Practice Answer: How do co-contributions work under Support at Home
Clear answers to common questions about occupational therapy practice in community aged care and Support at Home.
Under Support at Home, older people may be required to contribute towards the cost of some services they receive. Although these are commonly referred to as co-contributions, the official terminology is participant contributions.
The important point for Occupational Therapists is that not every Support at Home service attracts a participant contribution. The amount depends on both the type of service and the participant's individual contribution rate.
The three contribution categories
Support at Home services are divided into three contribution categories:
Clinical Supports — 0% participant contribution
Clinical services are fully funded by the Australian Government. This includes allied health services, meaning a participant does not pay a contribution towards the cost of their Occupational Therapy clinical service.
Independence — 5% to 50% contribution
Many services and supports that help a person maintain their independence attract a moderate contribution. Importantly for OTs, assistive technology and home modification items and associated materials/labour generally attract the
Independence contribution rate.
Everyday Living — 17.5% to 80% contribution
Services such as domestic assistance and gardening attract the highest participant contribution.
The participant's actual percentage is determined according to their circumstances, including pension status and, where applicable, an income and assets assessment undertaken by Services Australia.
For participants under the standard contribution arrangements, the rates are:
Participant | Clinical Supports | Independence | Everyday Living |
Full Age Pensioner | 0% | 5% | 17.5% |
Part pensioner / eligible CSHC holder | 0% | 5–50% | 17.5–80% |
Self-funded retiree* | 0% | 50% | 80% |
*The participant's circumstances and applicable Services Australia assessment still need to be considered. The current contribution settings are published in the government's Schedule of contributions for Support at Home services, with the current schedule applying from 1 July 2026.
What does this mean for Occupational Therapy?
This distinction becomes particularly important within the Assistive Technology and Home Modifications (AT-HM) Scheme.
The AT-HM contribution rules separate the clinical input from the item or modification itself.
Prescription and wrap-around services are treated as Clinical Supports, so the participant contribution is 0%.
The assistive technology item or home modification, including relevant materials and labour, generally attracts the participant's Independence contribution rate.
So an OT assessment and prescription may have no participant contribution, while the equipment recommended as a result of that assessment may.
A simple AT-HM example
Consider an older person who is a full Age Pensioner and requires a $2,000 item of assistive technology.
Their Independence contribution rate is 5%.
AT item: $2,000
Participant contribution: 5% × $2,000 = $100
Government subsidy: $1,900
If an Occupational Therapist also provides $300 of eligible prescription and wrap-around clinical support associated with the item, the participant contribution on that clinical component is $0.
So the participant's contribution is not 5% of the entire $2,300 pathway. The clinical and AT components are treated differently under the contribution rules. The government's AT-HM claiming guidance specifically confirms 0% contributions for prescription/clinical support and the Independence rate for AT-HM items.
What about home modifications?
The same broad distinction applies to home modifications.
The modification itself generally attracts the participant's Independence contribution rate, while eligible prescription and wrap-around clinical services are treated as Clinical Supports and therefore attract a 0% contribution.
There is an additional rule for participants living in MM6–7 remote areas who receive a high-tier home modification allocation. Their contribution applies to 66.6% of the total home modification cost, rather than the full cost.
Not everyone pays the standard contribution rates
The no worse off principle applies to people who were receiving a Home Care Package, or were approved for one, on or before 12 September 2024.
Their contribution arrangements are protected under the transition arrangements. For example, someone in this cohort who did not have to pay an income-tested care fee under their Home Care Package will not suddenly be required to start paying participant contributions under Support at Home.
This means you cannot determine what a particular client will pay simply from the service they are receiving.
Why does this matter for OTs?
Providers don't determine a participant's contribution rate - Services Australia does.
However, understanding the contribution structure is important when discussing recommendations with clients.
A client may hear that Occupational Therapy is fully funded and reasonably assume this means the equipment or home modification recommended by their OT is also fully funded. That isn't necessarily the case.
Similarly, a participant contribution should not be confused with the person's AT-HM funding tier. The funding allocation determines the government funding available for eligible AT-HM supports; the participant contribution rules determine the proportion of the relevant service price the participant is required to contribute.
Practice takeaway: When discussing AT-HM with a client, separate the clinical service from the item or modification. Eligible OT assessment, prescription and wrap-around clinical support attract a 0% participant contribution, while the AT item or home modification generally attracts the person's Independence contribution rate.
Key references
Australian Government Department of Health, Disability and Ageing, Support at Home Program Manual – A Guide for Registered Providers, current September 2026 edition.
Australian Government Department of Health, Disability and Ageing, Support at Home participant contributions.
Australian Government Department of Health, Disability and Ageing, Schedule of contributions for Support at Home services – 1 July 2026.
Australian Government Department of Health, Disability and Ageing, Assistive Technology and Home Modifications (AT-HM) Scheme.
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