How to Fund Speech Therapy in Australia

If you're reading this guide, commend yourself. A child's ability to communicate effectively will form the bedrock of their personal, social, and academic success throughout their lifetime. By seeking speech therapy for your child, you're laying down strong foundations that will benefit them for years to come. 

Living in Australia, you're uniquely positioned to tap into a wealth of world-renowned speech therapy resources. Take, for instance, the Lidcombe program—this Australian-born initiative has become a beacon of hope for countless families worldwide. Clinical trials indicate that children undergoing the Lidcombe program have a staggering 7.5 times greater likelihood of achieving stutter-free speech after just 6.3 months of intervention than those who don't get intervention^[1].

Beyond pioneering therapeutic approaches, Australia stands tall in offering an array of funding avenues for families. Whether you're exploring government assistance, private health insurance, or community-driven initiatives, Australia's robust support system ensures that no child is left behind due to financial constraints.

Navigating these options can be overwhelming, especially when combined with the emotional journey of supporting a child with communication disorders. This guide aims to simplify that process, giving you a clear roadmap of the various funding sources available and how to access them.

First we'll outline the funding options for speech therapy, then explore the health system in Australia, and identify how each funding optin can help.

The costs for speech therapy will vary based on provider. You'll find in the table below the average cost of speech therapy sessions across some of Sydney's leading clinics.

Please note that these are just averages - some providers may charge a higher initial consultation fee (up to $620) while others may charge fees that are below the average.

When evaluating whether a speech pathologist is right for you, price is only one of the concerns, albeit an important one. Expertise and areas of interest are far more important, as this may mean spending less in the long run for a better result.

This is a good question and one that is difficult to answer without saying, "it depends", because it does. The age of the client, their condition, family history, and ability to adhere to the program are all factors that play a role in how long you or your child will spend in therapy.

For children who stutter, the Lidcombe program generally takes no more than 9 months for stuttering severity to be 1.0 or below. During this time, you'll usually be seeing your clinician once a week. After stuttering severity has diminished, you'll proceed onto the maintenance phase. In this phase, you might see your clinician far less frequently - once or twice a month - until it is clear that risk of relapse is mitigated.

For adults who stutter, most can expect to spend at least 12 months in weekly therapy, followed by many more months of maintenance sessions. This should not discourage you, and you should consider it an investment in your future. Most adults who stutter have always stuttered and can not conceive of a world in which they don't. Following treatment, you may notice that new opportunities open to you as a result of your newfound freedom. It is difficult to take these unknowns into account when entering speech therapy as an adult, but it is worthwhile to consider them.

Other conditions such as apraxia or aphasia may have different timelines for treatment.

Before making an assessment, it's recommended to consult with a speech pathologist.

There are a number of programs in Australia aimed at supporting young children and school-aged children who have disabilities, as well as their parents or carers, and adults who have speech difficulties.

You can find some of the main ones listed below.

With all of these options, there is a high likelihood that you will be paying for some of the cost of speech therapy out of pocket.

The difference between what a funding option covers and what you have to pay is known as the gap fee. Some of the options listed above can be combined to reduce the gap fee.

Before we get into the different funding options available to you, let's investigate how Australia's healthcare system works.

Australia offers its residents both public and private healthcare options. For parents seeking speech therapy services for their children with communication disorders, understanding the intricacies of the system will save you time and money before you embark on your journey.

Rooted in the principles of equity and inclusiveness, the public healthcare framework in Australia offers a broad range of services, aiming to provide quality care to all, irrespective of their financial situation. This comes with some pros and cons.

• Universal Access: The public healthcare system in Australia is designed to give all residents access to essential medical services, regardless of their personal circumstances.

• Funded by Taxes: The system is predominantly funded through the Medicare levy, a tax taken from residents' income.

• Public Hospitals: Treatment in a public hospital, under the care of a doctor chosen by the hospital, is free for Australian residents.

• Wait Times: Due to the high demand in the public system, there can be waiting periods for certain non-urgent treatments or services.

The private healthcare system in Australia offers an alternative pathway for those who desire greater flexibility and personalised options in their health journey. Designed to complement the public health infrastructure, the private sector caters to those willing to invest in enhanced service offerings, faster access, and an expanded choice in healthcare providers.

• Choice of Doctor & Hospital: One of the primary benefits of the private system is the ability to choose one's healthcare provider and hospital. This can be especially important when seeking specialised services, such as speech therapy.

