Australian Incontinence Product Funding Schemes

There’s no doubt navigating the available schemes to assist with the payment of incontinence products is complicated, but an overall understanding of what’s available should help point you in the right direction.

Where you live and the condition of the person you care for will affect eligibility, but here’s an overview for Australian residence.

Australian Government

Continence Aids Payment Scheme or CAPS

• The current (financial year 2022-2023) payment is $650.40, but it can change marginally from year to year
• To be eligible, the recipient must be:
  o Over five years of age
  o An Australian citizen
  o Have permanent and severe incontinence caused by either an eligible neurological condition or other eligible condition
• You are not receiving government funding through another scheme such as the NDIS or a Home Care Package (MY Aged Care)

There are many conditions listed for both categories. Neurological conditions include several categories of disability, and non-neurological conditions include some types of cancers, prolapses, and fistulas.

If you have a non-neurological condition, you must also hold a Pensioner Concession Card from the Australian Government or the Department of Veterans’ Affairs.

Details, including how to apply, are on the CAPS website. or you can call the Continence Aids Payment Scheme (CAPS) team to answer queries and request a paper copy of the application form on 1800 239 309

National Disability Insurance Scheme or NDIS

• Incontinence products can be included in your NDIS package under its guiding principle of ‘reasonable and necessary supports’  . Like all parts of your plan, it will require assessment, application, and approval.

  In brief:

  • To be eligible for an NDIS package, you must be under 65 years of age and have a disability that requires assistance (technical, personal, modification of home, etc.)
  • If continence issues are a result of your disability, you should be eligible to include the cost of products and aids in your plan
  • The payment amount will depend on individual requirements detailed and approved in your plan

  The NDIS website provides details and examples of what they would and wouldn’t fund.

  To find out more, call 1800 800 110 or head to the NDIS website  where you can access information in different languages or use their WebChat to talk to someone about your individual situation.

Department of Veteran Affairs or DVA

• This department will assist in the purchase of continence aids and products from their contracted suppliers through their Rehabilitation Appliances Program or RAP. If you can’t find the products you need through their channels, there is flexibility to accommodate your needs. Program approvals are granted for two-year terms, with clients typically ordering a three-month supply at a time.

  • All cases are individually assessed for eligibility, and according to the DVA website, clients must have
    • A clinical need
    • A Gold Card, or
    • A White Card with an accepted or non-liability condition relating to the clinical need for the prescribed products.
  • All applicants must be clinically assessed and, if eligible, funding will cover the costs of prescribed incontinence products in quantities recommended by a healthcare professional

  You can find out more on the Continence Products page  of the DVA website, where there is a chat function. You can also call on 1800 550 457 or email RAPGeneralEnquiries@dva.gov.au 

MyAgedCare

• My Aged Care is the Australian government’s program that funds aged care services for people aged 65 and over or 50 years and over for Aboriginal and Torres Strait Islander people.

   

  The sector is going through a period of significant reform following the findings of a Royal Commission, passed down in March 2021. The timing of these changes is yet to be determined. The information here is correct as of June 2022 but check the Delivering Services Under the Home Care Packages Program  webpage for any updates.

   

  My Aged Care is a stepped program:

  • The Commonwealth Home Support Program, or CHSP, provides in-home services, such as cleaning, gardening, meals, and transport, through a local provider who has been funded to do this by the government. This program is designed to help older people with everyday tasks that may have become more difficult due to age
  • Home Care Packages are the next level of support. This is a block of funding (level 1, 2, 3 or 4) allocated to the person to pay for the services to meet their individual needs. In addition to the everyday services described above, you can access higher-care services including nursing, showering, physiotherapy, podiatry, community access, and more. Most people nominate a provider to manage their package, but self-management is an option
  • If a person is no longer able to manage at home, they can access a residential aged care facility.

   

  Incontinence products are not available on CHSP but can be purchased through a Home Care Package. What you require must be included in your care plan, requires assessment, and needs to be approved.

