Parents of children currently receiving support from the National Disability Insurance Scheme (NDIS) may face significantly higher medical expenses under proposed reforms set to take effect in mid-2027. Federal Health and Disability Minister Mark Butler announced plans to shift children with mild to moderate developmental delays and autism from the NDIS to a new initiative known as the Thriving Kids scheme. This transition raises concerns regarding the financial implications for families if their therapies become reliant on Medicare, which currently offers limited rebates.
At a press conference held at the National Press Club on March 15, 2024, Butler described the need to address the NDIS’s escalating costs and return to its original purpose of supporting individuals with permanent and significant disabilities. The proposed changes, which took many parents and state leaders by surprise, would redirect therapy services, including psychology, physiotherapy, and speech pathology, under the new scheme.
While details surrounding the reform remain vague, Butler indicated that the government is exploring new Medicare pathways for essential therapies. Families currently benefit from extensive NDIS coverage, averaging around 70 therapy sessions annually. If these services transition to Medicare, the potential for increased out-of-pocket expenses looms large. Current Medicare plans impose substantial gap fees, with initial occupational therapy assessments often exceeding $200, and ongoing sessions costing around $125.
The introduction of session caps through Medicare could further complicate access to necessary care. Existing limits of five to ten subsidised sessions per year may compel families to pause treatments before achieving key developmental milestones. Parents have expressed growing anxiety over the lack of clarity surrounding the proposed changes.
When questioned about whether the new Medicare items would be bulk-billed or subject to gap fees, a government spokesperson stated that Butler plans to establish the Thriving Kids Advisory Group. This group, chaired by Professor Frank Oberklaid from the Murdoch Children’s Research Institute, will provide guidance on program design and implementation in the coming months.
Advocates in the field, including Andrew Whitehouse from the Kids Research Institute Australia, have pointed out that the Thriving Kids initiative presents an opportunity to offer more tailored care in group and educational settings. They argue that by not placing a diagnosis at the forefront of treatment, the scheme could better serve children’s needs without the existing pressures of the NDIS framework.
The federal government plans to collaborate with service providers, parents, and state governments to develop the program. However, whether the new Medicare items will be financially burdensome or hinder children’s developmental progress remains uncertain. Butler assured that no children would be removed from the NDIS or left without support during the transition phase.
Concerns have been raised by various stakeholders, including Michelle Oliver, chief occupational therapist at Occupational Therapy Australia, who refuted claims of over-servicing in her field. She emphasized that her patients’ therapeutic goals demand consistent attention, making session limits counterproductive. Additionally, Rik Dawson, president of the Australian Physiotherapy Association, highlighted the necessity of consulting medical professionals to ensure that potential session caps do not restrict patient care.
The colleges representing physicians and general practitioners, along with the peak body for speech pathology, voiced general support for the proposed changes but underscored the need for more detailed information to properly assess the impact on patient costs.
In a recent interview on Sunrise, Butler acknowledged the concerns from parents and service providers regarding the announcement, stating, “I understand why they are seeking more detail and am committed to working with them over the coming months.” As part of the proposed reforms, an additional Medicare item for bulk-billed health checks for all children aged three is under consideration, which would facilitate referrals to allied health professionals for developmental assessments.
Opposition Leader Sussan Ley has expressed in-principle support for reforming the NDIS but called for further clarification on how the Thriving Kids scheme will operate. The government’s commitment to designing and implementing these changes will be crucial in addressing the needs of families and ensuring continued access to essential therapies for children with developmental challenges.
