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Medicare-funded Services for Children in Out-of-Home Care

Medicare Cards for Children in Care

As Medicare numbers are unique identifiers, Medicare has advised that it’s not possible to have a generic Medicare number for children in care. However, where a child is already enrolled in Medicare, and the carer attends a Medical Practitioner but does not have the Medicare card or number, the medical practitioner can contact Medicare Australia via the Medicare Provider Enquiry Line on 132 150 (local call rate) to get the number over the phone. This enquiry line offers a specific option – option 1 – for enquiries about Medicare cards, claiming and payment.

In addition to Medicare numbers being available to health professionals immediately over the phone, new or duplicate Medicare cards can be issued in 10-14 days. The process is only slowed down if the parentage of the child is unknown, as this may affect the eligibility of the child to access Medicare (if their parents are not Australian citizens). Also, if grandparent and other kinship carers can provide evidence that they have the full-time care of the child (such as court documents, information from Centrelink, or a letter from their doctor or child care centre), the child can be added to the carer’s existing Medicare card.

For foster carers, Medicare relies on child protection agencies to gather the information and supply the paperwork in order for a card to be issued in the child’s name. In cases where a foster carer contacts Medicare directly for a card or number for a child in their care, Medicare will refer them back to the child protection agency to gather the appropriate documentation.

Children in out-of-home care are issued cards in their own right, but in the electronic system they are under the auspices of the relevant child protection agency. In some cases, where a long-term court order is in place, a foster carer may be able to add the child to their own Medicare card. Currently no data is kept on the numbers of children listed on the Medicare cards of their carers however we’re following up with Medicare to see if data is available on the number of children listed on Medicare cards for the relevant child protection department in each jurisdiction.

Child protection systems in Queensland, New South Wales and Victoria have a standing arrangement with Medicare where they have direct access to the Tier 2 area to get Medicare cards for the children in their care, given the large numbers of children in care in these jurisdictions. Medicare could also put this same arrangement in place for other jurisdictions if demand required it.

Carers Claiming Reimbursements

Where a carer pays for a medical consultation for a child in their care, whether or not the receipt is made out to the carer, they can still claim the refund at a Medicare office because they have incurred the expense. This can happen even without the child’s Medicare card as Medicare staff can find the child’s Medicare number on the system in order to pay the claim. The person making the claim only needs to state that they incurred the expense – no other proof is required.

If Medicare staff are refusing to pay claims, carers can escalate the issue to the Office Manager (i.e. they can ask on the spot to see the Office Manager – there is always one onsite). The privacy provisions you mentioned in your email prevent Medicare staff from giving the child’s Medicare number to the carer however the carer can still be reimbursed.

Obtaining a Separate Card for Children in Care

This is the responsibility of the relevant state or territory child protection system. Medicare has policies in place for children in care, which are adhered to by all states. Staff in Medicare state headquarters process applications from government agencies for children in their care (i.e. wards of the state). Government agencies have contact phone numbers for these staff that enable them to obtain the Medicare number of a child immediately over the phone – this has been in place for eighteen months.

Children who are state wards are enrolled on their own Medicare card, with the relevant government agency as the group contact. Where the child is in care up to the age of eighteen years they may be included on the carer’s Medicare card – in this case, the carer would need to provide a copy of the court order which states that the child is in their care up until the age of eighteen years.

Health Check Medicare Item Numbers

There are items in the Medicare Benefits Schedule that cover all the consultations you have referred to below. For example, there is an item number for a Detailed Health Check which health professionals can use to do a comprehensive assessment of a child’s health when they first come into care. Information on the Medicare Benefits Schedule is available online at MBS Online via the Department of Health and Aging Website.

If the feedback you’re getting is that doctor’s aren’t aware of this, or aren’t willing to provide the service, then this is a separate issue. Perhaps this could be raised with an organisation such as the Australian Medical Association or the Royal Australian College of General Physicians?

Training of Medicare Office Staff

The information I’ve provided above is available to all Medicare office staff, in addition to the training they receive when they first start. Medicare office staff have access to an electronic reference manual which also has a search function, similar to Google. This allows them to search for specific information that they’re not sure of. For example, if a foster carer presented to a Medicare office with a receipt from a doctor for costs incurred for a child in their care and the receipt was in the child’s name, if the Medicare staff member was not aware of the fact that the foster carer can claim the reimbursement (as outlined above) then they could search the electronic reference guide for this information. Similarly, if a Medicare number of a child is unknown by their carer (whether that be a foster carer or a relative carer), the Medicare staff are able to look the number up on the system so that they can provide the reimbursement. Due to privacy issues they are understandably unable to provide the number to the carer over the counter, however they can still provide the carer with the relevant Medicare rebate.

Unregistered Births

Medicare legislation requires that a person must be an Australian citizen to access the Medicare system. A birth certificate is not required for enrolment in Medicare – proof of birth via the Family Assistance Office form is adequate (i.e. a doctor can sign to say he was present at the birth). In the case of very young babies whose births have not been registered, Medicare have advised us that state and territory child protection agencies can arrange for a birth to be registered providing the migration status of the parents is known. Again, it would be up to the relevant state/territory child protection agency to follow up on this process.


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