   

  Residential aged care facilities usually supply incontinence products, which is factored into their pricing.

   

  If you are in the process of applying for or recently received an HCP, the next step is to develop your care plan. This is usually done with someone from the provider you’ve chosen to manage your package. Don’t forget to mention your continence requirements, and they will guide you through the process.

State Government

With the exception of South Australia, all states and territories have their own schemes that will fund incontinence aids for eligible participants. Note that the Victorian scheme, SWEP, does not fund disposable pads or pants.

The rules for each program are different and the information provided is a simplified overview. Contacting the program’s administrators for further information is recommended.

NSW – EnableNSW Program

• This program requires participants to use CAPS (see above) before they access this program. It’s designed for New South Wales residents who have been granted and exhausted their CAPS allowance but need further assistance with incontinence aids, equipment, and products. 

  Applicants need:

  • To be experiencing moderate to severe incontinence, or
  • Bladder and/or bowel dysfunction
  • Other criteria can be found on the Enable NSW website

   

  For more information on entitlements, eligibility and how to apply, go to the Enable NSW website , call 1800 362 253 or email enable@health.nsw.gov.au

Victoria - Victorian Aids and Equipment Program SWEP

• This program funds up to $1,200 per annum for all types of  equipment and aids but does NOT cover disposable pads or pants. It funds washable continence pants, catheters, drainage bags, urine bottles, mattress protectors and other equipment.

  Eligibility includes:

  • Being a resident of Victoria, on a Permeant Protection Visa, Humanitarian Visa, or being an asylum seeker
  • Requiring assistive technology on a permanent or long-term basis for a health or age-related need
  • People not eligible for the NDIS can apply

  The incontinence part of this program is managed under SWEP https://swep.bhs.org.au/, the State-Wide Equipment Program, now run by Ballarat Health Services. On their site, you can check your eligibility  and find information on the Continence Aids Program.

  For further information, call 1300 747 937 or email swepcont@bhs.org.au

South Australia

There is no specific state-based scheme in SA, but residents are eligible for funding support through the national programs – CAPS, NDIS or DVA

Queensland – Medical Aids Subsidy Scheme or MASS

• This scheme funds a broad range of incontinence products and aids, including disposable pads and pants, catheters, bed and chair protectors, etc. Its website has the complete list.

  To be eligible, participants must:

  • Be a permanent Queensland resident
  • Hold a Pensioner Concession Card (issued either by Centrelink or DVA), Health Care Card, Centrelink Confirmation Concession Card Entitlement Form or Queensland Seniors Card
  • NOT be in receipt of assistance from other government programs such as WorkCover or DVA Rehabilitation Appliances Program, NDIS, National Injury Insurance Scheme (NIIS) or compensation or damages in respect of their disability
  • However, you may receive MASS assistance in addition to CAPS

  The full criteria, but administrative and clinical, can be found on the MASS website 

  For more information, complete the Feedback /Enquiry Form on the right-hand side of the MASS webpage . Include your email and phone number and check the ‘Continence Services’ box.

Western Australia – Continence Management and Support Service or CMASS

This program subsidises up to $490 per year for products required by eligible users.

Two operators work together to run the program:

• Assessment for eligibility and advice on how best to manage or improve continence is handled by Silver Chain.
• Product orders and delivery are managed by Independence Australia 

To be eligible, participants must

• Be 16 years of age or older and a permanent resident of Western Australia
• Have a defined chronic or intractable continence condition (lasting six months or more) 
• Hold a Pensioner Concession Card or a Health Care Card
• Not be in receipt of a Commonwealth Home Care Packages (Level 1 to 4) or living in a Commonwealth funded high-level residential care home. 
• Not have an approved NDIS plan

You may access CAPS at the same time.

For more information on eligibility and how to apply, call 1300 787 055 or email info@silverchain.org.au

ACT – ACT Equipment Scheme or ACTES

• To access the scheme, you need to meet the criteria and be referred by your health care professional (GP, therapist, specialist, etc.).

