Medicare and other funding
In an ideal world, assessment and diagnosis would be rapid, professional and free.
There are many state-funded services which do provide diagnosis and some people are able access these without a long wait and without having to travel too far.
However, most state-funded assessment services have very long waiting lists and families can be left waiting for up to 12 months for an appointment. You may need or choose to use private professionals to do an assessment of your son or daughter. There are some funding options that can help.
Your GP can refer you to a paediatrician or psychologist / psychiatrist for diagnosis, and there is a Medicare item number which can be claimed to pay for part of this cost.
The paediatrician or psychologist / psychiatrist can then give you referrals to see up to eight professionals for diagnostic services such as audiologists, occupational therapists, optometrists, physiotherapists, psychologists and speech pathologists.
For patients aged 25 years or under, Medicare rebates are available to help cover at least some of the cost.
These Medicare items cover:
Medicare items for autism diagnosis - Complex neurodevelopmental disorder and eligible disability
Medicare items are available for diagnosing and treating patients with an eligible disability.
The initiative links Better Start for Children to the Helping Children with Autism program (HCWA). These programs are now part of the NDIS. Patients with both an eligible disability, or complex neurodevelopmental disorder (such as autism spectrum disorder) can access MBS services associated with these programs.
Age criteria for MBS services
The patient must be under 25 years of age to have:
- allied health MBS items for assistance in diagnosing the patient or contributing to a treatment plan
- a treatment and management plan prepared by a specialist, consultant physician or general practitioner.
The patient must be under 25 years of age to have allied health MBS items for treatment services.
Better Access to Mental Health Care Scheme
The scheme is available to all Australians and we highly recommend you use it for anyone in your family or care where required. In particular if you are experiencing anxiety, depression or emotional strain it can be a huge help.
Many children, teenagers and adults on the autism spectrum take advantage of this program to help fund visits to a psychologist. Many parents and carers also access the scheme and find it very beneficial.
Under the scheme Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.
Medicare rebates are available for up to ten individual and ten group allied mental health services per calendar year to patients with an assessed mental disorder who are referred by:
- A GP managing the patient under a GP Mental Health Treatment Plan; or
- Under a referred psychiatrist assessment and management plan; or
- A psychiatrist or paediatrician
The first step to access the scheme is to see your GP who will assess whether you have a mental disorder and whether the preparation of a GP Mental Health Treatment Plan is appropriate for you.
Chronic Disease Management Plan
Again this scheme is available to all Australians and is a means to access additional services for both people on the spectrum and their parents or carers.
A chronic medical condition is one that has been present for six months or longer. In the area of ASD the most common examples include: anxiety, depression or stress (PTSD). There is no list of eligible conditions. However, these items are designed for patients who require a structured approach to their care and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary team.
Access to all of these Medicare rebates starts with a visit to your GP. It is invaluable to find a GP who understands autism spectrum disorder and who is across all the different Medicare rebates that can be accessed.
Not all GP’s will be well versed in this area so it’s important to make sure you do your research and be well informed before you go see your GP.
This is a Centrelink payment for carers who provide additional daily care and attention for someone with a disability.
If you are providing care to someone who is aged 16 or older:
- Carer Allowance is $144.80 each fortnight
If you are providing care to a child aged under 16 years Carer Allowance is either:
- For a child with higher needs – $144.80 every fortnight and a Health Care Card for the child OR
- For a child with lower needs – a Health Care Card for the child
If you share the care of the child and the other parent is not your partner:
- You get part of the payment
- The other carer gets the rest, based on how much care you each provide
If you meet the Carer Allowance income test, your income doesn’t affect how much Carer Allowance you can get. This payment doesn’t add to your taxable income. Payment rates change on 1 January each year to keep up with the cost of living.
It is a good idea to apply for Carer Allowance as soon as you have decided to seek an assessment, so long as you are providing daily care for your child. The payment starts from the date the form is lodged not from the date of assessment.
To start the process visit your GP, as you and a medical practitioner both need to fill in the form.
Health Care Card
You / your child with autism may be eligible for a Health care card if you get specific payments or supplements from Centrelink or the maximum rate of family tax benefit Part A. Check the health care card eligibility here.
A Health Care Card entitles the holder to:
the Office of Hearing Services
State and Territory Governments and local
councils may offer concessions, such as:
dental and eye care
This is a payment made to carers who provide care for a person with a severe disability who has higher needs. The payment is means tested, and evaluated based on income, assets and residential requirements.
Payments are made fortnightly and the rate varies depending on your individual assessment.
Annual Payments - Carer Supplement
This is an annual lump-sum payment to assist carers with the costs of caring for a person with a disability. To be eligible for the payment you must be receiving the Carer Allowance or the Carer Payment as of the 1 July each year.
The payment is up to $600 each year and you do not need to apply for it. You will automatically receive it if you are eligible however it’s always a good idea to check with Centrelink.
Annual Payments - Child Disability Assistance Payment
This is an automatic yearly payment if you are receiving the Carer Allowance for looking after a child with a disability or serious illness as of the 1 July each year.
The payment is up to $1000 for each eligible child who qualifies for the Carer Allowance. If you are getting Carer Allowance for 2 children, you will get 2 payments.
If you share the care for a child and get a part rate of Carer Allowance, you will get a part payment of the Child Disability Assistance Payment in the same ratio
Carer Adjustment Payment
This is a one off payment to assist families following a catastrophic event where a child younger than 7 is diagnosed with a severe disability or severe medical condition.
To get this payment you must provide full time care for a child younger than 7 and meet other rules.
The most any family can get is up to $10,000 for each child for one catastrophic event.
You need to complete a form to apply for a Carer Adjustment Payment.
Payments for people over 16 years of age
Once young people are over 16 years of age there are other funding supports available, such as the Disability Support Pension, Youth Allowance, Youth Disability Supplement and more.
The Australian Disability Parking Scheme (ADPS) includes an Australian Disability Parking Permit, which is recognised nationally.
It establishes nationally consistent eligibility criteria and national minimum parking concessions to help reduce the barriers for permit holders when travelling interstate.
Permit holders can:
- park in disability parking spaces that display the international symbol of access
- receive concessions in public parking spaces where signs or metres show specific time limits
State and Territory Governments are responsible for the management of the ADPS. Most States and Territories acknowledge that individuals with an Autism Spectrum Disorder may fit the criteria for a Mobility Parking Permit where the criteria specifies being able to walk independently. A tendency to abscond and/or the inability to understand or obey road safety rules may be taken into consideration by the GP when deciding if the individual meets eligibility criteria.
Enquiries about permit applications, cost, eligibility and use, should be directed to your relevant State or Territory authority.