Medical bills could surge in unclear NDIS shake-up
By Nick Newling
Parents of children set to be diverted off the NDIS would face thousands of extra dollars a year in medical bills if their therapies were shifted onto Medicare as it stands today.
Psychology, physiotherapy and speech pathology are among the services currently covered by NDIS packages for children with mild to moderate developmental delay and autism. But, with limited Medicare rebates, these could come at significant cost if the children continued their average 70 sessions a year, which federal Health and Disability Minister Mark Butler has described as an “over-service”.
Health and Disability Minister Mark Butler announced the reforms this week at the National Press Club. Credit: Dominic Lorrimer
On Wednesday, Butler took state leaders, parents and peak bodies by surprise when he announced plans to curb the NDIS’ ballooning growth, and return the scheme to its foundational goal of supporting those with permanent and significant disability, by diverting children with mild to moderate developmental delay and autism onto the new Thriving Kids scheme from mid-2027.
Though details of the transition remain unclear, Butler said the government was considering new Medicare pathways for occupational therapy, speech pathology and psychosocial therapy for children in need of additional support.
A lack of detail on the structure of the reform has caused anxiety among parents.
Replication of gap fees and service caps in existing Medicare allied health items would increase the cost of children’s care.
Presently, occupational therapy appointments – in which developmentally delayed and autistic children learn to dress themselves, use the toilet and manage sensory stimuli – can attract out-of-pocket costs exceeding $200 for initial assessments and $125 for ongoing sessions through existing Medicare plans.
Speech pathology – where tasks as foundational as swallowing and communicating are taught – and psychology sessions could similarly attract hundreds in gap fees a month.
Beyond the out-of-pocket expense, current caps of between five and 10 subsidised sessions a year could lead to families pausing allied health treatments despite primary goals not being met.
When asked whether the proposed Medicare items would be bulk-billed, or attract gap fees or service caps, a government spokesperson said Butler would establish the Thriving Kids Advisory Group, chaired by the Murdoch Children’s Research Institute’s Professor Frank Oberklaid, to advise on “program design and implementation arrangements over the coming months”.
After last week’s announcement, many in the field, including Kids Research Institute Australia’s Andrew Whitehouse, have said Thriving Kids has the opportunity to provide more appropriate care through group and educational settings, serving children well by not placing a diagnosis at the forefront of the treatment process, as is required to access the NDIS.
The federal government intends to work with service providers, parents and state governments over the coming months to design the program. Whether new Medicare items are cost prohibitive or hamper children’s opportunity to meet developmental goals remains to be seen.
Butler has said no children would be kicked off the NDIS or left stranded between programs.
Occupational Therapy Australia chief occupational therapist Michelle Oliver rejected claims that overservicing was an issue in her field, saying her patients’ therapeutic goals were not the type that could be pushed aside should a session cap be met.
“Whether [the NDIS] is or it isn’t the right place for those families to have their services, or to have their needs met, it certainly is the place where needs are being met at the moment, and we’re seeing way better outcomes for children and families from an OT perspective,” Oliver said.
Australian Physiotherapy Association national president Rik Dawson was concerned his field was not flagged for a new Medicare item. He said the government needed to consult doctors to ensure potential session caps were not restrictive on patient care.
“If somebody’s got really complex needs, they’re going to need more sessions. We really need the scheme to have some flexibility to actually meet the needs of individuals,” he said.
“We are concerned that we’re going back to a system that was flawed, and we’ve seen some really great results with kids getting really good treatments through NDIS.”
The physicians’ and GPs’ colleges, as well as the peak body for speech pathology, offered broad support of the planned reforms but said they needed more detail to evaluate patient costs.
Speaking on Sunrise on Friday morning, Butler said he understood why parents and service providers were seeking more detail on the announcement and was “committed to working with them over the coming months”.
“This is going to roll out over the next couple of years. It’s going to take a while to design,” he said.
An additional Medicare item to be investigated as part of the proposal was a bulk-billed health check for all three-year-old children, in which developmental concerns could be referred to allied health professionals for further investigation.
Opposition Leader Sussan Ley offered in-principle support for reforming the NDIS but requested further information from the government on how Thriving Kids would function.
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