Eligibility for Carer Payment (CP) when a care receiver is aged 16 years or over 009-04030020

Is the carer an Australian resident?

For help, see Residence assessment for customers claiming Carer Payment (CP).

• Yes, go to Step 2
• No, the carer does not qualify for CP. Procedure ends here

Are the carer's income and assets below the maximum allowed under the pension income tests and assets tests?

• Yes, go to Step 3
• No, the carer does not qualify for CP. Procedure ends here

The carer is not required to live with the care receiver.

Constant care is usually considered to be provided if both the carer and THP give positive responses to the relevant questions on the claim/review forms unless there are circumstances indicating constant care is not being provided.

Relevant questions for the carer in the paper claim:

• Carer Payment (CP) and/or Carer Allowance (CA) - Caring for a person 16 years or over (SA406)
• Q 20 - care provided on a daily basis
• Q 31 - constant care to the person in their home
• Review of care provided for Carer Payment and/or Carer Allowance when caring for a person 16 years or over (SA010)
• Q9 - care provided on a daily basis
• Q 17 - any changes in the amount of care provided
• Q 19 - constant care to the person in their home

Carer Payment and/or Carer Allowance Medical Report for a person - 16 years or over (SA332a) questions for the Treating Health Professional

• Q4 - care on a daily basis
• Q5 and Q6 - whether the carer is claiming CP, and if so, if the care required is significant

The following can be used as a guide if the responses to Q4 and Q6 are inconsistent in the SA332a form or the THP had not answered both questions:

• Q4 not answered and Q6 yes - unless the rest of the form and the Claimant Questionnaire indicates that CP and/or CA is not payable, accept that daily care is being provided
• Q4 not answered and Q6 no - if the rest of the form and the carer questionnaire indicate that CA is not payable, accept that daily care is not being provided. Otherwise, responses must be clarified with the THP
• Q4 and Q6 not answered - responses must be clarified with the THP
• Q4 no and Q6 yes - if the rest of the form and the carer questionnaire indicate that CA is payable, accept that daily care is being provided. Otherwise, the responses must be clarified with the THP, as either answer could be wrong
• Q4 no and Q6 not answered - if the rest of the form and the carer questionnaire indicate that CP is not payable, accept that constant care is not being provided. Otherwise, responses must be clarified with the THP
• Q4 yes and Q6 no - unless the rest of the form and the carer questionnaire indicate otherwise, accept that daily care is provided, and constant care is not being provided
• Q4 yes and Q6 not answered/unsure - the response to Q6 must be clarified with the THP, unless the responses to the other questions indicate that constant care is being provided
• If the carer answers No to their questions (on the SA406 or SA010), and the THP answers Yes to Q5 and No to Q6 on the SA332a, CP should be rejected/cancelled

Where inconsistency exists in the carer and/or the THP's responses, the Service Officer should:

• record the reasons for their decision on whether constant care is or is not being provided on a DOC, and
• include any clarification gotten from the carer and/or the THP

Carers can participate in paid work or study and still qualify for CP as long as the total time they are not providing constant care, including the time taken to travel, does not exceed 25 hours per week.

A medical report is not required if the carer is already receiving CA for the same care receiver and the care receiver already has a qualifying ADAT score. In these cases, it can be assumed that the care receiver meets the care requirements for payment.

Note: a medical report may be requested if Service Officers have concerns that the care receiver's condition has improved (which would mean the care receiver may no longer have a qualifying ADAT score), or that constant care is not being provided. The Service Officer would need to be able to support this decision.

Is the carer providing constant care for a disabled adult in the home of the care receiver?

• Yes, go to Step 4
• No, the carer does not qualify for CP. Procedure ends here

Is the care receiver an Australian resident, or a higher ADAT score adult who is receiving a social security payment and for whom another person could be granted CP under a scheduled international social security agreement?

• Yes, go to Step 5
• No, the carer does not qualify for CP. Procedure ends here

• Is the care receiver:
• receiving a social security payment or Service Pension, Income Support Supplement (ISS) or Veteran Payment.
  Note: if the care receiver is a DVA income support recipient, it may be necessary to contact the DVA Clearance Team (SCS) to confirm the care receiver's DVA payment details.
  If CP is granted, notification of any changes in the service pensioner's circumstances must be provided, or not in receipt of:
• a social security payment, but would be eligible for a social security payment if they had been a resident for long enough, or
• an income support payment, but they qualify under the components of the Care Receiver Income and Assets (CRIA) test?
• Yes, go to Step 6
• No, the carer does not qualify for CP. Procedure ends here

Does the carer care for a disabled adult who has a dependent child?

• Yes, go to Step 7
• No, go to Step 8

The assets assessment must not include:

• the family home
• funds from the National Disability Insurance Scheme (NDIS) deposited into an account specifically for the purposes of managing the care receiver's NDIS plan, and
• assets obtained to specifically help the care receiver in respect of their disability

Do the combined income and assets of the child, their parent(s) and the parents of other dependent children satisfy the Components of the Care Receiver Income and Assets (CRIA) test?

• Yes, go to Step 8
• No, the carer does not qualify for CP. Procedure ends here

Does the care receiver require care permanently, or for a minimum period of 6 months, or is the care receiver in the final phase of a terminal illness?

• Yes, go to Step 9
• No, the carer does not qualify for CP. Procedure ends here

All further determination of qualification is based on the assessment of the disability and of the level of care required.

A carer will be eligible for payment for an adult care receiver who:

• has an ADAT score of 25, where the THP's component is 10 or greater
• has an ADAT score of 20 and a minimum THP score of 8 where the care receiver provides care for a dependent child. The care receiver's dependent child must be either less than 6 years of age, or from 6 to 16 years attracting CA, or
• is in the final phase of a terminal illness and is not expected to live more than 3 months (where a medical practitioner has certified they are terminally ill, they do not need to undergo the ADAT assessment as their carer is granted payment automatically if they meet all other CP eligibility criteria)

However, the calculation of this requires the details to be provided on the claim and medical report to be coded on the system to give the ADAT score.

If the carer/care receiver are new customers, they will need to claim CP.

When the claim form is lodged, entitlement is determined by:

• processing the online or assisted customer claim, or
• coding the claim manually

When the personal care and care receiver medical details are recorded, the system assesses qualification for CP.