• Faster Access to Elective Treatments: The private system often has shorter waiting times for elective treatments or surgeries.

• Costs: Using private health services typically incurs out-of-pocket costs, even with private health insurance. However, insurance can significantly reduce these costs depending on the coverage.

• Private Health Insurance: Many Australians opt for private health insurance to help cover the costs of private treatment. This can be particularly beneficial for services not fully covered by Medicare, like some speech therapy sessions.

Medicare is Australia's publicly funded national healthcare system. It ensures all Australian residents have access to free or low-cost medical, optometric, and hospital care, and in certain cases, even allied health services.

When evaluating whether or not Medicare is a funding option for speech therapy, these things require consideration:

• Benefits Schedule: Medicare has a 'Medicare Benefits Schedule' (MBS) that lists a range of services covered, including some related to speech therapy. For each listed service, there's a set fee (the schedule fee) which Medicare recognises as the standard cost for that service.

• Rebate: If a speech therapy service is covered by Medicare, parents will typically receive a rebate, which is a percentage of the schedule fee. However, the therapist or service provider might charge more than the schedule fee, leading to out-of-pocket costs.

• Referral Required: To access Medicare benefits for speech therapy, a referral from a general practitioner (GP) or paediatrician is often required. This ensures the therapy is a necessary health intervention for the child.

• Limitations: Medicare rarely covers all speech therapy sessions and might only provide limited funding.

While the Australian healthcare system offers various avenues for support, understanding the difference between public and private options, and the role of Medicare, will help to ensure that you or your child gets help as soon as possible.

Medicare provides support for individuals, including children with communication disorders. However, like any system, there are specific criteria, processes, and limitations that you need to be aware of.

There are two main plans through the Medicare system that can help you with funding speech therapy. The latter plan also has a parallel program through the Department of Social Services where you can access additional funding for speech therapy.

• Chronic Disease Management (CDM) Plan: For children with long-term (chronic) communication disorders, GPs can set up a Chronic Disease Management Plan. This plan offers rebates for allied health services, including speech therapy. Usually, you will get 5 sessions in a calendar year with a rebate of $52.95 per session. A person who is of Aboriginal or Torres Islander descent may be eligible for an additional 5 sessions to make a total of 10 sessions in a calendar year.

• Better Start for Children with Disability Initiative: This initiative is designed for young children with developmental disabilities. It provides funding for early intervention services, including speech therapy, to improve the health and developmental outcomes of eligible children. Medicare can offer up to 4 allied health assessment sessions (must be used by 13th birthday) and up to 20 allied health treatment services (must be used by 15th birthday). The Better Start for Children with Disability Initiative from the Department of Social Services can offer up to $12,000 in funding that can be used to support your child in speech therapy.

• CDM Plan: To be eligible, the child must have a condition that has been present, or is likely to be present, for at least six months. This includes conditions like speech delay, language disorders, or other communication challenges. Additionally, the client must have complex care needs, meaning they need on-going care from a multidisciplinary team consisting of their GP and at least two other health care providers.

• Better Start Initiative: Eligibility is based on the child having one of several specific disabilities or conditions, which may include severe speech and language delay in some cases.

The Better Start Medicare items are early intervention services for children with any of the following conditions:

• Referral: For both the CDM plan and the Better Start Initiative, a referral from a GP or specialist (like a paediatrician) is essential.

Once you've settled on a program you are eligible for and want to claim benefits for speech therapy services through Medicare, the process is fairly straightforward.

1. Consultation with a GP: Start with a visit to a general practitioner to discuss the child's communication challenges and determine if they might be eligible for Medicare-supported services.

2. Obtaining a Referral: If eligible, the GP can provide a referral under a CDM plan or the Better Start Initiative, detailing the recommended services.

3. Choosing a Provider: Parents can then choose a speech therapist who offers services under Medicare. It's essential to inform the therapist about the Medicare referral during the initial appointment.

4. Payment & Rebate: Often, the therapist will charge a fee for the service. After paying, parents can claim a rebate from Medicare, which will be a portion of the fee. The exact rebate amount will depend on the Medicare Benefits Schedule.

• CDM Plan: The CDM typically provides rebates for up to five allied health services per calendar year. However, these sessions are shared among any allied health providers included in the plan, such as physiotherapists or occupational therapists.

