Autism – what can I claim from medicare and other govt schemes?

Understand what funding is available for autistic children (apart from the NDIS), including:

Autism Assessments

There are many state-funded services which do provide diagnoses, but these usually have year long waiting lists.
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.

Starting with your GP

As with most medical services, your GP will need to give you that initial referral to a paediatrician or psychologist / psychiatrist for diagnosis. There is an amount that can be claimed from medicare for this charge – it won’t cover the whole cost but something is better than nothing.

After your initial consultation

After your initial diagnosis appointment with a paediatrician or psychologist, a consultant paediatrician or psychiatrist can refer a child with autism to eligible allied health professionals for treatment services – up to a maximum of 10 services can be recommended.

This enables the referring practitioner to consider a report from the allied health professional(s) about the services provided to the child, and the need for further treatment.

These services include:

  • 82000 Psychologist
  • 82005 Speech pathologist
  • 82010 Occupational therapist
  • 82030 Audiologist, optometrist, orthoptist, physiotherapist
For children aged 13 years or under

Medicare rebates are available to help cover at least some of the cost.

These Medicare items cover:

  • Assessment and diagnosis by a paediatrician or child and adolescent psychiatrist
  • Up to 10 allied health professional assessments/services to assist with the diagnosis and treatment
  • Up to 20 treatment services can be delivered by allied health professional(s), who can provide one or more courses of treatment. (Eligible allied therapists include psychologists, speech pathologists, occupational therapists, audiologists, optometrists or physiotherapists)

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 10 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
  • 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.

For more information: Department of Health Chronic Disease Management

Carers Allowance

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 a child aged under 16 years Carer Allowance is either:

  • For a child with higher needs – paid 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:

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.
For more information: Services Australia website

Health Care Card

You / your child 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 or a Carer Allowance,

Check the health care card eligibility here.

Do you need help finding supports for your autistic child, friend or family member?

Call MyCareSpace on 1300 28893 or use our ONLINE FORM to get help finding autism friendly supports


This resource has been shared with full consent from MyCareSpace