through a new program that is specific to individuals who have (or are suspected of having) a ‘complex neurodevelopmental disorder and eligible disability’.
To be eligible for this Medicare program, your child’s paediatrician or psychiatrist must be of the clinical opinion that your son or daughter has challenges in two or more areas of development, such as thinking, learning, social or everyday skills. These difficulties must affect multiple parts of your child’s development, making it important for them to receive coordinated, multi-disciplinary support.
This is change is particularly important for families whose older children or young adults still need support as they transition through adolescence and beyond. With the expanded age range, families can access critical assessments and treatments during these later stages of development, ensuring their child gets the support they need at a time when continued help is often essential for their growth and independence.
How Many Appointments Are Covered for the Diagnostic Process?
Medicare now allows you to access up to 8 Allied Health assessment sessions as part of the diagnostic process. These sessions can be used to assess your child’s needs across different areas, such as speech, occupational therapy, and psychological development.
It’s important to note that this Medicare plan is available once in a child or young adult’s lifetime and must be established by a specialist doctor such as a paediatrician or psychiatrist. They will coordinate the diagnostic process with Allied Health professionals and create a comprehensive understanding of your child’s needs.
During the diagnostic phase, the first four sessions are usually covered with an initial referral from the paediatrician or psychiatrist. If further assessment is required, you’ll need approval from the referring doctor to access up to four more assessment sessions.
What Happens in the Management Plan Phase?
Once the diagnosis is made, your child’s specialist will develop a treatment and management plan that addresses their specific needs. This plan, like the diagnostic phase, is also established once and must be done by a specialist doctor.
Medicare allows you to access up to 20 rebated Allied Health treatment sessions in total, which can be used to support your child’s ongoing development through therapies like speech pathology, occupational therapy, or psychology.
The management plan will outline the goals of the treatment and recommend which services are most appropriate for your child. These therapy sessions are designed to address developmental delays and functional impairments that were identified during the diagnostic process.
It’s About Your Child’s Needs, Not Just the Diagnosis
Medicare’s program is designed to focus on what your child needs. It’s not just about having a diagnosis – your child’s eligibility for services is based on their functional needs across areas like language, motor skills, and emotional development. This means that the support is customised to where your child will benefit most.
How This Could Help Your Family
These changes to Medicare take some of the pressure off families by providing financial support for essential services during both the diagnostic and treatment phases. With rebates available for specialist assessments and therapy services, you’ll have access to more affordable options to help your child if you are waiting to make, or update, a National Disability Insurance Scheme ( NDIS) plan for your child.
Need More Information?
Kids First supports many families who use a Medicare plan to assist them during their child’s diagnostic and treatment planning process. Your family doctor or paediatrician should be your first point of call so that you can get accurate information that is relevant to your family. You can also get more information from Services Australia here.
