Child Medical Reviews for Carer Allowance (CA) (child) 009-08060100

CA (child) entitlement is based on the medical condition of the child, and the need for care due to the condition at the time of the claim or review. In some cases, the child may qualify the carer for CA at the time of claim, but once the child reaches a certain developmental milestone, it is deemed that the condition may no longer need the level of care needed to qualify the carer for payment.

All Child Medical Reviews (CMR) use the Disability Care Load Assessment (Child) Determination (DCLAD) (2020) to review carers and care receivers.

CMRs apply to carers in receipt of CA (child), CA (child) HCC or CP (XWP) carers receiving payment level CA (child). The review process coincides with patterns of childhood development and detects changes in care arrangements. Carers are exempt from the medical review if CA (child) was granted less than 12 months before the scheduled review date, or if they have been medically reviewed in the last 12 months.

Reviews are conducted for carers who are assessed under the CA (child) combined care rules, if 1 or both care receivers reach the developmental milestones. Carers who receive CP and CA under the CP combined care assessment or multiple care assessment will be reviewed manually.

The frequency of medical reviews for children with certain illnesses will vary because they are regarded as 'recognised disabilities' up until the child turns a certain age. A medical review will be scheduled at this time, to determine ongoing eligibility. See Recognised disability medical reviews for Carer Allowance (CA) (child). Where entitlement to CA (child) continues, a subsequent medical review for these cases will occur at the next applicable age related review.

CA (child) HCC is issued for a child who does not qualify for CA but, because of their disability, requires and receives more care and attention daily than that of a same aged child without a physical, intellectual, or psychiatric disability. This acknowledges the costs associated with the care of these children.

CA (child) HCC reviews are included in the CMRs. The purpose of a CA (child) HCC only review is to determine:

• a carer's ongoing entitlement to CA (child) HCC only, or
• whether a carer may have become eligible for CA (child) at payment level

When a CA (child) HCC only review is finalised, the Service Officer determines if the carer is entitled to:

• payment level CA (child)
• continuation of CA (child) HCC with no payment of CA (child), or
• cancellation of CA (child) HCC

The decision is based on the responses provided by the:

• Treating Health Professional (THP) on the medical report and
• carer’s responses on the Care Needs Assessment (CNA) form

If it is determined that the carer is entitled to receive CA payment a reassessment is completed. A new claim is not needed.

For the purposes of CA (child) and CA (child) HCC only, developmental milestones are the stages of a child's development at which the child should be able to perform additional functional abilities according to their chronological age.

A CMR and CA (child) HCC only will automatically start when the child is within 12 months of the following development milestones:

• 4 years and 8 months
• 10 years
• 13 years

If the carer is a member of a couple, and one receives CA (child) and the other receives CP for the same care receiver, these carers will not receive a CMR.

Issuing of the CMR forms may be delayed for carers returning from overseas.

CP (XWP) carers will be subject to Child Medical Reviews for CA (child) if they get payment level CA (child) or care for a child care receiver who qualifies for CA (child) HCC only. CP (XWP) is CP that is paid under grandfathering provisions for ceased Wife Pension carers.

A carer who is grandfathered as CP (XWP) remains qualified for CP (XWP) provided they continue to get payment level CA without a break in entitlement. This means that if the carer’s only or last payment level CA is suspended, cancelled or changed to CA (child) HCC only as a result of a review or for any reason, CP (XWP) will auto-cancel. Qualification for CP (XWP) is permanently lost if they have a break in payment level CA entitlement. See Transfer from Wife Pension (WP) to Carer Payment (CP).