Why is 10% of my Support at Home budget set aside for care management?

Why is 10% of my Support at Home budget set aside for care management?

For ongoing Support at Home services, 10% of your quarterly classification budget is automatically allocated to care management.

The remaining 90% is available for approved direct services, such as:

• personal care

• nursing

• allied health

• domestic assistance

• meals

• transport

• social support.

The 10% is not an optional provider fee. It is part of the government’s Support at Home funding model. Services Australia deducts it from each participant’s quarterly budget and places it into the provider’s pooled care management account.

What is the 10% intended to pay for?

It funds the work needed to make sure your services are properly planned, coordinated and reviewed.

This can include:

• developing and updating your care plan

• discussing your needs, goals and preferences

• coordinating workers, clinicians and other services

• monitoring your individualised budget

• checking whether services are achieving the intended outcomes

• reviewing changes in your health or circumstances

• responding after a fall, hospital admission or significant incident

• arranging care conferences

• helping request a Support Plan Review or reassessment

• coordinating transitions between hospital, home and respite

• helping you understand your services, rights and options.

Your provider must assign a care partner and provide ongoing care management, including direct care management activity at least monthly.

Why is the funding pooled?

The provider does not keep your 10% in a separate personal care management account.

Instead, the amounts from participants receiving services through the provider’s relevant service delivery branch are pooled together.

This allows the provider to allocate more care management to people who temporarily need additional help—for example, someone who:

• has just left hospital

• has rapidly changing needs

• is experiencing carer breakdown

• needs several services coordinated

• has complex clinical or safety risks.

A participant with stable arrangements may need less care management during that period.

The intention is to provide flexibility according to need rather than give every participant exactly the same number of care-management hours.

Does the 10% belong to me personally?

It forms part of the funding attached to your classification, but it does not operate like an individual balance that you can spend or carry forward.

You generally cannot:

• redirect it to cleaning or personal care

• ask for the unused portion to be refunded

• accumulate it for a future purchase

• calculate an individual entitlement by dividing the amount by the care partner’s hourly rate.

Because it is pooled, the provider is not required to spend precisely your deducted amount on you during that quarter.

However, pooling does not remove the provider’s responsibility to deliver appropriate care management to every participant.

Does 10% guarantee a particular number of hours?

No.

The allocation does not create a fixed personal entitlement to a set number of care-management hours.

The amount and frequency of care management should reflect:

• the complexity of your needs

• changes in your condition

• current risks

• the number of services being coordinated

• whether your care arrangements are stable

• whether family or informal supports are under pressure.

The provider must still meet the program’s minimum requirements and provide more care management where reasonably required.

Why use a fixed percentage?

The fixed allocation is intended to:

• ensure care management is consistently funded

• prevent providers from charging participants open-ended case-management fees

• separate care coordination from direct service prices

• give providers flexibility to respond to periods of greater need

• make the amount removed from direct-service funding predictable.

The government describes the arrangement as dedicated funding for care management, capped at 10% for ongoing participants.

Do I pay a participant contribution on care management?

Care management is treated as a clinical support. Participants are not charged a separate contribution for receiving it.

However, the 10% allocation still reduces the portion of your classification budget available for direct services.

For example, if your quarterly classification budget were $10,000:

• $1,000 would be allocated to pooled care management

• $9,000 would remain for approved direct services.

This example does not include any separate short-term pathway funding or historic unspent Home Care Package funds.

Can the provider receive more than 10%?

Some participants with particular needs may attract a care management supplement.

This provides the provider with additional funding for more intensive care management without taking more than the standard 10% from the participant’s ongoing classification budget.

Separate rules apply to the Restorative Care and End-of-Life pathways, where care-management costs are claimed against the relevant pathway budget rather than funded through the standard 10% pooled deduction.

What should I expect in return?

You should expect more than routine scheduling and administration.

Your provider should be able to explain:

• who your care partner is

• how to contact them

• when your last direct care-management activity occurred

• how your care plan is being monitored

• how your budget is tracking

• what changes have been made in response to your needs

• when your care plan will next be reviewed.

Ordinary business administration—such as rostering workers, submitting claims, staff recruitment and routine financial administration—should not be presented as personalised care management.

What if I receive very little care management?

Raise the issue with your care partner or the provider’s complaints team.

Ask:

• What care-management activities have been delivered for me?

• When was my last direct contact?

• How is my care plan being monitored?

• Why has nobody followed up on changes in my needs?

• What additional care management can be provided?

You can also seek assistance from OPAN on 1800 700 600 or complain to the Aged Care Quality and Safety Commission on 1800 951 822.

What should I do next?

1. Ask who the assigned care partner is and how to contact them.

2. Request examples of care-management work completed for you during the quarter.

3. Raise concerns if there is no meaningful contact, review or coordination.

Helpful Local Home Help resources

• Understand Support at Home

• Start with Liz

• Read Support at Home articles

Check the official guidance

Check current official Support at Home guidance. Aged care rules, funding amounts and program guidance can change, so check the current official information before making an important care or financial decision.