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Eligibility for Carer Allowance (CA) when the care receiver is aged 16 years or over 009-03020030

For Carer Payment/Carer Allowance Smart Centre Processing staff

This document explains how to assess eligibility for Carer Allowance (CA) when a person claims CA caring for a care receiver (aged 16 years or over).

Assessing eligibility for Carer Allowance (CA)

Step	Action
1	Carer living with care receiver Is the carer caring for an adult with a disability in a private home they share? Note: The co-resident carer provisions require Carer Allowance (CA) carers and care receivers to live together in a private home unless certain exceptions apply. Yes, go to Step 2 No, see Carer Allowance (CA) (adult) when caring in a private home not shared by the carer and care receiver. Procedure ends here
2	Care receiver aged 16 years or over Is the care receiver aged 16 years or over? Yes, go to Step 3 No, see Eligibility for Carer Allowance (CA) (child) when a carer is claiming or receiving CA only. Procedure ends here
3	Australian resident Are both the carer and care receiver Australian residents? For residence details, see Residence assessment for customers claiming Carer Allowance (CA). Yes, go to Step 4 No, The carer does not qualify for Carer Allowance (CA) See Processing claims for Carer Payment (CP) and/or Carer Allowance (CA) to finalise the claim Procedure ends here
4	Carer and care receiver identity confirmation Have both the carer and care receivers identity been confirmed? Yes, go to Step 5 No, see Identity Confirmation. When the identity for both the carer and care receiver has been confirmed continue to Step 5
5	Approved carer Is the care receiver a family member of the person or a person approved in writing by the Secretary? See the References page. Yes, go to Step 6 No: The carer does not qualify for CA See Processing claims for Carer Payment (CP) and/or Carer Allowance (CA) to finalise the claim Procedure ends here
6	Care provided on a daily basis On a daily basis, does the carer personally provide additional care and attention to the care receiver because of their disability or medical condition in a private residence shared by the carer and care receiver? Daily basis means care and attention is provided every day, 7 days a week. This daily care requirement also applies to carers who share care with someone else, including if both carers share CA or if only one carer receives 100% of the CA. If a carer is using more than 1 day of temporary cessation of care each week at claim, they generally would not be regarded as providing daily care. See Legislation in the References page for examples in the Social Security Guide, 1.1.D.10. Note: both the carer and THP must give certain responses to the relevant questions on the claim/review forms for this question to be answered 'yes'. On the Carer Payment and/or Carer Allowance Medical Report for a person - 16 years or over (SA332(a)), there are 3 questions for the health professional, concerning the care required: Question 4 relates to care on a daily basis for CP and care and attention on a daily basis for CA, and Questions 5 and 6 relate to whether the carer is claiming CP, and if so, if the care required is significant Note: question 6 specifically relates to the constant care requirement for eligibility to CP, and is not required to qualify the carer for CA The following can be used as a guide if the responses to Questions 4 and 6 are inconsistent or the THP had not answered Question 4: Response to Question 4 is not answered and Question 6 is yes, unless the rest of the form and the Claimant Questionnaire indicates that CP/CA is not payable, accept that daily care and attention is being provided Response to Question 4 is not answered and Question 6 is no, if the rest of the form and the Claimant Questionnaire indicates that CA is not payable, accept that daily care and attention is not being provided. Otherwise, responses must be clarified with the THP Response to Question 4 is not answered and Question 6 is not answered, responses must be clarified with the THP Response to Question 4 is no and Question 6 is yes, if the rest of the form and the Claimant Questionnaire indicates that CA is payable, accept that daily care and attention is being provided. Otherwise, the responses must be clarified with the THP, as either answer could be wrong Response to Question 4 is no and Question 6 is not answered, if the rest of the form and the Claimant Questionnaire indicates that CA is not payable, accept that daily care and attention is not being provided. Otherwise, responses must be clarified with the THP Response to Question 4 is yes and Question 6 is no, unless the rest of the form and the Claimant Questionnaire indicates otherwise, accept that daily care and attention is provided Response to Question 4 is yes and Question 6 is not answered, unless the responses to the other questions indicate otherwise, accept that daily care and attention is being provided If the carer does not indicate that they provide daily care, the payment should be rejected/cancelled unless the shared care provisions apply. See Shared care for Carer Allowance (CA). Yes, go to Step 9 No, go to Step 7
7	Eligibility under Social Security Act Is the carer eligible for payment under section 954A of the Social Security Act? Note: section 954A covers caring for a disabled adult in a private home not shared by the adult and carer. Yes, code the claim No, go to Step 8
8	Hospitalisation and treatment Is the care receiver temporarily hospitalised and the carer is participating in their treatment? See Carer or care receiver is absent from care for Carer Payment (CP) and/or Carer Allowance (CA). Yes, go to Step 9 No, The carer does not qualify for CA See Carer or care receiver is absent from care for Carer Payment (CP) and/or Carer Allowance (CA) to finalise the claim Procedure ends here
9	The care receiver's condition Does the care receiver achieve a qualifying ADAT score: Yes, go to Step 10 No: The carer does not qualify for CA See Processing claims for Carer Payment (CP) and/or Carer Allowance (CA) to finalise the claim Procedure ends here
10	Medical assessment is required to determine eligibility for CA Is the carer (the claimant) a current care receiver? Yes: The carer does not qualify for CA See Processing claims for Carer Payment (CP) and/or Carer Allowance (CA) to finalise the claim No, continue processing the claim. See Processing claims for Carer Payment (CP) and/or Carer Allowance (CA)