A Medicare Card or number is usually required for claiming a Medicare benefit, visiting a doctor who bulk bills, seeking treatment as a public patient in a public hospital, or having a Pharmaceutical Benefits Scheme (PBS) prescription filled.
However, it is not necessary to provide a child in care’s Medicare Card or number to access medical treatment or to claim reimbursement for a Medicare service. The claimant (the person who incurred the expense for the service, such as the foster carer) can be paid a Medicare benefit for a service they paid for, even if the patient (child in care) is not enrolled on their Medicare Card.
Child protection workers should refer to the Information Sharing Protocol between the Commonwealth and Child Protection Agencies – Appendix 2: Medicare (5.3 Medicare card numbers). The protocol is available in related resources.
Medicare can be contacted on 1300 660 035 for any departmental queries.
A child requires a Medicare Card
Child protection workers must apply for a Medicare Card as soon as possible for all children who enter care where the CEO has parental responsibility. Refer to the related resource In the CEO's Care - Parental Responsibility Chart (2012). Procedures to obtain a Medicare Card are outlined in the section ‘Completion of documentation’ below.
Where the CEO does not have parental responsibility, children should be issued with their parent’s duplicate card if they are in a placement arrangement for longer than one month. Where access to the parent’s Medicare Card is not possible, child protection workers should apply to Medicare to obtain a duplicate of the parent’s Medicare Card. Refer to the Department of Human Services website for details on requesting a duplicate card.
Some doctors bulk bill patients, such as Health Care Card holders and children under 16 years of age. If a child in care is taken to a doctor who bulk bills, the doctor can obtain the child’s Medicare Card number directly from Medicare Australia for billing purposes where it is not available.
Alternatively, if the foster carer has paid for a Medicare service for a child in their care, they can be paid the Medicare benefit at a Medicare office by advising the officer that they have paid for the service. The foster carer will need to provide the child’s full name and date of birth so they can be identified on the database.
It should be noted that a Medicare rebate cannot be claimed where a child protection worker takes a child in care to a medical practitioner that does not bulk bill and pays the patient account. The child protection worker should ask the surgery if they would accept delayed payment. If the surgery allows this, refer to ‘Medical costs and processing medical accounts’ below for details.
Children in care 15 years and older
Once a young person in care turns 15 years of age, they can request a Medicare Card in their own right. The child protection worker will need to discuss this as part of the planning for leaving care.
It should be noted that once a young person has their own Medicare Card, they are liable for the account. The young person should be advised to attend a surgery that bulk bills where possible. However, if they attend a doctor that does not bulk bill or does not allow deferred payment, the foster carer should attend with the young person and pay the account. The foster carer can then claim urgent reimbursement from the Department as required – refer to ‘Medical costs and processing medical accounts’ below.
The Department of Human Services website has details on transferring from one Medicare Card to another.
Completion of documentation
To obtain a Medicare Card, child protection workers must
complete Medicare - Form 3101 Enrolment Application Form in related resources or download from the Department of Human Services website . The application must be posted to Medicare Australia along with the following documents:
If a child protection worker requires further information from Medicare on the enrolment process or is unable to provide one of the above proof of birth documents, telephone 1300 660 035. For all general enquiries, telephone 132 011.
Provision of a Medicare Card to a foster carer
Once received, the Medicare Card should be given to the foster carer for convenience of use, although the card remains the property of the Department on behalf of the child.
The foster carer is authorised to make claims from Medicare on behalf of the child.
If a child requires a medicine on the Pharmaceutical Benefits Scheme (PBS), it is a legislative requirement that the child’s Medicare Card number be provided to the pharmacist to determine the child’s eligibility. However, where it is not possible for the child or foster carer to provide Medicare Card details (for example, the card has been lost or stolen), a pharmacist can use a pharmacy only ‘Special Medicare Number’. With consent of the foster carer or child, the pharmacist can also telephone the Medicare Australia PBS enquiry line to obtain the child’s Medicare Card number.
Medical costs and processing medical accounts
The fortnightly subsidy paid to carers incorporates an amount to cover basic general medical treatment and pharmaceutical requirements (non-prescriptive) for a child in care. This includes costs incurred when a child needs to visit a medical practitioner for a short-term illness such as a cold. Health assessments as part of the Health Care Planning pathway and ongoing medical treatment, diagnostic tests and specialist health services’ costs are not covered by the basic subsidy payment.
If a child is seen by a doctor that bulk bills, child protection workers should advise the foster carer that they can sign the claim form when taking a child to an appointment.
If the doctor does not bulk bill but accepts deferred payment, the foster carer should be advised to pass the client account and a completed Medicare Claim Form to the child protection worker to arrange reimbursement (if the cost is not covered in the carer’s subsidy payment).
In this instance, the child protection worker should:
- Determine the value of the Medicare rebate by either contacting the doctor's surgery or referring to the on-line Medicare Benefits Schedule .
- Note the difference between the value of the invoice and the Medicare rebate (“the gap”), and request approval for funding of the gap amount through Assist.
- Arrange payment of the gap amount to the medical practitioner using the Government Purchasing Card or make payment via Electronic Funds Transfer (EFT).
- Hand the original Medicare Claim Form and original invoice to the administration officer - he or she mails these to Medicare.
- The administration officer will forward the Medicare rebate cheque to the doctor when received from Medicare.
If the doctor does not accept delayed payment, foster carers need to pay the patient account and claim the Medicare rebate. If the medical cost is not covered by the basic subsidy payment, the foster carer must claim urgent reimbursement for the gap payment from the Department. In this instance, the following steps must be taken:
- As the receipt is in the name of the foster carer, they will have to claim the rebate from Medicare.
- The foster carer forwards the lodgement/rebate slip to the child protection worker, who will organise immediate repayment of the gap amount to the carer.
- The child protection worker must complete a ‘carer reimbursement’ in Assist for the gap. Refer to the Assist User Guide – Complete a Carer Reimbursement .