Specified chronic childhood disease medical expense assistance program is the program in which the national government studies the treatment of children 20 years old and under, who need treatment for specified long-term diseases, to lessen the burden of medical costs. Effective April 1, 2005, the program was moved under the Child Welfare Act and amendments made to the contents.
1. Target diseases (As of November 1, 2021)
There are 788 target diseases in 16 groups. HIV-positive children who are under the treatment of the listed disease can apply for the program.
2. Qualifying age
For all diseases, new registrants under 18 can now continued to be studied until they turn 20. For continuance, application must be made while the patient is 18 years of age (from the 18th birthday to the day before the 19th birthday). Only those whose continued treatment is deemed necessary will be eligible.
3. Scope of medical care
Previously, benefits were not necessarily granted to all outpatients, depending on their disease. Effective April 1, 2005, outpatients and inpatients of all diseases are now eligible for benefits. Medical care benefits are granted to eligible patients, on medical fees for treatment, cost of special diet during hospitalization, insured prescription drugs and visiting nurses. Benefits do not cover assistive devices.
4. Copayment
The amount of individual copayment will be determined from the amount of municipal and income taxes paid the previous year by the primary income earner of the household (see the table below).
*However, persons who apply to the following are exempt from paying medical costs.
a) Persons with hemophilia (including patients eligible for the congenital blood coagulation factor deficiency disease medical treatment research project)
b) Persons eligible for severe disease compensation
[Table] Maximum copayment for specified chronic childhood disease medical expense assistance program (Japanese Yen)
| Division |
Guideline for annual income
(a household consisting of a married couple and one child) |
Maximum limit
(Patient’s copayment ratio: 20%, outpatient and inpatient) |
| General |
Severe* |
Those who require support such as mechanical ventilator |
| Ⅰ |
Household on welfare |
0 |
| Ⅱ |
Municipal inhabitant’s tax-exempt |
Low income I (less than about 800,000 yen) |
1,250 |
500 |
| Ⅲ |
Low income II (less than about 2,000,000 yen) |
2,500 |
| Ⅳ |
General income I
(Municipal inhabitant’s tax is under 71,000 yen, or annual income is about 4,300,000 yen) |
5,000 |
2,500 |
| Ⅴ |
General income Ⅱ
(Municipal inhabitant’s tax is under 251,000 yen, or annual income is less than about 8,500,000 yen) |
10,000 |
5,000 |
| Ⅵ |
High income
(Municipal inhabitant’s tax is over 251,000 yen, or annual income is more than about 8,500,000 yen) |
15,000 |
10,000 |
| Meals during hospitalization |
50% of expense |
*Severe: If one of the followings applies, it is regarded “severe.” (1)Persons who pay high medical cost over a long period of time. More specifically, a total medical expense per month exceeds 50,000 yen (if a patient bears 20% of medical costs, it would be 10,000 yen/month) more than six times a year. (2)Persons who fall under the criteria of a patient with severe disease.
5. Recommendation to obtain a Physical Disability Certificate
Persons who are past the age subject to the specified chronic childhood disease medical expense assistance program can no longer use the program and many of them apply to the “medical payment for services and supports for persons with disabilities,” for which a physical disability certificate is required. However, those who started taking anti-HIV drugs from childhood are sometimes unable to obtain the certificate as they do not meet the standard of certification. Therefore, we advise patients to get the physical disability certificate before they start to take anti-HIV drugs.
