Coding a paper claim for Carer Allowance (CA) where the care receiver is under 16 years 009-03040050

A carer may be entitled to receive CA (child) if they provide care for a child under 16 years of age. CA provides 2 levels of assistance depending on the level of disability of the child care receiver:

• The first level of assistance provides for a Health Care Card (HCC) only for the CA child, no fortnightly payment
• The second level provides payment and HCC for a care receiver with a disability or medical condition

From 1 July 2010, a Disability Care Load Assessment Determination (DCLAD) 2020 must be completed for each care receiver as part of the claim for Carer Payment (CP) and/or CA.

There are specific provisions for re-use of Treating Health Professional (THP) medical reports and Care Needs Assessments (CNA) for claims lodged on or after 1 July 2010.

If the carer has claimed both CA (child) and CP (child), the claim for CA (child) should be determined before CP (child). If the carer is not eligible for CA (child) payments, they may be eligible for CA (auto) payments if CP (child) is granted. Coding a claim for CP may automatically assess eligibility for CA (auto).

If CA HCC only has been granted and during the CP claim the DCLAD score has increased (such as via the Care Load Validation process), a manual assessment of eligibility for CA auto or CA manual may be required.

CA (auto) child care receivers are eligible for a HCC in their name in addition to any Pensioner Concession Card (PCC) or HCC held by the carer. Normal concession card hierarchy rules apply.

Carers may claim CA at payment level and if they do not qualify for payment their entitlement for a HCC, only CA will be assessed. No additional claim is required from the carer.

A THP completes a Medical Report - Carer Allowance for a child under 16 years (SA333TDR/SA426). If the THP indicates the child requires at least 14 or more hours of extra care each week, and other eligibility requirements such as Period of Condition (POC) are met, but the carer does not qualify for CA at payment level, CA HCC only will be granted.

Both the payment of CA (child) and the HCC-only entitlement require the carer to submit an online claim or lodge a paper claim.

See Eligibility for Carer Allowance (CA) (child) when a customer is claiming or receiving CA only.

If a carer or care receiver passes away before the claim is finalised, additional coding is required within the claim to end-date any Electronic Messaging (EM) subscriptions.

See Centrelink - Notification, confirming and recording a death.

A carer may qualify for CA if they have 2 children in their care who do not individually reach the necessary rating on the DCLAD 2020. However, the carer can be qualified for CA if the disabilities of these children when combined have a significant impact (when assessed against the DCLAD 2020, both children's scores on the SA333TDR/SA426 are greater than zero and they have a combined Care Needs Assessment (CNA) score of 85 or greater).

Note: a CNA questionnaire is only a contributing CNA if the total score for that CNA questionnaire is 20 or more.

See Assessing a claim for Carer Allowance (CA) using the combined assessment scores of two children.

In some cases 2 carers may receive CA for the one care receiver.

CA can be shared by 2 carers who are not members of the same couple if they share the care of the same care receiver/s on a regular basis and the care receiver qualifies for CA including receiving care and attention on a daily basis from 1 or both carers.

If CA is to be shared, a declaration under section 981 of the Social Security Act 1991 is to be made before CA is payable to both carers. If 1 carer is already in receipt of CA, the new carer only has to complete a claim for CA. The child care receiver does not have to be tested a second time against the List of Recognised Disabilities (LoRD) or the DCLAD 2020 or previous determination.

If the carer indicates on their claim they share care, the Service Officer must assess if each carer would qualify for CA under shared care provisions (whether the other carer has claimed or not). Shared care provisions do not apply if, for example, the care receiver does not receive daily care and attention from either of the 2 carers (or their partner). If shared care provisions do not apply, the Other Carer's Details field should not be coded.

Note: while shared care provisions do not apply to Carer Payment (CP), the shared care arrangement must be considered when determining eligibility or continuing eligibility for CP.

The following carers will maintain qualification and payability under grandfathering provisions from 1 July 2010:

• granted CP (child) under the DCLAD (2009) or CA (child) under the Child Disability Assessment Determination (CDAD) (2001) will maintain qualification and payability under their existing provisions. This remains until selected for review under DCLAD 2020 or losing qualification on or after 1 July 2010. This group of care receivers will not appear on the Carer Payment Grandfathered (CRGF) screen
• granted CP (child) due to caring for a Profoundly Disabled Child (PDC), or two children who require the equivalent care of a PDC, will maintain qualification and payability under PDC provisions. This remains until selected for review under DCLAD 2020 or losing qualification on or after 1 July 2010. Carers in this group who reclaim CP (child) for the same care receiver from 1 July 2010 to 17 August 2020 are required to provide a DCLAD (2020) care load assessment and medical report. These groups of care receivers will appear on the CRGF screen

See Shared care for Carer Allowance (CA) for further information.

All CA (child) claims must be assessed for eligibility at payment level before being assessed for HCC only.

This requires the completion of a DCLAD. The DCLAD requires the completion of a medical report and a CNA.

The CNA is required to support the Care Load Validation process. Validation is required where there are discrepancies between the responses provided in the THP medical report and the CNA. Validation may result in changes to either the CNA or the THP which may change the carer's entitlement to payment level CA (child).

An assessment for CA HCC (only) should not be completed until:

• a CNA has been recorded, and
• any validation triggers on the carer's record have been investigated, and
• the carer has been assessed for CA at payment level

Where a carer fails to return the CNA the claim should be rejected 'failed to reply to correspondence' (FRC).

Note: to qualify for CA HCC only, the condition must be either permanent or expected to last 12 months or more.

To be eligible for CA, the carer’s and their partner’s combined adjusted taxable income must be under $250,000 a year. This includes deemed amount from account-based income streams if the account holder is 60 years of age or older. The same income limit applies if the carer does not have a partner. The income test does not affect the rate of CA.

CA claimants and recipients are exempt from providing their income details for the CA income test if they or their partner receives a qualifying payment or card that allows an exemption.

Qualifying payments and cards are limited to the following:

• an income-tested Centrelink or Department of Veterans' Affairs (DVA) Income Support Payment (ISP)
• Family Tax Benefit paid in fortnightly instalments, or
• a Commonwealth Seniors Health Card

CA adjusted taxable income details are collected in a CA claim or combined CP and CA claim unless the claimant is already exempt from providing their income detail for the CA income test at the time they complete their claim.

A CA claimant can become exempt from proving their income details or lose their exemption if:

• They are not already exempt at the time they complete their claim, they may become exempt due to being granted CP or when they or their partner are granted a payment or card that qualifies for an exemption
• Alternatively a CA claimant may be exempt at the time they complete their claim but when it is processed they have lost their exemption - in this case the Service Officer will manually issue a Carer Allowance adjusted taxable income details (SA489) form through Process Direct. The Resources page also contains a link to this form

Income details are requested in a paper claim without checking if the claimant is exempt from providing their income detail for the CA income test. Income details that are provided should be recorded. The system will not reject the claim due to the income test if the claimant is exempt.

See Carer Allowance (CA) income test - determining reference tax year and assessable income components for more information.

See Carer Supplement (CS) for detailed information relating to eligibility for CS in respect of CA.