• Better Start Initiative: This program has a set funding limit for early intervention services. Once the funding cap is reached (or the child reaches a certain age), no further Medicare rebates under this initiative can be claimed.

• Gap Payments: The rebate provided by Medicare might not cover the entire fee charged by the speech therapist. Parents may need to pay the difference, known as the "gap payment."

The National Disability Insurance Scheme (NDIS) represents a significant shift in the way Australia supports individuals with disabilities. Rather than a one-size-fits-all approach, the NDIS provides personalised support, ensuring that individuals with disabilities can lead a life they value.

For children with communication disorders, the NDIS can be an invaluable resource.

The NDIS recognises that early intervention can make a significant difference in the lives of children with developmental concerns or disabilities. For children with communication disorders, this can translate to funding, assistive technology, capacity building, support coordination and early intervention.

• Personalised Support: The NDIS operates on the principle that every individual's needs are unique. It offers tailored support to individuals, ensuring they get the specific interventions they need, including speech therapy for those with communication disorders.

• Lifespan Approach: The NDIS is designed to support individuals throughout their life. For children, this means early interventions that can drastically improve their quality of life in the long term.

• Capacity Building: One of the primary goals of the NDIS is to enable individuals to become more independent and involved in their communities. For children with communication disorders, improving their speech and communication skills can lead to better educational outcomes and social integration.
  

• Age Requirement: The individual must be under 65 years of age when making the application.

• Residency Status: The applicant must be an Australian citizen, hold a Permanent Visa, or be a Protected Special Category Visa holder.

• Disability Requirement: The disability must be permanent and significant. It should affect the individual's ability to partake in everyday activities and require support from others or assistive equipment.

For children with communication disorders, their condition should significantly impact their daily functioning and be long-term in nature to be considered for NDIS support.

Some of these disorders include:

1. Initial Application: Parents or guardians can start the process by contacting the National Disability Insurance Agency (NDIA), the body responsible for the NDIS.

2. Planning Meeting: Once initial eligibility is confirmed, a planning meeting is set up. Here, the child's needs, goals, and current supports are discussed. It's beneficial to come prepared, perhaps with reports from speech therapists or other specialists.

3. Drafting the Plan: Based on the planning meeting, an NDIS plan is drafted. This plan details the supports, both funded and non-funded, the child will receive.

4. Review and Approval: The draft plan is then reviewed by the NDIA. If approved, funding is allocated, and the supports can commence.

5. Regular Reviews: NDIS plans are regularly reviewed (usually annually) to ensure they remain relevant to the individual's needs. As a child grows and their needs change, their plan can be adjusted accordingly.

While the NDIS can fund therapeutic and assistive technology supports, they place a special emphasis on capacity building, which means supports that enable the individual to be independent in the community.

• Individual Assessments: Before starting any treatment plan, it's essential to have a comprehensive assessment by a qualified speech therapist. This assessment will guide the treatment plan and help tailor the interventions to the individual's needs. Funding is often available for such assessments.

• Therapy Sessions: NDIS often covers the costs of individual speech therapy sessions. These sessions could be aimed at improving articulation, language development, voice modulation, fluency, and so on.

• Group Therapy Interventions: Some children benefit from group settings, where they can interact with peers facing similar challenges. Group therapy is often less expensive than individual sessions and can be a good adjunct to individual therapy.

• Communication Devices: In cases of severe communication disorders, the NDIS might fund augmentative and alternative communication (AAC) devices like speech-generating devices, communication boards, or specialised software.

• Software: Various types of specialised software that aid in communication, like text-to-speech or picture exchange systems, can also be funded.

• Parent/Carer Training: As the primary caregivers, parents and carers play a crucial role in the child's development. Therefore, training programs that teach techniques to aid the child's communication skills can also be funded.

• Social Skills and Integration Programs: These are specially designed programs to improve social interaction, which can be a challenge for children with communication disorders. Such programs may include everything from how to initiate and maintain conversations to understanding social cues and norms.

NDIS funding is often tailored to the individual's needs, and while there isn't a universal funding cap, there are usually guidelines and limits based on the severity of the disability and the type of support required. The annual review process helps in adjusting the funding based on progress and emerging needs.

Some funds might be flexible within a broader category (e.g., you might be able to use funds allocated for therapy also for assessments). In certain cases, unused funds can be rolled over to the next year, but this often depends on specific circumstances and might require approval.