  Qualifying criteria include:

  • Have been a resident in the ACT for at least six months
  • Be ineligible to receive assistance from other government-funded schemes, including the NDIA, private health funds or through a Home Care Package
  • Hold a current Centrelink Pension or Low-Income Health Care Card in the applicant’s name. This does not include a Seniors Health Care Card (SHC) or Mobility Allowance Health Care Card (MO)
  • Not have an approved Home Care Package
  • Not have an approved NDIS plan
  • Not claiming costs through a private health insurance fund

   

  For further information, including what you may be entitled to, call (02) 5124 1076

Tasmania – Community Equipment Scheme or CES

• According to the Tasmanian Government website, this service will provide:

  • Assessment to determine the type of continence problems and the cause
  • Information about individual treatment and management choices
  • Education and support for people leaving hospital with a catheter
  • Assistance to access catheter, drainage, and continence product supplies
  • Referrals to other Health Care Services if needed

  Services are available in multiple locations across the state and are open Monday to , from 8am until 4.30pm. To book an appointment, call:

  South                    03 6166 5760
  North                    03 6777 4604

   

  Once you’ve been assessed, you may be eligible to have some or all of the products you need to be supplied free of charge. If approved, the supply of products is managed by Independence Australia. You simply submit your order, and it will be delivered directly to your door.

Northern Territory – Disability Equipment Program or DEP

• The program is accessed via a referral made by an approved health care professional such as a GP or Continence Nurse – not by the individual seeking funding. 

   

  The Northern Territory government may fund the provision of continence aids where:

  • The client has permanent moderate to severe incontinence, and
  • Equipment needs are greater than would be covered by the CAPS or
  • The client is not eligible for CAPS

  Other avenues of funding must be explored first.

  To find out about eligibility, entitlements, and the application process, speak to your doctor, nurse, or health co-ordinator.

  This information has been sourced from the NT Government DEP Clinical Guidelines sheet.It is for the use of professionals but may provide some guidance.

Other useful resources

• The Continence Foundation of Australia has a great fact sheet that you can download that gives additional information on each state scheme, including eligibility, contact details and how to apply.

• The Carer Gateway is an Australian Government site developed to help Carers find the supports they need. You can access the page on Incontinence here

• The Australian Government Bladder/Bowel website

• The National Continence Helpline on 1800 33 00 66 will be able to assist or direct you on all matters to do with continence

• Independence Australia manage the provision of products to many approved clients of CAPS, SVA RAP, NDIS, Enable NSW, MASS in Queensland, the CMASS and IPS in Western Australia, CES in Tasmania and SWEP in Victoria. You can also call them on 1300 788 855

If you are concerned about your or a loved one’s continence, or how you can afford to pay for the products you need, talk to your doctor or healthcare professional.

Source:

• https://www.health.gov.au/initiatives-and-programs/continence-aids-payment-scheme-caps
• https://www.servicesaustralia.gov.au/continence-aids-payment-scheme
• https://www.ndis.gov.au/
• https://ourguidelines.ndis.gov.au/would-we-fund-it/consumables/continence-consumables
• https://www.dva.gov.au/
• https://www.dva.gov.au/providers/rehabilitation-appliances-program-rap/rap-national-guidelines/continence-products
• https://www.myagedcare.gov.au/help-home/home-care-packages
• https://www.health.gov.au/initiatives-and-programs/home-care-packages-program/delivering-services-under-the-home-care-packages-program
• https://www.enable.health.nsw.gov.au/services/continence
• https://www.health.vic.gov.au/supporting-independent-living/victorian-aids-and-equipment-program
• https://www.independenceaustralia.com.au/funding-schemes/
• https://swep.bhs.org.au/
• https://www.health.tas.gov.au/health-topics/ageing-and-aged-care/accessing-ageing-and-aged-care-services/community-continence-service

Essity Australasia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.