How to Access a Mental Health Care Plan, Enhanced Primary Care Plan, and HCWA Referral in Australia

Seeking professional support for your child’s mental health and development can feel overwhelming, but in Australia, there are government-subsidised options to help ease the financial burden. The Mental Health Care Plan (MHCP), Enhanced Primary Care Plan (EPC) (now known as the Chronic Disease Management Plan), and the Helping Children with Autism (HCWA) Referral provide rebates for psychological and allied health services, making support more accessible for families. This guide outlines how parents can access these plans to get the help their child needs.

What is a Mental Health Care Plan (MHCP)?

A Mental Health Care Plan allows children to access 10 rebated sessions per calendar year with a Psychologist, or Mental Health Occupational Therapist through Medicare. It is designed for children experiencing mental health challenges such as anxiety, depression, trauma, or behavioural difficulties.

How to Get a Mental Health Care Plan

1. Book a GP Appointment: Schedule a long consultation with your child’s GP to discuss their mental health concerns. If needed, you can also see a paediatrician or psychiatrist for this.
2. Assessment by the GP: The GP will assess your child’s needs and determine whether a MHCP is appropriate.
3. Referral to a Specialist: If eligible, the GP will provide a written plan and referral to a psychologist, social worker, or occupational therapist.
4. Claim Medicare Rebates: The MHCP provides up to 10 rebated sessions per calendar year (initially six sessions, with a review required to access the remaining four). It’s important to note that a Medicare rebate only covers part of the session cost—not the full fee. You will usually be required to pay the remaining amount (often called the "gap") out of pocket.

What is an Enhanced Primary Care Plan (EPC)?

The Enhanced Primary Care Plan, also called a Chronic Disease Management Plan (CDMP), provides access to Medicare rebates for allied health services such as Occupational Therapy, Speech Therapy, and Physiotherapy. It is designed for children with chronic conditions that require multidisciplinary care.

How to Get an EPC/CDMP

1. Consult Your GP: Book an appointment with your child’s GP to discuss ongoing developmental, physical, or psychological concerns.
2. GP Assessment: If your child qualifies, the GP will prepare a Chronic Disease Management Plan, outlining necessary allied health services.
3. Referral to Specialists: The GP can refer your child to up to five allied health sessions per calendar year (spread across different specialists or concentrated in one area).
4. Medicare Rebates Apply: Parents can claim Medicare rebates for these sessions, making therapy more affordable. However, Medicare only covers a portion of the cost, so there will usually be a gap payment.

What is the Helping Children with Autism (HCWA) Referral?

The Helping Children with Autism (HCWA) Referral provides Medicare rebates for children diagnosed with Autism Spectrum Disorder (ASD). This plan allows access to up to 20 sessions with eligible allied health professionals (such as psychologists, speech therapists, and occupational therapists) over the child’s lifetime to assist with diagnosis and intervention.

These sessions can be used for a combination of diagnostic assessments and post-diagnosis therapy, helping families through both the discovery and support stages of their child’s development.

How to Get an HCWA Referral

1. Visit a Paediatrician or Psychiatrist: The HCWA referral must come from a medical specialist. For most families, this means booking an appointment with a paediatrician, psychiatrist.
2. Discuss Concerns About Autism: The specialist will assess your child’s developmental and behavioural presentation to determine whether a referral is appropriate for diagnostic assessment and/or therapy.
3. Receive a Referral: If eligible, the specialist will provide a written HCWA referral, which can be shared with your chosen allied health professionals.
4. Access Rebated Services: Once in place, the referral enables up to 20 rebated sessions (lifetime limit) to be used for autism-specific services, including assessments, therapy, and developmental support. However, Medicare only covers a portion of the cost, so there will usually be a gap payment.

Can My Child Use Multiple Plans?

Yes! In many cases, a child may qualify for more than one Medicare rebate plan. For example, a child undergoing an autism assessment might use:

• The HCWA referral for the autism-specific assessment and therapy,
• An EPC/CDMP for allied health services such as speech or occupational therapy, and
• A MHCP if there are co-occurring mental health concerns such as anxiety or social difficulties.

Using a combination of these plans can significantly reduce out-of-pocket costs and improve access to multidisciplinary support.

Final Thoughts

Navigating support options can feel complex, but understanding the MHCP, EPC/CDMP, and HCWA referral can make accessing professional help much easier. If you're unsure where to start, speaking to your GP or paediatrician is the best first step. They can help determine which funding streams are most suitable for your child’s needs.

At All About Kids, our team of psychologists, speech therapists, occupational therapists, and other specialists are here to support your family through every step of the journey—from initial concerns to assessment, diagnosis, and therapy.

If you’d like guidance on which plan may be best for your child, contact us today—we’re here to help!