Some treatments or equipment that are exceptionally specialised or expensive might have a separate approval process or be subject to additional scrutiny to ensure that they are the most appropriate and effective means of support.

To navigate NDIS support for speech therapy effectively, it's advised to work closely with a knowledgeable and experienced NDIS planner or coordinator.

While the Australian healthcare system provides substantial support through Medicare and the NDIS for children with communication disorders, many parents consider the benefits of private health insurance. It can serve as an additional safety net, ensuring that your child receives timely and comprehensive care.

As of the time of this writing, 55% of the Australian population had a general treatment policy under private health insurance, according to APRA^[2].

• Shorter Waiting Times: One of the primary benefits of private health insurance is potentially faster access to treatment. While the public system might have waiting lists for certain therapies, private insurance can often facilitate quicker appointments.

• Wider Choice of Providers: Private health insurance often allows parents to choose their preferred speech therapist, giving flexibility in selecting someone who might be a specialist in a particular communication disorder.

• Covering the Gap: While Medicare provides rebates for many services, it doesn't always cover the full fee. Private health insurance can help cover the difference, reducing out-of-pocket expenses.

• Additional Sessions: For children who need intensive or prolonged speech therapy, private insurance can offer additional sessions once the caps from Medicare or NDIS are reached.

• Coverage Level: Ensure that the policy covers speech therapy, and check how many sessions or what monetary amount is covered per year.

• Gap Payments: Look into how much the insurance plan will pay towards sessions and if there will be any out-of-pocket expenses.

• Choice of Therapist: Some insurance plans may have a preferred network of providers. Check if you can choose a therapist outside of this network and if it affects your rebate.

• Waiting Periods: Some policies have waiting periods before you can claim benefits for particular services. Ensure you're aware of any such periods for speech therapy.

• Policy Exclusions: Carefully review any exclusions in the policy. Some plans might not cover specific therapies or treatments.

• Premium Costs: Balance the monthly or annual premium cost against the benefits provided. Consider how often you'll use the services and if the insurance offers value for money.

Please note that while the following list includes major Australian health insurance providers known to offer benefits for speech therapy, it's essential to check with individual insurers for up-to-date policies and coverage details.

• Bupa: A prominent provider, Bupa's policies often cover speech therapy under their 'Extras' cover, with varying limits based on the level of cover.

• Medibank: Another leading insurer, Medibank, provides coverage for speech therapy in many of its extras covers.

• HCF: As one of Australia's largest not-for-profit health insurers, HCF's comprehensive covers usually include speech therapy benefits.

• nib: With various extras policies, nib often covers speech therapy, though limits may vary based on the policy level.

• Australian Unity: Their health covers often provide benefits for a range of therapies, including speech therapy.

• AHM: Under their extras cover, AHM typically includes benefits for speech therapy.

Below you can find these listed insurance providers along with an estimate of the weekly premium cost for a family making under $186,000 a year in NSW.

When considering private health insurance, compare policies, limits and refunds and ensure the chosen plan aligns with your child's needs.

Let's consider the example of treating a 4 year old's stutter with the Lidcombe program, for a family on the Bupa Super Extras plan.

These are the details of the Bupa Super Extras plan at the time of this writing.

Now consider that, on Lidcombe, you'll be visiting a speech pathologist weekly for about 9 months.

Your total cost could be around $7,600.

However, Bupa has an annual limit of $300, and will cost you $1,269 over this period, not to mention the 2 month waiting period.

Unless you or your other children have needs which you are using Bupa for, it would not be economical in this instance to take out private health insurance just to see a speech pathologist.

Other plans have higher limits (some above $1,000), so there may be other circumstances where it is indeed economical to take out private health insurance to assist with the costs of speech therapy, especially if you or your other children use it for dental, psychology, or other healthcare needs.

This example should not be taken as a blanket statement. Therapy plans differ depending on age and condition and insurance plans differ on cost and policy details. This example should also not discourage you from seeking help for your child. The economical and societal impacts of having communication difficulties as an adult will incur far greater costs. Rather, the intent of this calculation is to highlight how a pragmatic approach can yield the best result for all.

While national programs like Medicare, NDIS, and private health insurance play substantial roles in supporting children with communication disorders, individual states and territories in Australia have developed their initiatives, schemes, or programs to further aid these children. Each jurisdiction tailors its support based on the unique needs of its population.

State-specific initiatives, often operated by the Department of Health or Education in each state or territory, provide additional or complementary support to federal programs. These might include direct funding, access to local health services, specialised programs in schools, and more.

• Disability Support Funding: Offered through the Department of Education, it provides resources to schools to support students with disabilities, including communication disorders.

• Statewide Infant Screening - Hearing (SWISH) Program: This program aims to identify newborns with significant hearing loss.

• Early Childhood Intervention Services (ECIS): Services for young children with a disability or developmental delay, ensuring they receive timely support.

• School Student Transport Scheme: Assists with transport for students with disabilities, enabling consistent access to schooling and therapies.

• Queensland Kindergarten Funding Scheme: Provides additional funding to kindergarten programs supporting children with additional needs.

• Hearing Health Program: Aims at early detection and management of hearing conditions.

• Disability Support Program: Offered in schools to support students with disabilities, providing specialised resources and assistance.

• Early Childhood Services: Tailored services for young children with developmental delays or disabilities.

• Disability Services Commission: Offers various programs and support for children with disabilities, including communication disorders.

• School Psychology Service: Provides assessment and intervention services within schools for students with additional needs.

• Gateway Services: A primary point of contact for children and families requiring support services, including for communication disorders.

• School Health Services: Offers health assessments, advice, and referrals within the school system.

• Child Development Teams: Provides assessment and early intervention services for children with developmental delays or disabilities.

• Special Education Support Services: Tailored support within schools for students with additional needs.

• Therapy ACT: Offers assessment, advice, and intervention for children with developmental delays or disabilities.

• School Youth Health Nurse Program: Provides health support within schools, including for children with communication disorders.

While the aforementioned state-specific initiatives provide a snapshot of the available support, the landscape of health and educational services is dynamic. States and territories regularly assess and update their programs to better serve their populations. Parents and caregivers are encouraged to reach out directly to state health and education departments or local organisations for the most current information and resources.

For children with communication disorders, schools play a pivotal role in providing consistent and structured support. In the Australian education system, a variety of school-based supports are designed to cater to the diverse needs of students, ensuring an inclusive and conducive learning environment.

These services are often free, and can reduce the burden on households who want to work with professionals to overcome communication disorders, but are not able to through other avenues. It can also be convenient for you and your child to have their care in school.

• Specialist Support Teams: Most schools have a team of specialists, including speech pathologists, psychologists, and learning support teachers, who collaborate to provide individualised interventions.

• In-Class Support: Based on a child's needs, schools might provide teaching assistants or aides who offer extra guidance and assistance within the classroom setting, ensuring that the child can engage with the curriculum effectively.

• Individual Learning Plans (ILP): For children with pronounced communication disorders, an ILP can be created. This plan tailors the curriculum and teaching strategies to the child's specific needs, ensuring they can achieve their best potential.

• Resource Rooms: Some schools have dedicated spaces where students can access specialised materials or equipment that support their learning and communication needs.

• Peer Support Programs: Encouraging peer integration, some schools offer programs where students are paired with peers to foster better communication, understanding, and social integration.

1. Initial Assessment: If a child is suspected of having a communication disorder, the school may conduct an initial assessment to understand their needs. This could involve observations, tests, or consultations with parents.

2. Referral: Based on the assessment, the school might refer the child to a school-based speech pathologist or other relevant specialist.

3. Development of a Support Plan: Post assessment and consultation with specialists, the school will develop a support plan tailored to the child's needs.

4. Regular Reviews: Like the NDIS plans, school-based support plans are regularly reviewed and adjusted to ensure they remain relevant as the child grows and their needs evolve.

5. External Therapists: Some parents choose to engage an external speech therapist. If so, it's essential to keep the school informed so they can integrate and complement the therapy within the school setting.

Australian schools offer a range of services to support children with communication disorders. By understanding these supports, actively collaborating with school teams, and maintaining open communication, parents can ensure their child receives a holistic and effective education tailored to their unique needs.

Navigating the landscape of speech therapy in Australia can be daunting, but it's a journey that promises rewarding outcomes for both children and adults. Thankfully, families have a plethora of resources at their fingertips. While costs and duration of therapy may vary, what remains constant is the long-term value of investing in effective communication skills. Remember that you're not just seeking immediate solutions; you're laying the groundwork for lifelong success in personal, social, and academic spheres.

We hope this guide has been helpful in assessing and understanding the funding options available to you in Australia. If you have any questions or comments, please reach out to us directly.